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In the late 1960s, when I first studied coalminers in West Virginia, there still remained some mysteries and disputes about the diseases and disabilities they experienced. However, the standardised epidemiological methods used by the UK National Coal Board's Pneumoconiosis Field Research led to the description of robust exposure–response relationships, later replicated in the USA and elsewhere, and we quickly learned that what matters is, primarily, dust exposure and, secondarily, the combustibility (rank) and composition of the dust.1 Given the exposure concentrations over a working period and a knowledge of the rank and quartz content of the dust in a given mine or region, it should be possible to predict the risks not just of pneumoconiosis but also of loss of lung function and emphysema among the workforce.2 3 How many other industrial employers or governments, I wonder, are equipped with such predictive information on which to base their preventive measures?
The authors …