Digging Our Own Graves: Coal Miners and the Struggle over Black Lung Disease

© 2020 Barbara Ellen Smith

Originally published in 1987 by Temple University Press.

This edition published in 2020 by

Haymarket Books

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Front cover photo and photo gallery section © Earl Dotter.

Cover and text design by Eric Kerl.

Portions of certain chapters appeared earlier in article form: Barbara Ellen Smith, Black Lung: The Social Production of Disease, International Journal of Health Services 11, no. 3 (1981): 343-59, Baywood Publishing Co., Inc. (first reproduced under the same title by the International Institute for Comparative Social Research, Berlin, West Germany); Barbara Ellen Smith, History and Politics of the Black Lung Movement, Radical America 17, nos. 2-3 (1983): 89-109; Barbara Ellen Smith, Too Sick to Work, Too Young to Die, Southern Exposure 12, no. 3 (May–June 1984): 19–29. All are reprinted by permission. George Sizemore, Drill Man Blues, in George Korson, Coal Dust on the Fiddle: Songs and Stories of the Bituminous Industry (Philadelphia: University of Pennsylvania Press, 1943), 56-57 is printed by permission of Mrs. Rae (George) Korson.

Library of Congress Cataloging-in-Publication data is available.

To coal miners and their families all over the world

All royalties from the sale of this book go to support

the West Virginia Mine Wars Museum.

www.wvminewars.com

Black lung, black lung, oh your hand’s icy cold,

As you reach for my life and you torture my soul;

Cold as that water hole down in that dark cave,

Where I spent my life’s blood diggin’ my own grave.

Black Lung, by Hazel Dickens

Contents

Preface

Interviews

Chapter 1

Diagnosing the Problem

Chapter 2

The Medical Politics of Black Lung

Chapter 3

Where Is the Disease?

Chapter 4

The Contagious Spread of Rebellion

A Photo Gallery by Earl Dotter

With Images from His Historic Workplace Collection

Chapter 5

Resistance to Disease

Chapter 6

Reviving the Movement

Chapter 7

Black Lung and the Politics of Union Reform

Chapter 8

Reckonings

Acknowledgments

Appendix

Notes

Index

Preface

Digging Our Own Graves, first published in 1987, concluded with an ominous prediction: Black lung disease awaits the younger generation of coal miners who are now at work underground. Would that I had been wrong! Today, not only do coal miners still suffer from this lethal but preventable lung disease, they do so at younger ages, some even in their thirties, and they are contracting the most advanced form of black lung at the highest rates ever recorded. More than fifty years after the US Coal Mine Health and Safety Act of 1969 imposed a respirable dust standard on the coal industry, designed to prevent black lung, why do such carnage and suffering persist? This updated version of the original book seeks answers to that question.

My own introduction to black lung began in the winter of 1971–1972, when I came to West Virginia to work for the Black Lung Association. I was barely twenty years old. Extraordinary political transformations were in the making: coal miners, miners’ wives, and widows were challenging powerful institutions that had once commanded their acquiescence—the hierarchy of the United Mine Workers, the coal operators’ association, county political machines, and the Social Security Administration.¹ For a young college student from the Midwest, these developments in the mountains of West Virginia beckoned with a romantic excitement. Besides, the mountains were my ancestral homeplace; now I could return to them, not on a summer vacation in the backseat of the family car, but on my own.

Working with the older coal miners and impatient young organizers who made up the Black Lung Association at that time was a formative political experience for me. Coming from a long line of southern subsistence farmers and circuit-riding preachers, I was instilled with a righteous, if vague, sense of populism that made me eager to join the struggles of working people. But neither my political heritage nor my exposure to campus radicals prepared me for what I found in the coalfields of West Virginia: above all, the stark boundaries and clear perceptions of class antagonism. Virtually every coal miner over the age of sixty-five proudly claimed to have fought in the battle of Blair Mountain with a machine gun in 1921 to bring the union into southern West Virginia. They were up against the combined forces of coal company guards, the state police, county sheriffs and their deputies, aerial bombers, and, ultimately, the US Army. I was dumbfounded.

Fortunately, it didn’t occur to me to write about any of these experiences until my age and the changing times helped to deepen my understanding of what they might mean. In 1978, more than six years after I had first worked for the Black Lung Association, I began the research for a dissertation on the black lung movement. The political atmosphere was altogether different. A reform movement in the United Mine Workers of America (UMWA) had arisen, succeeded in a special election for leadership of the union, then disintegrated; the black lung movement had seemingly disappeared; and a storm of reaction was sweeping the Appalachian coalfields. The setbacks were frightening, but they made possible a more sober and critical perspective on the earlier period of upheaval.

