In short
The deepening black lung crisis in Appalachia, driven by silica dust exposure in coal mines, and the regulatory failures that allowed it to surge again—especially among younger miners.
Guests (and backgrounds)
Howard Berkus, retired NPR correspondent who has investigated black lung for over a decade (previously an NPR correspondent; continues reporting). He interviews miners and works with partners including NPR investigators Robert Benincasa and Wojong Nan, plus Chris Hamby (Center for Public Integrity). Medical experts cited include NIOSH epidemiologist Scott Laney and black lung clinic medical director Dr. Drew Harris.
Key claims
Black lung rates have risen sharply (NIOSH: one in three working career miners in Appalachia; earlier one in five). Silica is about 20x more toxic than coal dust and causes progressive massive fibrosis; government counts missed cases because NIOSH tests only working miners. MSHA’s proposed silica limits are delayed/weakly enforced.
Notable examples
Mark McCowan (diagnosed at 40); Mackie Branham (diagnosed at 39); Danny Smith (complicated black lung at 39; seeking double-lung transplant).
Written by AI. May contain mistakes. Listen to the episode to check what was said.
Chapters
Tap a time to open that second in VOUnderstanding Black Lung Disease
0:45 to 3:52
Discussion on the resurgence of black lung disease and its impact on miners.
“And knowing that that's coming to you, it's pretty hard to take.”
Investigating the Resurgence
3:52 to 7:54
Howard Berkus shares his journey and findings about black lung disease.
“and his father, who's also named Gary and also was a coal miner, he told me this.”
The Role of Silica Dust
7:54 to 9:03
Exploration of silica dust and its connection to worsening black lung cases.
“And there was something else that Mark McAllen and other miners talked about.”
The Role of Silica Dust
9:45 to 10:10
Exploration of silica dust and its connection to worsening black lung cases.
“Security teams are facing more alerts, more tools, and faster-moving threats.”
The Impact of Black Lung on Miners
10:16 to 14:00
Howard discusses the personal stories of younger miners affected by black lung.
“Howard, I want to ask you about your motivation for continuing the reporting.”
Mackie Branham's Struggle with Black Lung
14:00 to 16:01
Learn about Mackie Branham's experience with black lung disease and its personal impact.
“And I quickly found that both were swamped with cases, especially in Virginia, Kentucky, and West Virginia.”
The Mining Industry's Best Jobs
16:01 to 16:51
Explore why mining jobs are highly valued in Appalachia despite health risks.
“That's difficult to even hear how hard he's struggling just to talk.”
Rising Cases of Black Lung Disease
16:51 to 19:45
Investigate the alarming rise in black lung disease cases reported in clinics.
“A radiologist there named Brandon Crum is specially trained to assess the chest x-rays of coal miners.”
Missed Cases and Regulatory Oversight
19:45 to 21:02
Understand how regulatory agencies failed to account for many black lung cases.
“But 50 ,000 coal miners have lost their jobs since 2011.”
Investigating Silica Dust Exposure
21:02 to 21:48
Learn how data on silica dust exposure was gathered to link it to black lung disease.
“you know, these days are cutting through so much rock to get to the coal and they're encountering silica, but how did you prove that?”
Show all 20 chapters
Investigating Silica Dust Exposure
22:39 to 23:10
Learn how data on silica dust exposure was gathered to link it to black lung disease.
“Security teams are facing more alerts, more tools, and faster moving threats.”
Long-Term Findings on Black Lung Disease
23:16 to 26:19
Discuss the significant findings about black lung disease and its links to silica dust exposure.
“Howard and his team analyzed 30 years of data to try to document the number of dangerous silica dust exposures.”
Preventing Exposure in Mining
26:19 to 28:00
Examine methods that can be implemented to protect miners from dangerous dust.
“Well, for one thing, they didn't look at their own data.”
Challenges in Mining Dust Control
28:00 to 29:11
Learn about the limitations of current dust control measures in mining and the impact on safety.
“more effective at screening out dust, but miners complain that they can limit vision or hearing or both.”
Government Response and New Regulations
29:11 to 31:43
Understand the Mine Safety and Health Administration's proposed regulations and their implications for miners.
“We now know the government didn't bother to look at its own data and it had failed to act on recommendations for tougher limits on silica dust.”
Personal Stories of Miners Affected
31:43 to 35:09
Hear the personal accounts of miners suffering from black lung disease and the emotional toll it takes.
