Transcript of The black lung crisis deepens in Appalachia

I'm Ayesha 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 hardened, 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 nothing in your lungs. For instance, trying to take a bag of trash out. Steps and hills. I can't even walk up my driveway to check the mailbox. You get up hacking, spitting black and blood. Coughing to the point of almost throwing up.

That episode, "Coal's Deadly Dust," documents failed efforts to prevent this deadly disease and what those failures have meant for miners, their families, and their communities.

We're gonna 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.

Howard Berkes 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 Berkes is joining us again today to bring us a major update. He's still investigating. But first, let's go back 3 years to that original episode. In that interview with Howard back then, we talked about the revelations he reported over the years. 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, 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, The affected portion of the lungs become hard and eventually they no longer work. It's often death by suffocation.

I mean, it sounds like a, 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% in the next couple of decades.

Okay, so, 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. 29 coal miners were killed. 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, and his father, who's also named Gary and also was a coal miner, he told me this: He had black lung, and not only him, quite a few other younger guys.

And being that young, that's uncalled for.

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, 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. We 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 You ain't seen nothing yet.

You were hearing these heart-wrenching stories about how miners struggle with the disease. What did you do next? Like, did you have a hunch that these individual stories pointed to a much bigger trend?

You know, I did have that hunch, and so did the black lung experts. There was also another reporter who was thinking the same thing, Chris Hamby at the Center for Public Integrity. So 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 disease had soared. And actually, a more recent study found that 1 in 5 working coal miners who've been tested for black lung— and that's thousands of coal miners— have signs of the disease. We also found one likely reason for this escalation in disease. And it has to do with a fundamental change in mining. The big deposits of coal in Appalachia, the large seams, they're gone. For the past couple of decades, coal has been mined from much thinner strips embedded in rock.

Sometimes the coal was reduced to a 2-inch thickness, and you have to stay with that 2 inches because you know that's your coal seam. But 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 the last 20 years I've cut more rock than I cut coal. Because there weren't hardly no solid seams of coal left. A little seam of coal probably 8 inches thick, the rest of that was rock, 6.5 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 contains sharpened particles of silica, which is far more dangerous than coal dust alone.

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. We're back with The Sunday Story, and we're talking with retired NPR correspondent Howard Berkes. 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've 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?

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, but clearly it wasn't working. There must have been something else going on.

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.

It's like walking into a fog bank.

You're inhaling that into your lungs as well.

You know, that's just like fiberglass, it cuts your lungs outta 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. It's incurable, it's fatal, and it was once rare among younger miners.

So now you're, you're onto silica and you, and you're looking at that. How, 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: I've seen as many complicated black lung cases in the last month as I've seen in the last 30 years. Guys are really that sick. Something is up. Of 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 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. I interviewed there one of the sickest miners I've ever met, Mackey Branham. He was just 39 years old when diagnosed, and he compared his situation to his family's history of black lung.

I'll probably be the firstborn 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.

And like a lot of sick miners I've met, Mackey also talked about his eventual fate.

I never been scared of death. It don't bother me a bit. It's just not seeing 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 as long as I have.

Oh my goodness, 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. A 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, we're roughly around 9 to 10% complicated rate, which is around 3 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.

He told us that he was seeing a lot of it, really advanced disease, and it was concerning to him. And I guess my initial thoughts was, "It's probably not true." Why was the 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 5 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 Crumb'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.

Horror, shock. I don't know how other— I don't have many other words to, to use. I was really taken aback, not only that these cases were legitimate, but just how severe they were.

It wasn't just Crump's clinic. Across the Kentucky border in Virginia, Ron Carson managed 3 black lung clinics operated by Stone Mountain Health Services, and he said he had more than 600 cases in just 3 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.

So how could this happen? Like, how could the agency that is responsible for counting the cases of this disease miss so much?

Because the agency was only testing and counting working coal miners, that's its mandate, so it was missing retired and laid-off miners. As mines have closed, tens of thousands of miners have lost their jobs, so thousands of them inundated black lung clinics to see if they had disease and might qualify for black lung benefits payments. We surveyed clinics across Appalachia, and they reported 10 times the number of cases than the federal agency had reported.

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 dust in 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?

We knew that the Mine Safety Agency had been sampling for coal 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 Wo Jingnan. 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.

When we come back, what all that data revealed about the deadly conditions miners were facing. We're back with Howard Burkes talking about his decade-long investigation into black lung disease among coal miners. 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. Third, 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.

So it, 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 Monforton 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 believe that we would not be seeing the disease that we're seeing now and having miners die at such young ages from exposures that happened 20 years ago. I 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. I mean, that is quite an admission, and it's not normally what you would hear from a regulator or a former regulator. She's basically saying it's undeniable the, the Mine Safety and Health Administration is supposed to be protecting miners. 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.

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 spend quite a bit of time discussing. I'll give you some of 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 by providing some kind of protection, supplemental protection it's called. And in this case with coal miners, we're talking about masks or respirators. There's also a fraught history with the masks miners were issued in the past. Including hundreds of lawsuits with settlements and multimillion-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 feel like somebody just sitting there with their hand over your face.

About give you a heart attack trying to breathe through it.

They're not going to stop 100%. There's finer particles getting through them filters. Some of the companies I worked for didn't have them at all.

