Big bang for vaccination.

disease by 30%," which sits uneasily with the report's own acceptance that the Medical Research Council's hypertension trial found "no significant effect on heart disease" from the reduction of mild to moderate hypertension. To have maximum impact such reports should surely offer no unprotected flanks to their critics and should concentrate on limited and attainable targets for which unimpeachable evidence exists? The problem of overkill in preventive medicine is hinted at, but the report's words are not as telling as those of Richard Doll, who said: "A stitch in time may save nine but if 100 people each need one stitch to save a single person having nine, then the equation is much more complex." Unless such issues are faced squarely-as they were in the Medical Research Council's mild to moderate hypertension trial, in which 850 people had to be treated to prevent one stroke-the public reaction to such preventive measures may echo that of Eubie Blake, the jazz musician, who said on his 100th birthday: "If I'd known I was going to live that long, I'd have taken better care of myself." How to change public and private attitudes has been the challenge to propagandists throughout the ages. The authors hope to influence "individual citizens" and to help "public agencies and organisations in formulating policies and decisions that affect the public health." In this task they would do well to remember Engels's observations on England in the early nineteenth century: "the national character of the English is essentially different . . . the English have no common interests, only individual interests.... Only out of individual interests do they act together as a whole. In other words, only England has a social history. Only in England have individuals as such, without consciously advocating general principles, promoted the advance of the nation." If one substitutes "retreat" for "advance" the truth of Engels's statement is shown by the report's comment on the decline in immunisations against whooping cough, in contrast to the steady uptake of those against diphtheria and tetanus. This reinforces Engels's point, in that any number of worthy, truthful, but non-charismatic reports and exhortations may be instantly negated by pronouncements on the television by respected or eye catching public figures. Following Engels's thoughts, could we make faster progress by remedying scientific illiteracy in the few who catch the public eye, ear, and imagination rather than by preaching to the many who are already converted, which is what I fear The Nation's Health will be doing?