“Howard, so I know you could probably talk all day and probably longer about the details of the proposal and some of the other shortcomings.”
The Resurgence of Black Lung Disease
35:09 to 36:52
Learn about the alarming increase in black lung disease among miners and its causes.
“So we have Howard Berkus back with us to bring us up to date.”
Current State of Coal Miners' Health
36:52 to 42:00
Explore the ongoing health crisis among coal miners and the industry's response to regulations.
“Safety and Health, or NIOSH, tests hundreds of coal miners every year.”
Discussion on Black Lung Disease and Coal Industry
42:00 to 44:59
Learn about the implications of federal support for the coal industry and the concerns for coal miners' health.
“Trump has promised the industry close to$700 million in federal support.”
Discussion on Black Lung Disease and Coal Industry
45:04 to 45:30
Learn about the implications of federal support for the coal industry and the concerns for coal miners' health.
Transcript
Automatic transcript. May contain errors.0:01Howard Berkes:I'm Aisha Roscoe and this is The Sunday Story. Back in 2023, we brought you a story about the resurgence of black lung disease among coal miners. The doctor says my lungs started shutting down. They said it's hard and it's like a lump of coal. It's bad when you walk outside and all that air out there and you can't get none in your lungs. For instance, trying to take a bag of trash out. Steps and hills. I can walk up my driveway to check mailbox. You get up hacking, spitting black and blood. Coughing to the point of almost throwing up. That episode, Cole's Deadly Dust, documents failed efforts to prevent this deadly disease and what those failures have meant for minors, their families, and their communities.
0:50We're going to die from it. There's no cure for it. It's a death sentence. And knowing that that's coming to you, it's pretty hard to take.
0:59Howard Berkes:Howard Berkus has been investigating the rise of black lung disease for more than a decade, first as an NPR correspondent and now as a retired correspondent. Howard Berkus is joining us again today to bring us a major update. He's still investigating. But first, let's go back three years to that original episode In that interview with Howard back then, we talked about the revelations he reported over the years.
1:31Howard Berkes:So Howard, first of all, welcome to the podcast. I really appreciate being with you. I just want to better understand this disease. So when I think of Black Lung disease, it's not something that I think of and associate with today. I'm thinking of the past, the industrial revolution. You know, I'm not thinking 2023. You know, it's actually still pretty common in coal country in Appalachia to hear about dads and grandfathers, uncles, friends who mined coal and then suffered and died from black lung disease. It was typically an old miner's disease and the deaths can be really horrific. The lungs slowly build up with fibrotic tissue.
2:17The affected portion of the lungs become hard, and eventually they no longer work. It's often death by suffocation.
2:24Howard Berkes:I mean, it sounds like a terrible way to die. Has the government done anything to address this? Back in 1969, 40 ,000 coal miners in West Virginia staged a wildcat strike over black lung disease. And that prompted Congress to enact a new mine safety law. It put tough limits on exposure to coal dust, and it made a big difference. The rate of black lung disease plunged 90 percent in the next couple of decades. Okay, so what prompted you to begin investigating black lung disease in 2011, like when you got started with all this? Actually, the year before, in 2010, there was this terrible coal mine explosion at the Upper Big Branch mine in West Virginia.
3:17Twenty-nine coal miners were killed. It was catastrophic then. Dozens of mine rescuers, EMTs, and ambulances were mobilized. It's a total disaster control. I need all the resources you can give me. This was the worst mine disaster in 40 years. A year later, in 2011, a report about the disaster was released, and it contained a one-page sidebar. And that sidebar said that the autopsies on the miners who were killed in the explosion revealed an extraordinarily high rate of black lung disease. One of the miners who died in the explosion was named Gary Wayne Quarles. He was just 33 years old at the time.
3:58and his father, who's also named Gary and also was a coal miner, he told me this. He had black lung. Being in the mines for 13 to 15 years and already considered having black lung nowadays, it's unbelievable. And not only him, quite a few other younger guys, and being that young, that's uncalled for.
4:23Howard Berkes:So the thing that is striking about this is because with Black lung disease in the past, this was something that hit miners when they were in their 60s and 70s, like their later years in life. And that image that kind of comes to mind of older, retired miners hooked up to oxygen tanks after mining for 30 or 40 years, right? One of the shocking experiences we had right away was meeting coal miners who did not fit that description. They were far younger when they were diagnosed, and they got far sicker more quickly. This included a miner named Mark McCowan. He was only 40 years old when he was diagnosed.
