Lyme Disease Vaccines: A Cautionary Tale 251 Conclusions: The social and psychological efficacy of many risk-reducing prac- tices and products, such as new “personalized vaccines,” is to provide insurance and reduce fear. Yet the actions of self-interested actors can easily undermine this appeal. In addition to evaluating the scientific efficacy and safety of these practices and products, policymakers and others need to understand, anticipate, and perhaps shape the potential social and psychological work they might do. Keywords: Lyme disease, Lyme disease vaccines, history of medicine, history of public health, vaccines, health policy. I Dr. Paramour reads with dismay a report in the British Medical n george bernard shaw’s play THE PHILANDERER (1893), Journal that proves that the disease bearing his name is nonexistent. His patient with the hitherto-real Paramour’s disease, sitting nearby, feels liberated and is annoyed by Paramour’s despondency. Shaw’s carica- ture of late nineteenth-century medical pretensions elicited laughs when I saw the play in 1982, but I wonder if it would today, when patients often cling more tightly to controversial medical diagnoses than to their doctors. One such prominent contemporary controversy is over the diagnosis and treatment of Lyme disease (LD). In many ways, LD is an unlikely battleground. It is an old-fashioned “new” disease. In the late 1970s and early 1980s, entomologists and clinical researchers rapidly identified the tick vector and causative bacteria, the spirochete Borrelia burgdorferi (named after its discoverer, Willy Burgdorfer). Diagnostic tests were developed, and antibiotics were believed to be effective. These rapid developments might have led to a reassuring narrative about scientific ingenuity and medical efficacy. But events turned out differently. Nearly every aspect of the diagnosis, treatment, and prevention of LD has been fiercely contested. What is Lyme disease? Who gets to decide? The major issue since LD was named and “discovered” has been the legitimacy and reality of chronic Lyme disease (Aronowitz 1991). For many people in the LD lay advocacy community, LD is protean in its manifestations, often misdi- agnosed and underdiagnosed and capable of causing months and years of debilitating pain, fatigue, and anguish. From this heterodox perspec- tive, which has become a formidable opposition to LD orthodoxy, the