When it comes to home improvement, even the most experienced DIYer has a limit. I'm not going to come in here with the blow torch and get it hot and solder and put the copper pipes to come. I'm not doing it. I call it a very nice man to handle it. When to call the experts and when to do it yourself. That's This Week on Explain It to Me. My new episodes Sundays wherever you get your podcasts. When I was learning how to make radio, I had a day job in the file room at my aunt's family medicine practice just outside of San Francisco. They were old school and didn't really do computers. So there was just a pile of paper, taller than I was of faxes, doctor's notes, checkups, prescriptions, just everything. And as I filed that mountain of paper, I saw the community that they had built at that doctor's office, the generations of families visit after visit, living their lives, trusting their health and their loved ones with my aunt's care. So it resonates with me when VJ Sikand describes his work as a family physician. I take care of newborns to 90 and I say, stop at 90 because if you're 90, you don't need me. VJ has been a family doctor in a little town in Connecticut ever since he first drove up there with his wife in the 1980s. And we fell in love with the place. It was a small, charming town where you have a couple of very nice inns on Main Street. And just, you know, a lovely spot right there on the Connecticut shoreline at the bottom of the Connecticut River. But this town was special. The center of a newly uncovered disease that VJ had only really read about in textbooks. Old Lime is the place where I started my practice of medicine. It's also the place where Lyme disease was first discovered in this country. And it's consumed much of my life. The story of Lyme disease is long and winding. It's an old disease that's spread across much of the Northern Hemisphere. But in 1976, a Yale professor, Dr. Alan Steer, was the first to pin it down to ticks in Lyme, Connecticut, and give it its name. For the last 50 years, Lyme disease has impacted millions of lives and has become one of the fastest growing insect-spread diseases in the United States. But this isn't that story. This is VJ's story of how a disease and the search for answers can become a career, a community, a life. I'm Meredith Hodnott, and this is Unexplainable. So when did Lyme disease tip from something that was theoretical to becoming a part of your everyday life and your practice as a doctor? Very quickly in the mid-1980s, when the media reports started to come out, there was quite a lot of anxiety. So I started to get phone calls in my office almost every day. I almost spent an hour before going home at the end of the day, returning phone calls from parents who asked me what to do about their kids' tick bites. And so all of a sudden, we had a snowballing of interest, anxiety, stress, need for understanding, diagnosis, and treatment. How did it feel for you to be a family practice doctor, like you said, treating everybody from the infant to the grandma in the households and also be at this epicenter of Lyme disease in this country? It was a lot of fun. It was a lot of fun. It was a lot of fun. It was a lot of fun. Because how often do you get to be a doctor and treat stuff that not only seems this new, but to be right in the middle of it? I mean, it's the kind of thing where if you made a phone call to a customer service agent, they asked you what your address was, and you said Lyme, Connecticut, and they said, oh, where the disease is, right? Wow. It was kind of a, so as a doctor, it was kind of neat to have something that you can uniquely diagnose and be positioned to diagnose it as well as to cure it. Yeah. Yeah. I feel like it would be a lot less fun if you couldn't cure it. Right. And there are those cases. One could write a chapter or two in a book about that. Does VJ saw more and more patients come into his office with Lyme disease? You realized it wasn't always easy to recognize. That's because Lyme disease is a chameleon, a shape shifter that's always changing. Lyme disease is caused by a corkscrew shaped bacteria that lives in tics bellies. If an infected tick bites you, the bacteria gets in your skin and starts to spread in a rash, sometimes in this iconic bullseye shape. At this point, VJ says it's often easy to knock out with simple antibiotics. But if it gets past the skin, untreated, the Lyme disease bacteria can get into the blood stream and spread to your heart, your joints, your nervous system. VJ treated patients that had half their face paralyzed, patients who passed out because their hearts were beating too slowly. The longer a patient had Lyme disease, the harder it was to recognize. Lyme disease could look like arthritis. It could look like a summer flu. It could look like meningitis. It could be completely asymptomatic and look like nothing at all. And VJ was on the front lines, treating his patients, his friends, his neighbors. He contributed to dozens of academic papers in his spare time. And he was also