5:07We went to his house in southwest Virginia, and he held up an x-ray of his lungs in the light of his living room window. You go from being normal to where all of a sudden one day you try to do something you used to do and you can't do it. And you're just heaving to catch your breath. And you say, this is crazy. It can't be this bad. And then you realize a couple months down the road that it can be. And you realize a year down the road after that that you ain't seen nothing yet.
5:40Howard Berkes:What does Mark McCowan mean by that? Mark was 47 years old when we interviewed him. He'd been living with the disease for seven years, and it was getting worse and worse. So one of the things that he described is something we heard over and over and over again while interviewing dozens of coal miners with black lung disease. They talk about the simplest things that they can no longer do, like just being with their grandchildren. I say, little buddy, I've got to put you down for a few minutes. and he's learned to run a little bit. He'll say, run, Papa, run. He wants me to chase him. And I can't.
6:25I said, give Papa a minute. I might be able to in a minute. And I face Mount Everest every day. Sometimes I make it to the top and sometimes I don't.
6:37Howard Berkes:You were hearing these heart-wrenching stories about how miners struggle with the disease, what did you do next? Did you have a hunch that these individual stories pointed to a much bigger trend? I did have that hunch, and so did the black lung experts who were as shocked as Gary Wayne Quarrell's father. There was also another reporter who was thinking the same thing, Chris Hamby at the Center for Public Integrity. we teamed up and he did an analysis of government data that helped prove a dramatic resurgence of the disease. We found that the downward trend had reversed, that the rate of the disease had soared, and actually a more recent study found that one in five working coal miners who've been tested for black lung, and that's thousands of coal miners, have signs of the disease.
7:32Now we also found one likely reason for this. In the decades since that law was passed in 1969, miners began working longer hours, including lots of overtime and six-day weeks. By the time I was 40 years old, I'd mine more coal than most miners seen in a lifetime. And in fact, we found that on average, coal miners were each working 600 more hours a year. And there was something else that Mark McAllen and other miners talked about. The big coal seams were gone. The thinner coal seams that remained were still valuable, and they were embedded in rock. Sometimes the coal was reduced to a two-inch thickness, and you have to stay with that two inches because you know that's your coal seam.
8:21But the rest of what you need to mine may be solid rock. This is also something we heard repeatedly from the dozens of coal miners we interviewed. Everywhere I worked, we cut rock. No matter where you went, you had rock. Probably last 20 years I cut more rock than I cut coal. Because there wasn't hardly no solid seams of coal left. A little seam of coal, probably eight inches thick. The rest of that was rock, six and a half foot. In Appalachia, that rock contains quartz, and when quartz is ground up by mining machines, it produces a dust that is easily inhaled and contain sharpened particles of silica, which is far more dangerous than coal dust alone.
9:02Howard Berkes:After the break, the silica dust that made Black Lung worse, and the challenge for Howard and his reporting partners in determining how much worse. This message comes from NPR sponsor Charles Schwab with its original podcast on investing. It's hosted by Lizanne Saunders, Schwab's chief investment strategist, and Colin Martin. head of fixed income research and strategy for the Schwab Center for Financial Research. Each week, Lizanne, Colin, and their guests analyze economic developments and bring context to conversations around stocks, fixed income, the economy, and more. Download the latest episode and subscribe at schwab.com slash oninvesting or wherever you get your podcasts.
9:45This message comes from Arctic Wolf. Security teams are facing more alerts, more tools, and faster-moving threats. Arctic Wolf's Aurora Agentic SOC brings AI-led security operations together with expert human validation so organizations can investigate faster, reduce manual work, and stay focused on reducing risk, not managing another stack. It's modern security operations for the AI era. Learn more at arcticwolf.com slash NPR.
10:15Howard Berkes:We're back with the Sunday story, and we're talking with retired NPR correspondent Howard Berkus. Howard, I want to ask you about your motivation for continuing the reporting. Like, you spent a year investigating that 2010 mine disaster in West Virginia. You spent another year investigating and documenting a dramatic resurgence of black lung. For a lot of reporters, that would have been enough. Like you had exposed what was going on. You had borne witness to it. You could have left it there and moved on to other stories. And that's what usually happens. Like, why did you keep thinking about this?
