 Good morning. I am pleased to open this hearing to gather oral comments on the commission's notice of rules from proposed rulemaking regarding safety standard for magnets. Before we begin, I just want to confirm all the commissioners are here. Commissioner Miyako here. Commissioner Feldman. I'm here, Mr. Chairman. Thank you. Mr. Trump. I'm here. Good morning. Great. This is the first rulemaking hearing. The commissioner has held in nearly five years. But as our rulemaking agenda has been speeding up, so has our hearing schedule. So I look forward to holding two more of these over the course of the spring. Rulemaking aims, this rulemaking aims to protect consumers from horrific injuries and deaths caused by small and seemingly harmless magnets. It will protect small children who will put almost anything in their mouths, as well as teenagers from devastating and deadly internal injuries caused by tiny magnets pulling together one another in their intestines. We have two distinguished panels today and I'm eager to hear their testimony and to give my colleagues and myself the opportunity to ask questions. Each panelist will have 10 minutes for their presentations and I will call my colleagues to ask questions again in 10 minutes each per round with multiple rounds necessary. Witnesses, you will receive a chat from the staff when you have two minutes left in your presentation and again when you have 30 seconds left. At that point in time, I will ask you to wrap up. The public comment period is open until March 28th and I encourage witnesses who are here today as well as other members of the public to submit comments into the docket. We'll now introduce our first panel. We have Dr. Ben Hoffman who is testifying on half the American Academy of Pediatrics. He serves as chair of the AAP Council on Injury Violence and Poison Prevention Executive Committee. Dr. Mazan Abbas is a pediatric gastroenterologist and is testifying on half of the North American Society for Pediatric Gastroenterology, Hibatology and Nutrition where he serves on the Health and Public Policy Committee. Dr. Hoffman and Dr. Abbas, welcome to the CPSC and Dr. Hoffman, you are recognized for 10 minutes. Thank you so much Chair Honsar, Commissioners Biakko, Feldman and Trumpka. It's a pleasure to be here with you today. My name is Dr. Ben Hoffman and I'm here today as Chair Honsar mentioned on behalf of the American Academy of Pediatrics, which is a nonprofit professional organization of over 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists who are devoted to the health, safety and well-being of infants, children, adolescents and young adults. I currently serve as the chair of the AAP Council on Injury Violence and Poison Prevention Executive Committee, leading the Academy's work on developing evidence-based policy statements on issues impacting children's health, our efforts to educate pediatricians and parents about children's product safety issues and our advocacy at every level of government for policies to prevent injuries. My aura remarks today will be followed by a joint formal submission of written comments from the AAP and NASPEGAN. The AAP strongly supports the CPSC's notice of proposed rulemaking to create a safety standard to address the unreasonable risk of injury and death associated with the digestion of loose or separable high-powered magnets. The AAP has long called for a safety standard to protect children from these unsafe magnets that we see leading to critical injuries and death. We support the CPSC's prior action to remove these dangerous products from the marketplace and we were very disappointed to see its rescission following the legal challenge. There's a rich and strong body of evidence and peer-reviewed literature that documents the hazard that magnet ingestions pose to children. When two or more of these high-powered magnets are swallowed, their attractive force or flux allows them to find each other across different segments of the digestive system. For example, connections can occur between the stomach and the small intestine, between the small intestine and the large intestine, or across loops of bowel. These connections can lead to gastrointestinal tissue necrosis and perforation, which can lead to bleeding, serious infections, and even death. Like many pediatric colleagues, I have personally seen the harms these products can cause up close. There was a three-week period in 2019 after high-powered magnet sets had returned to the marketplace, where my institution admitted three children over the course of this three-week period for magnet ingestions, requiring surgeons to remove a total of 36 of these tiny magnets from their gastrointestinal tract. I personally worked with a five-year-old boy who swallowed five of these magnets and narrowly averted requiring a colostomy, as the magnets attracted each other and found each other across multiple loops of bowel and cut off the blood supply. The current voluntary standards, recalls, and compliance actions, while important, are simply not adequate to protect children from the risk of injuries associated with these high-powered magnet sets. These products represent a constant and clear danger to children who have access to them, and warning labels and other voluntary efforts are woefully insufficient to prevent the significant and completely preventable suffering that I and my colleagues see in our work. The AAP has expressed concerns about the voluntary standards that focus on marketing and packaging, and not on the standards needed to address the underlying hazards that these products pose. Young children are inherently curious, built to explore their environments, and due to their developmentally appropriate exploratory behaviors, ingestion will remain a risk, even with improvements in packaging and labeling. Children may be influenced by the attractiveness of some magnet set products and the colors, which can give them a candy-like appearance. CPSC staff own analysis shows that the majority of incident reports involve products that were clearly labeled with warnings to keep the product away from children. We agree with the analysis and the notice of proposed rulemaking that a mandatory standard is necessary to effectively reduce the risk of injuries and death associated with magnet ingestions. Public education campaigns are important, and pediatricians can and will inform families about the risks of hazardous products, but that can only do so much. The most effective prevention