If it is still unclear whether the current duty hour limits have met their allotted goals, and possible that they even may have had a negative effect on resident education and training, third why then impose even more draconian restrictions? Improvements of the magnitude envisioned by the IOM require a national commitment to well-defined objectives focused on improving patient care with clear outcome metrics and a tracking system set in place prospectively to determine whether these objectives are being met. Equal attention should be paid to other initiatives that have been shown to minimize preventable medical errors, including the implementation of electronic health records, the introduction of standardized management algorithms, meticulous peer review, and team training.

15,16 The decision of whether to impose additional restrictions on resident duty hours should be based on the prevailing evidence, and not on political expedience.
The GlaxoSmithKline Vaccine HPV-007 Study Group Lancet 2009;374:1975�C1985 [PubMed]. Cervical Cancer: Problem Solved? Vaccinating Girls Against Human Papillomavirus Crosbie EJ, Brabin L. BJOG 2010;117:137�C142 [PubMed]. Human papillomavirus (HPV) vaccinations hold a commanding position in the prevention of cervical cancer. There is accumulating evidence that the protection offered by the vaccines is enduring, which is encouraging if extensive programs are rolled out in developing countries where booster doses would increase the complexity of delivery.

The latest data show that Cervarix? (human papillomavirus bivalent [types 16 and 18] vaccine, GlaxoSmithKline, Research Triangle Park, NC) is effective in preventing recurrent HPV infections in HPV-naive young women who were vaccinated 6 years previously. In a trial by the GlaxoSmithKline Vaccine HPV-007 Study Group, the vaccine prevented any cervical neoplasia associated with types 16 and 18 as well as most other lesions independent of HPV DNA type. Possibly more significant were the levels of neutralizing antibodies that were sustained in the study population. Naturally occurring infections are superficial and do not provoke strong antibody responses, unlike the injected vaccines which result in high levels of circulating antibodies. The vaccine antibodies peak at 7 months then taper off but it appears as if they are maintained-at least from 3 to 6 years-suggesting long-term immunity with models of 20 years being quoted.

These encouraging data should galvanize international efforts such as the GAVI Alliance (Global Alliance for Vaccines and Immunisation) to provide vaccines for the poorest countries. Approximately 80% of cervical cancers occur in developing countries and if the vaccine price could be reduced to $10 then cost-effective worldwide protection Cilengitide is possible.1 The situation in developed countries is eloquently summarized in an article by Crosbie and Brabin that opens the question of future screening by cytology and HPV DNA testing.