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

Alarm bells are ringing about widespread engineered stone silicosis in the US, with experts warning the identified cases are just the “tip of the iceberg.”  Doctors Fazio, Gandhi, and Harrison in (JAMA, Dec 18, 2023) Comment & Response: Workers at Risk of Silicosis—Ongoing Overexposure and Lack of Medical Surveillance—Reply  note many more cases likely exist nationwide, supported by their finding that most California fabrication shops exceeded the OSHA permissible exposure limit, exposing workers dangerously. They commend California’s Medicaid expansion for undocumented immigrants, many of whom make up the affected workforce.  Concerns about worker protection were echoed by Drs. Hodgson and Smith (JAMA, Dec 18, 2023)  Comment & Response: Workers at Risk of Silicosis—Ongoing Overexposure and Lack of Medical Surveillance. They highlight the need for treating doctors to report employers with silica risks to OSHA while protecting patient confidentiality through whistleblower protections.  Drs. Wagner and Michaels (JAMA, Dec 18, 2023) Comment & Response: Preventing the Continuing Tragedy of Silicosis call engineered stone silicosis among young Latino immigrants “tragic and shocking,” but also “predictable.” They underscore the known risks for centuries and documented lung transplants in affected workers since 2012. Criticizing OSHA’s lack of resources and reach, they term the situation an “occupational obscenity.”  Drs. Hua, Rose, and Redlich (JAMA, Dec 18, 2023) – Comment & Response: Preventing the Continuing Tragedy of Silicosis—Reply add that early detection through active medical surveillance can prevent fatal disease. They cite Australia’s successful campaign, where widespread surveillance led to the recent total ban on engineered stone due to the impossibility of safe use.  Notably, no such surveillance system exists in the US.