272 Robert A. Aronowitz This well-established controversy over chronic LD has not gone away. Not long after the LD vaccines were withdrawn, the next major bat- tle in the Lyme wars was over attempts by the Connecticut attorney general to sue a major infectious disease organization for monopolistic practices related to its consensus criteria for diagnosing and treating LD. This mobilization of antitrust laws against the typical ways that expert physicians make and communicate consensus recommendations dismayed most medical observers but was seen by many in the het- erodox community as a counterbalance to the power of the medical establishment to set the entry criteria for a much-coveted diagnosis and to discipline “Lyme-literate” practitioners. More biomedical acceptance of the legitimacy of patients’ suffering, whether or not it fits an accepted diagnostic scheme, and clinical manage- ment strategies that focus on symptoms rather than specific diagnoses might go some way in lessening the heat of this thirty-five-year-old controversy (Aronowitz 1998). But because this controversy is so en- trenched, these patient-centered approaches run against more dominant reductionist tendencies in clinical care and are unlikely to have much impact. The LD vaccine controversy is unlike the controversies surrounding AIDS and other diseases that also have had a very determined and of- ten oppositional lay advocacy (Epstein 1996). These controversies often center on the inclusion of patients, minority groups, and other stake- holders in the planning and execution of clinical trials and policymaking (Epstein 2007). But Lyme disease is not AIDS. Advocates and experts have often lived in entirely different universes, in which basic assump- tions and motivations are built on the negation of the other. There has often been almost a totally incommensurate view of the opposing group’s actions. Arguably, inclusion should not be valorized in itself but for what it brings: fairness, accurate research sampling, different perspectives, and so forth. The attempt to include the orthodox and heterodox perspectives in consensus conferences and other research and policymaking venues has, by any standard, failed. Perhaps it is time to name and act as if Lyme disease and chronic Lyme disease were separate entities that have very little to do with each other. Even if there are no ready solutions to the LD controversies, it remains important to understand what was at stake in the rise and fall of the LD vaccines because American medical practice is increasingly consti- tuted by many similar, risk-oriented interventions (Aronowitz 2009).