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To the Editor.—
In their article on the epidemiology of diarrhea in travelers, Steffen et al1 refrain from comparing the incidence of diarrhea in those travelers who took medication prophylactically against it and those who did not, because "duration and dosage of this heterogeneous medication was not noted and... it was not controlled by placebo." An equally valid argument would have been the lack of random allocation of the travelers to the treatment and control groups.However, the lack of a control group and/or randomization did not prevent the authors from presenting results on other factors affecting the incidence or clinical course of diarrhea in travelers, such as the destination, the type and the duration of the trip, general precautions, and the use of therapeutic medications. The reader obviously needs to exercise judgment in interpreting these results.As pointed out in the accompanying editorial,2 some antimicrobial and other
Allard R. Epidemiology of Travelers' Diarrhea. JAMA. 1984;251(9):1161. doi:10.1001/jama.1984.03340330023010
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