Response to a letter to the editor by Dr. Murray M. Finkelstein regarding the article by Finley et al. (2012)

Our plain-English summary of Response to a letter to the editor by Dr. Murray M. Finkelstein regarding the article by Finley et al. (2012), by B.L. Finley, J.S. Pierce, D.J. Paustenbach, et al (Regulatory Toxicology and Pharmacology, 2013).

The study

• Authors: B.L. Finley, J.S. Pierce, D.J. Paustenbach, D.A. Galbraith
• Journal: Regulatory Toxicology and Pharmacology
• Published: 2013;65(1):180-1
• Type of article: Letter, Comment
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

In this letter to the editor, the authors replied to Dr. Murray M. Finkelstein's criticism of their 2012 paper. That paper compared mesothelioma cases reported among US auto mechanics in 1975 to 2007 with background cases expected in the total auto mechanic population without asbestos exposure. The authors stated it was never meant as an epidemiologic study and its findings were not relevant to whether mechanics were at risk. It aimed to test Lemen's 2004 claim that published case counts were higher than expected; the answer was "no". They acknowledged under-reporting but said it did not matter for that aim. Dr. Finkelstein guessed that fewer than 1 in 20 malignant pleural mesothelioma cases among brake mechanics are reported in the literature, which he believed would correspond to an SMR of 4 or higher. The authors called this guesswork and cited published studies that, they said, reported no increased risk. They also questioned whether 29 cases he reviewed as a testifying expert were representative. The authors concluded that case reports are not a sufficient basis for conclusions about disease risk.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor (reply to another letter); no new data
• Who was studied: No population was studied in this letter. It discusses the authors' 2012 analysis of reported versus expected mesothelioma cases among US auto mechanics, 1975 to 2007.
• Exposure: Work with asbestos-containing brakes by vehicle mechanics. The letter also mentions possible amphibole asbestos exposure in other occupations.
• Main results:
  • The authors stated that their 2012 analysis was not intended as a formal statistical or epidemiologic study for determining risk of disease among auto mechanics.
  • The authors described the comparison in their 2012 paper as reported cases in auto mechanics versus background cases expected in the total auto mechanic population absent asbestos exposure. They called this the only valid comparison for their objective and rejected the alternatives Dr. Finkelstein proposed.
  • The authors restated that their 2012 paper found the number of reported cases was not higher than expected, contrary to the suggestion in Lemen (2004).
  • The authors said the degree of under-reporting of cases in the literature was not relevant to the purpose of their analysis.
  • Dr. Finkelstein believed that fewer than 1 in 20 cases of MPM (malignant pleural mesothelioma) occurring among brake mechanics are reported in the literature. He believed this would correspond to an SMR for pleural mesothelioma of 4 or higher. This was his inference, not a measured result.
  • The authors called Dr. Finkelstein's estimates guesswork and said there is no reason to guess at an SMR. They pointed to published studies (Figure 4 of their paper) that, in their account, reported no increased risk.
  • The authors argued that the 29 mesothelioma cases in auto mechanics that Dr. Finkelstein reviewed as a testifying expert were probably not representative. They also noted that Dr. Finkelstein did not state how many of these cases had exposure to amphibole asbestos in other occupations.
• The authors' conclusion: The authors concluded that case reports do not represent a sufficient basis for conclusions about disease risk. They maintained that well-constructed epidemiologic studies should form the basis of health and regulatory decisions.
• Limitations the authors state:
  • The authors stated that the findings of their 2012 analysis are not relevant to whether auto mechanics are at risk; that question requires epidemiologic investigation.
  • The authors acknowledged that not all mesothelioma cases could be reported in the literature.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Chrysotile, Mesothelioma.

Related studies

• Response to Murray M. Finkelstein, letter to the editor re Bernstein et al: Health risk of chrysotile revisited. Crit Rev Toxicol, 2013; 43(2): 154-183 — D. Bernstein, J. Dunnigan, et al. (2013)
• Authors' response to Finkelstein's letter to the editor regarding our recent review of ambient airborne asbestos concentrations (Abelmann et al., 2015) — A. Abelmann, M.E. Glynn, et al. (2016)
• Response to Letter to the Editor Regarding "Ambient Asbestos Fiber Concentrations and Long-Term Trends in Pleural Mesothelioma Incidence Between Urban and Rural Areas in the United States (1973-2012)" by Finkelstein — K.A. Keeton, M.E. Glynn, et al. (2018)
• Letter concerning the paper by Finley and colleagues: dx.doi.org/10.1016/j.yrtph.2012.05.015 — M.M. Finkelstein (2013)
• Letter to the Editor regarding the Donovan et al. (2011) article — D. Egilman, J.H. Schilling (2012)
• Regarding "absence of radiographic asbestosis and the risk of lung cancer among asbestos-cement workers: extended follow-up of a cohort", by Murray Finkelstein, American Journal of Industrial Medicine 2010 — R.M. Ross (2011)

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