10:57The truth is, Aisha, I did move on to other reporting, some of which also involved other aspects of coal mine safety. But, you know, I met a lot of sick and dying coal miners while I was working on coal mine safety. I met a lot of crippled workers and their families. I met a lot of loved ones of miners who were killed on the job. And I just came to believe that work should not be a death sentence, that coal miners and other workers deserve to go home every night whole and alive. And here's the thing. They were supposed to be protected. This was an era of tougher mine safety laws and a regulatory system that was supposed to protect them.
11:36But clearly, it wasn't working. There must have been something else going on.
11:41Howard Berkes:Now, before the break, you mentioned silica. This is a common mineral in rock. Can you talk more about it? Like, what's the connection with this, you know, surge in black lung, especially among young miners? All that rock that miners were cutting produced this silica dust. And silica is actually 20 times more toxic than coal dust alone. And because it's sharp, it can embed in lungs forever. Every miner we talked to had a story about silica dust. The more rock you had to cut, the duster it was. It's like being in a room full of smoke. Like you're sitting in a cloud. Like walking into a fog bank.
12:21You're inhaling that into your lungs as well. You know, that's just like fiberglass. It cuts your lungs out of hell. It'd choke you up. I used to spit it up constantly. We just couldn't keep the dust down good enough. These silica particles are invaders in the lung, and the lung tissue fights back. It becomes thicker and harder as it tries to expel this foreign substance. Fibrotic tissue builds up and builds up, and it makes it more and more difficult to breathe. Nodules form, and when they get larger and more of them form, the disease becomes far more serious. This is known as progressive massive fibrosis, or simply it's called complicated black lung.
13:02It's incurable. It's fatal. And it was once rare among younger miners like Mark McCowan.
13:08Howard Berkes:So now you're on to silica and you're looking at that. How did you begin this part of the investigation? Of all things, it was a text message. In the summer of 2016, my cell phone buzzed. This was a text message from a very reliable source. And it simply said this,
13:39Of course, I had to verify this, and I thought about two kinds of places that would be witnessing a monumental escalation in cases if such a thing was actually happening. One, there are law firms that represent coal miners who are seeking state or federal black lung benefits. They'd have an increase in business. And two, the medical clinics that diagnose black lung and treat symptoms. And I quickly found that both were swamped with cases, especially in Virginia, Kentucky, and West Virginia. One clinic in particular in eastern Kentucky had dozens of cases, including younger miners who were getting very sick very fast.
14:21I interviewed there one of the sickest miners I've ever met, Mackie Branham. He was just 39 years old when diagnosed, and he compared his situation to his family's history of black lung. You can hear how hard it is for him to breathe. I'd probably be the first one to be this bad in the family. And what do you mean this bad? For it to actually be this progressive and in this bad of shape. I mean, don't get me wrong, they can't breathe, but they can still get up and walk around and do stuff. The more I talk, the more I get out of breath. It's just a lot of pressure in my chest all the time.
15:16And like a lot of sick miners I've met, Mackey also talked about his eventual fate. I've never been scared to death. It don't bother me a bit.
15:29It's just not seeing my kids grow up.
15:37But if I had it to do over, I would do it again. Yeah, that's all it took to provide for my family as long as I have.
16:00Oh, my goodness.
16:02Howard Berkes:That's difficult to even hear how hard he's struggling just to talk. But then he says he'd do it all over again. I think that will be hard for a lot of people to understand. You know, mining jobs have been the best jobs in the hills and hollers of Appalachia. The best pay, the best benefits. Miners sometimes have the best houses. They sometimes have the newest pickup trucks. There isn't usually anything else that compares or even comes close to what mining can provide these workers. So how many Mackie Branhams were out there? How many cases are out there like this? To begin to answer that question, I went to the clinic where Mackie Branham was diagnosed.
16:56A radiologist there named Brandon Crum is specially trained to assess the chest x-rays of coal miners. I think the percentage of black lung that we're seeing now here in central Appalachia is unprecedented in any recorded data that I can find anywhere. In this clinic, we're roughly around 9 % to 10 % complicated rate, which is around three times higher than even the highest reported numbers. Crum was so shocked, he approached epidemiologists at the National Institute for Occupational Safety and Health, which tracks black lung disease. He spoke with Scott Laney, one of the nation's most prominent black lung researchers.
17:37He told us that he was seeing a lot of really advanced disease and it was concerning to him. And I guess my initial thoughts was, that's probably not true.
