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RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne.

After the deadly explosion at the Upper Big Branch mine in West Virginia, President Obama promised to investigate how mine safety and health laws are enforced. This focus on safety also calls attention to a disease that comes from working in the mines - black lung, which seemed on the way out, is back. NPR's Brenda Wilson reports it claims the lives of several hundred miners each year.

BRENDA WILSON: At the Tug River Clinic in Gary, West Virginia it's the day miners get screened for black lung. Dr. Randy Forehand, a lung specialist, is thumbing through a dozen or so X-rays of patients with black lung.

Dr. RANDY FOREHAND (Pulmonologist): There was a time that that might've taken me six, seven, maybe ten years to accumulate this number. This has taken me about six months.

WILSON: He puts one of the X-rays up on the screen.

Dr. FOREHAND: This gentleman is probably going to require a lung transplantation.

WILSON: Mining, getting coal out of the earth, makes dust - a lot of dust. It clings to everything. It seeps into the lungs. As the dust collects in the lungs, scar tissue forms, less oxygen is circulating. It becomes more difficult to breathe.

After the 1968 Farmington, West Virginia mine disaster, when 78 miners died in an explosion, new regulations led to inspections to sample the dust to make sure it wasn't over certain levels and required masks, respirators, that the men wouldn't wear. Miner David Neil says they'd become clogged with coal dust.

Mr. DAVID NEIL (Miner): Didn't really do much good to wear a respirator. Couldn't keep the filters from stopping up.

WILSON: For eight years he worked underground, on his hands and knees, in a space no more than three feet high. A miner with black lung may have no symptoms at first, but it catches up with them.

Mr. NEIL: I was having problems with my chest. They went and done an X-ray. And the radiologist at Montgomery told me that I need to go get checked for black lung. And then that's when I went and found out that I had it. And before I got laid off I came back down here and they took another chest X-ray, and they said it's gotten worse.

WILSON: Black lung used to be thought of as an old man's disease, but Neil was first diagnosed in his 30s. Mining seemed like a good deal. He was making good money and starting a family.

Mr. NEIL: Me and my twin brother used to work in the mines together. We came home one time and our kids run to the door to meet us and didn't know who their daddy was, because we was both black.

WILSON: Technology was being introduced, fewer miners were needed. The rate of black lung cases was going down. Mike Attfield, an epidemiologist with the National Institute of Occupational Safety and Health - or NIOSH - in West Virginia, says five years ago researchers started seeing the rate of black lung cases go up.

Dr. MIKE ATTFIELD (Epidemiologist, National Institute of Occupational Safety and Health): Production has gone very high compared to the old days. And when you're producing a lot of coal, you're making a lot of dust.

WILSON: There may be fewer miners now, he says, but they're working longer hours. Longer hours mean they inhale more dust and don't have enough time outside the mine to cough it out. Even more important, may be the fact that the coal that's easy to get at has been mined out. What's left are thinner seams that with technology are now more accessible. This type of mine, Attfield says, posses a greater danger.

Dr. ATTFIELD: Thinner-seam mining is much more difficult to do, because you're often cutting the rock that's adjacent to the coal seam, where you didn't have to do that before. That adjacent rock contains silica in many cases, and silica is about - the way it's regulated at least - is about 20 times more toxic than coal mine dust.

WILSON: That raises a number of questions: whether mining companies are monitoring silica and coal dust levels and keeping them at appropriate levels, and whether those levels are low enough.

And because there are disagreements over exactly what doctors are seeing on X-rays, there are often disputes over diagnoses and ultimately the workers health benefits. Companies pay just 10 percent of the disability claims that are submitted.

Anita Wolfe, a public health analyst with NIOSH, says the fact that miners are dying of black lung is just as tragic as miners dying in disasters.

Ms. ANITA WOLFE (Public health analysts, National Institute of Occupational Safety and Health): When something like what happens at the Massey mine happens, it gets immediate attention because it's an immediate death. You know, we have 29 miners now that were here yesterday, and they are not here today. We also have over 700 miners who, every day, are living with black lung and are dying a slow, agonizing death.

WILSON: Miners deserve to go home healthy every night, she says, just as they deserve to go home safe ever night.

Brenda Wilson, NPR News.

MONTAGNE: And we have more information on black lung disease at npr.org.

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