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Rate of black lung disease among miners may be 10 times higher than reported

Lung disease is a well-known deadly consequence of working in the coal industry. But a new NPR study finds miners are suffering from the most advanced form of the disease at a rate ten times higher than the government has reported. Hari Sreenivasan speaks with NPR's Howard Berkes about the causes of this late-stage lung disease, possibilities for treatment and why it's been direly underestimated.

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    Black lung disease is well known for causing the deaths of thousands of American coal miners over decades. Now, a new report finds that miners may be suffering from the most advanced form of the disease at a rate ten times higher than what the U.S. government has reported.

    Hari Sreenivasan in our New York studios has the story.


    For the past five years, the government has reported just under 100 cases of complicated black lung disease, which is also called progressive massive fibrosis. But a new NPR investigation found nearly 1,000 cases in nearly the same time from clinic reports in four states — Virginia, West Virginia, Pennsylvania and Ohio.

    The extent of the problem has stunned a number of researchers and experts who work with miners as well. One of the miners diagnosed with black lung and profiled in the NPR stories — Mackie Branham — spoke of just how difficult it is for him to breathe and his ill health. But he said mining was in his blood.

  • MACKIE BRANHAM, Diagnosed With Black Lung:

    Takes a lot of pressure in my chest at all times. I've never been scared to death. It don't bother me a bit. It's just I won't see my kids grow up. But if I had it to do over, I would do it again. If that's what it took to provide for my family.


    Howard Berkes has been uncovering this in a two- part series that concludes tonight on "All Things Considered" and he joins me now from Salt Lake City.

    Howard, it is so difficult to hear that man struggling to breathe, and it's also hard to reconcile how he says he would do this again because this is what he would do for his family, even though the health challenges that he and so many people in this community are facing.


    It's so common to hear that. Miners want to go back to work. Mackie Branham told me if he could get a lung transplant tomorrow, he hopes he could go back to work, which is not going to happen. But mining, as he said, is in his blood. It's part of the local culture, local history. Generations of families mine and it really is about the only decent job in most parts of Appalachia.


    All right. Let's talk about the gap between the numbers here, the numbers the government documented and the numbers you're able to uncover in your investigation. What accounts for this?


    Well, first of all, it's the limitations on government researchers. This is the National Institute for Occupational Safety and Health, and they track black lung disease by bringing in miners for x-rays. But they're limited by law to only testing working miners, number one, and the x-rays are voluntary, number two.

    So, they miss non-working miners, people who've retired, and they're also missing a huge segment, most miners, really, who avoid getting tested because they fear if there's a positive test for black lung, somehow their mining company will figure out and they will lose their jobs.


    But that's illegal.


    It's illegal, but miners widely believe it. Every single miner I've talked to in Appalachia in the last five years has said the same thing. What they fear is just even going to the NIOSH Vans that come into their communities with x-ray equipments and being seen going into the vans, just that could cause the mining company to say this guy might have black lung.

    And mining — the last mining company you worked for is the mining company that saddled with your black lung benefits and your healthcare. And so, you could have worked for another mining company for 20 years, but if you worked for the last one for a year, they're the ones that pay. And so, miners believe that if the mining company finds out, they'll lose their jobs, so they don't get tested.


    This is also one of the worst forms of black lung. Is there something different that's happening in the mining that's happening now that's increasing the likelihood they get the worst form of it?


    Well, for at least a decade or so, the big coal mining seams in Appalachia have played out and there are thinner seams now, and those thinner seams have coal mixed in with rock. That rock contains silica, and they mine the rock and coal together, and so, their silica dust mixed in with the coal dust, with the coal dust, and silica is especially toxic and that is believed to be the cause of this very more serious stages of disease that are affecting these miners.

    It's also causing them to get black lung a lot younger than what was typically used to be when you would see miners maybe in their 60s and 70s. We've talked to miners in their 30s and 40s who are now getting this most serious stage of black lung.


    All right. So, what happens to a miner with this sort of the disease? I mean, who pays for it especially when so many small coal companies are going bankrupt because the energy markets are favoring natural gas now?


    Well, it's also very large coal companies going bankrupt. If the coal company is self-insured and they don't have enough assets, then they're not going to have enough money to pay for the benefits, and the coal company is first in line to pay the benefits. If the coal company can't pay the benefits then it shifts to the Federal Black Lung Trust Fund, a federal program.

    And the problem is if you have all the miners coming into the system requiring black lung benefits, coal companies are unable to pay, then that shifts to taxpayers.


    And there's an Affordable Care Act twist to this as well? These are pre-existing conditions if they went to a different plan, but if the Affordable Care Act is repealed, would these miners lose these benefits?


    Well, not only that, there is in the Affordable Care Act a specific benefit for coal miners with black lung that makes it easier for them to get black lung benefits. So, if the Affordable Care Act is repealed, it will be back to the old days when it was much more difficult to get benefits in the first place.


    All right. Howard Berkes is joining us from Salt Lake with NPR. Thanks so much.


    Thank you.

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