I began this book as a labor history, asking obvious questions that seemed most important at the time: Why did the movement end this way? What did it accomplish? How did it fail? Who or what was to blame? As I dug deeper into the history of the black lung movement, however, these apparently clear-cut questions about victories and defeats began to seem ambiguous, even misleading. The assessment of whether the movement had succeeded or failed depended a great deal on whose goals were used as the standard of measurement—and goals varied considerably among different participants. Moreover, what the larger political culture defined as the movement’s greatest accomplishments often turned out to be mainly symbolic; they represented the visible outcomes of formal processes of reform (the passage of legislation, for example), but in and of themselves did not necessarily signify substantial and lasting change. The simplicity of my original questions faded as the labels of victory and defeat, success and failure, appeared more and more ephemeral. The central analytical problems increasingly seemed to involve the maddening complexity of social change itself, which prevented any person or group from controlling the course or outcomes of this movement.

As I delved further into the reforms sought and controversies engendered by the black lung movement, it became apparent that the movement was more than an important episode of labor resistance. At issue in the struggles over black lung, which have reemerged today, is not only how to prevent the disease or compensate those affected by it but also the very definition of black lung. Frequently, the most ideologically powerful opponents that miners have faced in their successive surges of activism are not coal operators or conservative politicians but physicians. At the center of the black lung controversy has been a profound power struggle between miners and physicians over who will control the definition of this disease.²

As a result of these and other shifts in emphasis, this book is a hybrid. It draws on diverse theoretical traditions in order to analyze not only the organization and development of the black lung movement, but also the history and conflict that underlie the brutal fact of coal miners’ diseased bodies. Beginning with how and why black lung originates in the workplace, this book also explores the medical history of the disease and the conflicting meanings that miners and certain physicians, lawyers, and government administrators invest in black lung.

After moving away to a self-imposed exile some twenty-five years ago, I live once again in West Virginia. Contrasts with the 1970s heyday of working-class activism are evident throughout the rural landscape of abandoned gas stations, rusted coal tipples, and boarded-up union halls. The differences are personal as well: when I interviewed black lung activists in the 1970s, I was the age of their daughters and granddaughters; today, I am eligible for Medicare. As I conducted additional interviews in 2019, mostly with retired coal miners close to my age, their bodies as well as their words spoke the story of black lung disease and the physical toll of hard-labor jobs. Conditioned as a white woman to thinking of my embodiment primarily in terms of gender, I was struck again and again by how the privileges of class have shielded me from harm and become subsumed into my body. This updated and revised book, which includes two new chapters and a moving, evocative photo gallery by Earl Dotter, thus entails not only additional research into medical, legal, and economic materials relevant to black lung, but also historical reckonings both political and personal.

Today, as I write this preface, the power relations that miners experience on the job are dangerously asymmetrical, and their outcomes grim. Coal miners in southern West Virginia, once the stronghold of the UMWA in central Appalachia, where those who crossed a picket line invited ostracism if not assault, now work nonunion. Coal companies, facing shrinking domestic markets and in many instances bankruptcy, force workers, coal communities, and American taxpayers to bear the costs of their decline. Black lung can only be fully understood as part of this historical moment, when resistance, remarkably, persists. Digging Our Own Graves analyzes the dreadful resurgence of black lung within the long history of efforts to legitimate this disease and make it visible, prevent black lung in the workplaces where it is produced, and extend dignity and a measure of justice to those for whom prevention comes too late.

Interviews

The original interviews with the individuals listed below were conducted under terms of anonymity and confidentiality, a decision I later regretted. Unfortunately, I was unable to locate all respondents some six years after the interviews to request permission to reveal their names in association with specific quotes. Therefore, all excerpts from these original interviews remain anonymous.

