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We consider that the strength of the evidence linking drinking water to endemic gastrointestinal illness in developed nations has been overstated in the recent paper in this journal by Schwartzet al 1 and the accompanying editorial.2
As noted in the editorial, there have been a number of documented waterborne outbreaks in countries with good water treatment practices. In such outbreaks the association between drinking water and disease has been supported by a substantial amount of evidence including very large effect size, evidence of water treatment failures, robust epidemiological study designs, or identification of the responsible microorganisms in both water and stool specimens. In contrast, the existing body of evidence linking drinking water to endemic gastrointestinal illness is not of an equivalent standard.
The paper by Schwartz et al presents a complex analysis of the relation between variations in drinking water turbidity and hospital admissions for gastrointestinal illness among …