17:48Howard Berkes:Why was epidemiologist Scott Laney so skeptical? Because Laney's Federal Research Agency, which has tested tens of thousands of working coal miners for black lung for decades, had counted and reported just 99 cases of complicated black lung nationwide in the previous five years. Brandon Crum had two-thirds as many cases in less time at his small clinic in Kentucky. Laney wanted proof, so he went to Crum's clinic. And he agreed to show us some of the medical images, and we sat there for an entire day, one after another after another, looking at these chest x-rays, the worst I've ever seen. And I asked Laney how he reacted to what he was seeing.
18:36Horror, shock. I don't know how many other words to use. I was really taken aback, not only that these cases were legitimate, but just how severe they were. It wasn't just Crum's Clinic. Across the Kentucky border in Virginia, Ron Carson managed three black lung clinics operated by Stone Mountain Health Services, and he said he had more than 600 cases in just three years. I'm not an epidemiologist or a scientist or a doctor. I just see the results that comes through the doors and something is going on. Something major is going on.
19:23Howard Berkes:So how could this happen? Like, how could the agency that is responsible for counting the cases of this disease miss so much. It turned out there was nothing really nefarious going on. Remember that I said that Laney's agency, the National Institute for Occupational Safety and Health, or NIOSH, tested working miners for black lung disease. That's its legal mandate. But 50 ,000 coal miners have lost their jobs since 2011. That's because coal plants have shut down and mines have closed. Some of those miners went into black lung legal and medical clinics to see if they might qualify for black lung benefits.
20:05So the clinics were testing laid off and retired miners who NIOSH was not testing. We surveyed clinics in Virginia, Kentucky, West Virginia, Ohio, and Pennsylvania. They diagnosed close to a thousand cases of complicated black lung, 10 times the NIOSH count.
20:25Howard Berkes:I mean, that's a big difference. And I guess if they didn't really know how many people were sick, then they didn't even know to try to look for a cause of this rise, right? That's right. If the official count was so low, then there wasn't anything major to be alarmed about. In fact, there was never direct regulation of silica dusting coal mines. So at this point, you know, and government officials are starting to learn that the official count is way off and lots more miners have this complicated black lung than was previously known. And you suspect that the problem may be silica because miners, you know, these days are cutting through so much rock to get to the coal and they're encountering silica, but how did you prove that?
21:16We knew that the Mine Safety Agency had been sampling for cold dust and silica dust, and we knew that the agency analyzed those samples. So in 2017, I turned to two of my colleagues on the NPR investigations team who are whizzes at analyzing complex sets of data. That's Robert Benincasa and Wojong Nan. And they obtained 30 years of sampling data going back to 1986. Now, we cast a wider net and went to even more black lung clinics to get a more complete count of cases. We were trying to definitively show how many dangerous silica dust exposures had occurred, what caused them, what the mine safety agency did or not do in response, and how many more cases were out there.
22:05Howard Berkes:When we come back, what all that data revealed about the deadly conditions miners were facing.
Read the full transcript
22:38latest episode and subscribe at schwab.com slash oninvesting or wherever you get your podcasts. This message comes from Arctic Wolf. Security teams are facing more alerts, more tools, and faster moving threats. Arctic Wolf's Aurora Agentic SOC brings AI-led security operations together with expert human validation so organizations can investigate faster, reduce manual work, and stay focused on reducing risk, not managing another stack. It's modern security operations for the AI era. Learn more at arcticwolf.com slash NPR.
23:15Howard Berkes:We're back with Howard Berkus talking about his decade-long investigation into black lung disease among coal miners. Howard and his team analyzed 30 years of data to try to document the number of dangerous silica dust exposures. So, Howard, what did you find? Okay, stick with me here for a minute because it's a lot of numbers, but it shows how such important details were overlooked. First, we documented another 1 ,000 cases of complicated black lung, with a total then of over 2 ,000 cases since 2010. Second, we documented 21 ,000 instances of overexposure to silica dust since 1986, exposures that exceeded the federal health standard.
24:04Third, we found that the agency's response to excessive silica dust exposures failed to lower the dust to safe levels close to 9 ,000 times. Fourth, we obtained government documents that showed that the Mine Safety Agency had identified a cluster of advanced lung disease in coal miners back in 1996, and officials at the time connected that cluster of disease to exposure to silica dust. They even sent out warnings to the mining industry. But nothing was done then or since to force protective action on silica dust.
