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Tuesday Sep 05, 2017

Halting Health Studies Harms Patients, Hinders Physicians

West Virginia isn't known for being healthy. It is known for leading the nation in overdose deaths(www.cdc.gov) (by a wide margin, I might add) and morbid obesity(www.cdc.gov), and it competes for the top spots in unemployment(www.huffingtonpost.com) and overall mortality(www.kff.org)

A mining company removes the top of Kayford Mountain in West Virginia in search of coal. The process has been linked to an increased risk of lung cancer and other health issues. [Image used in accordance with Creative Commons Attribution-ShareAlike 2.0 license]

There has long been speculation about our state's poor rankings, and there are data to suggest it comes down to socioeconomic influences, because the areas with the most poverty and the least education have the worst health outcomes(www.theet.com). But one of the biggest contributors is industry.

The Trump administration recently halted a study(www.cnn.com) by the National Academies of Sciences, Engineering and Medicine on the health consequences of mountaintop removal mining in Appalachia. As a physician who cares for patients who work at these sites or live near active or abandoned mine sites, this decision is heartbreaking. The study wasn't stopped because there is no longer suspicion that this type of mining is bad for community health, and it wasn't stopped because it was proven safe.

The entire practice of medicine is founded in science, research and doing no harm. We don't take anything for granted; we don't make any diagnostic or treatment decisions based on speculation. Everything we do, from the questions we ask our patients to the dose and length of treatment for a round of antibiotics, is based on multiple studies that confirm safety and efficacy. So why aren't we holding the employers and industries in our communities to the same standards?

Many people assume the detrimental effects of mining are limited to underground mines and black lung, but data already exist that show associations between poor health outcomes and mountaintop removal mining.

I see patients with coal worker's pneumoconiosis (black lung) often, and it is an awful disease that doesn't respond to treatment like other chronic lung diseases. Chronic obstructive pulmonary disease, sarcoidosis and asthma all pale in comparison to the debility black lung causes. I have one patient who may need a lung transplant because of black lung and another with progressive heart failure as a result of the same condition. But individual cases are only the tip of the iceberg. Studies show that cancer mortality and prevalence are higher(www.ncbi.nlm.nih.gov) in areas with close proximity to mountaintop removal mining. And these effects -- mortality rates, specifically -- are significantly higher in mining communities, even when corrected for what we now call social determinants of health.

My concern doesn't end with those directly touched by a mountaintop removal mine. My patients dedicate themselves to jobs in related industries such as logging, trucking, welding, mechanics, logistics operations, security and electrical work. And they all are placed in situations that may compromise their health, often by limiting their access to medical care despite providing health insurance.

The coal and gas companies, in particular, tend to provide work seasonally, and layoffs are just part of the deal. But as a physician, the cycle is maddening. Patients never know when the layoff will happen. Once it is announced, they have health insurance for 30 more days, and then it's gone until the call comes to return to work. These patients have multiple poorly controlled chronic diseases. When they have work, it is six or seven days a week for months with no opportunity for a blood pressure check or doctor's appointment since the last layoff. They see me when they can and I find some red flags, attempt to get them set up for sleep studies and stress tests, colonoscopies and mammograms, and then they lose coverage before I can get them scheduled. The following year, they come back sicker than the last time, and we repeat the process.

This is not justice. This is not the American dream. This is not health care. This is the epitome of sick care.

We know fragmented care is bad. We know that the best outcomes come from obtaining primary care from a usual source. And we know from experience that big catastrophes come from placing profit and economic growth ahead of methodical, evidence-based research.

Preventing researchers from answering questions about mountaintop removal mining and community health doesn't make that industry less of a threat. It simply makes it harder for physicians like me to care for our patients.

Kimberly Becher, M.D., practices at a rural federally qualified health center in Clay County, W.Va.

Posted at 03:15PM Sep 05, 2017 by Kimberly Becher, M.D.

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