January 6, 2009 The Pump Handle 7Comment

by Carole Bass (posted with permission from the On-Line Journalism Project, New Haven (CT) Independent)

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.

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. 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.

‘The statistics are important, and they help us pinpoint and evaluate the problem,’ Petsonk says.

But statistics don’t tell the whole story. The federal Mine Safety and Health Act, passed in 1969 and fully effective since 1973, was specifically designed to eliminate the most advanced black lung cases altogether. Even without the statistics,

‘what we know is these cases of young people getting sick. And that’s wrong.  That’s a failure of the Act.  The real tragedy,’ Petsonk continues, ‘is that these are hardworking people who are doing a service for their companies and our society, and what they get for it is a really -‘

‘Raw deal,’ Wolfe interjects.

‘Well, more than a raw deal,’ Petsonk replies. ‘If you see the suffering of a person struggling to breathe, every minute of every day, this is like a diabolical torture.’

 So what have the NIOSH researchers learned that might explain the increased torture?  The short answer is:  The miners are breathing too much dust. That, pure and simple, is what causes the inflammation and scarring that characterize black lung.

Under the mine act of 1969, dust in coal mines must total no more than 2 milligrams per cubic meter of air.  That’s too high, the researchers agree:  Since 1995, NIOSH has recommended cutting the limit in half, to 1 milligram per cubic meter.  But NIOSH, which is part of the Centers for Disease Control, has no regulatory power.  That falls to a separate agency, the labor department’s Mine Safety and Health Administration, which has declined to set a stricter standard.

But the short answer doesn’t solve the mystery, since miners have been breathing dust for as long as they’ve been digging coal out of the earth.  Something has changed to make the disease more common and more aggressive in the hot spots of southern West Virginia, eastern Kentucky and western Virginia.  In the western U.S. coal mines, by contrast, black lung rates continue to fall.

Petsonk figures that, whatever changed, it probably began in the 1980s, since black lung takes years to develop.  He, Wolfe and Attfield offer two main explanations.  First, miners are working longer hours. The 2-milligram dust limit “was set for an eight-hour shift [and] a 40-hour week,” Petsonk says. “Most miners now say they’re working 60-hour weeks, and often 12-hour or 16-hour shifts.”

That packs a double whammy, he explains.

‘If you work 50 percent more, not only do you get 50 percent more dust in, but you have a lot less time to cough it out. The effect on the lungs is greater than would be considered just from the increase of work hours.’

Indeed, statistics on the MSHA website show that the average underground coal miner worked just over 2,000 hours in 1998, a peak production year.  That marked a 32 percent jump from 1978.  (Work hours continued to rise through 2007, to more than 2,100 per miner.)

During that same 20-year period of 1978 to 1998, productivity more than quintupled, to 9,545 short tons per miner.

‘They are working hard, fast, and generating lots of dust,’ Petsonk observes. What’s more, ‘they’re using very aggressive equipment’ that also may produce more dust than older mining techniques.

Wolfe and Attfield are currently trying to track down data that would let them look for a possible correlation between longer work hours and black lung rates.

A second theory isn’t about coal at all.  It’s about rock.  In the old Appalachian areas that are black-lung hot spots, “all the easy coal has been mined,” Wolfe notes. Much of the remaining black fuel lies in what the industry calls “thin seams,” 28 inches or less.

Coal companies used to leave the thin seams alone, because mining them brought too much rock along with the coal.  But Petsonk says modern techniques make it easier to wash out the rock. And rising coal prices make that effort pay off. 

“The coal industry tells me, ‘Yeah, we take up to 40 percent rock.'”

So what?  Well, the rock contains silica, which is 20 times as toxic as coal dust.  If miners are breathing even a slightly higher percentage of silica dust than in the past, they could be seeing significantly more silicosis. That lung ailment is medically distinct from black lung — but both diseases produce “small, rounded cavities in about the same area of lung,” Petsonk says.

A pathology lab can easily tell the diseases apart. But “on the X-ray, they don’t look that different. In any individual miner, it’s really hard to look at the X-ray and say, ‘that’s silicosis’ or ‘that’s black lung.'”  So Petsonk suspects that some of what is being diagnosed as an increase in black lung is actually an increase in silicosis.

