The day after the New York Times unveiled a masterful exposé of Merck's marketing campaign for the cervical cancer vaccine Gardasil, the New England Journal of Medicine published a cost-effectiveness analysis that questions the wisdom of spending billions to vaccinate young girls against this minor health threat.

There are about 12,000 new cases of cervical cancer a year in the U.S. About 3,600 women die from the disease. Is this problem worth investing $1.4 to $1.6 billion a year (Merck's take alone)? As the NEJM study shows, this vaccine costs the health care system $46,000 per quality-adjusted life year saved, and that assumes the vaccine provides lifelong immunity to the 12-year-old girls who get it.

For all those politicians (like the National Lieutenant Governor's Association) who are taking Merck's campaign contributions and voting to tax the health care system by making the HPV vaccine mandatory, here are some alternative uses for the money:

* A national advertising campaign encouraging adults at risk of a heart attack to take a baby aspirin daily: Saves the health care system money (i.e., negative cost per QALY);

* Smoking cessation counseling for smokers: Saves the health care system in the short and long-run;

* The NIH-designed Diabetes Prevention Program (lifestyle counseling and intervention by trained counselors): $1,100 to $8,800 per QALY;

* Screening adults for alcohol abuse and brief counseling: Negative cost per QALY.

Ah, but what do all those programs have in common? They are public health interventions that depend on government spending. For a politician, they require raising taxes slightly so that the health care system (employers, families, Medicare, Medicaid and other public payers) has lower costs.

It's a lot easier for the pols to take Merck's corporate campaign contributions, pass a vaccine mandate, and ask the health care system to pick up the tab. The still unfolding Gardasil story provides a textbook example of why we spend more than any country on earth on health care, yet still rank in the second tier in terms of life expectancy. We're throwing big bucks at small problems while ignoring the obesity, smoking, and substance abuse epidemics that are the major drivers of poor health in our society.