Let's say that you wanted
to conduct an experiment.

In this experiment,

you randomly assign people
to live in blasting zones

or in control locations without explosives
going off over their heads.

They live in the community for years,

just downwind and downstream

from sites where tons of explosives
are used almost daily.

And millions of gallons
of water contaminated.

With random assignment,
you could carefully study

the long-term health effects
of living in these blasting communities

without a bunch of annoying
confounders and covariates.

Random assignment does wonders.

That would be a rigorous,
powerful scientific inquiry

into the effects of these
environmental exposures.

Of course, such a study
could never be done.

Most scientists wouldn't have
the stomach for it.

The institutional review board
would never approve it;

it would never pass human subjects review,

because it would be unethical, immoral.

And yet in effect,
it is happening right now.

In my mind, this prompts some questions.

What is the ethical obligation

of the scientists who believes
populations are in danger?

How much evidence is enough
to be confident of our conclusions?

Where is the line between
scientific certainty and the need to act?

The unplanned experiment
that is happening right now

is called mountaintop removal.

The abbreviation for it is MTR.

It is a form of surface coal mining

that takes place in Appalachia,
here in the United States.

MTR occurs in four states: Virginia,
West Virginia, Kentucky and Tennessee.

Over 1.2 million acres
have been mined in this way.

This is an area about the size of Delaware

but it is spread over a footprint

as large as Vermont
and New Hampshire combined.

The process involves clear-cutting
ancient Appalachian forest,

home to some of the richest
biodiversity on the planet.

The trees are typically burned
or dumped into adjacent valleys.

Then, to reach the buried coal seams,

explosives are used to remove
up to 800 feet of mountain elevation.

Over 1,500 tons of explosives

are used for coal mining
in West Virginia alone.

Every day.

Rock and soil debris
is dumped over the valley sides

where it permanently buries
headwater streams.

So far, over 500 mountains
have been destroyed.

About 2,000 miles of streams
have been permanently buried.

Water emerging from the base
of the valley fills is highly contaminated

and remains contaminated for decades.

The coal then has to be
chemically treated,

crushed and washed before it can be
transported to power plants and burned.

This cleaning takes place on-site.

The process produces more air pollution

and contaminates billions
of gallons of water with metals,

sulfates, cleaning chemicals
and other impurities.

All of this to produce three percent
of US electricity demand --

only three percent
of US electricity demand.

As you can appreciate, this prompts
all sorts of other questions.

What are the health impacts
of mountaintop-removal mining?

There are over a million people
who live in counties where MTR takes place

and millions more downstream and downwind.

What has been the response
of industry and government

when these issues are documented?

And again, what is the ethical
obligation of science

when faced with this disturbing situation?

I began to research this issue in 2006.

I had just taken a job
at West Virginia University.

Before then, I hadn't done
any research related to coal.

But I started to hear stories

from people who lived
in these mining communities.

They said that the water
they drank was not clean,

that the air they breathed was polluted.

They would tell me
about their own illnesses

or illnesses in their family.

They were worried about how common
cancer was in their neighborhoods.

I met with many people
in southern West Virginia

and eastern Kentucky

to listen to those stories
and hear their concerns.

I searched the scientific literature

and was surprised to learn
that nothing had been published

on the public health effects
of coal mining in the United States.

Let me say that again --

nothing had been published
on the public health effects

of coal mining in the US.

So I thought, "I can make
a new contribution,

no matter what I find,

to either confirm these concerns
or to alleviate them."

I had no personal
or organizational agenda.

Many of my colleagues
initially were skeptical

that there would be any link
between public health and mining.

They predicted that the health problems
could be explained by poverty

or by lifestyle issues,
like smoking and obesity.

When I started, I thought
maybe they would be right.

We started by analyzing existing databases

that allowed us to link
population health to mining activity

and to control statistically for age, sex,
race, smoking, obesity, poverty,

education, health insurance
and others we could measure.

We found evidence that confirmed
the concerns of the residents,

and we started to publish our findings.

As a very brief summary,

we found that people who live
where mountaintop removal takes place

have significantly higher levels
of cardiovascular disease,

kidney disease and chronic
lung disease like COPD.

Death rates from cancer
are significantly elevated,

especially for lung cancer.

We've seen evidence
for higher rates of birth defects

and for babies born at low birth weight.

The difference in total mortality
equates to about 1,200 excess deaths

every year in MTR areas,
controlling for other risks.

Twelve hundred excess deaths every year.

Not only are death rates higher,

but they increase
as the levels of mining go up

in a dose-response manner.

Next, we started to conduct
community door-to-door health surveys.

We surveyed people
living within a few miles of MTR

versus similar rural
communities without mining.

Survey results show higher levels
of personal and family illness,

self-reported health status is poorer,

and illness symptoms across
a broad spectrum are more common.

These studies are only associational.