Martin Amburgey

Willie Anderson

Bill Bailey

Rick Bank

Eric Brandt

Gina Brandt

Basil Brown

Don Bryant

Mike Burgess

Lyman Calhoun

Carl Clark

Eustace Clay

Clara Cody

E. E. Cody

Grant Crandall

Penny Crandall

Levi Daniel

Jesse Durham

Gail Falk

Walter Franklin

Robert Guerrant

Frank Hale

Leona Hall

Jim Haviland

George Hughes

Paul Kaufman

Lorin Kerr

Gibbs Kinderman

Joe Malay

Robert McDaniel

Warren McGraw

Arnold Miller

Woodrow Mullins

Joe Mulloy

Karen Mulloy

Milton Ogle

Willa Omechinski

John Pawlus

Robert Payne

Helen Powell

Frank Powers

Don Rasmussen

Tom Rhodenbaugh

Ernest Riddle

Craig Robinson

Norita St. Clair

Ray St. Clair

Sydnee Schwartz

Earl Stafford

Don Stillman

Bill Stone

Paul Stone

Lonnie Sturgill

Phoebe Tanner

Bill Weiss

Leslie Wellman

Teri West

Benita Whitman

During 2019–2020, as I updated and revised the original book, I conducted additional interviews with the individuals listed below, most of whom preferred to be quoted by name.

John Cline

Jerry Coleman

Charles (Hawkeye) Dixon

Gary Hairston

Mary Huntley

Chris Mark

Joe Massie

Howard Phillips

Linda Raisovich-Parsons

Steve Rentch

Josh Roberts

Dennis Robertson

Danny Whitt

Debbie Wills

Chapter 1

Diagnosing the Problem

The black lung movement breached the wall of silence that conceals the work-related diseases and deaths of workers in the United States. In 1968, it launched a controversy over occupational health that has persisted on and off to this day. Textile workers fashioned a brown lung movement after coal miners’ example.¹ Asbestos workers pressed for a federal compensation program similar to that covering disability and death from black lung.² With increasing frequency, trade union activists have included occupational safety and health protections among their collective bargaining demands; in the legislative arena in 1970, they secured the federal Occupational Safety and Health Act patterned in part after the Coal Mine Health and Safety Act of 1969.³ Despite the many tangible accomplishments of the black lung movement, including an unprecedented federal compensation program and strict respirable dust standard designed to prevent the disease, coal miners today experience in their bodies the injustice that they fought to eliminate more than fifty years ago (see photos 2 and 4). One-fifth of underground working miners in central Appalachia who have twenty-five or more years on the job show evidence of coal workers’ pneumoconiosis (CWP), one of the ensemble of occupational respiratory diseases that miners call black lung.⁴ Moreover, they are contracting the most advanced, breath-robbing form of CWP—pulmonary massive fibrosis, or PMF—at the highest rates ever recorded.⁵

Coal miners and their families possess insights about why this resurgence is occurring, but their perspectives differ in important ways from prevailing explanations.⁶ The latter include technical approaches that analyze factors like increased silica content in mine dust, and liberal political accounts that emphasize governmental regulatory failure.⁷ By contrast, many unionized miners have long focused on their power relations with the coal operators, those who own and supervise the mines, as fundamental to their health as well as safety. This is not to suggest that either the composition of dust or the content of regulation is irrelevant. Rather, such factors unfold within historically specific class dynamics that function to restrain or intensify the hazards of mining. When miners have enjoyed significant leverage in the workplace, they have been able to, for example, refuse unsafe work and insist on accurate dust sampling (photo 1). However, in the present period—indeed, for more than forty years now—miners and their trade union, the United Mine Workers of America (UMWA), have been under attack, and miners’ bargaining power is considerably weakened. Digging Our Own Graves traces these transformations in the balance of power between underground miners and operators within the overall political economy of the bituminous coal industry, and, drawing on the testimony of miners themselves, analyzes the social and economic production of black lung.

The Saudi Arabia of Coal

Central Appalachia, including eastern Kentucky, southern West Virginia, and southwest Virginia, is the contemporary epicenter of black lung disease.⁸ During the late nineteenth century, this region of thickly forested mountains and modest farms alchemized into coalfields, as companies bought land, built towns from the ground up, and hired men of diverse racial and national backgrounds to retrieve from the earth rich deposits of bituminous coal.⁹ Classic elements of the resource curse—thwarted economic development, anti-democratic politics, economic whipsaws of boom and bust, endemic poverty—soon became apparent in this rural region.¹⁰ But central Appalachia is also the site of extensive popular organizing and collective resistance. Long before the black lung movement began in southern West Virginia, Appalachian coal miners banded together and, during three long decades of hard-fought strikes and armed confrontations, sought to join the UMWA. In 1933, they largely succeeded.

