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Brian Lehrer: Brian Lehrer on WNYC. We'll talk some more primary day politics later. We'll also have our WNYC centennial series, 100 Years of 100 Things, thing number 99, 100 years of the fight for LGBTQ rights. We have a really interesting historian lined up for that as we're going to go back to 1924, exactly 100 years and a year ago, and trace some of the politics and the stories. We'll invite oral history calls. That's coming up.

Now, our usual Health and Climate Tuesday section of the show today, how they intersect around President Trump's desire to reinvigorate the coal industry, of all things, even as a New York Times article reveals the greater toll that black lung disease is taking among younger coal miners in today's generations. I don't know if we'll find any callers in our New York area-based listenership with personal experience or family experience, or anything related to the coal mining industry. If you're out there, you're invited to call in and talk about black lung disease specifically, or whether the coal industry is worth saving or regrowing in your view. 212-433-WNYC, 212-433-9692. You can call us now.

This New York Times article says black lung disease was known as an old man's disease, but in reality, right now, the disease is showing up in men as young as their 30s and 40s. In fact, one in five working miners in Central Appalachia are estimated to be afflicted, according to the article. This resurgence does come as President Trump, as part of "drill, baby, drill", is promoting so-called beautiful clean coal, as he says. The Trump administration has slashed funding for federal research on black lung.

We have the writer of the article, Kate Morgan, a Pennsylvania-based journalist who traveled across Appalachia to speak with miners, doctors, patients, and researchers for her piece titled How Black Lung Came Roaring Back to Coal Country, published in the Times. Kate, thanks for your time today. Welcome to WNYC.

Kate Morgan: Hi, Brian. Thank you. I'm glad to be here.

Brian Lehrer: Listeners might be familiar with the term black lung disease, but might think of it as a disease from a different era. What exactly is it, and what causes it?

Kate Morgan: Sure. Yes, I know. I think there is a pretty wide misconception that this is a disease that belongs to the history books. It's like dysentery on the Oregon Trail. That is very much not the case. Black lung is an umbrella term. It's not exactly a scientific diagnosis. It's more a colloquial term for a set of lung conditions. The more scientific term for what we're talking about here is coal workers' pneumoconiosis. Essentially, what happens is you breathe in dust, coal dust, other things. It settles in the lungs, and the big pieces, your body can eject. You can cough them up and out, but the smaller pieces get stuck. They're too fine for your body to get out of your lungs.

Instead, there's an immune response. It's like when you get a splinter that you can't quite get out. Sometimes a lump forms around that splinter under the skin. Imagine that happening inside your lungs millions of times over. These macrophages, they're called, their immune cells, they get sent to eat up the dust, and they essentially wall it off and wrap it up, and then they form these little lumps. Over time, those macrophages and those little lumps can all come together and form nodules, and then those nodules can come together and form masses.

This is a progressive disease that ultimately turns into something called progressive massive fibrosis. These masses are so large now that they take up huge parts of the lung. Often on autopsy, this tissue has hardened. It's not the spongy, well-aerated lung tissue that you would expect to see in an organ designed to fill with air. Instead, it's hard and almost like rock, and it is the color of coal. That's why it gets its name, black lung.

Brian Lehrer: It's disabling as people become less able to breathe. Obviously, it takes its toll in premature death. A central premise of your article is it used to take more decades to develop severe black lung. Now, coal miners are getting it at younger ages. What changed?

Kate Morgan: That's correct. In coal mining communities, you will struggle to find anyone who can't tell you a story about their dad or their grandfather or their uncle, or sometimes all of those people who got to the end of their life and struggled for breath. They weren't necessarily all diagnosed with black lung. That is down to the era. We didn't even really recognize it as a disease, certainly not a compensable one, until the 1970s.

For generations before that, men have been working a full career in the coal mines. They spend 40 or 50 years underground, and then when they retire, they progressively struggle more and more and more to breathe. They often-- they die of heart attack or they get a flu or a pneumonia or something. They don't necessarily die of black lung, but it's certainly related. Now what we're seeing is men who have been working for 15 years, 20 years, in some cases even less time than that, who are as sick and in many cases sicker than those miners from a prior era.

