A resurgence of the most advanced and deadly form of black lung disease appears to be far worse than had been originally reported, according to a new government scientific report and an investigation by National Public Radio.
Researchers from the National Institute for Occupational Safety and Health said in their new report that they found a significant pocket of the Progressive Massive Fibrosis, or PMF, at one clinic in Eastern Kentucky, a finding that shows weaknesses in the way the government counts black lung and indicates the true extent of the coalfield health crisis isn’t fully understood.
“The actual extent of PMF in U.S. coal miners remains unclear,” said the report, published in Morbidity and Mortality Weekly Report, a journal from NIOSH’s parent agency, the U.S. Centers for Disease Control.
NIOSH’s new paper was published online Thursday, just hours before NPR broadcast and posted online the findings of an investigation by correspondent Howard Berkes, whose reporting identified nearly 1,000 cases of PMF in the last decade, 10 times the most recent count from NIOSH. NPR documented 962 cases of the disease in miners at 11 black lung clinics in Virginia, West Virginia, Pennsylvania and Ohio.
Some of the clinics included in the NPR project had only partial data, so the actual extent of the disease is likely higher.
The results of the NIOSH paper and the NPR investigation are the latest in a series of alarming findings that show the most serious form of black lung — a disease once thought to be largely eliminated or at least in serious decline — has come roaring back, especially in parts of the Appalachian coalfields.
While a new U.S. Mine Safety and Health Administration rule was touted by the Obama administration as an effort to “End Black Lung Now,” any real reforms to save miners from the deadly disease suffered a more than quarter-century of setbacks as lawmakers and regulators from both administrations failed to act on longstanding recommendations from worker health advocates.
“The current numbers are unprecedented by any historical standard,” NIOSH epidemiologist Scott Laney, a co-author of the agency’s paper, told NPR. “We had not seen cases of this magnitude ever before in history in central Appalachia. The number of cases that we were seeing ... far exceeds anything that we were aware of.”
Black lung, or coal workers’ pneumoconiosis, is actually a collection of debilitating and often fatal ailments caused by breathing too much coal dust. Miners inhale tiny particles that are released into the air by coal-cutting machines. As the dust collects over time, lungs become black, scarred and shriveled. Miners often develop a cough, or shortness of breath. Frequently, as the most serious and fatal forms of the disease progress, miners have to fight for every breath.
In 1969, when it passed landmark mine safety legislation, Congress made eliminating black lung a national goal. But since then, 78,000 miners have died from the disease. While the law required mine operators to take steps to limit dust exposure, most experts say that the law has fallen far short of its goals, at least in part because of industry cheating.
The NIOSH paper and the NPR report focus on PMF, the most progressive form of black lung, which is incurable and fatal.
NIOSH researchers wrote about a cluster of 60 cases of PMF that they found in Kentucky that had not been detected by the federal government’s program to track black lung. Government researchers were concerned enough about their own findings, saying they were a reminder that one of the “core objectives” of the federal mine safety and health law “has not been achieved.”
“Finding these cases in such a small geographic area is a strong signal that action is needed in the area to identify existing cases at an earlier stage and prevent future cases,” the NIOSH paper concluded.
Both NPR and NIOSH explained the government’s black lung monitoring program is limited by law to working miners, and that some miners may have in the past avoided the government testing out of concern that being diagnosed with black lung would make it hard for them to continue to find work in the industry.
As the industry has contracted, many more miners — thinking further employment in coal is unlikely — may be seeking lung tests in the hopes of obtaining whatever federal black lung benefits their may be eligible to receive. NPR’s investigation had a broader reach, and NIOSH says in its new paper that it wants to work “to better characterize the scope of the problem.”
NPR quoted miner Charles Wayne Stanley, 53, of Pound, Virginia, who waited to get tested until he was out of work after 30 years mining coal.
“If you’re working and you go and have that stuff done and the company finds out about it, they’ll find a way to get rid of you,” Stanley told NPR. “As long as you’re working and producing coal, you’re an asset. But now when you get something wrong with you, you become a liability. And they’ll find a way to get rid of you.”
Some of the same dynamics that are eating into coal production in parts of Appalachia may also play a role in the resurgence of black lung.
With the best coal often mined out, operators are digging into thinner seams, cutting more rock to get at that coal, many experts believe. Cutting through rock containing quartz and coal together releases silica dust, which is especially harmful to the lungs. While the U.S. Mine Safety and Health Administration’s new rule to limit coal dust exposure tries to partly address silica exposure, MSHA has not issued a separate new silica rule that has long been promised to miners.