There are many US Pharmacopeia talcs available in the United States. We reported 286 consecutive thoracoscopic talc poudrages using talc from Spectrum Chemical Co (Gardena, California), without any pulmonary infiltrates ascribed to talc when given in 5-g doses.4 Unfortunately, the FDA recently ruled arbitrarily that US Pharmacopeia talc must be sterilized under the supervision of a pharmacist, even though other thoracoscopic materials are sterilized by the hospital’s central supply. Many pharmacies are not equipped for the sterilization procedure. Our team switched to Sclerosol in 2004, which raised the talc cost per patient from 15 cents to $240. Our success rate of 90% at 1 year with the Spectrum talc5 dropped to 13/18 (72%) (Y. Aelony, MD, unpublished data, 2002, 2004), stressing the importance of the unknown success rate in the article by Gonzalez et al.1 I second Gonzalez’ call for the FDA to approve the European-graded (large-particle) talc because it has been shown prospectively not to cause ARDS in 558 cases,6 and it has a long-term effectiveness of about 90% in thousands of cases.