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In the preamble to 1990 rule, we stated that, [f]or Medicare payment purposes, the hepatitis B vaccine may be administeredupon the order of a doctor of medicine or osteopathyby qualified staff of home health agencies, skilled nursing facilities, ESRD facilities, hospital outpatient departments, HMO's, persons recognized under the `incident to physician's services' provision of the law (section 1861(s)(2)(A) of the Act), as well as doctors of medicine and osteopathy. This policy is included in the Medicare Claims Processing Manual, Chapter 18, section 10.1.3

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In this context it was fair enough to assert that environmentalism allied itself with ideas of justice and decency, and that it was about people as well as everything else on the planet