Black lung disease rates among Appalachian coal miners have reached 50-year highs, with one in three career miners now diagnosed—a 65% increase since 2018. Retired NPR correspondent Howard Berkes reveals how regulatory failures, dangerous silica dust exposure, and industry lawsuits have stalled life-saving protections while thousands of young miners develop incurable disease. One in three career coal miners in Appalachia now have black lung disease, the highest rate in nearly 50 years, compared to just 7% after protective laws passed in the 1970s.