COMMENTARY

Unhealthy Attraction: Revisiting the Risks of Magnet Ingestion in Kids, as Product Recall Fails

William F. Balistreri, MD

Disclosures

May 12, 2017

Judging the Impact

The success of the recall remains a bit unclear, because there is no national tracking system for magnet ingestions in either the United States or Canada. However, some insight can be gained from a recent study.

Rosenfield and colleagues[25] evaluated the effectiveness of a mandatory product recall on the frequency of multiple mini-magnet ingestion at a large tertiary pediatric hospital in Toronto, as well as the impact of these ingestions on morbidity and mortality. They searched electronic patient records for patients younger than 18 years who had been diagnosed with ingested magnetic foreign bodies between 2002 and 2015. They compared the frequency and character of ingestions during the post-recall years (2014-2015) with the 2 years immediately preceding the recall year (2011-2012).

The incidence rate ratio was 0.34 (95% confidence interval [CI], 0.18-0.64) for all magnet ingestions and 0.20 (95% CI, 0.08-0.53) for ingestion of multiple magnets. The incidence of overall magnet ingestion and multiple magnet ingestion both significantly decreased (P < .001), and the morbidity associated with magnet ingestion also decreased. During the 2011-2012 period, 29 children underwent medical or surgical procedures to remove magnets vs 10 children in 2014-2015. The number of abdominal surgical procedures was also reduced (six cases vs one case).

The significant decrease in multiple mini-magnet ingestion after the mandatory product recall demonstrated its effectiveness, supporting efforts to keep the recall in effect.

They're Back!

In late 2016, the US Court of Appeals for the 10th Circuit ruled in favor of Zen Magnets LLC in a 2-1 ruling, vacating the USCPSC rule promulgated in September 2014 that prevented the importation of magnets. The federal appeals court overturned the government ban on high-powered magnets, ruling that the USCPSC data, including reports of "possible" ingestions, were "too uncertain and imprecise to constitute substantial evidence for the Commission's findings on the risk of injury." The ruling stated that the USCPSC "cannot promulgate a safety standard unless it concludes "that the rule...is reasonably necessary to eliminate or reduce an unreasonable risk of injury. Underlying findings that peg the risk of injury as a mere 'possibility' provide the Court no assistance in assessing that conclusion."[26]

You can once again legally purchase magnetic balls, and their return to the market has been reported in a celebratory fashion by the relevant companies.[17,27]

Several groups (eg, Kids In Danger, Public Citizen) wrote to Benjamin C. Mizer, principal deputy assistant attorney general, Civil Division, US Department of Justice, to urge that he request an en banc review in the case Zen Magnets v USCPSC, owing to the dangerous implications for consumers and children in light of the Court of Appeals' decision.[28]

In the interim, children should receive immediate medical attention for a known or suspected magnet ingestion.

Consumers and healthcare providers are strongly encouraged to report incidents of ingestions and all magnet-related injuries to the USCPSC website. In addition, implementation of a national tracking system would provide actionable data upon which future policy could be based.

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