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The Identified Engineered Stone Silicosis Cases Are the “Tip of the Iceberg” of an “Occupational Obscenity”

The cases of engineered stone silicosis identified in California, Texas, Oregon, Washington, Georgia, and other states are “just the tip of the iceberg” and “many more cases are occurring nationwide” according to Drs. Fazio, Gandhi, and Harrison, JAMA, December 18, 2023 – Comment & Response: Workers at Risk of Silicosis—Ongoing Overexposure and Lack of Medical Surveillance—Reply.  The authors also note that the majority of engineered stone fabrication shops sampled by the California Special Emphasis Program had exposure levels above the OSHA permissible exposure limit (PEL), showing that the PEL “is not preventing overexposure”.  Further, noting that many fabrication workers have undocumented status, the authors were pleased to note that California will be expanding Medicaid coverage to undocumented immigrants.  These concerns were first expressed by Drs. Hodgson and Smith, JAMA, December 18, 2023 –  Comment & Response: Workers at Risk of Silicosis—Ongoing Overexposure and Lack of Medical Surveillance, who also stated treating doctors “may refer an employer with silica exposure risks to OSHA without releasing the patient’s silicosis diagnosis to the employer” and that “OSHA whistleblower protections prohibit employer retaliation”.   Drs. Wagner and Michaels, JAMA, December 18, 2023 – Comment & Response: Preventing the Continuing Tragedy of Silicosis state that “the case repots of silicosis associated with occupational exposure to dust from engineered stone occurring primarily among young Latino immigrant me are tragic and shocking.”   They further note it was “also predictable” the risks “have been known for centuries” and “lung transplants among engineered stone workers were reported in the scientific literature in 2012”.   They also state that “OSHA is severely underresourced and cannot conduct sufficient inspections….most [fabrication] shops will never see an OSHA inspector.”  They conclude that engineered stone silicosis is “an ‘occupational obscenity’”.   In reply to Wagner and Michaels, Drs. Hua, Rose, and Redlich, JAMA, December 18, 2023 – Comment & Response: Preventing the Continuing Tragedy of Silicosis—Reply, note that over half of the severe silicosis stone worker patients are initially misdiagnosed and that when “active medical surveillance and public health outreach” has been conducted, they find earlier stage, less severe, silicosis in time to prevent fatal disease.  Notably, it was only after “widespread medical surveillance for early disease detection among engineered stone workers” was “instituted in Australia” that the health experts were able to determine that there was no safe way to use engineered stone, which led finally to the recent total ban in Australia.   Neither the U.S. federal government nor any state government has any established surveillance and reporting system in place for these workers.