The NIOSH team has prepared some research on silica levels and black lung rates, which it will present at a conference in May.  Petsonk says he can’t reveal the results yet, but implies that they should answer some of the questions about the resurgence of black lung disease.  Meanwhile the researchers — like the miners themselves – will keep digging.

Carole Bass, a journalist, writes frequently about workplace and environmental
health.  She wrote this article as a 2008 Alicia Patterson fellow, focusing on toxic exposures on the job.  
 This article was reported and written with the financial support of the Alicia Patterson Foundation.

TPH Editors’ notes: 

(1) The 1995 NIOSH recommendation for a lower permissible exposure limit (PEL) for coal mine dust was contained in “Criteria for a Recommended Standard Occupational Exposure to Respirable Coal Mine Dust” (336-page PDF). 

(2) A federal advisory committee appointed by Secretary of Labor Robert Reich recommended unanimously in November 1996 that MSHA consider lowering the coal mine dust exposure limit, based on the NIOSH recommendation, and develop separate PELs for crystalline silica and coal mine dust.  The Committee’s report include 20 major recommendations to achieve the goal of eliminating pneumoconiosis among coal mine workers.  (150-page report PDF)

7 thoughts on “Why is Black Lung back?

  1. The point of departure for these comments is the EPA NAAQS for PM2.5 and below, which are 15 micrograms/cubic meter 24/7/365 or 35 ug/m^3 for 24 hours 6 times a year for several years. Increases in exposure in this range are associated with increased death and hospitalization from respiratory and cardiac diagnoses. The 24 hr limit is roughly equivalent to 100 ug/m^3 8/5/250 respirable [working year].

    The respirable coal dust limits, which are 2.4 mg/m^3 by OSHA, 2 by MSHA and ACGIH, and a NIOSH REL of 1, are absurdly high. Characterizing the prevailing exposure levels and trends, from the massive exposure data base, would address this.

    There’s more, but this fits in the comment box.

  2. I believe it is called the Latency period of new generations of human beings/workers being exposed to suffer and die as those before them.Take Libby Mt for generation killing. Libby Mt got three generations of my family.But with all these things that is known to kill you such as asbestos and coal/black lung,this is why,each generation wakes up and most lay dormant for 10 to 40 years, this is the latency from the day you first breathe that deadly air.Cigarettes don’t help/they are legal.When will we all learn that we are being killed by Corporations that are allowed by this Govt to do so.I do hope that 09 and Obama/Biden…this will stop and many will be held accountable for knowingly poisoning more people by the lies they are being told that the air is safe to breathe.It is not.Stay away from Libby Mt.Thank you.NO TO COAL!!! HELL NO TO ASBESTOS

  3. Thank you for your article on the resurrection of black lung disease. As a former coal miner and someone who has worked in the field of workplace health and safety most of my life, I have a few insights that you should consider if you do a follow-up article.

    1.NIOSH’s Dr. Petsnok and team have identified a sentinel event regarding the resurgence of black lung. I suspect that what they haven’t been able to capture is a huge underreporting of the disease in its various progressive stages. Only when miners/widows file for black lung benifits are most cases identified. If we had a more comprehensive occupational health/injury surveillance system we would know more and sooner. Certainly some of NIOSH’s more recent aggressive screening will provide more information about rates and disease stages.

    2. I can tell you that miners never participated in the MSH Act/NIOSH run screening program. Partly they didn’t know about it, partly out of fear of job reassignment and partly they didn’t trust it. There was barely a mention of the program at new miner orientation training. After that it was never mentioned. They never saw a NIOSH screening truck at the mine bathhouse. NIOSH did a poor job of doing outreach and education to miners and their families. Convincing them to participate would still be a challenge due to a real fear of retaliation and the ever important focus on safety. Plus this widely held notion that if you work in a coal mine, well, then you get black lung.

    2. Air sampling under the Act is broken when it is run by the company. One of those Congressional backroom compromises on the passage of MSH Act that really spelled doom for the air sampling program. Back when MSHA had some teeth they actually prosecuted companies for falsifying data or altering the cassettes. Some miners used to sabotage their filter cassettes since they were cynical about the intregity of the program. So all this thinking that through air sampling, certain findings would lead to mining and ventilation changes and increased compliance activity was based on false premises/false program. Plus of course, the PEL is not protective.

