Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: Dr Mujeeb argues there was no equipoise
for the Karachi Soap Health Study because public health scientists already
know that handwashing reduces diarrhea. However, the degree of diarrhea reduction
that can be achieved with intensive handwashing in highly contaminated settings,
especially among children at highest risk of death, is not well established.
Indeed, as noted in our article, there has been substantial methodological
criticism of the prior studies on handwashing. If handwashing is going to
be advocated for prevention of diarrhea, it is important to understand the
degree of its effectiveness.
Luby SP, Agboatwalla M. Handwashing Promotion and Childhood Diarrhea in Pakistan—Reply. JAMA. 2004;292(14):1682-1683. doi:10.1001/jama.292.14.1682-c