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CORRESPONDENCE practice makes it more difficult Furthermore physicians are individually fiercely independent This methods of surgical implantation intraperitoneal and intrapleural inoculation of fibrous glass makes it doubly difficult for anyone to lead a group of physicians Consequently less benevolent interest groups have more punch To change this it is first necessary to point out these facts and to realize the potential of Medi- tumors were developed in rats similar to those observed in exposed animals and man These investigations are of importance because these materials are being increasingly used particularly as a substitute for asbestos There is cine as a leading force Then it will be necessary also increasing use of narrow diameter .05-3 m to see the importance of exercising this potential fibers for thermal insulation and other products. in using medical expertise in directing our society These fibers are eminently respirable durable ' Finally the process must start in medical school where this potential responsibility to society should be emphasized The medical profession does have a responsibility to lead to lead towards a cleaner healthier environment to lead towards and may represent the physical structure found most carcinogenic in animal experiments Stan- ton 1974 The assertion that contemporary work substantiates the classification of this ma- terial as inert is unsupported Questions of responsibility in preventing inflicted ._disease alcoholism cigarette smoking occupa- tional disease Part of health is mental health and part of mental health is happiness Medicine -should focus more on the social determinants . ~ health and happiness * the Now is ' time medical profession has the power and the responsibility to lead ED SARGENT MD University of Oregon Medical School Portland REFERENCES 1. Another war for independence Editorial West J Med 490-491 Dec. 1976 2. A broader knowledge base for medicine Editorial Essay West J Med 383-384 Nov 1976 3. Medical care as a social enterprise Editorial West J Med 125 148-149 Aug 1976 problems Editorial 4. Another approach to health care : West J Med 310-311 Oct 1976 Essay carcinogenicity of fibrous glass are unresolved and arc indeed under very active study at this. International Agency for Research Against C.ancer example largely due narrow recent introduction of long fibers into workplace environment Both fiber duced fibrosis and carcinogenicity require long latent periods for example for mesothelioma usually more than 30 years Epidemiological studies to date have had methodologic shortcomings and have dealt with workers exposed to thicker and therefore less respirable fibers We are concerned that fine fibrous glass fibers may be inhaled migrate to the pleura and exert a carcinogenic effect in man exactly like asbestos and that fibrous glass may act as a lung co- carcinogen with cigarette smoke and other car- Carcinogenicity of Fibrous Glass cinogens We are not convinced that fibrous glass does not have a cellular toxic effect on alveolar macrophages and pulmonary living cells that may TO THE EDITOR There recently appeared in THE WESTERN JOURNAL OF MEDICINE 485 Dec 1976 a short scientific communication epitome by Jean Felton MD titled Fiberglass Carcinogenic This note may do a disservice to the uninitiated in reporting this material as biologically innocuous This subject area should have been more critically reviewed The literature has numerous references attest- ing to the carcinogenicity of fibrous glass in experimental investigation This has been estab- lished in a number of recent animal studies utiliz- ing different routes of administration and fiber types The work of Pott and Friedrichs 1974 Stanton and Wrench 1972 and Wagner Berry and Skidmore 1974 have demonstrated the ability of various forms of fibrous glass to induce malignant tumors in laboratory animals Utilizing lead to fibrosis ' That fibrous glass may be ogically hazardous if inhaled into the lung is a potentially im- portant problem which deserves extensive and urgent study . WILLIAM N. ROM MD MPH ARTHUR M. LANGER PhD Environmental Sciences Laboratory Department of Community Medicine Mount Sinai School of Medicine New York City REFERENCES 1. Pott F Huth F Friedrichs KH Tumorigenic effect of fibrous dusts in experimental animals Environ Health Perspect 313-315 Dec 1974 : 2. Stanton MF Wrench C Mechanisms of mesothelioma induction with asbestos and fibrous glass J Natl Cancer Inst 48 : 797-816 Mar 1972 3. Wagner JC Berry J. Skidmore JW Studies of the carcinogenic effects of fiber glass of different diameters following intra- pleural inoculation in experimental animals In Symposium on Occupational Exposure to Fibrous Glass NIOSH ~ D~DHEW Washington DC 1974 pp 193-197 4. Dement JM Environmental aspects of fibrous glass production and utilization Environ Res 295-317 Jun 1975 5. Stanton MF Fiber carcinogenesis Is asbestos the only THE WESTERN JOURNAL OF MEDICINE . 413 aN ee re JNJ 0027601 000027601 lel Pas CORRESPONDENCE ; hazard Editorial J Natl Cancer Inst 633-634 Mar 1974 6. Stanton MF Some etiologic considerations of fibre cinogenesis In Bogorski P Timbriell V Gilson JC et al logical Effects of Asbestos Lyon France IARC WHO pp 289-294 : carBio- 1972 7. Kuschner M Wright GW The effects of intratracheal in- stallation of glass fiber of varying size in guinea pigs In Sym- posium on Occupational Exposure to Fibrous Glass NIOSH CDC DHEW Washington DC 1974 pp 151-168 8. Beck EG Holt PF Manojlovic N Comparison of effects on macrophage cultures of glass fibre glass powder and chrysotile asbestos Br J Ind Med 280-286 Jul 1972 and glass 9. Botham SK Holt PF Comparison of effects of glass fibre powder on guinea pig lungs Br J Ind Med 30 232-236 Jul 1973 10. Murphy GB 704-710 Dec 1961 Fiber glass pneumoconiosis Arch Health Industr 11. Schepers GWH The biological action of glass wool Arch Health 280-287 1955 The epitome encapsulated the opinions of Milne and Gross whose writings have appeared in schol- arly review journals In essence the im- plantation studies cited embodied artificial introductions of fibers into the pleural cavity and in quantities in excess of those possible in occupa- tional exposure Further extrapolation of findings from one species to another may produce falla- cious conclusions To be sure direct deposition of fibers provoked tumors but replication in vivo in the intact * . os thorax bears no immediate relationship to the reality of the work setting The Panel Responds TO THE EDITOR The comments of Drs Rom and It is agreed that long latent periods are needed for carcinogenicity in asbestos exposure and glass fiber should be pursued as a comparable toxic Langer are appreciated and valued they come agent under the circumstances of worker contact from an investigative group long identified with .and inhalation. _ significant contributionisn the field of fibrogenic pulmonary disease _ . Co ae - won E FELTON - Industrial Medicine Advisory Panel pete ae Tracking Down Migraine Patients have a built aversion to the word migraine They will not use that They term they don't like it . I ask them this Are you headachy Don't ask a patient Do you have headaches He'll tell you about the time he got hit on the head at a football game in 1937. : How do you get that family history That is very important If you say Did your mother or dad ever have migraine No That's what they'll say right off the bat Don't ask them that Ask them this Did mother or dad have sick headaches No. may even hold on that Well was your mother or dad headachy Oh yes My dad had bad headaches But he had sinus headaches They'll call it sinus headache they'll call it hypertensive headache they'll call it allergic headache and they'll call it tension headache If you go into the history it's migraine time after time after time The family history is critical So you can't say Did they have headaches You've got to say Were they headachy - , LAWTON SMITH MD Miami East Extracted from Digest Ophthalmology Vol 14 No. 11 in the Digest Foundation's subscription series of tapetape- recorded programs For subscription information 1577 Chevy Chase Drive Glendale CA 91206 414 MAY 1977 126 6