The new prescription: industrial injuries benefits for smokers?

Nationalisation of the coal industry by the 1945 Labour Government provided Britain with a unique opportunity for preventing the disablement of coal miners. At that time several thousand miners received disability benefits each year for pneumoconiosis in South Wales alone, and the Medical Research Council had started an important series of investigations into the relationships between dust exposure and disease. 1 2 The late Dr John Rogan, Chief Medical OYcer of the National Coal Board, with extraordinary far sightedness set up the Pneumoconiosis Field Research which ultimately studied the dust exposure, symptoms, chest radiographs, and lung function of some 50 000 miners over nearly 30 years. 3 This research was planned to answer the questions " How much and what kinds of dust cause pneumoconiosis, and what dust concentrations need to be maintained if miners are not to be disabled by the dust that they breathe? " The National Coal Board embarked on a massively costly programme of research into dust control in mines alongside its medical research and, in full consultation with the mining unions, progressively implemented the research results into its practical management of the pneumoconiosis problem. As an example of enlightened management in dealing with work related ill health, this endeavour is unparalleled. The pneumoconiosis statistics tell the story, the disease having largely been eliminated. Implicit in Dr Rogan's original question was the understanding that disease other than pneumoconiosis might disable coal miners. This proved to be the case, the research demonstrating impressive evidence of a relationship between dust exposure and airways obstruction and, in accompanying pathological studies, centriacinar emphy-sema (in the presence of some evidence also of fibrotic nodular pneumoconiosis). This led me to suggest to the Industrial Injuries Advisory Council (IIAC) that in certain circumstances chronic airways obstruction should be regarded as an occupational hazard of coal miners, appropriate for prescription. 4 At first my arguments were not accepted, but further evidence from the Coal Board's research eventually persuaded the IIAC and the disease was prescribed in 1992. Central to my evidence was discussion of the problem posed by the frequency of the disease in miners, as in non-miners, as a consequence of smoking. This habit was and is commonplace among miners and is, of course, the main reason most develop airways obstruction. Epidemiologically , in any population of miners rather more will develop disease than would be the case in a non-dust exposed population …