We welcome the opportunity to respond to Goodman et al,1 and to correct their misperceptions about our paper.2 As noted in their letter, Kerper et al 3 also recently analysed lung function decrements associated with pleural plaques. While the methodological details of our publications differed somewhat, the identified literature and the conclusions regarding magnitude of effect on lung function were well aligned. We found statistically significant 2–4% decrements in lung function in people exposed to asbestos with pleural plaques relative to asbestos-exposed people without abnormalities. Kerper et al 3 reported 3–5% decrements. It is not clear why Kerper et al 3 chose to ignore differences in study size: all studies were considered equally in their analysis, despite sample sizes ranging from tens to thousands, and a summary estimate was not calculated.

With respect to the specific points raised, …