B-Readers

Silicosis isn’t something I run across in my practice, so when I ran across the term B-reader on NPR yesterday afternoon, I had to look it up. According to this, NIOSH B Reader represents a demonstration of proficiency for physicians who interpret chest radiographs for the pneumoconioses.

Respirable silica can produce irreversible damage to the lungs, leading to silicosis, lung cancer and tuberculosis. With up to 1.7 million exposed workers in the U.S., litigation associated with silicosis, as with asbestosis, is a high-stakes contest. With all of that money involved, this was probably inevitable:

The silicosis cases of thousands of plaintiffs in the federal silica multidistrict litigation may be on the verge of collapse after three days of Daubert hearings revealed what the presiding judge called "great red flags of fraud" in their diagnoses (In re: Silica Products Liability Litigation, No. 03md01553, S.D. Texas).

The Daubert hearing conducted in this case calls into question the diagnoses made by several medical experts for the plaintiffs. In certain instances, several of the same B-readers who found evidence of silicosis had found asbestosis in some of the same plaintiffs in prior asbestos litigation. In some cases, the diagnoses were judged to be mutually exclusive: signs of asbestosis but no silica exposure previously, evidence of silicosis but no asbestos presence now, raising the possibility of fraud on the part of the physicians making those diagnoses. Judge Janis Graham Jacks remanded all of the silicoses cases, potentially affecting 10,000 plaintiffs, in part because of unreliable diagnoses (a copy of her 250 page ruling can be found here – and is actually a handy resource that contains a concise history of silica hazards and regulatory actions). There a possibility of sanctions for the plaintiff attorneys as well as prosecution for some of the physicians who offered up the unreliable diagnoses.

This case has already been a rallying cry for advocates of tort reform, which raises the concern among advocates for workers that such reform would strip away workers’ options for compensation, if they weren’t protected properly by employers (NIOSH notes that the effects of respirable silica exposure are preventable through appropriate work practices, personal protective equipment use, exposure monitoring and medical surveillance). At the same time, workers who are truly sick from respirable silica exposure are precluded from timely help because of the thousands of cases clogging the court system.

The other concern here is this is yet another example of how science, in this case radiographic screening of workers with pneumoconiosis, has been allowed to be twisted to serve some economic end.