Doctors hired by employers to examine miner X-rays for black lung show ‘alarming’ bias: study

Chicago — Physicians contracted by mine operators to review chest X-rays of coal miners who file “totally debilitating disease” workers’ compensation claims with the Department of Labor’s Federal Black Lung Program may have a bias strongly related to financial conflict of interest, researchers at the University of Illinois at Chicago suggest.

The researchers examined nearly 64,000 X-ray diagnoses from 264 doctors in benefits claims filed from 2000 to 2013. The doctors, also known as B-readers, must be certified by NIOSH.

Findings reveal that B-readers hired by coal mine operators reported a negative reading for coal workers’ pneumoconiosis – a deadly but preventable disease commonly known as black lung – for 84.8% of images. That compared with a 63.2% rate of negative image diagnosis for B-readers contracted by DOL and 51.3% for those hired by individual miners.

“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,” Lee Friedman, lead study author and associate professor of environmental and occupational health sciences at the UIC School of Public Health, said in a press release. “But the degree of bias shown in this data is alarming. It begs the question: Are those actions enough and are they helping?”

The release notes that although NIOSH has established a review panel to assess and potentially decertify B-readers who frequently offer “unreasonably inaccurate” X-ray classifications, concerned stakeholders must submit complaints to NIOSH, which will decertify a B-reader only after three independent investigations.

The researchers also found that 64 B-readers reported a negative reading for pneumoconiosis on at least 95% of their image diagnoses, with 93.3% of classifications made by physicians hired by a coal miner’s employer. Conversely, 23 B-readers diagnosed simple pneumoconiosis in at least 95% of their classifications, with 22% of diagnoses made by those hired by miners.

“While there is evidence of bias on both sides, it is clear that the degree of bias is much heavier on the employer side, and this is twofold,” said Robert Cohen, study co-author and director of the UIC Mining Education and Research Center. “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.

“It is clear from this data that this bias is a systemic problem and the most significant offenders are identifiable – the records show a clear pattern of B-reader conflicts of interest.”

The study was published online March 29 in the Annals of the American Thoracic Society.

UIC research released in May 2018 show that more than 4,600 coal miners have developed the most severe form of black lung disease since 1970, with nearly half of the cases emerging after 2000.