    3. The growing number of non-union mines and the reduced strength of the UMWA has had a huge impact on what miners can challenge management about regarding labor and health and safety issues. The very idea of not being in a union and working in underground mining is frightening. When you loose the right to refuse to do unsafe work you have to lower your expectations about your workplace, so dust controls/ventilation is way down on your priority list. Its no good being a leader without backing if you loose your job and can’t feed your family.

    4.Hopefully, NIOSH/MSHA has data that looks at what types of mining operations these miners worked in and some kind of exposure matrix. There are real dust generation differences between continuous mining vs. longwall mining vs. pillaring. Today, the ratio of the number of miners to the number of tons mined is incredible and yet the venitilation engineering controls have not changed much. Also some mines take more top or bottom for various reasons and yes therefore more silica dust. Silica on the rails for breaking and silica in roof bolting and silica in the limestone for rock dusting.

    5. The truth of the matter is that many miners have mixed lung disease, CWP but also silicosis, COPD and emphysema. That was how the battle was joined. Was there enough CWP to be compensable? If you looked at the work environment then smoking as an outlet for the stress and anxiety make a lot of sense. Chewing tobacco and rubbing snuff in the mine was like mainlining nicotine and so smoking above ground wasn’t just a bad habit, but a real addiction.

    I could go on but I won’t. There is no true mystery here. Its not like we are just missing that one critical epidemiological study we need, to nail it down.

    I once met a miner who was 22 years old and already had advanced CWP. Needless to say he looked like he was 40 and his life was short and painful. Maybe we don’t see miners like that anymore but being having CWP at 50 in an older body and having severe shortness of breath is no better.

    Yes, there are many things that could be said about these findings by NIOSH. A lot of finger pointing and hand wringing goes on. More than anything these findings show that the black lung movement and the movement in the coalfields leading to the passage of breakthrough legislation and the creation of new regulatory and research agencies and the strengthening of the union all contributed to safer mines and reduced disease and fatalities. The chipping away at them over the years took their toll. The is no real mystery here…

  4. Very interesting article. You may want to keep track of this proposed rule concerning Coal Miners and Personal Monitors.


    Mine Safety and Health Adminisration

    30 CFR Part 74

    RIN 1219-AB61

    Coal Mine Dust Personal Monitors

    AGENCY: Mine Safety and Health Administration (MSHA), Labor.

    ACTION: Proposed rule and close of comment period.

    SUMMARY: This proposed rule would revise requirements that the Mine Safety and Health Administration (MSHA) and the National Institute for Occupational Safety and Health (NIOSH) apply to approve sampling devices that monitor miner exposure to respirable coal mine dust. The proposal would establish criteria for approval of a new type of technology, the “continuous personal dust monitor,” which would be worn by the miner and would report exposure to dust levels continuously during the shift. In addition, the proposal would update application requirements for the existing “coal mine dust personal sampler unit” to reflect improvements in this sampler over the past 15 years. This rulemaking is limited to approval requirements and does not address requirements concerning how sampling devices must be used to determine compliance, e.g., who and when to sample. Those requirements are addressed in existing 30 CFR parts 70, 71, and 90.

    DATES: MSHA and NIOSH invite comments on this proposed rule from interested parties. All comments must be received by midnight Eastern Standard Time on March 17, 2009.

    ADDRESSES: Comments must clearly be identified with “RIN 1219-AB61” and may be submitted to MSHA by any of the following methods:

    (1) Federal e-Rulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.

    (2) Electronic mail: zzMSHA-Comments@dol.gov. Include “RIN 1219-AB61” in the subject line of the message.

    (3) Facsimile: (202) 693-9441. Include “RIN 1219-AB61” in the subject line of the message.