We all know that correlation
does not prove causation.

These studies did not include data

on the actual environmental conditions
in mining communities.

So we started to collect
and report on that.

We found that violations
of public drinking-water standards

are seven times more common
in MTR areas versus non-mining areas.

We collected air samples

and found that particulate matter
is elevated in mining communities,

especially in the ultra-fine range.

The dust in mining communities
contains a complex mixture,

but includes high levels of silica,
a known lung carcinogen,

and potentially harmful organic compounds.

We used the dust in laboratory experiments

and found that it induced
cardiovascular dysfunction in rats.

The dust also promoted the development

of lung cancer in human
in vitro lung cells.

This is just a quick summary
of some of our studies.

The coal industry does not like
what we have to say.

Neither does the government
in coal country.

Just like the tobacco industry
paid for research

to defend the safety of smoking,

so the coal industry
has tried to do the same

by paying people to write papers
claiming that MTR is safe.

Lawyers have sent me harassing demands
under the Freedom of Information Act,

eventually denied by the courts.

I'd been attacked at public testimony
at a Congressional hearing

by a congressman
with ties to the energy industry.

One governor has publicly declared
that he refuses to read the research.

And after a meeting
with a member of Congress,

in which I specifically
shared my research,

I later heard that representative say
they knew nothing about it.

I worked with scientists
at the US Geological Survey

on environmental sampling
for more than two years.

And just as they were starting
to publish their findings,

they were suddenly instructed
by their superiors

to stop work on this project.

In August of this year,
the National Academy of Sciences

was suddenly instructed
by the federal government

to stop their independent review

of the public health consequences
of surface mining.

These actions are politically
motivated, in my view.

But there is opposition
from researchers, too.

At conferences or meetings,
they express skepticism.

OK, we are all taught,
as scientists, to be skeptical.

They ask, "What about
this possible explanation?"

"Have you considered
that alternative interpretation?"

They wonder, "There must be
some confounder that we missed.

Some other variable
we haven't accounted for."

"An in vitro study, what does that prove?"

"A rat study -- how do we know the same
effects would be found in people?"

Maybe so.

Technically, you have to acknowledge
that they could be right,

but you know, maybe these health problems

are not the result
of some unmeasured confound.

Maybe they result
from blowing up mountains

over people's heads.

(Laughter)

(Applause)

There can always be doubt,
if doubt is what you seek.

Because we can never do that
defining experiment.

Any next study
must always be associational.

So perhaps you can understand
why I've started to wonder,

how much evidence is enough?

I've published over 30 papers
on this topic so far.

Along with my coauthors, other researchers
have added to the evidence,

yet government doesn't want to listen,

and the industry says
it's only correlational.

They say Appalachians
have lifestyle issues.

As though it had never occurred to us

to control for smoking or obesity
or poverty or education

or health insurance.

We controlled for all of those and more.

There comes a point
where we don't need more research,

where we can't ask people
to be unwilling research subjects

so we can do the next study.

As scientists, we follow
the data wherever it goes,

but sometimes data can only take us so far

and we have to decide,
as thinking, feeling human beings,

what it means and when it is time to act.

I think that is true, not only for MTR
but for other situations

where evidence is strong
and concerning but imperfect.

And when failing to act if you're wrong
means people's lives.

It may seem strange
that there is any controversy

over the health effects
of mountaintop-removal mining.

But somehow, this subject has wound up

in a scientific
and political twilight zone

alongside the debate over climate change

or the argument years ago

about whether or not
smoking caused cancer.

In this twilight zone, much of the data
seems to point to one conclusion.

But the economics or the politics
or the prevailing public view

insist on the opposite conclusion.

When you're a scientist
and you think you have a valid insight

where the health
of entire populations is at stake

but you find yourself trapped

in this twilight zone
of denial and disbelief,

what is your moral and ethical obligation?

Obviously, scientists are responsible
for telling the truth as they see it,

based on evidence.

Simply stated, we have an obligation
to stand up for the data.

It can be extremely frustrating
to wait around for public opinion

or political consensus to catch up
to the scientific understanding.

But the more controversial the subject
and the more frustrating the debate,

the more critical it is for scientists
to preserve our objectivity

and our reputation for integrity.

Because integrity is the coin of the realm

in scientific and public policy debate.

In the long run,

our reputation for integrity
is the most powerful tool that we have,

even more powerful than the data itself.

Without an acknowledged integrity
on the part of scientists,

no amount of data
will ever convince people

to believe painful or difficult truths.

But when we cultivate and guard
our reputation for integrity,

when we patiently stand up for the data
and keep doing the studies

and keep calmly bringing
the results to the public,

that's when we have our greatest impact.

Eventually, scientific truth
does and will win out.

How many lives will be lost while we wait?

Too many already.

But prevail we will.

Thank you.

(Applause)