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

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In this experiment,
you randomly assign people

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to live in blasting zones.

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

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They live in the community for years,

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just downwind and downstream

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from sites where tons of explosives
are used almost daily.

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And millions of gallons
of water contaminated.

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With random assignment you could

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carefully study the long-term
health effects

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of living in these blasting communities

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without a bunch of annoying
confounders and covariates.

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Random assignment does wonders.

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That would be a rigorous,
powerful scientific inquiry

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into the effects of these
environmental exposures.

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Of course, such a study
could never be done.

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Most scientists wouldn't have
the stomach for it.

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The institutional review board
would never approve it,

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it would never pass human subjects review
because it would be unethical.

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Immoral.

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And yet in effect,
it is happening right now.

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In my mind it's prompted some questions:

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What is the ethical obligation
of the scientists who believes

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populations are in danger?

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

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

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The unplanned experiment
that is happening right now

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is called mountaintop removal.

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The abbreviation for it is MTR.

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It is a form of surface coal mining

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that takes place in Appalachia
here in the United States.

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

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Over 1.2 million acres
have been mined in this way.

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This is an area about the size of Delaware

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but it is spread over a footprint

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as large as Vermont
and New Hampshire combined.

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The process involves clear-cutting
ancient Appalachian forest,

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home to some of the richest
biodiversity on the planet.

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The trees are typically burned
or dumped into adjacent valleys.

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Then, to reach the buried coal seams,

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

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Over 1500 tons of explosives

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are used for coal mining
in West Virginia alone.

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Every day.

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Rock and soil debris is dumped
over the valley sides,

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where it permanently buries
headwater streams.

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So far over 500 mountains
have been destroyed.

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

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

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and remains contaminated for decades.

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The coal then has to be
chemically treated,

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

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This cleaning takes place on-site.

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The process produces more air pollution

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and contaminates billions
of gallons of water with metals,

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sulfates, cleaning chemicals,
and other impurities.

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

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only three percent
of US electricity demand.

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

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What are the health impacts
of mountaintop removal mining?

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

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and millions more downstream and downwind.

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What has been the response
of industry and government

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when these issues are documented?

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And again, what is the ethical
obligation of science

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when faced with this disturbing situation?

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I began to research this issue in 2006.

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I had just taken a job
at West Virginia University,

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

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But I started to hear stories

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from people who lived
in these mining communities.

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They said that the water
they drank was not clean,

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that the air they breathed was polluted.

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They would tell me
about their own illnesses

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or illnesses in their family.

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

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I met with many people
in southern West Virginia

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and eastern Kentucky

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to listen to those stories
and hear their concerns.

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I searched the scientific literature

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and was surprised to learn
that nothing had been published

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

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Let me say that again --

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nothing had been published
on the public health effects

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of coal mining in the US.

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So I though, I can make
a new contribution,

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no matter what I find.

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To either confirm these concerns
or to alleviate them.

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I had no personal
or organizational agenda.

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Many of my colleague
initially were skeptical

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

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They predicted that the health problems
could be explained by poverty,

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or by lifestyle issues,
like smoking and obesity.

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

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We started by analyzing existing databases
that allowed us to link

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population health to mining activity

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

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education, health insurance
and others we could measure.

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We found evidence that confirmed
the concerns of the residents

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and we started to publish our findings.

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As a very brief summary,

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we found that people who live
where mountaintop removal takes place

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have significantly higher levels
of cardiovascular disease,

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kidney disease and chronic
lung disease like COPD.

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Death rates from cancer
are significantly elevated,

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especially for lung cancer.

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We've seen evidence
of higher rate for birth defects

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and for babies born at low birth weight.

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The difference in total mortality
equates to about 1200 excess deaths

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every year in MTR areas,
controlling for other risks.

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Twelve hundred excess deaths every year.

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Not only are death rates higher,

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but they increase
as the levels of mining go up

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in a dose-response manner.

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

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We surveyed people living
within a few miles of MTR

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versus similar rural
communities without mining.

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Survey results show higher level
of personal and family illness,

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self-reported health status is poorer,

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and illness symptoms across
a broad spectrum are more common.

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These studies are only associational.

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We all know that correlation
does not prove causation.

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These studies did not include data

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on the actual environmental conditions
in mining communities.

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So we started to collect
and report on that.

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We found that violations
of public drinking water standards

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

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We collected air samples

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and found that particulate matter
is elevated in mining communities,

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especially in the ultra-fine range.

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The dust in mining communities
contains a complex mixture

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

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and potentially harmful organic compounds.

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We used the dust
in laboratory experiments.

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And found that it induced
cardiovascular dysfunction in rats.

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The dust also promoted the development

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of lung cancer in human
in vitro lung cells.

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

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

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Neither does the government
in coal country.

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Just like the tobacco industry
paid for research

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to defend the safety of smoking,

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so the coal industry
has tried to do the same

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

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

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eventually denied by the courts.

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

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by a congressman with ties
to the energy industry.

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

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And after a meeting
with a member of Congress,

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in which I specifically
shared my research,

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

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I worked with scientists
at the US Geological Survey

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on environmental sampling
for more than two years.

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And just as they were starting
to publish their findings,

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they were suddenly instructed
by their superiors

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to stop work on this project.