Period. Now, 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 coworkers and to see the movement of massive equipment around you.

Okay, so, 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.

So bring us up to date. Like, 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.

Howard, so I know you could probably talk all day and probably longer about the details of the proposal. But I want to get back to the miners you've interviewed over the years, um, because that's what this is really about. I mean, their lives are at stake, uh, and I know that even with coal plant shutdowns and, 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 miner named Danny Smith, who was a lot like Mackey Branham. He's one of the youngest and sickest miners I've met. Danny 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 2 years that I'm going to die over this, over, you know, and it's heartbreaking, you know, not knowing where you're going to see, have grandkids and you're going to ever see them. And 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 gonna die over black lung, and it's heartbreaking.

Danny 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. In one text that he sent to 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. He 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.

Diggin' black gold 10 feet above hell, but there's nothin' he wouldn't do. He put food on our table, traveling close on our backs while he was bent over in the deep dark underground. So down there's the scariest place there could be in the cold and black, but he still went down. I have questioned my pride, I pray to the Lord above me for the man whose lungs are black is a coal miner in Kentucky. That was Howard Berkus from our 2023 episode on the resurgence of Black lung disease. A lot has happened in the world of coal mining and Black lung since that episode aired 3 years ago. So we have Howard 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. And in their latest report, they find that 1 in 3 working career coal miners in Appalachia, that's miners there who've toiled underground for at least 25 years, they have black lung disease, 1 in 3, Aisha. Oh 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 5 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.

So Howard, how do these latest findings compare to what was happening when we last heard from you in 2023?

When we last spoke 3 years ago, the most recent report from NIOSH was from 2018, It found that the same group of career miners had black lung at a rate of 1 in 5, or a 20% chance of having the disease. So it went from 1 in 5 to 1 in 3. That's a 65% increase in the rate of disease in less than 10 years. But here's another perspective. In the 1960s and '70s, Congress passed tough mine safety laws to protect miners from the coal mine dust that causes black lung. Lung. And those laws were effective. By 1999, the rate of disease for these miners plunged to just 7%. That's less than 1 in 10 miners. Now we're at 1 in 3. So when we say the disease has come roaring back, we're not exaggerating at all.

I mean, that's a really shocking uptick, especially when we're talking about 2026.

Like, you would think things would be safer and Even the black lung experts were shocked by this data. I shared this news, by the way, with one pulmonologist who treats coal miners. Dr. Drew Harris is the medical director at the nation's largest black lung clinic, and he sees miners from across Appalachia.

If you imagine 1 out of every 3 schoolteachers are 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. And 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.

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.

And data bears this out. Here are some numbers. From 2020 to 2023, more than 1,700 miners died from black lung. In just the last 5 years, at the one Virginia clinic I mentioned earlier, another 2,400 miners were newly diagnosed with the disease. And in 2024, the last year reported, more than 26,000 miners or their survivors collected black lung benefits payments.

So Howard, since that earlier episode, I understand the Federal Mine Safety Agency did adopt the tough new limits on silica dust exposure. Shouldn't that have made a big difference for miners?

It might have, but 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 some miners are still being exposed to dangerous levels of silica dust. And while these new protections for miners are on hold, the Trump administration is trying to prop up the coal industry with close to $700 million in federal support. That prompted this from Celeste Monforton, 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 BlackRock and not a love affair or compassion or concern for coal miners.

So what's the Trump administration and the mining industry saying about this newly reported rate of black lung disease?

The Mine Safety and Health Administration has yet to respond. The National Mining Association says the new rate of disease is the result of past dust exposures, probably 10 years ago or more, given the time it takes for disease to develop and to be diagnosed. So the new rate of disease, the association says, does not reflect the exposure in coal mines today. And coal mines have gotten much better at controlling silica dust exposure. Exposure in the last decade. Still, there were more than 5,000 instances of overexposure to silica dust since 2014. So some miners are still at risk.

Finally, I've got to ask about coal miner Danny Smith. We heard from him 3 years ago. At the time, he was struggling to breathe. Can you give us any update on him? How's he doing?

Since we last heard from Danny, his life has been a roller coaster. He was able to get on a transplant list, but then his house burned down and he took himself off that list to deal with the aftermath of that tragedy. He tried again for a transplant but was rejected. You can be too sick to qualify. But he's being assessed again now. One more thing about Danny. He told me in 2018 he was hoping to live long enough to see his two daughters graduate from college, and he's done that. Now he's hoping to hold on long enough to hold a grandchild.

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.

Thanks for having me back.

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 and Ben Rapoport. The earlier episode featured today was produced by Justine Yan. Our editor is Jenny Schmidt. Maggie Lu Luthar and Kwesi Lee were the engineers for this episode. Music was provided by Audio Network, Blue Dot Sessions, and Ramtin Arablouei. The song "Coal Mine in Kentucky" was performed by Erica Coleman, Chris Preston, Tyler Ball, and Sydney Caldwell. Liana Simstrom is our supervising producer, and Irene Noguchi is our executive producer. We'd love to hear from you. Send us an email at theSundayStory@npr.org. I'm Ayesha Rascoe. Up First is back tomorrow with all the news you need to start your week. Until then, have a great rest of your weekend.