moonlighting at the local ER until one day he got a call. I was making rounds in the hospital. And the nurse on the floor came up to me and said, hey, Doc, there's a guy on the phone. He says he's from a drug company. He says he wants to talk to you. I said, drug company? Why is he calling me? At the hospital, I'm making rounds. And she's, I don't know. He says, can you talk to him? I said, OK. I went over to the nurse's station and I picked up the phone. And there was a gentleman there on the phone. His name was David Kraus. He introduced himself and said, you know, we've developed a vaccine for Lyme disease that's now ready for phase three, which is the actual late-stage testing to see if it works. It had only been through the early phases where you would just check to see that it's actually sort of safe to give to animals. Then you'd see if it's safe to give to people. And then as it may be safe in a small number of people, but you don't check to see if it actually works until you know all of those ducks are in order. So anyway, so Dr. Kraus said, would you be interested in working with us on this vaccine now that we've reached this stage? And I said, well, that's fascinating. Of course. And I signed on. The drug company was Smith Glyne Beacham, a huge international pharmaceutical company. And this vaccine was kind of unusual. The thing about Lyme disease is that it takes about a day, maybe two days, after the tick bite for the bacteria to travel from the tick into your skin. And in that time, there's a window after the bite, but before the transfer. So the vaccine does not work on the bacteria in you. What it does is the tick sucks up your blood, which has the antibodies. And it kills the bacteria before they can come and infect you. So it kills it in the tick itself. Yes. So here we have the vaccine, which is very unusual because it kills the bacteria that cause Lyme disease in the tick before those bacteria can infect you. It's almost as if it were vaccinating ticks. Exactly. The previous drug trials were promising. But now it was time to test this vaccine in the real world. There were going to be dozens of test sites across the country with thousands of patients. And where better to test a new Lyme vaccine than in Lyme, Connecticut? So VJ signed up to run a test site as an independent contractor for the drug company. That meant he'd be recruiting participants, enrolling them in the study, and watching over them carefully for the next 20 months. Now, as soon as I just started the process of recruiting patients, I couldn't handle the number that started coming in. No way. It was just mind boggling. I put a little out of a newspaper and the phone started ringing off the wall. I had to get more phone lines. I had to hire a person just to answer it. Within a couple of weeks, I cut my work at the hospital in half. We ended up recruiting 1,200 adults, well age 15 and over, and had to shut it down because I couldn't handle it anymore. I had to end up asking a colleague if he would rent space to me because I needed more space just to see all these patients. So I lured a couple of nurses from the hospital and ended up having a large staff to take care of 1,200 people. So within about six weeks of that phone call from Smithcline Beachham, I was deeply involved in this study. So we took the baton and we ran with it. My wife volunteered. Ethically, I'm not the one who did her consent or gave her the shots. In the pediatric study, which followed, both of my kids received the vaccine. I didn't know, and they didn't know whether they were getting a vaccine or placebo. Oh, I had neighbors. All matters of people. I had people, the lady who ran the donut shop across the road. She would of course bring donuts every time. I have to mention this. Years later, my son came home and told me he's getting married, and the woman he was marrying was one of those kids from the vaccine study from 15 years earlier. Wow. It's a small world, and it's fun and it connects you to people. Do you feel like it changed your perspective on the community? Yes. In a way, it did, because I was pleasantly surprised to see that so many people would turn out to stick their arms out and have a needle stuck in them. So we gave half the patients a placebo, and we gave half the patients Vaxial Lyme Disease vaccine. I didn't know what they were getting, Vaxial Lyme Disease, but it's what we call a double blind study. It's the gold standard for studies. Then we followed these individuals for a couple of years through tick seasons. We checked them closely to see if they got symptoms of Lyme Disease. We checked them in the most intense detail. We drew blood beginning of the season, end of the season, and any time you had an illness that might or might not have been Lyme Disease during those two years, we drew your blood again. I had a photographer helping me with photographing the skin rash as patients came down with, et cetera. So we had the guy across the road also next to the bakery who had a Photoshop. And the Photoshop guy, every time I