266 Robert A. Aronowitz that are characterized by exacerbations and remissions. Many of the psy- chosomatic diseases of midcentury (asthma, hay fever, and ulcerative colitis) were, in subsequent decades, reframed as autoimmune diseases (Aronowitz 1998). While much of this reframing was built on real and important new understandings of immunity, it was also the case that one appealing, intuitive, and flexible overriding causal scheme— psychosomatics—was replaced by another, autoimmunity. (For a general argument about the nexus of lay and scientific ideas about immunity in etiological thinking, see Martin 1994.) The immune concerns about the LD vaccine have some parallels with concerns about drugs such as Tamoxifen and Finasteride, which have been marketed to prevent breast and prostate cancer, respectively. De- spite some evidence of their scientific efficacy for prevention and their regulatory approval, these drugs—when used as preventives—have been market failures. In contrast, the screening tests for these cancers, mam- mography and PSA tests, are widely used despite controversy over their efficacy, overdiagnosis, and iatrogenic harm. One explanation is that these drugs, unlike the screening tests, evoke different fears because of their direct effects on the body. Tamoxifen, for example, can cause uterine cancer and immediately produces menopausal-like symptoms in many women. The LD vaccines, like Tamoxifen and Finasteride, may be feared be- cause of their putative direct effects on the body. In the case of the cancer preventives, the comparison with the enthusiasm for screening is telling because the indirect effects of screening—overtreatment re- sulting from overdiagnosis—may be as consequential but, I surmise, are feared less because their negative impact on health is less direct (Welch, Schwartz, and Woloshin 2011). In addition, the risk of radia- tion from screening mammography has sometimes played a large role in these controversies (Aronowitz 2007). The point is that social and psychological effects of practices and products, as much as or more than their scientific efficacy, often play a determinant role in their actual use or rejection. Consumers worry that these preventives directly impact the body in unknown and uncertain ways, in one case toward cancer itself and in the other toward murky immune problems. In each case, a preventive drug was marketed as reducing risk and controlling un- certainty/fear and yet has the potential to add risk and raise fears. As a result, many risk-reducing drugs and vaccines are unstable consumer products.