Dr. David Blackley came back to his alma mater, East Tennessee State University, with a warning.
A research epidemiologist at the National Institute for Occupational Safety and Health, a component of the Centers for Disease Control and Prevention, Blackley noted an alarming uptick in a disease that at the end of the last century was on the decline: black lung.
Blackley, who earned a doctor of public health degree from ETSU in 2013, made his presentation as part of “Art and Coal in Appalachia,” a panel organized by the ETSU College of Public Health in early April 2024.
Despite a “steep decline in black lung rates” following the passage of the Coal Mine Safety Act of 1969, rates began to rise around the turn of the century. “The prevalence and severity have increased in recent years, especially here in the Appalachian region,” Blackley told an audience of about 50 people at the James and Nellie Brinkley Center on the campus of ETSU in Johnson City, Tennessee.
Now, one in five miners experiences black lung, he said. This rise in incidents of black lung comes at a time when state lawmakers made it more difficult for miners to be diagnosed. In 2018, Kentucky’s Republican-controlled legislature passed a law restricting diagnosis and assessment for compensation to only pulmonologists, doctors specializing in the lungs and respiratory system.
At the time, only six pulmonologists in the entire commonwealth had the proper federal certification to diagnose the disease, and as NPR reported following the law’s passage, “four of them routinely are hired by coal companies or their insurers.”
Today, only one doctor in the Bluegrass State is certified to diagnose black lung.
According to NIOSH spokesperson Christina Spring, the institute “was not consulted about this bill,” despite being the agency responsible for training and certifying the medical professionals (known as B Readers) who diagnose black lung. “There is no evidence that performing ILO classification, a standardized process for describing findings present on chest radiographic images used in evaluating black lung cases, is done differently by B Readers with medical backgrounds in radiology vs. pulmonology,” she added in a 2018 statement.
The United Mine Workers of America, a labor union representing coal miners, claimed that “radiologists have a slight edge with 90% passing exams in the last 10 years, while 85% of pulmonologists were recertified.” The UMWA opposed the Kentucky law, one which radiologist Brandon Crum says is putting the commonwealth’s miners at a unique disadvantage.
“I know of nowhere in the United States of America or the world except Kentucky where radiologists cannot read chest X-rays to diagnose a disease,” Crum told NPR in March. He says the law changed “because I found too much black lung and complicated black lung. It’s the truth.”
A 2021 study from the University of Illinois Chicago (UIC) corroborates Crum’s assertion. It found “financial conflicts of interest that exist among doctors who review the chest X-rays of coal miners who file workers’ compensation claims of totally disabling diseases with the U.S. Department of Labor’s Federal Black Lung Program.” UIC researchers found these doctors “were strongly associated with the party that hired them,” and that party was frequently the coal companies. Doctors who were ever hired by the coal miner’s employer “read the images as negative for [black lung] in 84.8% of the records” reviewed by researchers.
Crum contacted NIOSH in 2016, concerned by the rising numbers of black lung he was seeing in the eastern coalfields. “Ultimately he identified 60 cases of severe black lung over a year and a half period,” Blackley says. “Most of these were miners that worked as either roof bolters or continuous miner operators. Both of those are very dusty jobs at the coal face.”
Most of the modern black lung cases, Blackley points out, come not from coal dust but from silica inhalation in the process of accessing coal beds, which after more than 100 years of mining are increasingly inaccessible, requiring drilling through sandstone beds to access smaller veins of coal as the larger, more accessible veins have increasingly been extracted.
Pointing to a published report of 19 Appalachian coal miners with severe black lung, Blackley said they all reported “regularly cutting through rock with machines that were designed…