ØLee Petsonk, MD

“Why is Black Lung Back? Tracking an Epidemiological Mystery” was published in early January at the Online Journalism Project, New Haven (CT) Independent.  The article features NIOSH respiratory disease specialist, Edward L. “Lee” Petsonk, MD, who has been a member of APHA and the OHS Section for about 25 years.  He received his medical training at McGill University's Faculty of Medicine in Montreal, with such notable mentors as Drs. Margaret Becklake, Peter Macklem, and Anthony Robbins (who later served as NIOSH director and APHA President).  Dr. Petsonk joined NIOSH as a Public Health Service medical officer in 1979, and over the last 10 years has provided medical leadership for the NIOSH Coal Workers' Health Surveillance Program.  On Jan. 1, 2009, he retired from the Public Health Service. 

Below is an excerpt from “Why is Black Lung Back? Tracking an Epidemiological Mystery” http://www.newhavenindependent.org/HealthCare/archives/2009/01/why_is_black_lu.php by journalist Carole Bass.

Black lung disease used to be nearly as common as dirty fingernails among American coal miners.  Roughly a third of them got the fatal illness.  Starting in the 1970s, a federal law slashed that rate by 90 percent. But now it’s back.  Dr. Edward L. “Lee” Petsonk was a respiratory disease specialist, but not a coal mining expert, when NIOSH put him in charge of its Morgantown-based black lung program about 10 years ago.  The program offers each underground coal miner a free chest X-ray every five years. That’s how NIOSH tracks rates of the disease.

Although coal production is booming, the number of underground miners has dropped to fewer than 45,000 nationwide.  For a variety of reasons, most miners don’t take advantage of the X-rays.  So when Petsonk took over the black lung program, he decided it was feasible to orient himself by looking at every single new X-ray that came in.

“After a couple of years, something changed,” he recalls. “I began to see the type of disease that was only in the textbooks — this massive fibrosis, where the lung is basically destroyed.  It’s nothing but black scar tissue. I was incredulous.  And it was young people.  It wasn’t the older miners. I thought, something is wrong here. We decided we’d better do some research.”

In September 2007, Petsonk reported that the disease rate had more than doubled among miners who worked 25 years or more underground, from about 4 percent in 1997 to 9 percent in 2006.  The rate among miners with 20 to 24 years’ experience jumped even more, from 2.5 percent to 6 percent.  While those are still small percentages, the trend is going in the wrong direction.  “The statistics are important, and they help us pinpoint and evaluate the problem,” Petsonk says.

But statistics don’t tell the whole story. The federal Mine Safety and Health Act, passed in 1969 and fully effective since 1973, was specifically designed to eliminate the most advanced black lung cases altogether. Even without the statistics,

“what we know is these cases of young people getting sick. And that’s wrong.  That’s a failure of the Act.  The real tragedy,” Petsonk continues, “is that these are hardworking people who are doing a service for their companies and our society, and what they get for it is a really-”

“Raw deal,” interjects Anita Wolfe, Petsonk’s NIOSH colleague. 

“Well, more than a raw deal,” Petsonk replies. “If you see the suffering of a person struggling to breathe, every minute of every day, this is like a diabolical torture.”

Read the full article at:

http://www.newhavenindependent.org/HealthCare/archives/2009/01/why_is_black_lu.php

(Carole Bass is recipient of a 2008 Alicia Patterson Fellowship to investigate and write about workplace and environmental toxins)

ØMatt Kiefer, MD, MPH

The Migrant Clinicians Network’s Streamline newsletter recently featured an article on the work of Matthew Keifer, MD, MPH, who has been a member of the APHA OHS Section for more than 20 years.  The profile was written by Amy K. Liebman, MPA, another OHS Section member and co-coordinator of the Section’s “Occupational Health Disparities Institute.”

The following is an excerpt from the Streamline article; read the full article online at  http://www.migrantclinician.org/files/20080708_mcn_streamline.pdf

Each month for the last 13 years, Dr. Matt Keifer has flown from Seattle to Toppenish, the heart of Washington’s agricultural region, where he runs a half day occupational clinic at the Yakima Valley Farm Workers Clinic. Dr. Keifer deals with the complicated cases regarding work related injuries and exposures, cases no longer manageable in the primary care setting.  Yakima Valley Farm Workers Clinic Executive Director Carlos Olivares feels that offering an occupational medicine clinic on site in a migrant and community health center is critical to quality care and stresses the need to expand this model across the country. “If your mission is truly focused on improving the health of the worker, having an occupational medicine clinic is a no-brainer,” says Mr. Olivares. “Migrant health is generally thought of only from a primary care perspective, but occupational health is almost as critical. Can you imagine how the injured patient feels, knowing that specialty care is needed and having to go to a major metropolitan area for treatment? And how do you think the family doctor feels making this referral? The chances of the patient actually getting the treatment are almost zero. It’s not good care. And it’s certainly not cost effective. We need specialists like Dr. Keifer who can leave the university and come to the workers.”

Dr. Keifer works with the clinicians to help them understand occupational medicine. One key component that primary care providers often overlook is the determination of cause in occupational medicine. While the medical condition is diagnosed with the same certainty applied to any medical condition, the determination of the cause of the condition, whether it is in fact attributable to the workplace, is made on a “more probable than not” basis. In other words, clinicians only need to be more than 50 percent certain that the illness or injury is work related in order to file a claim. Documenting charts to satisfy both the medical and legal systems becomes critical for the patient’s as well as the clinic’s success in obtaining benefits from the worker compensation system.

For Dr. Keifer, his monthly clinics have helped him tremendously in designing relevant, applicable research projects, and more importantly, in gaining access to both the clinicians and the community to be able to do the research. Dr. Keifer is a renowned scholar regarding pesticide health effects and has published extensively in the peer reviewed literature on this topic. Most recently, his research has focused on cholinesterase monitoring of pesticide applicators in Washington, and some of his efforts involve community based participatory research. “When I do work in the community, I have first hand knowledge of what their health concerns and problems are,” says Dr. Keifer. “They know me and trust me. Having credibility is fundamental to doing any kind of research in the community.”

The clinicians in Yakima also have confidence that Dr. Keifer’s research efforts are going to be worthwhile. He feels his work with the health center has helped break down the perception of the “Ivory Tower” as his clinical activities have a track record of benefiting farmworkers. “They (the clinicians) know what they see. They know I know what they see. They know this guy’s out here in the trenches with them.” When he proposes research projects, the clinic tends to be very supportive of his work.

In the end, Dr. Keifer feels his monthly trips to the Yakima Valley have been as beneficial to him as to the patients he cares for. “It’s much more than volunteering. It’s about really doing the work I was trained to do. It’s motivating and it’s interesting. It keeps my Spanish in great shape. More than anything else, it’s my constant reminder that social justice and occupational medicine go hand and hand.”