Graphic:Black lung by the numbers
PRESTONSBURG, Ky. -- Ray Marcum bears the marks of a bygone era of coal mining. At 83, his voice is raspy, his eastern Kentucky accent thick and his forearms leathery. A black pouch of Stoker's 24C chewing tobacco pokes out of the back pocket of his jeans. "I started chewing in the mines to keep the coal dust out of my mouth," he says.
Plenty of that dust still found its way to his lungs. For the past 30 years, he's gotten a monthly check to compensate him for the disease that steals his breath -- the old bane of miners known as black lung.
In mid-century, when Marcum worked, dust filled the mines, largely uncontrolled. Almost half of miners who worked at least 25 years contracted the disease. Amid strikes throughout the West Virginia coalfields, Congress made a promise in 1969: Mining companies would have to keep dust levels down, and black lung would be virtually eradicated.
Marcum doesn't have to look far to see that hasn't happened. There's his middle son, Donald, who, at 51, has had eight pieces of his lungs removed. He sometimes has trouble making it through a prayer when he's filling in as a preacher at Solid Rock Baptist Church.
There's James, the youngest. At 50, his breathing is becoming more labored, and his doctor has already discussed hooking him up to an oxygen tank part-time.
Both began working in the late 1970s - years after dust rules took effect - and both began displaying symptoms in their 30s. Donald now has the most severe, fastest-progressing form of the disease, known as complicated coal workers' pneumoconiosis. James and the oldest Marcum son, Thomas, 59, have a simpler form, but James has reached the worst stage and is deteriorating.
Men with lungs like the Marcums' aren't supposed to exist. "In 1969, I publicly proclaimed that the disease would go away before we learned more about it," said Dr. Donald Rasmussen, a pioneer in recognizing and diagnosing black lung who is still practicing, at 84, in Beckley, W.Va. "I was dead wrong."
Throughout the coalfields of Appalachia, in small community clinics and in government labs, it has become clear: Black lung is back.
The disease's resurgence represents a failure to deliver on a 40-year-old pledge to miners in which few are blameless, an investigation by the Center for Public Integrity and NPR has found. The system for monitoring dust levels is tailor-made for cheating, and mining companies haven't been shy about doing so. Meanwhile, regulators have sometimes neglected to enforce even these porous rules.
A Center analysis of databases maintained by the federal Mine Safety and Health Administration found that miners have been breathing too much dust for years, but MSHA has issued relatively few violations and routinely allowed companies extra time to fix problems.
MSHA chief Joe Main issued a statement in response to the findings: "The current rules have been in effect for decades, do not adequately protect miners from disease and are in need of reform. That is why MSHA has proposed several changes to overhaul the current standards and reduce miners' exposure to unhealthy dust." Similar attempts at reform have died twice before.
From 1968 through 2007, black lung caused or contributed to roughly 75,000 deaths nationwide, according to government data. In the decades following passage of the 1969 law, rates of the disease dropped significantly. Then, around the late 1990s, this trend reversed.
Many of the newer cases have taken a particularly ugly form. While rates of black lung overall have increased, incidence of the most severe, fast-progressing type has jumped significantly. These cases, moreover, are occurring in younger and younger miners. Of particular concern are "hot spots" identified in central Appalachia by the National Institute for Occupational Safety and Health, NIOSH, a government research agency.
"I think any reasonable epidemiologist would have to consider this an epidemic," said NIOSH's Scott Laney.
The National Mining Association, a trade group representing mining companies, agrees that black lung's comeback is a problem in need of attention. To the association, however, it is primarily a regional phenomenon - one that doesn't justify new national rules. What's needed, it says, is more research and better enforcement of current standards.
'A diabolical torture'
"They call me Lucky," retired miner James Foster says as he takes off his shirt and presses his chest against an X-ray machine in the back of an RV in Wharton, W.Va. "Worked 37 years in all kinds of mines. Been covered up twice. Been electrocuted."
His brushes with death aside, he's here because he fears there may be one hazard he can't dodge. "I come in here to file for my black lung," he says. During a recent heart surgery, he says, doctors said they saw what appeared to be signs of the disease.