‘Incentivise diagnosis of silicosis’

India has punitive provisions for doctors who do not report cases of silicosis to appropriate authorities after diagnosing the disease. This is a hindrance in doctors identifying silicosis, says Rajnarayan R Tiwari, director of National Institute of Research on Environmental Health. Excerpts:

Bhagirath Srivas (BS): What are the main reason for misdiagnosis of silicosis in India?

Rajnarayan R Tiwari (RRT): Most doctors give the excuse that they are not trained in the International Labour Organization’s (ILO’s) International Classification of Radiographs of Pneumoconioses. This is a myth because the classification is a nomenclature tool and not a diagnostic tool. Any worker having history of silica exposure and signs of interstitial fibrosis can be safely diagnosed as a suspected case of silicosis which can then be classified as per ILO classification with the help of experts and institutes like the National Institute of Occupational Health. Another possible reason could be the legal intricacies involved after diagnosis of silicosis. The law of the land states punitive action against those diagnosing and not notifying to appropriate authority. Instead of punitive action, if the diagnosis of silicosis is incentivised, it may possibly work. Further, a detailed occupational history should also be made a routine practice while taking clinical history. This will help in identifying occupational sources of free silica exposure and thereby keeping silicosis into differential diagnosis.

BS: Only four-five states have a silicosis policy, even though silicosis is a national problem. Do you think there is a need for a policy or programme on silicosis at the Central and state levels?

RRT: Rajasthan, which has many stone mines causing exposure to free silica by virtue of occupation, has silicosis as a much bigger problem as compared to other states. However, any state where mining, construction and relevant cottage industries resulting into potential free silica exposure, should also have silicosis policy. In fact, there is a need for revival of National Silicosis Elimination Programme which was initiated in mid-1990s.

BS: Which are the sectors in India where the risk of silicosis is the highest?

RRT: Mining, construction, agate grinding, stone carving, glass bangle units, slate pencil units, stone quarries, ceramic and pottery units are some of the occupations, where workers face free silica exposure.

BS: Studies show that without controlling silicosis, the tuberculosis eradication programme cannot be successful. What is your opinion on this?

RRT: Exposure to free silica increases the susceptibility to added tuberculosis infection. Those having silicosis may have latent tuberculosis due to autoimmune nature of silicosis. Thus, it is essential to address silicosis and silico-tuberculosis if we want to eliminate tuberculosis.

BS: What kind of health challenges does silicosis pose?

RRT: Silicosis is serious because it progresses even after elimination of source of exposure. Currently, there is no cure for silicosis and hence, in a way, it is a fatal disease. Further, the impairment of pulmonary functions due to parenchymal lung disease results into considerable disability. But the good thing is that it can be prevented by industrial hygiene methods such as wet suppression, dust control measures and personal protective measures.

This was first published in the 1-15 April, 2025 print edition of Down To Earth