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Black Lung Is Back: Easily Cheated Regulations and Little Oversight Lead to Severe Cases in Young Miners

Researchers are struggling to explain why black lung is striking younger and younger miners and robbing them of their breath faster and faster.

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From 1968 through 2007, black lung caused or contributed to roughly 75,000 deaths in the United States, according to government data.  In the decades following passage of the 1969 law, rates of the disease dropped significantly. Then, in the late 1990s, this trend reversed.

Many of the newer cases have taken a particularly ugly form. While rates of black lung overall have increased, incidence of the most severe, fast-progressing type has jumped significantly. These cases, moreover, are occurring in younger and younger miners. Of particular concern are “hot spots” identified in central Appalachia by the National Institute for Occupational Safety and Health, NIOSH, a government research agency. Though levels of disease are still below what they were before 1970, medical experts and miners’ advocates are alarmed.

“I think any reasonable epidemiologist would have to consider this an epidemic,” said Scott Laney, a NIOSH epidemiologist. “All cases of [black lung] are preventable in this day and age, but these cases of [the most severe form] are just astounding … This is a rare disease that should not be occurring.”

The National Mining Association, the main trade group representing mining companies, disputes some of NIOSH’s data but agrees that black lung’s resurgence is a problem in need of attention. To the association, however, it is primarily a regional phenomenon of central Appalachia — one that doesn’t justify new national rules. What’s needed, the group says, is further study and better enforcement of current standards.

Researchers are struggling to explain what, after years of progress, has caused the backsliding and why black lung, traditionally viewed as an old man’s disease, is striking younger and younger miners and robbing them of their breath faster and faster. They are trying to figure out why men like the Marcums are the new face of black lung.

‘A diabolical torture’

“They call me Lucky,” retired miner James Foster says as he takes off his shirt and presses his chest against an X-ray machine in the back of an RV in Wharton, W.Va. “Worked 37 years in all kinds of mines. Been covered up twice. Been electrocuted.”

His brushes with death aside, he’s here because he fears there may be one hazard he can’t dodge. “I come in here to file for my black lung,” he says. During a recent heart surgery, he says, doctors said they saw what appeared to be signs of the disease.

He’s one of a handful of miners on an April afternoon to move through the RV parked at the fire department in Wharton, in the heart of coal country. Inside, a team of NIOSH workers shepherds them from station to station: medical history, questionnaire, breathing test, chest X-ray. Foster hopes the tests will provide evidence he can use to submit a claim for benefits. Other miners are still working and want to make sure their lungs are clear.

It is from this rolling medical unit, in part, that NIOSH has documented the return of black lung. For decades, miners have been entitled to free X-rays every five years, and this has helped track the drop in the disease’s prevalence. After the data started showing a reversal, NIOSH sent its RV out to gather more data in 2005.

What these researchers found, combined with data from routine medical monitoring, was worrisome: From the 1970s through the 1990s, the proportion of miners with signs of black lung among those who submitted X-rays dropped from 6.5 percent to 2.1 percent. During the most recent decade, however, it jumped to 3.2 percent.

Even more disturbing: Prevalence of the most severe form of the disease tripled between the 1980s and the 2000s and has almost reached the levels of the 1970s.

 
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