had a patient with a skin rash, he would go out of his way to get the film, develop it overnight, provide a high quality picture for me to then FedEx to the manufacturer. And so we had the FedEx guy, we had the Photo guy, we had the Bakery lady bringing in the donuts. It gave me a sense not only of being a physician in the community, but being a part of it in a unique way. Throughout the vaccine, the drug company funding fueled VJ's drive to pin down this shape-shifting disease. Take, for example, the first symptom of Lyme Disease, the rash. Everybody talks about the bullseye. But if you have 12 different ways this rash might look, wait a minute, it's not so easy to diagnose. Sometimes the Lyme rash can appear in ways that we never imagined. We had dozens of different rashes. Anytime a patient in our study had a rash, they'd immediately say, you got a seamy dot, I've got a rash. Because we had the resources of the large pharmaceutical company, we biopsied those rashes. Now nobody in his right mind, or even if they had a million dollars, would be able to have their patient in their private practice office have their skin lesion biopsied instead to a lab. We had to prove if it was really Lyme Disease or not. So we did a little biopsy from the edge of all of those skin rashes to see if they could find the Lyme Disease bacterium in it. You would be amazed at half the time there were rashes that I had no idea whether they're Lyme Disease or not that turned out to be Lyme Disease. Which if we hadn't had the study, we would never have known. We would never have known. VJ was managing one of the biggest test sites for this phase three vaccine trial. As a matter of fact, it got so busy I had to stop my private practice completely. He stopped moonlighting at the ER. He stopped working extra jobs in local clinics. The study was his life, and he was the face of the study for his community. Where's there ever, ever for you, even the smallest moment of doubt? I love that question because being a double blind study, I had no idea whether patients were receiving vaccine or placebo. As you can imagine, during the course of those few years where we were blinded, I had patients out of 1,200 coming down with all kinds of things. Whether it's heart attacks, strokes, things that people have in the normal course of their lives when you're adults. I always wondered, gosh, I hope the vaccine's not causing it. But fortunately, we had what's called a data safety monitoring board, independent board, which was not blinded. They were able to look at all these things that were happening that were worrying me and other investigators and know whether there was a signal or not that the vaccine was involved. Finally, this data safety monitoring board never called and said, hey, stop the study, which I wondered, gosh, I hope I'm not doing this. VJ had to sit with these open questions. Did the vaccine actually work? Was it safe? Were there side effects? VJ monitored his patients for nearly two years, but then the study was out of his hands. As you can imagine, the very vast amount of data that were accumulated from all the sites around the country had to be collated, analyzed, sliced and diced by statisticians, run by data safety review boards where they're looking at adverse effects that patients had reported throughout the study to see whether they may or may not have been related to the vaccine. But patients actually became impatient in a way. They were not up unintended because they wanted to know. Of course, patients, we didn't unblind the study until after it was over. So, we're wondering, did I get the real thing or not? Of course, it was a game. There were people who would say, I know I got the real thing because I felt my arm really ached or I had this achiness the next day or at this little temperature. I think I got the real thing. It'd be amazing how often they were wrong. Finally, after months of needles and months of waiting, the people of Lyme got their answer. The study results were published in the New England Journal of Medicine in July 1998. 66 people in the placebo group got Lyme disease that year, compared to 16 cases in the fully vaccinated group. So, prevented roughly 80% of cases of Lyme disease that would have occurred in people who were vaccinated compared to people who weren't. With over 10,000 patients, this wasn't the biggest of studies, but it was a perfectly respectable phase three trial, showing that there were no major side effects over the 20 months that the patients were monitored. Most symptoms from the vaccine, as reported by the study, were a sore arm, a little fever, nothing a few days and some ibuprofen didn't resolve. I was thrilled. I was thrilled. Vijay was a lead author on the paper, with scientists from some of the biggest research universities in the country. He contributed to textbooks and helped educate doctors around the world about Lyme disease. And with the study over, Vijay took on a new role, advocacy. Being the physician on the ground there in Lyme, Connecticut, my job was to