24:43Howard Berkes:So it sounds like you had a lot of smoking guns here. More cases of disease, more evidence of this hidden epidemic, enough excessive exposures to maybe show the cause of the epidemic, and then a failure by regulators to protect miners, even when they knew about the danger. What kind of reaction did you get to that? More shock, more horror, and a rare acknowledgement by a former top official at the Mine Safety Agency. Celeste Monforten was a top aide in the agency during the Clinton administration in the 1990s. We failed. Had we taken action at that time, I really believed that we would not be seeing the disease that we're seeing now and having minors die at such young ages from exposures that happened 20 years ago.
25:40I mean, I don't know how you can reach any other conclusion. I mean, this is such a gross and frank example of regulatory failure. Wow.
25:54Howard Berkes:I mean, that is quite an omission. And it's not normally what you would hear from a regulator or a former regulator. She's basically saying it's undeniable the Mine Safety and Health Administration is supposed to be protecting minors. So how do you account for this failure? Like, what were those officials doing instead? Well, for one thing, they didn't look at their own data. They also ignored repeated recommendations by NIOSH going back to 1974, which called for a silica exposure limit that was twice as tough. That was also recommended by a special Labor Department commission on black lung in 1996.
26:38Howard Berkes:Well, I wanted to ask you about how miners can be protected from dangerous dust. Like the pandemic obviously taught us all about N95 masks. Don't coal miners use masks or respirators for protection? This is a subject we could talk a lot about. I'll just give you the highlights. And it starts with a fundamental principle in workplace safety, which is companies are supposed to provide first and foremost a safe working environment. They're not supposed to be able to get away with having an unsafe environment, providing some kind of protection, supplemental protection, it's called. And in this case, with coal miners, we're talking about masks or respirators.
27:23operators. There's also a fraught history with the masks miners were issued in the past, including hundreds of lawsuits with settlements and multi-million dollar verdicts. And miners did not really like wearing these masks. They would clog up with dust, sweat, and spit. I just never could get enough air. And then it'd feel like somebody just sitting there with their hand over your face, about to give you a heart attack, trying to breathe through. They're not going to stop 100%. There's finer particles getting through them filters. Some of the companies I work for didn't have them at all, period.
27:56Now there are respirators and helmets available today that are more effective at screening out dust, but miners complain that they can limit vision or hearing or both. That's not good in a dangerous work environment where it's critical to clearly communicate with co-workers and to see the movement of massive equipment around you.
28:17Howard Berkes:Okay, so masks are not a perfect solution. What else can mining companies do to protect miners from dangerous dust? So mines have massive fans that push through clean air that sweeps away coal and silica dust. This robust ventilation is one thing that works if it's done right. Mining machines also spray water as they cut into coal and rock that also tamps down dust, if the sprays are working right. The other thing mining companies can do is slow down the mining machines, which can result in less dust. They could choose not to mine the thin seams with so much rock. Of course, both of those options involve mining less coal and making less money.
29:09Howard Berkes:So bring us up to date. We now know the government didn't bother to look at its own data and it had failed to act on recommendations for tougher limits on silica dust. But they're finally doing that, right? Well, the Mine Safety and Health Administration is finally proposing to make the silica dust exposure limit twice as restrictive. And it is proposing to directly regulate silica dust for the first time so that citations and fines are possible for exposing miners to dangerous levels of dust. But the proposal appears to be weak on oversight and enforcement, on making sure that coal companies actually follow the regulations and actually protect miners.
29:56And the agency does not include in this proposed regulation some of the key trends about complicated black lung that it has overlooked in the past. It's not citing the data that shows thousands of continuing overexposures to silica dust. It doesn't cite the actual numbers of minors who are sick and dying from the disease. These numbers are important because when agencies propose a new regulation, they have to sell it. They have to sell it to the industry that's affected because they don't want to get sued, and they don't want the industry to appeal to their friends in Congress to try to block it.
30:31And in fact, a House Republican has already launched an attempt to block implementation of the new silica dust regulation, even though there's not even a final version of the proposal. So it's critical to make the best case, but the proposed regulation undersells the potential benefits. The proposal predicts that the new regulation will save just 63 coal miner lives and prevent just 244 cases of disease over 60 years. Our latest survey of black lung clinics shows more than 4 ,000 cases of disease in the last decade.
