Clearing the Pathway: Deadly Lung Disease Can Be Prevented (Op-Ed)

Seth Shulman is a senior staff writer at the Union of Concerned Scientists (UCS), a veteran science journalist and author of six books. This article will appear in Shulman's column 'Got Science?'. Shulman contributed this article to LiveScience's Expert Voices: Op-Ed & Insights.

The power of science is rarely showcased more clearly than when it helps craft policies that definitively save human lives. That's why it is such welcome news that, in a long-overdue development, the White House last month allowed a proposed new science-based rule to move forward that will finally modernize protections for millions of U.S. workers exposed to silica dust, preventing thousands of unnecessary deaths from silicosis — perhaps the world's oldest-known occupational illness.

The story of this silica-dust rule is a clear object lesson about the vital role science plays in the government and how that role can too frequently be drowned out by political wrangling and corporate interference. In this case, the science is a slam dunk, and the pathway toward saving lives from preventable illness is clear. And yet, implementing this particular science-based regulation has, so far, still proven to be a tortured and arduous process, taking decades longer than it should have — a period during which thousands of American workers have needlessly died.

The most recent White House chapter in this saga is no exception, prompting hundreds of scientists and medical professionals to speak out when the review by the Barack Obama administration's Office of Management and Budget dragged well beyond its mandated 90-day deadline into what ultimately would become a two-and-a-half-year delay. More on that in a minute. Let's first consider what's at stake and the role science has played so far.

Silicosis: Incurable but entirely preventable

Silicosis is an incurable and often deadly lung disease in which victims lose their ability to breathe. It is not an infectious disease like AIDS or the flu. Rather, as scientists have long known, it's an occupational disease, caused by exposure to silica dust — the fine particulate raised when workers cut rock in mines or quarries, during some construction work such as sandblasting, as well as in a number of other work situations, including some modern hydraulic fracturing (fracking ) operations.

Silicosis develops when too many of the tiny silica particles — each a hundred times finer than a grain of sand — lodge deep in a person's lungs and, as part of the body's natural defense mechanism, result in the formation of scar tissue that permanently destroys normal breathing and lung function.

A well-understood disease pathway

Scientists have recognized this workplace hazard for centuries. In fact, Bernardino Ramazzini, widely considered the father of occupational medicine, noticed the link between respiratory symptoms and "sandlike substances" in the lungs of stone cutters back in the 1700s.

So what's the role of silica dust in causing silicosis? Scientists have understood that for nearly a century. The U.S. Public Health Service issued a report on the dangers of silica dust for miners, granite cutters, "foundrymen'' and glassworkers back in 1917. Horrific worker exposures since then have even led to widespread public outcry.

In the early 1930s, for instance, the Hawk's Nest Tunnel disaster in West Virginia demonstrated the dangers of acute silicosis in what is still one of the nation's worst-ever industrial tragedies. As 5,000 men drilled and blasted unprotected through the quartz rock of West Virginia's Gauley Mountain, the toxic silica dust coated their lungs and caused them to die so fast that they were reportedly buried in a nearby cornfield in an attempt to cover up the extent of the tragedy. More than 764 workers are believed to have perished in that tunnel alone. Partly in response, the federal government declared silicosis to be the U.S.' No. 1 industrial health problem in 1938, when then-Secretary of Labor Frances Perkins convened a National Silicosis Conference in Washington, D.C., and even issued a remarkable educational film called "Stop Silicosis" to try to reduce silicosis deaths.

2 million at-risk workers

Today, thanks to a detailed scientific assessment, the U.S. Occupational Safety and Health Administration (OSHA) estimates that some 2.2 million workers are exposed to so-called respirable crystalline silica in their workplaces, most commonly in the construction industry. OSHA also says that the rules currently in place to protect these workers are confusing, inadequate and based on 40-year-old science. The agency estimates that the proposed new silica rule will save nearly 700 lives and prevent 1,600 new cases of silicosis every year once it comes fully into effect. What's more, scientific research has helped establish that silica dust, in addition to causing silicosis, is strongly associated with lung cancer, other respiratory disease and kidney disease.

