It is said that the word ``social'' negates the meaning of whatever it modifies, as in ``social responsibility'' or ``social justice.'' Likewise, ``public,'' if not always a negation, suggests something that is shabby, decaying, mired in bureaucracy, and designed to reduce things to the least common denominator. Inevitably, it is in the realm of government-theoretically accountable to the citizenry but in reality vested with sovereign immunity. The ballot box may work to boot the rascals out, but they may already have delegated broad authority to executive agencies, which operate with little or no legislative oversight. Bureaucrats are even harder to remove than legislators.

Resistance to the ``social'' or ``public'' adjective is portrayed as opposition to the noun (say responsibility or health). As Frederic Bastiat (1801-1850) wrote in his classic The Law, ``Every time we object to a thing being done by government, the socialists conclude that we object to it being done at all. We disapprove of state education. Then the socialists say that we are opposed to any education. We object to a state religion. Then the socialists say we want no religion at all...It is as if the socialists were to accuse us of not wanting persons to eat because we do not want the state to raise grain.''

These days, persons who question a government mandate for a certain vaccine may be suspected of being anti-vaccine Luddites, who would have persecuted Edward Jenner. Those who oppose school-based clinics may be thought to favor allowing sick children to die in the streets. Disagreement with county ordinances that forbid smoking in restaurants invites suspicion of collusion with Big Tobacco. And criticism of an EPA edict may be tantamount to advocacy for pollution.

Suspicion of public health is not opposition to health but to the rationale for an increasingly coercive and intrusive regime that is developing a worrisome resemblance to a state religion with its own dogma and priesthood. Features to watch:

Decision-making by elite committee: Recommendations for mandated vaccines originate with the Advisory Committee on Immunization Practices. While some of the meetings are open to the public, there are also secret deliberations. The committee is a public-private partnership, with many members having potentially lucrative relationships with vaccine manufacturers. Researchers or public health workers have reason to fear the equivalent of excommunication should they voice dissent.

Militaristic structure and goals: The U.S. Public Health Service is a uniformed service. The goals for public health are often viewed as war, with global campaigns to eradicate disease. Failure to follow orders might be viewed as collaboration with the enemy disease (or chemical or other hazard). War maps with pins track the success of multi-million-dollar campaigns to establish state registries, first for vaccines (but what next?).

Emphasis on prevention and compliance. The purpose of public health has always been to contain disease so as to protect a population, rather than to cure afflicted individuals. Traditionally, however, public health efforts focused on the clear and present danger. Authorities might restrict personal liberty, as by quarantine, but only if the person might spread disease.

Today, public health authorities have surrendered in the battle against disease foci, at least in the cases of hepatitis B and AIDS. Having failed to capture persons at high risk, they seek to enlist the entire population, beginning at birth. No longer is it the infected person, but the unimmunized person, who is considered the public health threat. The former is not even recognized; the latter is excluded from school, regardless of the incidence of hepatitis B in his age group or locality.

The role of the public schools. Knowledgeable citizens are essential to the security of any society. Properly indoctrinated subjects are essential to the success of any coercive government program. ``Environmental education'' is favored by the EPA and other government agencies as well as radical environmentalists. ``Health'' (e.g. condom use without noting failure rates) is part of the curriculum, of course. Beyond that, schools are key elements in the enforcement mechanism, as for mandatory vaccines, as well as in monitoring compliance.

Surveillance. One stated rationale for government access to all medical records in computerized format is the need to monitor public health. This includes immunization records, but many other items as well. The ``health'' information collected by schools may contain a detailed social history, attitude surveys pertaining to student and family, and behavioral assessments. A common feature in federal legislation to assure ``privacy'' is an exemption (or mandate) for schools as well as medical facilities or physicians to supply records to public health or health oversight agencies. Other government-subsidized entities, such as home-health agencies, are also being made responsible for increasingly detailed reports. The new OASIS (Outcome and Assessment Information Set) demands that home-health workers assess the client's use of profane language, sexual behavior, state of mind, bathroom performance, living arrangements, family support, etc. Data sets relate to health in the broad sense-and include what could be construed as heresy or deviant behavior (sin), or lack of worthiness for spending resources.

Masked coercion. Although federal health mandates cannot usually be imposed forcibly on the states, failure to implement a ``voluntary'' directive may mean the loss of millions of dollars in federal funding. Similarly, private institutions or individuals can be deprived of government subsidies, accreditation, or licensure for failure to comply.

Extrapolation. Scientific arguments justifying various government mandates may be based largely on extrapolation (e.g. the linear no-threshold hypothesis of radiation carcinogenesis), as frequently discussed here. Less well-recognized is the extrapolation of safety data from relatively small study populations to millions of mandatory vaccine recipients. Delayed, relatively uncommon adverse effects─especially those restricted to genetically susceptible populations that may have been excluded from pre-licensure trials─show up only on post-marketing surveillance. And it is exceptionally difficult for government to admit a mistake.

Just as ``public education'' (government schooling) has not produced a well-educated citizenry, public health can be inimical to the health of large numbers of individual members of the public. ``Do no harm'' is not a part of the ethic of public health authorities. Yet their capacity for harm vastly exceeds that of an individual physician.

