Lyme Disease Vaccines: A Cautionary Tale 261 supporters. David Weld, executive director of the American LD Foun- dation (perhaps the sole advocacy group that supported the orthodox position), in testimony at the 1998 ACIP meeting, had wondered out loud if the vaccine “may be very beneficial in that it’s going to reduce the incidence of a lot of people claiming to have Lyme disease when they don’t.” While the efficacy trials, adverse event reports, and the HMO surveil- lance system had not found evidence of the vaccine’s dangers, the 2001 VRBPAC meetings heard a lot of testimony from individuals claiming serious harm. “What disturbs me is that in the SmithKline presentation there were 950 adverse events,” chair Robert Daum noted. There was a nice presentation of that. And this afternoon we heard testimony from twenty individuals of twenty, of approximately twenty people who had very significant adverse events. And the disconnect for me is I’m hearing that and I’m seeing that data, and I don’t see any reflection of one to the other as if we were in two different universes. Not only were different types of evidence (statistics comparing the vaccinated and controls with the personal narratives) marshaled, but some heterodox advocates offered radically different interpretations of the same evidence. Rather than understanding the absence of asymp- tomatic seroconversion among the vaccinated as evidence of vaccine ef- ficacy, some detractors offered a diametrically opposed interpretation: the vaccine caused people with prior or latent infection to become symptomatic with an LD-like disease, resulting in no one left to be asymptomatic. As one vaccine skeptic put it, the vaccine “is turning asymptomatic Lyme disease into symptomatic cases” (Kathleen Dixon, testimony, VRBPAC 2001). Kay Lyon, another vaccine skeptic, argued that asymptomatic infection was better understood as a “smoldering” infection and that the vaccine “might be a trigger that turns this smol- dering infection on, converting it almost instantly into late-stage dis- seminated Lyme disease.” In support of the view that asymptomatic infection could later turn into serious disease, she noted that asymp- tomatic seroconverters, whom the research was designed to detect, had been treated with antibiotics by study investigators. Lyon continued: “This was, of course, the humane way to treat study participants. But it is absolutely not reflective of medical practice in the real world our children live in” (VRBPAC 2001). Again, LD advocates proved adept at using insiders’ knowledge of how research was conducted to score points for the heterodox position.