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In August of this year,

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the National Academies of Sciences
was suddenly instructed

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by the federal government

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to stop their independent review

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of the public health consequences
of surface mining.

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These actions are politically
motivated, in my view.

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But there is opposition
from researchers, too.

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At conferences or meetings
they express skepticism.

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

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They ask, "What about
this possible explanation?"

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"Have you considered that
alternative interpretation?"

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

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Some other variable
we haven't accounted for."

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

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

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Maybe so.

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

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but you know, maybe, these health problems

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are not the result
of some unmeasured confound.

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Maybe they result
from blowing up mountains

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over people's heads.

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(Laughter)

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(Applause)

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

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Because we can never do that
defining experiment.

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Any next study must
always be associational.

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

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00:10:13,530 --> 00:10:15,895
how much evidence is enough?

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

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

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yet government doesn't want to listen

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and the industry says
it's only correlational.

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They say Appalachians
have lifestyle issues.

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As though it had never occurred to us

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00:10:32,796 --> 00:10:35,474
to control for smoking or obesity
or poverty or education

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or health insurance.

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00:10:37,442 --> 00:10:39,609
We controlled for all of those and more.

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

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

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00:10:48,268 --> 00:10:50,996
so we can do the next study.

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As scientists, we follow
the data wherever it goes

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but sometimes data can only take us so far

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00:10:57,270 --> 00:11:00,260
and we have to decide,
as thinking, feeling human beings,

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00:11:00,284 --> 00:11:03,017
what it means and when it is time to act.

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00:11:03,775 --> 00:11:06,927
I think that is true, not only for MTR
but for other situations

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00:11:06,951 --> 00:11:11,243
where evidence is strong
and concerning but imperfect.

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00:11:11,934 --> 00:11:15,983
And when failing to act if you're wrong
means people's lives.

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00:11:17,721 --> 00:11:20,508
It may seem strange
that there is any controversy

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00:11:20,532 --> 00:11:23,620
over the health effects
of mountaintop removal mining.

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00:11:24,332 --> 00:11:26,174
But somehow, this subject has wound up

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00:11:26,198 --> 00:11:28,536
in a scientific
and political twilight zone

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00:11:28,560 --> 00:11:30,681
alongside the debate over climate change

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00:11:30,705 --> 00:11:32,120
or the argument years ago

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00:11:32,144 --> 00:11:34,739
about whether or not
smoking caused cancer.

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00:11:35,865 --> 00:11:39,468
In this twilight zone, much of the data
seems to point to one conclusion.

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00:11:39,492 --> 00:11:42,778
But the economics or the politics
or the prevailing public view

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00:11:42,802 --> 00:11:45,068
insist on the opposite conclusion.

215
00:11:46,180 --> 00:11:49,101
When you're a scientist
and you think you have a valid insight

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00:11:49,125 --> 00:11:51,426
where the health
of entire population is at stake

217
00:11:51,450 --> 00:11:53,823
but you find yourself trapped

218
00:11:53,847 --> 00:11:57,355
in this twilight zone
of denial and disbelief,

219
00:11:57,379 --> 00:12:00,179
what is your moral and ethical obligation?

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00:12:01,625 --> 00:12:05,609
Obviously, scientists are responsible
for telling the truth as they see it,

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00:12:05,633 --> 00:12:06,942
based on evidence.

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00:12:07,331 --> 00:12:10,408
Simply stated, we have an obligation
to stand up for the data.

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00:12:11,625 --> 00:12:14,693
It can be extremely frustrating
to wait around for public opinion

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00:12:14,717 --> 00:12:17,950
or political consensus to catch up
to the scientific understanding.

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00:12:17,974 --> 00:12:22,140
But the more controversial the subject
and the more frustrating the debate,

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00:12:22,164 --> 00:12:26,029
the more critical it is for scientists
to preserve our objectivity

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00:12:26,053 --> 00:12:28,253
and our reputation for integrity.

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00:12:28,823 --> 00:12:31,363
Because integrity is the coin of the realm

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00:12:31,387 --> 00:12:33,879
in scientific and public policy debate.

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In the long run,
our reputation for integrity

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00:12:36,857 --> 00:12:38,871
is the most powerful tool that we have,

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00:12:38,895 --> 00:12:41,838
even more powerful than the data itself.

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Without an acknowledged integrity
on the part of scientists,

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00:12:45,370 --> 00:12:47,488
no amount of data
will ever convince people

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00:12:47,512 --> 00:12:50,112
to believe painful or difficult truths.

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00:12:50,958 --> 00:12:56,085
But when we cultivate and guard
our reputation for integrity,

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

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00:12:59,284 --> 00:13:02,006
and keep calmly bringing
the results to the public,

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00:13:02,030 --> 00:13:04,474
that's when we have our greatest impact.

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00:13:05,585 --> 00:13:11,781
Eventually, scientific truth
does and will win out.

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00:13:13,141 --> 00:13:15,941
How many lives will be lost while we wait?

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00:13:16,433 --> 00:13:17,583
Too many already.

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00:13:18,218 --> 00:13:20,090
But prevail we will.

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00:13:21,004 --> 00:13:22,185
Thank you.

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00:13:22,209 --> 00:13:29,094
(Applause)