That's happening for a couple of reasons. The way that we-- The standards have improved. There are standards in place to lower the acceptable amount of dust. There is new technology that can create ventilation inside mines. There are lots of ways to try to reduce this from happening, but it's happening nonetheless. That has to do with a lot of things. A pulmonologist I spoke to at the University of Illinois, Chicago, his name is Robert Cohen, and he explained that they considered a couple of things. One is that there is much less union density in Central Appalachia.

There was a time when nearly-- I mean, certainly a majority of coal miners in this region were affiliated with the union. That union provided them with a lot of protection because it was an extra level of enforcement of the standards that are in place to keep them safe. Also, it made sure that they were not working too much overtime, that their shifts were only the length that they were supposed to be, and thus that their cumulative dust intake would be limited. Now there's not a single union mine in eastern Kentucky. Dr. Cohen speculates that that has a lot to do with essentially men spending more time underground. The more time you spend down there, the more dust you take in. There's also--

Brian Lehrer: Let me jump in on that. The industry broke the unions?

Kate Morgan: Yes. This is a long and winding history. You may have heard of the phrase "Bloody Harlan" if you know anything about the history of coal mining. That refers to Harlan County, Kentucky. In the 1930s, there was an all-out war, an armed conflict in which people fought and died and killed to unionize the mines and to grant the coal miners a living wage and just essentially to put things in place that would protect their lives and their livelihood, and provide for their families when this extremely dangerous career turned deadly.

Then it happened again in the '70s. In 1973, also in Harlan County, there's a documentary that was very popular. It came out in 1976 and it's called Harlan County USA, and it's certainly worth a watch. It's about a major strike, a major United Mine Workers of America strike that took place in order to get those men a contract. They were on strike for, I believe it was 13 months. That strike-- Yes. It involved men standing on the picket line in Harlan County outside the mine entrances.

It also included-- They sent people to New York City to stand on Wall Street to talk to shareholders in Duke Power, the power company that used the coal that was coming out of the mine in question and encouraged them to divest from Duke Power because of what was happening hundreds of miles away in a place that most New Yorkers didn't even know existed.

Brian Lehrer: They won those unionization battles at that time, but then it sounds like things changed.

Kate Morgan: Things certainly did change as things do. It was a slow decline of the union. I will say that the union remains a very vocal part of this conversation. They still exist, and they still exist very loudly, and they weigh in on these issues. They are very much still there, but their membership has declined precipitously. As I said, in Eastern Kentucky, which is where a lot of this reporting happened, there are no, not a single, union mine. As a result, you can see how that would then ostensibly lead to more overtime, longer shifts, and less ability to do anything about that.

Brian Lehrer: We're going to take one caller who has family history in coal country. Then, Kate, I'm going to ask you to tell us how Trump administration policy and possibly even previous administration policies, but certainly what Trump is trying to change with "drill, baby, drill" plays into this, and then we'll be out of time. Louise in Brooklyn, you're on WNYC. Hi, Louise, thank you for calling in.

Louise: Good morning, Brian. Good morning to you, guest. My question is about the environmental issues that can occur within a family, whether they have been in the mines or not. My cousin's husband has inoperable non-smoker's lung cancer, which fortunately, Sloan Kettering has kept him alive for 20 years in a trial. His father, who was a coal miner in Pottsville, Pennsylvania, he died of black lungs, his mother died of melanoma, his brother died of esophageal cancer, and his other brother has leukemia.

While I was waiting for you to pick up my call, this is the question that came to my mind. Even if you have-- Although my cousin's husband has been-- He was in the mine once, and then at some point in his life developed his lung cancer. Environmentally, how do these coal mining expeditions jeopardize lives of the people living in those areas? I don't know if your guest can address that.

Brian Lehrer: Kate.

Kate Morgan: Sure. I would love to say that that experience is an isolated one, but it's not. I think there are plenty of families in coal country who could go through and list really similar ailments. What we're talking about here is coal dust. It is pervasive. When you're down in the mines, yes, you're breathing that dust, you're surrounded by it. There's also something called fugitive dust. I live not far from there in Pennsylvania, and we've got underground mines. There are also open-pit mines. Plus, when coal is moved around and it's dumped, and it's-- I mean, just imagine like clouds of dust. They're boiling up. That dust has to go somewhere.

