Air Pollution - A Modifiable Risk Factor

April 30, 2018 - 10:05am

       We often talk about the public health risks of air pollution because it's a modifiable risk factor. In other words, you have the ability to fix it. The proof is passage of the beefed-up Clean Air Act in the 1970s, which lowered levels of particles, ozone, lead, carbon monoxide, nitrogen and sulfur dioxide, along with numerous other toxic pollutants, by around 70 percent while the economy thrived. Gross domestic product has grown by 246 percent since it was enacted.  

       We left behind (sort of) the super-smoggy, lung-, heart- and brain-damaging air quality that haunted cities large and small before the banning of leaded gasoline in 1996 (phasing out began in the '70s). "On the autopsy table, it's unmistakable," a city medical examiner told The New York Times in 1970. "The person who spent his life in the Adirondacks has nice pink lungs. The city dweller's are black as coal."      

But now there is talk of rolling back emission standards for cars. Why, why, why? It benefits neither the economy nor people. It's just one example of the push to disregard science and health-protecting regulations.

       Another example -- and one that should upset us all, even though there are only 50,000 folks directly affected in the U.S. -- is the resurgence of black lung disease among intrepid coal miners found mostly throughout Kentucky, Virginia, Pennsylvania and Ohio. It's a vivid example of what can happen when safeguards and regulations are weakened or ignored.

       The epidemic is a result of new automated mining techniques that allow companies to use what are dubbed "continuous miners" to extract coal from places where it was previously unprofitable. These machines pulverize and remove more rock that's a mix of coal, iron and silica, the last being an extremely potent lung irritant. As The New York Times put it, "Silica dust from pulverized rock can damage lungs faster than coal dust alone." Smithsonian Magazine reports that, "Silica's toxicity comes from a variety of chemical properties, including electrostatic charge."

       Once, the medical community considered black lung disease nearly obsolete (just 31 cases were reported from 1990 to 1999). But the shift in mining techniques has changed that. Over the past four years, after 500 cases were reported in just four clinics, NPR did a wider survey and uncovered nearly 2,000 reported cases over the same four years.

       Some sources estimate that advanced black lung disease (also called "progressive massive fibrosis," or "PMF") may affect one in every 14 below-ground miners, which would be around 3,500 current workers. And it's happening to younger and younger folks. There is no cure for PMF; lung transplantation is the only effective treatment.

       Rep. Bobby Scott, D-Va., the ranking Democrat on the House Committee on Education and the Workforce, has said, "Each case of advanced black lung disease is an entirely preventable tragedy, and represents mine operators' unwillingness to adequately control mine dust exposures, and safety regulators' failure to set, monitor and enforce standards necessary to protect miners." He and Rep. H. Morgan Griffith, R-Va. recently have secured increased funding for 28 black lung clinics in 15 coal-mining states -- up to $10 million this year, from $2.7 million previously.

       At the same time, Kentucky legislators passed bills to limit the ability to diagnose black lung disease to only certified pulmonologists (there are just six in the state, and according to NPR, four of them "work for coal companies"). This excludes federally certified radiologists who were previously able to award state black lung compensation to PMF sufferers.

       Wouldn't it be smarter and less costly both in human and economic terms to PREVENT advanced black lung disease by enforcing and strengthening safety standards for the workers?

       Lack of regulatory rigor at the state level and by our Environmental Protection Agency costs many millions of dollars in avoidable Medicaid and Medicare expenses, not to mention the human toll of disability and unimaginable suffering. No one should have to be gasping for air to demonstrate just how dangerous unchecked air pollution can be.
       * * *
       Mehmet Oz, M.D. is host of "The Dr. Oz Show," and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. To live your healthiest, tune into "The Dr. Oz Show" or visit
       (c) 2018 Michael Roizen, M.D. and Mehmet Oz, M.D.
       Distributed by King Features Syndicate, Inc.

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