Today, some two decades into the twenty-first century, the Appalachian coal industry is in the doldrums. Since 2000, the region’s coal production (both surface and underground) has fallen by half, with central Appalachia accounting for 84 percent of that drop. By contrast, output nationwide fluctuated but, until 2012, generally rose.¹¹ However, the geographic center of the industry shifted: in 1993, after more than two decades of exponential growth, vast surface mines in the Powder River Basin and other areas west of the Mississippi River surpassed Appalachia as the primary locus of production, most of it thermal coal destined for utilities. That market is now in a tailspin nationwide due to closures of coal-fired electric plants and competition from renewables and natural gas.¹² Central Appalachia’s top-grade metallurgical (met) coal, once produced for the large domestic steel manufacturers that owned most of these mines (photo 3), has become increasingly subject to the vagaries of the export market. In southern West Virginia and southwest Virginia, where most of the coal produced is metallurgical, total underground output shrank by more than 60 percent from 1994 to 2019, and, in 2018, more than 40 percent of this area’s metallurgical production was shipped out of the US.¹³ Faced with long-term collapse in domestic market demand, Appalachian coal operators disingenuously but successfully positioned themselves as embattled allies of their workers against former President Obama’s presumed war on coal.¹⁴

Chart 1. US Bituminous Coal Production by Region and Year

For definitions of terms, geographic areas, and other details that appear in the charts, see the explanatory note in the appendix.

Sources: US Energy Information Administration, Coal Industry Annual 1985, 1990, 1995, 2000; Annual Coal Report 2005, 2010, 2015, 2018.

The changing political economy of the Appalachian coal industry helps make sense of certain technical factors that epidemiologists and other scientific researchers fault for the rise in black lung. These include positive correlations between lung disease and small mines (fewer than fifty workers), longer work hours, rank of coal, and the practice of cutting into silica-laden rock.¹⁵ One analysis of working miners’ chest X-rays taken by the National Institute for Occupational Safety and Health (NIOSH) Coal Workers’ Health Surveillance Program from 1970 to 2009 concluded that workers from small mines were five times as likely as workers in larger operations to contract PMF. This tendency is evident in X-rays beginning in the 1980s, then worsens considerably in subsequent decades.¹⁶ In roughly the same period of time, 1978–2008, data from the Mine Safety and Health Administration (MSHA) indicate a large jump (by almost one-third) in the number of hours that miners work each year.¹⁷ As for the composition of dust, researchers have long known that the higher the rank of coal, ranging from low-rank soft lignite (brown coal) to anthracite, the more damaging its respirable dust; virtually all central Appalachian coal is medium or high rank.¹⁸ Since 1980, chest X-rays of miners from West Virginia, Kentucky, and Virginia increasingly revealed a type of opacity associated with silica exposure as well; indeed, X-rays taken during 2000 to 2008 reveal a 7.6-fold increase in this opacity over those from the 1980s.¹⁹ Since black lung typically takes several years to manifest on an X-ray, these findings suggest that developments in central Appalachian coal mining, beginning in the late 1970s and intensifying thereafter, have been increasingly hazardous for miners’ health.

Ask UMWA miners about these trends and their explanations vary, but they often include the workplace consequences of the fierce, protracted, and ultimately successful anti-union offensive that certain operators spearheaded in the late 1970s. (See chapters 7 and 8.) Between 1973 and 1992, UMWA membership plummeted by more than 50 percent, from an estimated 213,000 to 82,000. By 1993, only 32 percent of the 32,000 underground miners in central Appalachia belonged to the UMWA; as of 2018, union density had dropped much further, to 7 percent.²⁰ Given the region’s large pool of surplus labor, miners’ realistic fear of job loss, and the weakened position of the UMWA, union representation cannot guarantee protection against bosses’ demands for productivity, regardless of safety and health. But, without the union, there is little protection at all.

Lack of a worker organization to counter unreasonable or abusive employers is significant in any workplace, but it is especially so in an industry as inherently dangerous as underground coal mining. Longer hours, which of course increase dust exposure, are a direct result of working without a union contract that specifies the circumstances in which miners work overtime. Changes in working conditions are less easily quantified but equally important. Retired miner Terry Lilly:

I had to go to nonunion because I couldn’t find a union job … When you work nonunion, you have no voice … You didn’t hang curtain [used to control ventilation], you didn’t ask about curtain, you didn’t ask about dust pumps [devices for sampling respirable dust]. It was all pretty much, This is what you’re going to do. I think the coal miners lost their voice, and I think their voice is in the UMWA.²¹

Chart 2. Percentage of Workers in UMWA at Underground Mines in Appalachia and Subregions, 1993 and 2018

Sources: US Energy Information Administration, Coal Industry Annual 1993, Table 45, pp. 66–67; Annual Coal Report 2018, Table 20, p. 35.