There's a phrase for it. It's called fugitive dust. Basically, dust that is not contained, and that can get anywhere. Anyone in a certain radius, whatever way the wind's blowing, they could breathe that. Also, it sounds like your cousin's husband's father was a coal miner, which I can tell you means that he probably came home black every day, covered in coal. This is an aside, but in this part of Pennsylvania and a lot of the coal region, people tend to have basement bathrooms. There's a term for it, it's called a Pittsburgh potty. It exists because the coal miner would come home and go straight down to this bathroom that the rest of the family wasn't using and clean up.

They usually have a little shower stall, and it was just enough for him to wash the black off. You figure if you're surrounded by that every day, that's part of your environment. I don't think that it would be shocking to tie that disease back to coal dust.

Brian Lehrer: It's like secondhand smoke.

Kate Morgan: Exactly.

Brian Lehrer: Give me a policy thought. In April, more than 800 employees at the National Institute for Occupational Safety and Health were laid off, including some of your interviewees who were working directly on addressing this black lung issue. You report initiatives canceled, potentially affected include the development of technology to monitor silica dust exposure in real time. President Trump is all in on coal. He's been talking about "clean coal," or even "beautiful clean coal", and promising coal jobs since his first presidency. In April, he signed an executive order aimed at reviving the coal industry. Give us a short take here because we're going to run out of time on what that executive order actually does.

Kate Morgan: Sure, I'll talk fast. I want to say that, first, these scientists are the best in the world. They set the standard for research in mining and mining-related issues. They are who figured out that a big part of why this is happening is because miners are breathing more silica. Coal dust is very bad. Silica is so much worse. They're cutting through more rock now to get to coal. Modern technology can create or can cut through more rock, can pulverize it into finer dust. Silica is like- it's like breathing a million shards of glass, and it makes you sicker faster.

Anyway, so these scientists at organizations like the National Institute for Occupational Safety and Health got laid off in April, right around the same time that those executive orders got signed. What their organizations do, they're essentially the-- they're the security guards for coal miners. They're the front line in this battle against black lung. They review miners' X-rays, they monitor progression in black lung. They are often the only place that a minor gets an X-ray or an evaluation for whether he has black lung or is at risk for developing black lung.

They are also the only way that a minor who is showing signs of having gotten black lung can present that evidence then to his employer, and he has the right to be transferred to a dust-free environment. That is like a super short version of all the amazing things that these scientists do. Then they just lost their jobs with little to no warning. Then the Coal Workers' Surveillance Program, which is a tiny part of NIOSH, that's the National Institute for Occupational Safety and Health, they got their jobs back.

These are the people who are reading these X-rays, and they also have these mobile units. It's like a big van that drives around coal country and offers free, and this is crucial, confidential evaluations to miners so that they needn't fear that their employer is going to think, "What's he going to get an X-ray for?" and retaliate. Those people got their jobs back. That's people like Dr. Scott Laney, who is the epidemiologist in my story.

However, their division is still crippled. They don't have gas money for the mobile units. They've been parked since January in Morgantown, West Virginia. They canceled all their contracts with B readers. Who are the people who are qualified to read these X-rays. Now they have this huge backlog of X-rays, they can't actually fulfill their necessary tasks. People who didn't get their jobs back include the entire mining research division of NIOSH. That's people who worked in Pittsburgh and Spokane.

To make matters worse, the proposed budget for 2026 has an 80% cut to NIOSH. What's left, the 20%, is almost all earmarked for the mining research division. To put it another way, the people who got their jobs back at NIOSH don't have any money and won't be given any. The people who are getting all the money at NIOSH are fired.

Brian Lehrer: Wow. Yet another example. I'm so glad you wrote this article, and we were able to have you on for one of our Health and Climate Tuesday segments on the show, as we've been looking in different weeks at different kinds of cuts to the health infrastructure at the federal level and their impacts. The one that you have documented and put in such stark terms just now is one that so many people don't know about. I'm really glad you did this article. We're going to have to leave it there for now with Kate Morgan. Her new piece in the New York Times is titled How Black Lung Came Roaring Back to Coal Country. Thank you so much for joining us today.

Kate Morgan: Thanks, Brian.

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