31:09Howard Berkes:Has the Mine Safety Agency responded to your recent reporting? Like, did officials explain why they left out those compelling details? They responded, but they did not explain. Instead, they said in a statement that they would now consider the actual number of diseased and dying miners. And they said officials there are deeply disturbed by that. Now, this is actually a work in progress. The proposal is now under review. A final regulation is likely months away, and we'll see if it actually incorporates what we've reported. Howard, so I know you could probably talk all day and probably longer about the details of the proposal and some of the other shortcomings.
31:53Howard Berkes:And listeners can find out more about that and your story on our website at npr.org. But I want to get back to the minors you've interviewed over the years. Because that's what this is really about. I mean, their lives are at stake. And I know that even with coal plant shutdowns and mines closing, there will still be tens of thousands of workers mining coal for years to come. So what have these miners left you with after all these hours you've spent with them and all that you've learned in your reporting, what stays with you? I keep thinking about a minor named Danny Smith, who was a lot like Mackie Branham, one of the youngest and sickest minors I've met.
32:46Danny only worked 12 years underground. He was diagnosed with complicated black lung at just age 39. And when we visited with him at his home in eastern Kentucky in 2018, he was just trying to do something simple, mow his lawn. But he had a hacking fit that forced him to stop. He bent over. He started coughing so bad that he was spitting up what looked like crusted bits of black paper with red streaks. Later, his respiratory therapist told us that that was dead lung tissue that he was coughing up. Danny was taking his plight very hard. It's eat at me and eat at me for at least the last two years that I'm going to die over.
33:32It's heartbreaking, you know, not knowing where you're going to have grandkids and you're going to ever see them.
33:41And of all the things that could have killed me while I did work there, Rock Falls and all that stuff, you know, and I lived through all that. And I find out years later that I'm going to die over a black lung, and it's heartbreaking. We was all young and strong and stout, and they took advantage of us. Every one of us is either crippled or dead, you know. We was all young men. We were just kids.
34:13Danny Smith was 46 years old when we spoke with him in 2018, and he showed me then the burial plot that he'd picked out for himself in his family cemetery. Danny and I have been communicating since then, most recently by text message, because he says he doesn't feel strong enough to get through a phone conversation. He's being assessed right now for a double lung transplant. He has good days and bad days. In one text that he sent me recently, he said he'd rather be poor and homeless than suffer what he's been going through and knowing it will only get worse. But he also wrote that he was grateful for the good life mining made possible for him and his family.
34:54He has two daughters he's immensely proud of, one a pharmacist now, and the other studying to be a physician's assistant in emergency rooms. Both were inspired by Danny's suffering from complicated black lung. And I want to leave you with this. His older daughter, Sydney, wrote and performed a song about her dad and his disease.
35:29Howard Berkes:He put food on our table and clothes on our backs While his was bent over in the deep, dark, underground So down there's the scariest place there should be In the cold and black And he still went down
35:53I have questioned thy pride I prayed to the Lord above me For the man whose lungs are black Is a coal mine in Kentucky
36:12Howard Berkes:A lot has happened in the world of coal mining and black lungs since that episode three years ago. So we have Howard Berkus back with us to bring us up to date. Hi, Howard. Hey, Aisha. Thanks for having me back. I wish I had better news for you this time, but it's always good to talk to you. Well, you know, we always appreciate it. And let's get right to that news. As I understand it, this resurgence of Black Lung disease not only continues, but it's getting worse? Like, is that right? That's right. Sadly, it is getting worse. The federal research agency that tracks black lung disease, the National Institute for Occupational Safety and Health, or NIOSH, tests hundreds of coal miners every year.
37:00And in their latest report, they find that one in three working career coal miners in Appalachia, that's miners there who've toiled underground for at least 25 years, they have black lung disease, one in three, Aisha.
37:16Howard Berkes:My goodness. I mean, that's just terrible. Like, how did they come to that finding? Well, by testing working underground miners in Kentucky, Virginia, and West Virginia, and they did that in the last five years. The last time that this group of miners had that rate of disease was 1978, nearly 50 years ago. What about younger miners? Are they also experiencing higher rates of black lung? They are. Even working coal miners in that same region, with as little as 15 to 20 years underground, have tested positive at a rate not seen in nearly 40 years.
37:58Howard Berkes:So Howard, how do these latest findings compare to what was happening when we last heard from you in 2023? Well, when we last spoke three years ago, the most recent report from NIOSH was from 2018, and it found that the same group of career minors had black lung at a rate of one in five, or a 20 % chance of having the disease. So it went from one in five to one in three. That's a 65 % increase in the rate of the disease in less than 10 years. And here's another perspective. Back in the 1960s and 70s, so many coal miners were sick and dying that thousands staged a wildcat strike and marched on Washington.
