The New York Times continues its "The Evidence Gap" series, this time examining new vaccines that aim to prevent cervical cancer. It's been a terrific series of articles, underscoring what many in the health policy world have come to accept, but too few in the real world of patients (and often their doctors themselves) understand: more and new medicine isn't always better medicine; and, we often spend money on drugs, tests and procedures without really knowing if they are more helpful than simpler or older and cheaper alternatives.

Cervical cancer is not a major killer in the United States or other industrialized countries, unlike in Africa and the developing world. The article raises questions about whether the vaccine should be adopted as widely and quickly as it has been (millions of girls and young women have already taken it); whether it's worth the cost given other unmet needs in women's health; and, whether it will really prove to be that effective. The Times quotes experts saying that some data suggests that protection may diminish in three-to-five years, meaning women would need boosters, possibly periodically. It's unclear whether women might think they don't have to worry about cervical cancer or pap smears (low tech, effective and inexpensive) if they have the vaccine (which doesn't protect against all strains of the virus linked to cervical cancer). The vaccine is being adopted widely and swiftly—although sometimes it takes years to get a full picture of the long-term safety profile. As the article notes:

One of the vaccines, Gardasil, from Merck, is made available to the poorest girls in the country, up to age 18, at a potential cost to the United States government of more than $1 billion; proposals to mandate the vaccine for girls in middle schools have been offered in 24 states, and one will take effect in Virginia this fall. Even the normally stingy British National Health Service will start giving the other vaccine—Cervarix, from GlaxoSmithKline—to all 12-year-old girls at school this September.

The lightning-fast transition from newly minted vaccine to must-have injection in the United States and Europe represents a triumph of what the manufacturers call education and their critics call marketing.

One concerned doctor the article quoted is Dr. Diane Harper of Dartmouth Medical School. She was a researcher on both Gardasil and Cervarix, and has worked with the World Health Organization on global cervical cancer vaccine planning. She definitely sees the benefit in the vaccine—she had her own daughters vaccinated. But she is worried about the scope, speed, and drug-company push.

"Because Merck was so aggressive, it went too fast," Dr. Harper said. "I would have liked to see it go much slower."

The NYT says the cervical cancer vaccines were the first approved for universal use in any age group that cost the health system money, rather than saved it. Less expensive shots, against measles and tetanus, for example, pay for themselves by preventing diseases.

All this make you a bit queasy? It appears the vaccine itself makes some girls faint...Doctors are now told to observe them for 15 minutes.