Ownership of the Appalachian coal industry also began to transform during the 1980s. Following a brief heyday in the wake of the Arab oil embargo of 1973–1974, when coal became the reliable, seemingly limitless domestic energy source and drew new investment from major oil companies, among others, the Appalachian portion of the industry began to decline. Expanded production of low-sulfur, surface-mined coal from thick seams in the West, prompted in part by the Clean Air Act of 1970, drove a long, downward slide in the price of thermal coal. Simultaneously, demand for Appalachia’s top-grade metallurgical coal tanked along with the fortunes of domestic steel producers, whose output fell by one-third from 1974 to 1984.²² Faced with shrinking profitability, some larger operators in the East began to hire small, nonunion contractors to mine their coal more cheaply. Others, including Big Oil and, eventually, domestic steel, began to divest their coal holdings; by 1990, oil company ownership of coal was back to its 1970 level.²³ As get-rich-quick expectations escalated during the 1990s throughout US businesses, vulture capitalists began circling the eastern coal industry, stripping assets from larger coal operations, selling off mines one by one, and sometimes declaring bankruptcy, a legal maneuver that typically allowed them to shed contractual obligations to pay unionized miners’ retirement and health benefits for life.²⁴ Underground employment in the region declined precipitously and, in central Appalachia, those who were able to find jobs increasingly worked in small mines. Throughout the 1980s and 1990s, even as coal nationwide became more concentrated in ownership, the central Appalachian coal industry became increasingly fractured, unstable, and nonunion.²⁵

Chart 3. Percentage of Underground Miners at Small Mines in Appalachian Subregions by Year

Source: MSHA Mine Data Retrieval System, available at https://www.msha.gov/mine-data-retrieval-system.

UMWA miners describe the working conditions in small, nonunion mines, so-called dogholes, with particular disdain. Mines with relatively few employees have long been the bane of the UMWA: they are difficult to organize and, even when miners elect to join the union, the undercapitalized coal operators who often own such mines may seek to evade their contractual obligations to pay into UMWA benefit plans. Unable to invest in expensive equipment to increase productivity and, hence, profitability, more marginal operators of small mines tend to extract as much value as possible from miners’ hard labor. Retired miner Danny Whitt, from southern West Virginia, describes working in such a mine:

I worked at one [small, nonunion] mine. They told me when they hired me, When you come to work here, we don’t pack a lunch bucket. We don’t have time. If we break down, we want you either shoveling [coal] on the belts, or hanging curtain, or hanging cable, or something. They really had bad equipment, old equipment, trying to get by cheap as they can, mine coal and make money. Their primary objective was to get that coal out. They’d get you inside—it was about five mile—and the ride they’d take you in on would have to sit out there and charge for eight to ten hours before they could come back in to get you. That’s how bad the batteries were.²⁶

Operators of small mines are often extracting coal from thin seams that were once considered unmineable, or at least insufficiently profitable. Virtually all thin-seam mines (96 percent) are in Kentucky, Virginia, and West Virginia.²⁷ The price that central Appalachia’s metallurgical coal can command during good years in global markets is an important inducement for operators small and large to go after narrower and less accessible seams. Formerly a miner and then an MSHA inspector, Ron Barber, who now teaches at the National Mining Academy in Beckley, West Virginia, commented: We’re sitting in the middle of the Saudi Arabia of coal, metallurgical coal. When met coal is at three hundred dollars a ton [a price it reached in 2011], we start mining stuff that was marked in the 1970s as unmineable … These guys [operators] live and die with the price of met coal. When it’s booming, they go after everything they can get.²⁸

Mining coal that is relatively inaccessible and/or in thin seams often entails drilling through sandstone rock with high silica content. When ground into dust and inhaled, tiny, respirable particles of silica act like ground glass, destroying lung tissue far more rapidly than coal dust.²⁹ The rotating drum on the continuous miner, the machine commonly used in central Appalachia to cut coal from the face, may exceed the width of a thin seam and cut considerable rock during routine mining. Moreover, many coal seams are neither close to the surface nor uniform: miners must often drill into the side of a sandstone mountain to access the seam; hence, even surface miners, especially drilling operators, are susceptible to black lung.³⁰ Once miners reach the seam, it may still be interrupted by walls of rock or split by a middleman, a rock extrusion that runs through the coal.³¹ Danny Whitt describes drilling through sandstone in a small, at the time unionized, underground mine:

At 1979 or ’80, I got on at Massey. It was really small; they had a little old dinky office down here at what they call Rawl, beside the post office … It was really low coal, anywhere from 32, to 36, up to 38 inches … They hit a roll [of rock], and they went every direction trying to get around it to that coal. It was pure doghole conditions. I was on the third shift and we’d be on a jackhammer in sandstone, drilling, trying to get that roll to shoot [break up].³²

Not surprisingly, labor productivity (tons of coal produced in relation to hours worked) in such small mines tends to be relatively low, and since the early 2000s it’s been getting worse. Although productivity can swing from year to year and many factors influence it, the effort to extract coal from increasingly marginal seams likely contributes to relatively low, and falling, productivity in central Appalachia. Most other areas in the Appalachian states also saw a decline in productivity beginning in the early 2000s, but it was not nearly as severe.³³

Machinery, physical infrastructure, labor productivity, and work practices in larger, more capital-intensive mines contrast sharply with the doghole working conditions that often characterize smaller mines. Longwall operations, for example, require heavy investments in machines that shear coal off the face on panels hundreds of feet wide and sometimes more than a mile long. Although longwall machines also produce high levels of dust, relatively few miners actually work at the face; the great majority of the workforce is outby (toward the entry where fresh air comes into the mine). In addition, capital-intensive mining brings with it a financial incentive for operators to maintain good ventilation to reduce buildups of methane gas and coal dust, which can explode and destroy their entire investment.³⁴ Former miner Josh Roberts, head of the UMWA’s Health and Safety Department, describes some of these financial calculations:

[It requires] a huge front of money to put in a longwall. We’re talking a larger structure, larger water lines. They may have to cut the track higher to make sure you can haul the shields in. A lot of money up front that some companies may not have.

Up north, I’m talking about northern West Virginia, where a lot of [Robert] Murray’s operations are located, he has all longwall operations up there. Come down to southern West Virginia, he’s not as predominant down there. That’s a lot of continuous miner operations down there, a lot more met coal operations in southern West Virginia. Northern West Virginia, you’re looking at a lot more steam coal. In southern West Virginia with the met coal, they’re getting higher prices out of that coal so they can afford to have higher [per-ton labor] costs.³⁵

Chart 4. Percentage of Underground Coal Production by Longwall in Appalachia and Subregions, 1993 and 2018

Sources: US Energy Information Administration, Coal Industry Annual 1993, Table 5, p. 12; Annual Coal Report 2018, Table 3, p. 9.

Taken together, these patterns, trends, and distinctions within Appalachian coal mining help to explain the resurgence of black lung, specifically in central Appalachia. They suggest coherence and meaningful internal relationships among technical variables, such as mine size and increased exposure to silica, which otherwise appear random and disconnected. Destruction of the union has been particularly pronounced in this region, and that loss has left miners vulnerable to relatively unfettered exploitation and longer work hours. However, that is not the whole story. The changing political economy of the industry enabled the persistence of smaller operators who sought to profit, regardless of the consequences for their workers’ health, from mining narrow and barely accessible seams of coal. Mine size, rank of coal, silica content in dust, work hours—all may be identified as potential contributors to miners’ lung disease, but what sets them in motion are the decisions and actions of human beings. Attributing causality exclusively to technical factors banishes the world of social relations, economic incentives, and the day-in, day-out dynamics of power in the workplace that shape the production of disease.

A second major explanation for the resurgence of black lung is distinct from solely technical analyses. It attributes the escalation of the disease to a gross and frank example of regulatory failure, and cites MSHA’s unwillingness to adopt a separate standard for respirable silica as evidence.³⁶ Lowered in 2014, the respirable coal dust limit underground is now 1.5 mg/m3 air, but there is no separate threshold or direct sampling required for respirable silica.³⁷ MSHA’s failure to adopt a separate silica standard is indeed reprehensible, especially in view of the fact that NIOSH, as early as 1974, recommended that the permissible exposure limit for respirable silica in all workplaces in the US be no higher than 0.05 mg/m3 of air.³⁸ Two generations and forty-four years later, in 2018, the Occupational Safety and Health Administration (OSHA) finally began enforcing a 0.05 mg silica standard across many industries, but OSHA does not set standards for coal mines.³⁹ Those who favor the regulatory failure explanation claim that had MSHA adopted the same standard when significant silica became evident in coal mine dust samples, beginning in the mid-1990s, We would not be seeing the disease that we’re seeing now.⁴⁰

This argument is in one sense indisputable: had MSHA stepped in with sufficient determination, capacity, and punitive authority to regulate, monitor, and enforce limits on