From a textbook now in use in teachers' colleges, entitled Reading Process and Practice: from Socio-Psycholinguistics to Whole Language, by Constance Weaver:

``[Promotion of the teaching of phonics] may not necessarily be what the proponents claim: namely, the desire to teach all children to read. A great deal of the force behind such advocacy seems to be the desire to promote a religious agenda and/or to maintain the economic status quo.''

Weaver states that phonics keeps children from reading or thinking for themselves and thus fits into the ``Far Right'' agenda of promoting docility and obedience in members of the lower classes so as to preserve social stratification.

The Vast Right-Wing Conspiracy probably started with Rudyard Kipling and The Just-So Stories, which explain ``How the Alphabet was Made'' so that people could write exactly what they meant: ``Taffy, dear, I've a notion that your Daddy's daughter has hit upon the finest thing that there ever was since the Tribe of Tegumai took to using shark's teeth instead of flints for their spear-heads. I believe we've found out the big secret of the world [that letters stand for sounds]....And after thousands and thousands of years, and after Hieroglyphs, and Demotics, and Nilotics,... the fine old easy understandable Alphabet...got back into its proper shape for all the Best Beloveds to learn when they are old enough.''

The ``world's largest iatrogenic transmission scenario known to date''─injecting antischistosomal therapy with reusable syringes-may explain why nearly 24% of Egyptians carry hepatitis C virus, making it the hardest-hit country in the world (Science 285:27, 1999).

The global campaign for universal immunization against hepatitis B virus (HBV) will do nothing to help the scourge of hepatitis C (HCV, formerly known as hepatitis non-A, non-B).

Worldwide, some 170 million people are believed to be infected with HCV (cf. more than 200 million with hepatitis B). The global infection rate is four times as high as for human immunodeficiency virus (HIV). In the U.S., the annual death rate for HCV-caused cirrhosis or liver cancer may overtake that from AIDS within the next few years. About 1.8% of Americans harbor HCV (cf. 0.1 to 0.5% for HBV), and HCV now causes 8,000 to 10,000 U.S. deaths annually. HCV is the most common reason for liver transplants. Only 15% to 25% of patients manage to clear the HCV; the rest become chronically infected. Of those, up to 20% eventually develop cirrhosis, and 1 to 5% a form of liver cancer.

HCV has little in common genetically with hepatitis B. There are more than 100 strains, vastly complicating efforts to develop a vaccine. Another difficulty is lack of a reliable way to grow the virus in culture.

Sustained treatment (48 weeks) with a combination of ribavarin and interferons has had a good virologic response in about 43% of patients.

HCV was transmitted in blood transfusions before a screening test was developed in 1990. Now, contaminated needles are the most common mode of transmission. It is not clear whether sexual transmission occurs; if so, it is relatively inefficient. Perinatal transmission occurs in about 6% of babies born to infected mothers (Science 285:26-30, 1999).

Because of concerns about trace quantities of this mercury-containing preservative, the American Academy of Pediatrics (AAP) now states that if ``new mothers are proven to be free of ... hepatitis B, their newborns can safely postpone getting a hepatitis B vaccine until they are a few months older.''

The Arizona State Department of Health recommends starting the hepatitis B vaccine series at 2 months instead of at birth and completing the three-dose series before age 1 year.

Of course, concerns about this vaccine have been unrelated to the preservative. It is politically more acceptable to express concerns about a ``chemical'' than about the vaccine antigens (which are also chemicals). The AAP is urging manufacturers to find a substitute preservative or reduce mercury concentrations as soon as possible, while stating that current vaccines are safe and children do not need to be tested for mercury levels.

Formerly, thimerosal was commonly used as a topical antiseptic (Merthiolate). It is often present in eyedrops and contact lens solutions. It has been used to prevent bacterial contamination in biologics and vaccines since the 1930s, particularly in multi-dose vials. It is now present in DPT and Hemophilus vaccines as well as hepatitis B. Several doses of all these vaccines could transiently produce a cumulative mercury level in excess of the EPA's permitted level.

Parents' groups are pleased about the news, as they frequently hear complaints from parents that hospitals will refuse to release them until their newborn receives its first dose of hepatitis B vaccine.

Organic mercury poisoning causes paresthesias; headache; pain; visual, hearing, and speech disorders; neurasthenia; loss of memory; incoordination; spasticity; irritability; paralysis; or stupor and coma. Such symptoms have been reported after hepatitis B immunization, also in adults. If mercury caused such effects, the treatment would be chelation. Blood mercury levels above 180 nmol/L (3.5 mg/dL) are abnormal, and symptoms may be seen with blood levels above 1 mmol/L (20 mg/dL).

More cities and counties are passing ordinances that ban smoking in restaurants. Evidence to support this was presented to the Public Health Committee of the Pima County Medical Society by M. Lebowitz, Ph.D. The Committee concluded that there was no evidence of a public health benefit from such a ban. Interesting tidbits from published research: Acute respiratory symptoms occurred on 54% of days in non-smoking households; 32%, if 1-20 cigarettes/day were smoked; and 70% with >20 cigarettes/day! (The possibility of a hormesis effect was not mentioned.) The relative risk of symptomatic chronic airways disease was 0.73 (below normal but not significantly) for those with only adult current exposure to second-hand smoke, though there was a significant increase in RR (1.72) for those with childhood and past adult exposure.

An unintended side effect of banning smoke from bars: more people went to the bars (and presumably drank).