tell these folks from the FDA why we even needed a vaccine for Lyme disease. In 1998, Vijay and other sponsor representatives for the drug company went to a holiday in Bethesda, Maryland to present the vaccine study to an FDA advisory committee. This meeting lasted all day. Going into the weeds of the study design, the efficacy results, the safety data. Vijay shared what he had learned about the many faces of Lyme disease, how it could look like so many different things. It's often difficult to diagnose. It may be difficult to treat. It can have adverse consequences, which may be serious and untreatable or become chronic. And now we have a vaccine that is safe and effective in preventing it. What can we do except for give this to the American people? Then the coordinating investigator of the vaccine study, Dr. Alan Steer, shared some new findings of his own. Dr. Steer was a big deal. He's the one that first discovered that Lyme disease came from ticks decades before. And he'd been studying Lyme on his own, apart from the vaccine trial. He was particularly focused on how Lyme disease impacted the immune system. He noticed some cases where people with Lyme disease developed arthritis that was resistant to treatment with antibiotics. And he thought the immune system might be involved. It was pretty rare. We're talking about a fraction of a fraction of a percent of people with Lyme disease. And Dr. Steer wanted the FDA panel to know because he thought an even smaller subset of these rare patients with vulnerable immune systems might react differently to the vaccine. Even though the study showed that for thousands of patients, the vaccinated groups and placebo groups didn't have any significant difference in arthritis side effects. So what did this mean for the vaccine and autoimmune arthritis? The FDA panel wanted more clarity and asked for additional testing on long-term safety. But ultimately they concluded the vaccine was safe and effective. Later that year, the vaccine branded with the name Lymerix was approved by the FDA. But the questions from the advisory panel meeting haunted the vaccine. There were some dark clouds on the horizon. There were unanswered questions. That's after the break. Hi, I'm Maria Sharapova, host of the Pretty Tough Podcast. Each episode I sit down with high-achieving women to discuss the pursuit of excellence without apology. This week, model sports illustrated cover girl and entrepreneur Ashley Graham talks about the time she almost quit. I called my mom and I said, mom, I just I'm not going to do this anymore. And she told me, no, you are going to stick this out. Your body is going to change someone's life. Every decade, you're going to go through something different. So be really happy with who you are right now because things change. Check out Pretty Tough, new episodes on Wednesdays. You can watch it on YouTube or listen in your favorite podcast app. So the 2026 midterms is shaping up to be an all-out brawl. But the biggest fight may not be between Democrats and Republicans, but over the congressional maps itself. Jerry Mandarin is not a good thing. We don't like it. And then all of a sudden we're going out and telling people, vote for this. So I'm in Ashland, Virginia, a small town just outside of Richmond, which calls itself the center of the universe. And that checks out because it's the center of the political universe, at least when it comes to the 2026 midterms. That's because Ashland sits in Virginia's first congressional district, which is one of only about 35 or so that are actually competitive. That makes Virginia particularly important when it comes to the question of Jerry Mandarin. The Jerry Mandarin is a major problem, but it's not like Democrats drew first blood with this one. Donald Trump doesn't think he should be held accountable by anybody, so he's trying to change the rules because he doesn't like the game. We've shown what we're capable of. Now let's keep up the push through the midterms. America actually will be in your feeds and on YouTube every Saturday with an interesting interview in politics or culture. She put the lime in the coconut she'd dragon pulled up. She put the lime in the coconut she'd dragon pulled up. There were two things that changed the course of vaccine medicine in the late 90s. First, a British medical journal published a small, now very soundly debunked study connecting the MMR vaccine to childhood autism. So here, this researcher had his license stripped from him at the end of the day. He had the black eye, the journal had the black eye, but the damage was done. And then just a few months later, another childhood vaccine, this one against rotavirus, was taken off the market because it had a rare but dangerous side effect. And so the public perception of bad vaccines took off. So we had a perfect storm back then. Wait a minute. How do you guys know that it's vaccine safe? Look at that MMR. We read about it in the paper. This was the beginning of the modern anti-vax movement. And the newly approved lime disease