38:43That prompted Congress to pass new mine safety laws, including strict limits on exposure to the coal mine dust that causes black lung. And those laws were effective. 20 years later, the rate of disease for these miners had plunged to just 7%. That's less than 1 in 10 minors. So when we say now that the disease has come roaring back, we're not exaggerating.
39:05Howard Berkes:I mean, that's a really shocking uptick, especially when we're talking about 2026. Like, you would think things would be safer and better. Even the black lung experts were shocked by this data. I shared this news, by the way, with one pulmonologist who treats co-miners. Dr. Drew Harris is the medical director at the nation's largest black lung clinic, and he sees minors from across Appalachia. If you imagined one out of every three school teachers were getting an incurable lung disease because of something that they were exposed to at work, the whole country would put their hands up screaming and stop whatever this exposure was immediately.
39:47And it's sad that this is largely impacting rural Appalachian folks that don't have a voice, that don't have a country to unite behind them. That's really why this is happening.
40:00Howard Berkes:In the episode we just heard, you talked a lot about the increase in silica dust in coal mines. Does that also explain this new milestone? That's what the NIOSH researchers say, and there's really nothing else that could explain it. They also note that this is a progressive incurable disease. Scott Laney is the NIOSH epidemiologist who led the study. This is not going to get better because of all of the disease that's already in the pipeline. You know, these guys are being treated like disposable widgets, not human beings, and we're watching them die right before our eyes. In fact, another NIOSH study last year counted more than 1 ,700 deaths from black lung just from 2020 through 2023.
40:45And there's other evidence of a black lung crisis and of lasting impact. That black lung clinic we mentioned earlier diagnosed 2 ,400 new cases of disease in just the past five years. And in 2024, the last year reported, more than 26 ,000 sick and dying coal miners or their surviving dependents received federal black lung payments, this is for living and medical expenses, that was at a cost of$175 million.
41:16Howard Berkes:But, you know, we just heard that the Federal Mine Safety Agency had adopted these tough new limits on exposure to silica dust. Will that make a difference, at least for miners who aren't sick yet? Well, the mining industry sued, and now federal courts and the Trump administration have put enforcement of that new silica dust regulation on hold indefinitely. So miners are still being exposed to silica dust, which is believed to be driving these new cases of disease in basically the same regulatory system that failed to protect them in the past. And while these new protections for miners are on hold, the Trump administration is trying to prop up coal mining and coal burning power plants.
42:02Trump has promised the industry close to$700 million in federal support. And that prompted this from Celeste Monforten, a former federal mine and workplace safety regulator and a specialist in occupational health. When I hear the president or other people in the administration talk about coal, it's like they have this love affair with coal. They have a love affair with the Black Rock and not a love affair or compassion or concern for coal miners.
42:37Howard Berkes:So what are the administration and the mining industry, what are they saying about this newly reported rate of Black lung disease?
42:49Howard Berkes:Howard, thank you for bringing us up to date and for your continued reporting. You know, a true reporter never stops reporting, and even when they're retired. Well, thanks for having me back, Aisha. I hope to get back to being retired soon.
43:07Howard Berkes:Howard's latest reporting on Cole's Deadly Dust was for Public Health Watch, an independent nonprofit investigative newsroom, and was done in collaboration with Justin Hicks of Kentucky Public Radio. This episode of The Sunday Story was produced by Andrew Mambo. The earlier episode featured today was produced by Justine Yan. Our editor is Jenny Schmidt. Maggie Luthar was the engineer for this episode. Music was provided by Audio Network, Blue Dot Sessions, and Ramteen Arablewe. The song Coal Mine in Kentucky was performed by Erica Coleman, Chris Preston, Tyler Ball, and Sydney Caudill. Liana Simstrom is our supervising producer, and Irene Noguchi is our executive producer.
43:59Howard Berkes:We'd love to hear from you. Send us an email at thesundaystoryatnpr.org. I'm Aisha Roscoe. Up First is back tomorrow with all the news you need to start your week. Until then, have a great rest of your weekend.
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From the publisher
On The Sunday Story, Howard Berkes investigates the devastating human cost on Appalachian families, decades of regulatory failures, and why life-saving protections from toxic silica dust remain stalled in federal court.
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