That black lung was making a comeback among coal miners has been known for a while. What's shocking and disturbing are newly published findings about the severity of the resurgent disease in Eastern Kentucky, West Virginia and Virginia.
The prevalence of the most severe form of black lung, progressive massive fibrosis, is as high now in Central Appalachia as it was more than 40 years ago right after Congress enacted the first law aimed at protecting miners from black lung. That's according to a study by the National Institute for Occupational Safety and Health that was published this week.
With effective dust control and worker protections in mines, black lung is preventable. By the late 1990s, the most severe form had all but been eliminated.
The study found that the resurgence is especially pronounced among Central Appalachian miners — and not just those who work underground. The most severe form of the disease, which is incurable and torturous, is also appearing in surface-mine workers.
The study's authors attribute the increase to two causes: overexposure to dust or increased toxicity stemming from changes in dust composition.
As Central Appalachia's coal has been depleted, miners must cut through more rock to extract coal from smaller seams, releasing more dust and more kinds of dust, including silica, long recognized as a cause of respiratory disease.
Black lung's comeback is just one more example of how the cost of coal mining has become prohibitive in Eastern Kentucky.
Resource depletion has pushed up production costs, rendering the price of Appalachian coal noncompetitive with coal from other regions and natural gas, leading to mine closures and unemployment.
The industry's monetary costs pale beside the suffering of miners stricken with black lung and their families who struggle to care for their sick and dying loved ones and survive the loss of income.
Last year, an investigation by the Center for Public Integrity revealed that coal companies have employed underhanded legal tactics to deny black lung victims the benefits they are due. And the industry has long been notorious for evading dust control rules by tampering with dust monitoring and sampling.
Since 1968, the year before Congress enacted landmark mine safety and health legislation, black lung has been implicated in more than 75,000 miners' deaths; the government has paid out $45 billion in black-lung benefits
For almost two decades, NIOSH has been recommending lower dust limits in coal mines, and, finally, this year the U.S. Mine Safety and Health Administration said it would phase in more protective dust limits.
The coal industry, which is challenging the new limits in court, contends they are unfair because black lung is not increasing in most regions.
A few years ago when another federal agency acted to protect Appalachia's water from surface mining, the industry, along with the Beshear administration, sued, saying it was unfair to single out Appalachia for water protections not imposed elsewhere.
Now the industry objects to dust-control rules on grounds that only Appalachian miners will suffer and die without the extra protections. And the industry has long considered Appalachian miners expendable.