    (4) Regular Mail: MSHA, Office of Standards, Regulations, and Variances, 1100 Wilson Blvd., Room 2350, Arlington, Virginia 22209-3939.

    copied from http://www.cyberregs.com

  5. First of all I appreciate your article Carol, I just wish the people that could solve this problem were looking at your blog. It is true that there is a big crisis in the mining industry about dust control It is only the tip of a huge iceberg. I know first hand about this having mined for 22 years, 5 years on the surface and 16 years underground all in the hard rock mines of Nevada, these mines are mostly igneous rock with high silica content. Last year I was diagnosised with acute silicosis. At 47 I am still relatively young to get this industrial illness.

    There are probably other factors that should be looked at if we are going to solve the black lung and silicosis crisis. I’ll list a few.

    First of all most regulation for dust in the MSHA Regs are aimed at the nations coal mines. Because most hard rock mines are non union there has be little or no regulation to protect the miners of the hard rock industy.
    So close compliance on dust levels, and health monitoring are barely minimal at best. There are over 45,000 metal/nonmetal mining operations in this country ranging from gravel pits- large scale mining operations.

    Rule making should be proposed to extend the benefits of the mining law to all of the nations mines & miners. Most companies will only comply with the law when forced by the law. It hard to know there is a problem if your not looking.

    Another factor that should be consider is that the quality of respirator have improved. Over the past twenty years there have been respirator that have been faulty, and there are still mines that are using paper dust mask that are about as good as going bare faced because of almost zero protection for dust encountered in mining. The best respirators in the world don’t work when not worn. There are alot of miners that think they are bullet proof. Especially when your young and health.

    Another is how frequently dust samples are taken. Most mines test a couple of times a year. If your going to cure the problem it takes better monitoring. This should be a weekly event not semi annually when MSHA comes around with their IH people for compliance testing. Most mine operators aren’t to concerned as most dust related illness take years to develop. The majority of mine operation don’t last but 10 years or less, so the company could be closed and long gone before the illiness shows up.

    Another problem is tracking of the illness. With almost zero followup xrays in the hard rock industry there is not way to track trends or see if illness rates are increasing or not. When the miner goes to the doctor to find out why he can’t breath. It is already to late, prevention takes place only if monitor is happening. In the hard rock industry miners are usually given a chest xray when hired and thats it. No, 5 year follow up like the coal industry gets. So how can you track something that your not looking for. In addition many miners leave mining after several and never look back and are lost to the tracking process. Once mines are mined out most record are keep for short periods of time and then discarded so tracking miners thru the industry is haphazard at best.

    In addition very few state have tracking or prevention programs in place to monitor for the lung disease. We are relying on doctors to come forward to report this and very few are taking part because most don’t know what they are looking for. So the tracking by CDC on illness and mortality rates are skewed at best. Many miners are not diagnoses with the lung disease until after they retire. If the deaths of these retired miners where reported on current mining accident death databases there would be a greater outcry to stop the killing.

    Black lung, silicosis, abestosis, etc., ultimately kills miners, it is no different then an industrial accident that kills an individual rapidly. It kills them painfully and slowly but they are ultimately just as dead.

    If black lung and silicosis and other lung illness had the lawyers chasing after mining companies like those in abestosis case maybe something would change for the better.

    Just a thought.

  6. Dr E. Petsout & Anita Wolfe

    My name is Randel Taylor
    I worked underground for 38 years and in management for 34 of those years we have gotton to medical and political about what causes black lung please bear with me as my speling isnt the greatest

    Less just think logical for a minite and you might agree with what ive learned to believe in those years do i have black lung proubley but have never been checked

    I smoke and most miners do and the ones that do tend to half to breathe threw threw mouth whitch is a open path to the lungs for dust to travel stright to the lungs because the nose pasage way is
    stoped up and if your breahing threw your nose the dust has hair and moister as well traping a lot more dust than the open mouth breathing does

    so we need small in mouth resperators for miners to use as ive worn about every kind made and never found a very unconfortable
    one so if the miners wear nose strips like the ones you sleep in will allow them to breath threw there nose it will make a world of differance in how many get black lung from coal dust think about this and ask your self is this why miners that smoke have a greater chance of getting black lung is it because they are mout breathers whit all the fumes in our air more and more people are becomeing mouth breathers because of allergies and not leting there nose be the filter it was ment to be

    your,s truley
    Western ky coal minner Randel Taylor

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