260 Robert A. Aronowitz resulted in “thousands of letters from the public indicating that that wasn’t true” (VRBPAC 2001). Such a statement was perceived as a direct attack on a core heterodox position. The gap between the orthodox and heterodox positions has been wide and consequential. From the orthodox vantage point, many LD advocates did not deserve a seat at the table. It was as if people who had biop- sies for breast cancer and tested negative demanded a say in how breast cancer practices and policies were being developed. Some LD advocates believe their children or partners died from Lyme disease, while most experts are skeptical that LD is ever fatal. Members of both communi- ties frequently acknowledge that they have been living in different and oppositional worlds. “Your reporting system might do well in the belt- way,” one patient advocate complained at the postmarketing regulatory hearings. “But out where the ticks are, out in the hinterland, nobody knows about it, or they are not telling you” (Pat Easton, testimony, VRBPAC 2001). One lay advocacy organization that SKB initially supported was the Lyme Disease Foundation. At the 1998 VRBPAC meeting that ulti- mately gave approval to the vaccine, Karen Vanderhoof-Forschner, the foundation’s president, offered passionate support for LYMErix. Simi- lar in many ways to the SKB-sponsored clinician who addressed the meeting, Vanderhoof-Forschner argued that LD was a geographically widespread, underdiagnosed, chronic, devastating, and costly disease— and thus worthy of prevention by vaccination. But in 2001 she told the same advisory board that the vaccine “represents an imminent and substantial hazard to the public health and needs to be immediately recalled.” Why did she change her mind so quickly? LD advocates were not, of course, against preventing the disease per se but were against the way the vaccine might reinforce the idea that LD was an acute, un- problematic, and clinical entity. For many in the heterodox community, the vaccine, the vaccine’s scientific efficacy, and the narrow disease def- inition had become mutually reinforcing concepts. Once the vaccine’s efficacy was established, there was a collateral implication that the nar- row diagnostic criteria used to establish this efficacy “worked” as well. This type of stabilization of both the technology and its target is some- times understood as “co-production” in science and technology studies (Jasanoff 2006). The heterodox antipathy to the vaccine also might have followed from the potential impact of widespread vaccination to reduce the ability of people to claim they had LD. Although there was never any evidence of this motivation, it was clearly in the minds of LD vaccine