vaccine, Limericks, was one of their first targets. One of the things that people were worried about with the lime disease vaccine was whether it might cause an unusual form of arthritis related to autoimmunity. Scientists were still digging into how the immune system was connected to chronic lime symptoms like arthritis. And so the FDA and the drug company wanted to keep close tabs on a vaccine that used the immune system to fight lime disease. After approval, one and a half million people received the lime vaccine over the following three years, two or three years. What happens afterwards? The manufacturer actually collected a large amount of data on the people who received the vaccine after it was approved. This is called a post-marketing surveillance study, and it's common for new drugs. Basically, it's a trial period to make sure there aren't any side effects that are so rare, the other smaller phases of the trial miss them. Another retrospective study showed that of the nearly 1.5 million people who had the vaccine, a few hundred people reported any joint or muscle pain, and 59 developed arthritis. A similar number of people would have developed arthritis in a group of one and a half million people who hadn't had the vaccine. But in the wake of all the other vaccine skepticism unfolding at the time, it was a good story. A day didn't go by where I didn't get contact from one of the national or international media asking to talk about that vaccine that we heard might be causing arthritis or other autoimmune problems. How did all this media attention, what did it mean for your patients? Were they starting to get worried? That's a good question because these patients covered the whole spectrum. We had patients who said, hey, I was in the study, I came down with multiple sclerosis doc, my neurologist diagnosis. Do you think it's connected in any way to the vaccine? Because I read that there were maybe problems. I mean, you get stuff and you wonder, is it connected? Beyond the study, some patients were worried, confused. Maybe they had unexplained symptoms they didn't understand or a health care system that they didn't trust. And then some doctors were confused too. They were getting mixed messages from the government. The CDC recommended that only people at high risk for getting Lyme disease should even consider getting the vaccine. Lyme disease was dismissed as a yuppie problem, a frivolous concern, and the vaccine, which could cost hundreds of dollars, was a luxury. Everybody else was doing just fine, wearing long socks, doing tick checks, and taking antibiotics if they caught it. And then the lawsuit started. It all happened so fast. Within months of Lymex going on the market, a law firm in Philadelphia sued the drug company, claiming over 100 people experienced bad reactions from the vaccine, often citing crippling arthritis. And more lawsuits followed that. One of the people who enrolled in the class action lawsuit to sue the company and indirectly me was the wife of a doctor colleague of mine at the hospital. So it got that close. The pressure ratcheted up, and the FDA called back the advisory panel in 2001 to go over all of the safety data again. Reports from the time, say the meeting, was riotous. By this point, scientists had learned a little more about the interplay between the immune system and the rare treatment resistant Lyme arthritis that had originally sparked confusion back in 1998. They found that these patients were more genetically vulnerable to getting arthritis, with or without getting Lyme disease, and that the Lyme disease antibodies weren't necessarily causing an autoimmune reaction. I mean, scientists still don't fully understand all of the complexity of Lyme disease and the immune system, especially for people with chronic Lyme. So while there were no absolute definitive answers, this research made the hypothetical connection between autoimmune arthritis and the vaccine even more tenuous. Once again, the FDA found that LymeRx was safe and effective, a recommended tool against a significant disease that was spreading fast. But sales of the vaccine took a nosedive, and by 2002, the Lyme vaccine just wasn't good business. I'll never forget that meeting because I actually almost missed the ferry. Gosh, that was those for the days. There's a ferry across the island's tower as to give this talk about Lyme disease to doctors. And there happened to be an accident on Route 95 that shut down the highway. On my cell phone, I called the ferry. It's like, gosh, are you running late by any chance? It turns out the woman who answered the phone was a patient of mine. She recognized my voice. This is what happens when you're in a small community. She says, hey doc, I know it's you. Just get here as soon as you can. Don't bother to park the car. Hand your keys to the attendant and jump on, which is what I did. So that in itself was hairy. I get on the ferry, we cross the island's sound, and reach this lovely restaurant. There's a whole bunch of doctors, about 40 of them gathered to hear