The proposed new standard has years of sophisticated scientific research behind it. The National Institute for Occupational Safety and Health (NIOSH) recommended an occupational exposure limit for silica back in 1974 and published an updated report on the subject in 2002 that the government still cites as a definitive reference today.

Reviewing hundreds of scientific studies, the 2002 NIOSH report noted significant risk of chronic silicosis for workers exposed at current exposure limits and recommended that no worker be exposed to silica dust in excess of 50 micrograms per cubic meter of air for up to a 10-hour workday over a 40-hour week.

Kathleen Rest, executive director of the Union of Concerned Scientists, was serving as acting director of NIOSH when the 2002 report was released. "Our scientific understanding of the dangers of workplace exposure to silica dust has been known for decades — and was robustly documented in that 2002 report," Rest said. "That's why, as great as it is to finally see these rules move closer to implementation, it's also tragic that it's taken this long for rules that reflect the best-available science. It adds up to thousands of deaths and tens of thousands of cases of serious disease, all of which could have been prevented."

So, what took so long?

If the science was so clear-cut, why has it taken so long to bring worker safety rules on silica up-to-date?

A big piece of the answer is powerful industry opposition. While the rules languished in the White House for years, logs reveal no fewer than nine closed-door meetings between the White House and industry groups on the subject of the silica rule.

A large part of the objections, of course, is that tighter rules on silica-dust exposure come at a price. OSHA estimates that adhering to the new rules will cost smaller firms (with fewer than 20 employees) about $550 per year on average, and larger workplaces an average of $1,242 in additional costs annually. But those costs, the agency points out, should be balanced against savings in health care costs that will easily rise into the billions over the coming decades.

Another factor is the anti-regulation fervor prevalent in some quarters of Washington and Wall Street, in which practitioners are so keen to decry the ills of regulation they often downplay even their potentially life-saving benefits. Silicosis offers a case in point. Technically speaking, given the current understanding of the hazards and techniques to avoid them, no worker anywhere in the world should die of silicosis. In fact, this very thinking inspires the World Health Organization's (WHO) current worldwide campaign to completely eliminate the disease. As WHO puts it, "In the field of occupational health, there are few risk factors, and thus few health outcomes, that can be completely eliminated at the global level. Silicosis is a positive exception."

But it's not just big business…

This brings us, finally, to the unacceptable lack of transparency at the White House's Office of Information and Regulatory Affairs (OIRA), a branch of the Office of Management and Budget, where the proposed silica rule stalled for the past two-and-a-half years. Designed to review rules from federal agencies, OIRA wields unacceptably vast power in determining whether new regulations ever actually come into force. According to the latest government figures, OIRA's current backlog includes some 70 regulations beyond their required 90-day deadline, with more than a dozen proposed regulations having sat in OIRA's bureaucratic black hole for more than two years with no clue about when, if ever, they might re-emerge.

The lack of transparency means that OIRA can undermine science-based provisions of regulations with little accountability. The public deserves better, especially from an administration that claims to be committed to increased government openness. One group pushing for more OIRA accountability is the Coalition for Sensible Safeguards, a consortium of science, effective-government and other public interest groups. According to the group's recent analysis, rules currently stalled at OIRA include everything from safety standards for coal-ash waste to improved oversight of imported food.

When it comes to silica dust, workers and proponents of science-based regulation won an important round with OIRA's recent action. But it is important to note that the silica rule remains a proposed rule. OSHA will now move forward to accept public comments, but we're still many months, and likely years away, from implementing a silica rule. For the sake of the 2.2 million American workers currently exposed to silica dust, let's hope from this point forward the science is heeded with the urgency it deserves.

The views expressed are those of the author and do not necessarily reflect the views of the publisher. This article was originally published on LiveScience.