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F. H. Y. Green, MD; V. Vallyathan, PhD; Daniel Banks, MD
National Institute for Occupational Safety and Health Morgantown, WVa

James Merchant, MD, DPH
Tulane University School of Medicine New Orleans

JAMA. 1981;246(21):2431.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The recent article by Fisher et al, "Objective Pathological Diagnosis of Coal Workers' Pneumoconiosis" (1981;245:1829), is misleading. The conclusion—that considerable overlap exists between the anthracitic pulmonary pigmentation in coal workers and non-coal-workers—is not justified by the evidence presented.

First, the two populations studied are not necessarily drawn from comparable environments. The miners were derived from a community of 5,000; the control subjects, from a heavily polluted industrial city (Pittsburgh)¹ with a population in excess of 2 million. In this context, it is not surprising that evidence of substantial amounts of pulmonary pigment is present in the lungs of these urban dwellers. Second, the documentation of the environmental histories of the cases leaves much to be desired. Occupational histories were derived from clinical summaries (a notoriously inaccurate source); years of mining exposure and smoking history were not obtained. Both of these factors have a profound effect on pulmonary . . . [Full Text PDF of this Article]

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