about the Lyme vaccine. And I start my talk always by showing photographs of the disease and just a little education about the disease itself. And then what we did in the study, what did we find? How did we do it? Why is it safe, etc. And how to go about giving it to your patients. So even though I was sponsored by the company that makes the vaccine to give the talk, I spent at least half the time just teaching them stuff about the disease. And that's what, that's the fun I get out of it. So we had a nice dinner, a nice evening, and then I was tapped on the shoulder. I think it might have been during dessert. I was tapped on the shoulder by this person who worked for the pharmaceutical company, he said, I want to have a word with you. And so we ducked into a hallway, and then I find out the vaccine's been pulled. I just gotten through a lecture to about 40 physicians about the vaccine and how great it was for their patients. And I found out the end of that meal after that meeting that the vaccine was withdrawn. The drug company, now GlaxoSmithKline after a merger, said that they were expecting so few sales that it just wasn't worth manufacturing the vaccine anymore. They settled the lawsuits without emitting any wrongdoing and covered legal fees without paying any other damages. It was like Lymerix had never happened. VJ was shocked. Here's something that I had invested many years of my life into. I'd given up my private practice. I really had devoted many years of my life to not only doing the study, but doing it well. And, you know, you wanted to do something in a way that you knew you could hang your head on it, you knew at the end of the day it wasn't just because you're checking off boxes and you have this patient, you have this blood test done. No, it was your life. What did we lose when we lost this vaccine in 2002? We lost a very valuable tool that came into existence because of incredibly complicated and careful science which had been conducted over years by truly, truly dedicated brilliant scientists with all stripes. We had microbiologists, immunologists, regular family docs, we had all kinds of people, people in the lab creating the vaccine. We had people who were putting together the data for us or opening the FedEx packages or there were just thousands and thousands of people who devoted untold hours to this vaccine coming into being and we knew it was safe. We knew it was effective. We knew it worked and yet this had happened. Limericks wasn't a perfect vaccine but now there are a lot of unanswered questions because of how it ended. Questions that could have only been answered with follow-up studies and closely monitoring millions of people taking the vaccine. And in a lot of ways we're living in the shadow of Limericks. This was a big win for the nascent anti-vax movement. They had the power to face down a giant pharmaceutical company and get a vaccine pulled by going around the official government systems. And now they are a big influence within those very same government systems. I wouldn't want to bring out a new vaccine this year with the current administration in terms of vaccine acceptance. You know, is it worth it? For years Limericks has been seen as a cautionary tale of science communication gone wrong. How mixed messages can confuse people and lose the trust of communities that this science was supposed to help. But for Vijay it's more personal than that because for him this science was a part of bringing his community together. Even years later I can say even way after the studies ended I will meet people on the street who will say wow those were the days we remember they call it the Lyme Study. Over 25 years after the Lyme Study, Pfizer and a French drug company Valneva are testing a new Lyme disease vaccine based on similar science. And as of this spring, Pfizer is planning on submitting the vaccine to regulatory authorities. This episode was produced by me, Meredith Hodnott. It was edited by Lyssa Soap. Christiana Yalla did the mixing and we collaborated on scoring with music from Noam Hasenfeld. Melissa Hirsch checked the facts. Joanna Solotarov and Sally Helm are having fun in the sun. And thanks as always to Brian Resnick for co-creating the show with Bird Pinkerton and Noam. If you have thoughts about the show we would love to hear from you. Please email us at unexplainable at vox.com. And if you'd like to support this show and the journalism that Vox does, you should become a member. It's really easy to do. Just go to vox.com slash members. And for those of you who have emailed us to let us know that you signed up to be a member because of unexplainable, thank you. It really means a lot. Thanks also to those of you who have left us a nice review wherever you listen to your podcasts or just told somebody about the show, your best friend, your cousin's wife, your boss's janitor. Anyways, you're all the best. Unexplainable is part of the Vox Media Podcast Network and we will be back very soon with another episode about everything that we do not know just yet.
