Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: The major cause of diarrhea
in poor settlements in Pakistan is strongly believed to be the contamination
of drinking water,1 and water treatment, food
hygiene, and handwashing are the standard intervention practices.2,3 I believe that there is no equipoise
in this regard, and because of this no need to have a “placebo”
control with standard habits and practices as was done in the study on handwashing
and childhood diarrhea by Dr Luby and colleagues.2 In
their study, field workers neither encouraged nor discouraged handwashing
in the control group, allowing habits and practices that were promoting diarrhea
in the community to continue. I believe that it would have been more ethical
to have a control group that received handwashing promotional messages, and
2 intervention groups that received handwashing promotional messages and either
plain or antibacterial soap.
Mujeeb SA. Handwashing Promotion and Childhood Diarrhea in Pakistan. JAMA. 2004;292(14):1682-1683. doi:10.1001/jama.292.14.1682-b