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Endemic Pleural Calcification and Mesothelioma-Reply

Mark Germine, MD
JAMA. 1988;260(3):340. doi:10.1001/jama.1988.03410030055020.
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In Reply..—  Langer and others have two criticisms of my letter regarding the possible association of fibrous tremolite with endemic pleural calcification and mesothelioma in Greece. They point out that I did not cite their article in which the hypothesis regarding the tremolite content of Metsovo whitewash was originally presented. I did, however, cite two articles by the same group of workers, including a more recent article than the one to which they refer.Second, and much more seriously, they state that I have made an error in my use of the terms asbestiform and nonasbestiform, which they have "tried to correct" in the past,1,2 obviously without success. Nowhere in my most recent letter, however, did I refer to the highly elongate fibers exhibiting inclined extinction, which Langer and others call "cleavage fragments," as being asbestiform, although I consider them to be so. My use of this term in


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