Black Lung Disease Is Back

Black lung disease used to be nearly as common as dirty fingernails among American coal miners. Roughly a third of them got the fatal illness.

Starting in the 1970s, a federal law slashed that rate by 90 percent. But now it's back.

When Anita Wolfe and her co-workers discovered that the rate of black lung has doubled among U.S. coal miners in recent years, she took it personally. The daughter and granddaughter of West Virginia miners, Wolfe watched her father die of black lung disease. "These are people that are out there working to give our country power," she says. "They deserve to be protected as much as anybody else."

For Wolfe and other researchers at the National Institute of Occupational Safety and Health (NIOSH), the resurgence of this old-time killer is not just a moral outrage. It's also an epidemiological mystery. After decades of steady decline, why has black lung disease made a comeback? Why is it progressing faster and striking younger miners - those who have spent less time on the job, and who never worked in the bad old days before the federal law took effect? And why is the spike limited to a few geographic hot spots?

The NIOSH researchers in Morgantown, West Virginia, have a couple of theories. Neither is yet proven, but they are determined to solve the deadly mystery.

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Dr. Edward L. "Lee" Petsonk was a respiratory disease specialist, but not a coal mining expert, when NIOSH put him in charge of its Morgantown-based black lung program about 10 years ago. The program offers each underground coal miner a free chest X-ray every five years. That's how NIOSH tracks rates of the disease.

Although coal production is booming, the number of underground miners has dropped to fewer than 45,000 nationwide. For a variety of reasons, most miners don't take advantage of the X-rays. So when Petsonk took over the black lung program, he decided it was feasible to orient himself by looking at every single new X-ray that came in.

"After a couple of years, something changed," he recalls. "I began to see the type of disease that was only in the textbooks -- this massive fibrosis, where the lung is basically destroyed. It's nothing but black scar tissue. I was incredulous. And it was young people. It wasn't the older miners. I thought, something is wrong here. We decided we'd better do some research."

Dressed in the khaki uniform of the U.S. Public Health Service, Petsonk sat down for a two-hour interview in Morgantown in December 2008, just days before he retired. He was joined by Wolfe, a public health analyst who sipped coffee from a blue-and-yellow West Virginia mug, and Michael Attfield, their sweater-clad boss.

Lean and balding, Petsonk teases Wolfe about taking black lung disease personally. But he shows every bit as much passion about solving the mystery of the lethal illness.

As soon as he stumbled upon the surprisingly advanced cases, "I said, 'The clock is running,'" he recounts. "'These miners out there are getting sick and dying, and we know about it.'"

The team presented its information to NIOSH's then-director, John Howard. He agreed it was urgent and came up with money for a mobile X-ray unit. Headed by Wolfe, a crew would take the van out into the field, encouraging miners to come for black lung screening. The purpose was twofold: to alert miners who had developed disease, and to gather data so NIOSH could fill in the current black lung picture.

In September 2007, Petsonk reported that the disease rate had more than doubled among miners who worked 25 years or more underground, from about 4 percent in 1997 to 9 percent in 2006. The rate among miners with 20 to 24 years' experience jumped even more, from 2.5 percent to 6 percent. While those are still small percentages, the trend is going in the wrong direction.