Help docs! my smoker friend says black lung is a lie. is this true?

Not altogether: To deny that smoking causes terrible and irreversible damage to the lungs is like believing the moon is made of green cheese. This being said, as a pathologist interested in occupational lung disease, it is true that (1) many miners have been compensated for "black lung" actually due to smoking instead; (2) extra carbon in the lungs of smokers isn't the problem and is often only modest.

Condition exists.: During my training years, I performed an autopsy (cadaveric dissection) of a patient who died from "metastatic encephalopathy". I scraped out what literally looked like charcoal from the lymphatic tissue in her lungs. We knew she was a heavy smoker. I don't know if she was a (female) miner, but I doubt it. But if that didn't meet the definition of "black lung", I don't know what would. It IS real!