More ticks means more Lyme disease, which Dr. Steere has been studying for 24 years, longer than anyone else. In fact, he was the first to identify the brand new ailment among a baffling cluster of children with swollen knees in Lyme, Conn. And, over the protests of civic leaders, he gave it its name.
But more recently he has enraged many patients and their doctors with his contention that Lyme disease has become a junk-drawer diagnosis, covering maladies ranging from fibromyalgia to hypochondria. Many people receiving antibiotic treatment, he argued, are being done more harm than good.
''I suppose Lyme disease is one of the few diseases that some people want to have, because it's defined,'' Dr. Steere said. ''I think it's very difficult to have something that is not well understood.''
Still, in the realm of Lyme disease, few are as influential as Dr. Steere.
As chief of the rheumatology and immunology department at Tufts School of Medicine, Dr. Steere led the research effort on Lymerix, the preventive Lyme vaccine, which first hit the market in January. The research took four years, covered 10 states and involved 11,000 patients and 31 scientists.
The vaccine proved 78 percent effective. But its impact is not likely to be felt during this summer's tick onslaught. For fullest protection, the drug is taken in three shots administered over the course of a year, according to the manufacturer, SmithKline Beecham.
Nonetheless, some uncertainty remains about the vaccine's ultimate safety, especially for people with certain conditions. When the National Vaccine Advisory Committee of the Food and Drug Administration certified the drug in December for people 16 to 70 years old, members appended a list of concerns about the long-term effect of the vaccine, especially among those with chronic arthritis or heart conditions.
''It's rare that a vaccine is voted on with such ambivalence and such a stack of provisos,'' Dr. Patricia L. Ferrieri, the committee chairwoman and a professor at the University of Minnesota Medical School, said at the time of the vote.
Given the Lyme problem nationally, the F.D.A. released the vaccine on public health grounds, recommending that it be considered by people at the highest risk for the disease.
Even Dr. Steere has his doubts about the safety of the vaccine, which he has not taken himself, he said, because Lyme is not a serious problem in the Boston area.
Since 1982, 128,327 cases of Lyme disease have been reported to the Centers for Disease Control and Prevention, but the number may be much higher. Dr. David Dennis, who coordinates the agency's Lyme program, says he believes that only a third of the cases are reported.
In 1972, his final year of medical school at Columbia College of Physicians and Surgeons, Allen Steere learned epidemiology, as a dodge, after hearing from an Army recruiter that some 90 percent of new doctors would be drafted and shipped out to Southeast Asia, unless they found alternative service. Dr. Steere discovered the Epidemic Intelligence Service, the C.D.C. division that investigates outbreaks of new diseases, like AIDS and Legionnaires' disease. From 1973 to 1975, he practiced the science of epidemiology across America. Afterward, he headed for Connecticut to begin a fellowship at Yale in his passion, rheumatology. ''I hoped that my C.D.C. experiences were something I could apply to the study of arthritis,'' he said.
His opportunity came four months later with a call from Connecticut's chief epidemiologist, who asked Dr. Steere to visit a concerned woman in Lyme, a tiny, wooded hamlet at the mouth of the Connecticut River. The woman, Polly Murray, was reporting an unusual cluster of a rare disease, juvenile rheumatoid arthritis, in her town. Victims included two of her four children, whose knees were so swollen that they could not walk without crutches. Dr. Steere's interest was piqued. ''If there was one child in a town the size of Lyme,'' he said, ''that's about what you might expect.''
Mrs. Murray handed Dr. Steere a list of dozens of ailing children. He began by calling each family and eventually compiled a list of 39 children. Then came the time-consuming effort to learn what they had in common.
Some residents blamed a new nuclear power plant upriver; some suspected the drinking water or the local swimming pool or something they had all eaten; others feared the disease was communicable. That all had to be ruled out, one supposition at a time.
Dr. Steere soon developed an insect theory, based upon the observation that symptoms seemed to begin in the summer or fall. But only a quarter of the children remembered being bitten, and each described the bite differently. Nobody saw an insect.
Two years would pass before Dr. Steere and his colleagues put in place the last piece of the puzzle, and it came to them by coincidence, when an ecologist walked into Dr. Steere's office with a vial containing a tick he said had bitten him.
''It was about this size,'' said Dr. Steere, seizing a pen and drawing the dimmest mark on a piece of paper. It turned out to be a nymphal Ixodes scapularis tick, a nearly invisible black-legged newcomer to the region carried on the backs of deer and field mice.
Local insect census takers were tracking the tick's march across Connecticut. Laying their surveillance maps over Dr. Steere's maps for juvenile rheumatoid arthritis produced an exact geographical match.
For this breakthrough work, Dr. Steere has been widely heralded. At a ceremony in Hartford last year, Gov. John G. Rowland proclaimed Sept. 24 as Allen C. Steere Day.
But the adulation became short-lived. In the early 90's, Dr. Steere he began to hypothesize that many people complaining of Lyme disease symptoms did not, in fact, have the disease.
Writing in The Journal of the American Medical Association in 1993, Dr. Steere said the disease was overdiagnosed and overtreated -- a statement that utterly balkanized groups of sufferers, scientists and clinicians into squabbling factions.
In one group is the American Lyme Disease Foundation, mostly representing researchers, including Dr. Steere; in the other is the Lyme Disease Foundation, mostly representing clinicians and patients.
Their chief discord is over the possibility that Lyme disease, in some patients, develops into a chronic disease requiring massive doses of antibiotics over long periods of time, as some doctors believe.
Dr. Steere thinks not. Instead, he argues that persisting symptoms may be owing to something he calls ''post-Lyme syndrome,'' undefined neurological damage and immune-system malfunctions resulting from the initial infections.
A year-old National Institutes of Health study to try to resolve the dispute is continuing. Meanwhile, as a result of Dr. Steere's influence, insurance companies have sometimes refused to pay for continuing treatments for Lyme. This, in turn, has provoked patients to heckle and even picket Dr. Steere.
The Lyme Disease Foundation has condemned him as dismissive of patients' complaints. So has Polly Murray.
''I am dismayed about Dr. Steere's position,'' said Ms. Murray, who wrote of her struggle with the disease in ''The Widening Circle'' (St. Martin's Press, 1996). ''He feels that it's overdiagnosed and overtreated, but I see people in the area who are having a real struggle with getting over Lyme disease. And some of them have responded to longer-term treatment.''
To patients with Lyme disease perhaps Dr. Steere's most audacious gesture came in 1994 when he testified at a board of medicine hearing against Dr. Joseph Natole of Saginaw, Mich., who was treating patients for chronic Lyme disease. Because Dr. Natole had so many people on intravenous antibiotics, authorities charged him with medical malpractice and insurance fraud. Dr. Natole was ultimately stripped of his medical license for six months.
Pointedly, Dr. Steere expressed no regret for his role in the case. In his experience, he said, these persistent health complaints ''are not best handled in the long run with chronic antibiotic therapy.''
''And for that opinion,'' he added, ''I have been pilloried by
certain groups. But it's still my opinion.''