Lyme Disease Vaccines: A Cautionary Tale 273 The LD vaccine narrative reconfirms that the success or failure of risk- reducing practices and products depends heavily on different sorts of trust. Biomedical interventions that promise risk reduction are different from others that relieve pain, take away symptoms, or reduce suffer- ing. The consumer of a risk-reducing product or practice has to place much more trust in aggregate probabilities of benefit and harm because these practices or products have no felt impact. At the same time, con- sumers do generally expect a more immediate effect from risk-reducing interventions. These interventions are often designed and promoted as practices or products that promise to restore control, combat fears, and lessen uncertainty. But if these same interventions are later linked to even small probabilities of risk or harm, this social and psychological efficacy can be easily undermined, and the trust shattered. The rise and fall of the LD vaccines shows just how hard it is for this trust to be maintained and how easily it can dissipate. And a lack of trust can easily be generalized to other interventions. At the postmarketing hearings (VRBPAC 2001), consumer activist Sidney Wolfe testified that the problem with the LD vaccines was that they reduced the public’s faith in other public health measures. He compared the situation with the “the tragic lesson of the swine flu vaccine . . . when one sees a very questionable immunization campaign such as this going on, about the implication and the negative effect on public health generally and on vaccinations in specific.” Knowledge of the social and historical context in which the LD vac- cines became market failures may be useful to policymakers, especially as the number of health risk–reducing interventions—preventive mea- sures, screening tests, and treatments aimed at reducing the probability of recurrence or new manifestations—is growing (Aronowitz 2009). This history suggests that the evaluation of benefit and safety of risk- reducing practices and products, which increasingly dominate medical care, should proceed with more nuanced attention to the challenges posed by their social and psychological and not only by their scientific efficacy. In many cases, evidence-based, quantitative evaluations of objective health benefits and risks of interventions will profit from the simultane- ous identification and examination of the expected and actual social and psychological work done by interventions sold as consumer products. Currently, the consideration of such factors is marginal and not explicit and is carried out in an ad hoc fashion. In the formation of LD vaccine policy, regulators and expert clinical opinion clearly had misgivings