US Doctors Hired by Employers Show Black Lung Bias

There is significant bias amongst doctors hired by employers to classify X-rays in coal miners’ black lung claims, a new study has found.

Researchers from the University of Illinois at Chicago suggest there is a financial conflict of interest among doctors hired by employers to review the chest X-rays of coal miners filing workers’ compensation claims with the Department of Labor’s Federal Black Lung Program.

A study conducted by UIC revealed that doctors, also known as B-readers, were making X-ray classifications strongly aligned with the party that hired them.

Almost 64, 000 X-ray diagnoses made by 264 doctors in claims filed between 2000 and 2013 were analysed. The results found B-readers hired by a coal mine operator reported negative readings for pneumoconiosis in 84.8 per cent of cases. This compared to a 63.2 per cent rate of negative readings from B-readers hired by the Department of Labor and a 51.3 per cent rate for those hired by a miner.

Pneumoconiosis is the general term for a class of lung diseases caused by the inhalation of dust. Coal workers’ pneumoconiosis (CWP) is commonly known as black lung disease and is caused by long-term inhalation of coal dust.

The study revealed a clear association between X-ray classifications and financial conflicts of interest, as well as a lack of consistency in classifications. According to the study, significant improvements are needed in transparency, oversight and objectivity for black lung claims.

The National Institute for Occupational Safety and Health (NIOSH) has established a review panel to assess and possibly decertify B-readers who frequently report “unreasonably inaccurate” classifications. Currently NIOSH will only decertify a B-reader after three independent investigations.

Associate professor of environmental and occupational health sciences at the UIC School of Public Health and study co-author Lee Friedman suggests current action might not be enough.

“Certainly, we anticipated finding some bias, as there has been anecdotal evidence for some time and the Department of Labor has even taken action since 2013 to avoid such bias. But the degree of bias shown in this data is alarming.”

Results also revealed 64 B-readers reported a negative reading for pneumoconiosis in at least 95 per cent of their classifications, with 93.3 per cent made by those hired by a coal miner’s employer. Conversely, 23 B-readers diagnosed simple pneumoconiosis in at least 95 per cent of their classifications, with 22 per cent made by those hired by miners.

Study co-author and director of the UIC Mining Education and Resource Center Robert Cohen said although there is evidence of bias on both sides, the degree of bias is heavier on the employer side and reveals a systemic problem.

“Not only are those hired by an employer much more likely to classify a chest X-ray as negative for black lung disease, but it is also much more likely that an employer will have the resources to hire its own expert – at a much higher fee – in the first place.”

The study was published March 29 in Annals of the American Thoracic Society and can be found online here.