Letter: ginger as anti‐emetic for acute gastroenteritis in children—interpreting evidence gingerly
Abstract
Nocerino et al found that oral ginger extracts effectively and safely improved vomiting in children with acute gastroenteritis (AGE). The authors' attempt to bridge the gap on the controversial use of ginger as antiemetic, although commendable, still fails by a large margin due to inherent weakness in the methodology we wish to address.1 Firstly, none of the cited previous studies favour ginger dosing/ intervention in the paediatric group. These included opinionated narratives and systematic reviews demonstrating unclear to no clinical benefit on vomiting and clinical trials showing no added benefit of ginger to a standard of care (Table S1). There is no strong evidence comparing ginger against placebo in an acute setting, and the wrong choice of placebo might have resulted in confirmational biases. In AGE, the authors' choice of placebo seems biased towards positive outcomes with ginger compared with a treatment known to be inferior, revealing nonrecognition of “clinical equipoise,” thereby inviting “confirmation” and “framing and ambiguity effect” types of cognitive biases.24 The placebo also contained anise and stevia; both agents worsen nausea and vomiting.5,6 Sample calculation was inapprorpiately extrapolated from an ondansetron superiority design trial. Ideally, the authors should have designed a noninferiority trial against a better placebo or an equivalence trial against the validated 5HT3 antagonist ondansetron. The authors misquote ginger as an efficacious agent…
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