Coal workers' pneumoconiosis, also known as black lung disease, is a pulmonary illness caused by inhaling coal dust over time, most commonly while working in coal mines. There are varying degrees of black lung disease, ranging from simple pneumoconiosis to progressive massive fibrosis. Black lung disease can be a devastating illness. And there is no cure, only treatments to ease symptoms (often with the same medications prescribed for asthma), manage complications, and boost oxygen levels with supplemental oxygen when needed. 

Coal workers with total permanent disability due to black lung disease are eligible for compensation under the US Department of Labor’s Division of Coal Mine Workers’ Compensation. An essential component of the medical evaluation of black lung disease is a chest X-ray paired with a standardized interpretation method specific to pneumoconiosis. 

A recent study published in Annals of the American Thoracic Society reviewed nearly 64,000 standardized chest X-ray interpretations performed by 264 physicians certified in reading black lung chest X-rays. The study found that physicians hired by coal mining companies were more likely to interpret the X-rays as having less severe disease than physicians hired by coal workers (who were more likely to interpret the X-rays as having the more severe disease). The study provides valuable evidence to question the practice of financial incentives for physicians making a diagnosis of black lung disease in a medical evaluation intended to be objective. 

Reference:

Friedman LS, De S, Almberg KS, Cohen RA. Association between financial conflicts of interest and International Labor Office classifications for black lung disease. Ann Am Thorac Soc 2021;18:1634–1641. https://www-atsjournals-org.umassmed.idm.oclc.org/doi/10.1513/AnnalsATS.202010-1350OC