measures are regulatory actions that can keep fundamentally dangerous products out of the marketplace. As the incident data in the notice show, CPSC's effort to limit this hazard through a mandatory standard in the period from 2014 to 2016 were working to protect children. The AAP supports the CPSC's proposed scope for the safety standard. The agency is correct to include a wide variety of consumer products in its definition of subject magnet products for this standard, including children's jewelry. The proposed rule would establish a two-part performance requirement starting with the determination regarding whether a magnet is small enough to be swallowed. If the magnet is small enough to fit within the small part cylinder, it must meet the strength requirement of a flux index of less than 50 vapors. The AAP supports this consensus flux index limit to protect children from the most dangerous products, and we also support ongoing prospective investigation and research into the risk of ingestion of magnets with a flux index below 50. We remain concerned by the potential harm that could be posed by the products that have a slightly lower flux index and encourage further study into this hazard. We look forward to providing more detailed feedback with our written testimony. Thank you again for this opportunity to comment at this public meeting, and I look forward to answering the questions that you have. Thank you, Dr. Hoffman. I'm going to turn to Dr. Abbas before we start questions from the commission. Dr. Abbas, welcome. Good morning. I'm Dr. Abbas, a pediatric gastroenterologist practicing Kailua, Hawaii, and covering hospitals in Madeira, California, and Bangor, Maine. I'm a member of the North American Society for Pediatric Gastroenterology, Hepatology, Nutrition, or NASFIGAN, and serve on its Health and Public Policy Committee. I thank the commission for this opportunity to deliver remarks on behalf of NASFIGAN in support of the commission's recently proposed safety standard for magnets. All remarks will be followed by formal joint submission of comments from NASFIGAN and the American Academy of Pediatrics. NASFIGAN represents more than 2,500 pediatric gastroenterologists in the United States, Canada, and Mexico. It is the only organization, singularly, dedicated to advocating for children with gastrointestinal disease. For more than a decade, NASFIGAN and its physician members have advocated for a strong federal safety standard for tiny magnets that have the strength to cause serious medical injury and even death when two or more are accidentally ingested. There is overwhelmingly scientific evidence and a growing body of peer-reviewed literature describing the significant hazard associated with magnets that have a force or flux of 50 or greater. Moreover, there is also emerging data on risks associated with magnets with a flux index of less than 50. Kids ingest a lot of things they shouldn't, and roughly 98% of foreign body ingestions occurring in children are unintentional and most are the result of developmentally appropriate behavior. While many foreign objects pass through gastrointestinal tract and exit the body out in the stool without medical complications or interventions, the ingestion of rare earth high-powered magnets are strikingly different. When two or more magnets are ingested, their attractive forces allows the magnets to find each other across or between different segments of the digestive tract, placing children at a remarkably high risk of abdominal catastrophe and death. The proposed rule provides an accurate and thorough description of the health threats posed by ingestion of hazardous magnets, but which bears repeating in this form. When two or more high-powered magnets or a single hazardous magnet and a ferromagnetic object are ingested, the medical implications can include gastrointestinal perforations, abdominal abscesses, or fistulas in the bowel. Sometimes the magnetic force of two or more magnets causes the intestine to twist on itself, cutting off its blood supply and leading to bowel death. A 2015 survey studied by Waters et al. reported that of the 99 children that had ingested multiple magnets, 73 required abdominal surgery. More concerning, 17% of the children are found to have at least one perforation or fistula, and 34% of the children have multiple perforations over their gastrointestinal tract. The injuries that occur from magnets are serious and often have lifelong consequences. For example, some children who ingest hazardous magnets now require surgically placed feeding tubes or nutrition provided intravenously via catheter tunnels from the skin to the heart or other central blood vessels due to the cessation of function of the magnet injured while. Children universally require high-cost medical intervention following a magnet ingestion. All require some form of emergency services such as an emergency department visit or often need multiple x-rays. In some lucky patients, the magnets eventually pass without further intervention, although these children must be monitored in the hospital. More often, however, pediatric gastroenterologists and surgeons must perform endoscopy and or surgery in order to retrieve the magnets to prevent complications or to treat resulted injuries. Because of the inability of physicians to determine the flux of a magnet from a radiograph, all magnet ingestions must be medically managed, which means that even magnets that have a flux under 15 may need to be endoscopically or surgically removed, subjecting pediatric patients to the risk of an invasive procedure, anesthesia, and serial radiographs. A federal safety standard for hazardous magnets is the most powerful tool to prevent accidental pediatric magnet ingestions. Data as presented in this proposed rule and obtained by the National Electronic Injury Surveillance System or NICE and the Consumer Product Safety Risk Management System showed that there were far fewer magnet ingestions than the period 2014 to 2016 when the initial magnet rule was announced, an effect compared with earlier and more recent periods. These data are supported by injury trends in the national poison data system, the database for American Association of Poison Control Centers, as well as independent analysis of the NICE database. I was involved in two studies, the first in 2012 and the other in 2017 that performed analysis of the NICE database for magnet ingestions. We showed a significant increase in magnet ingestions between 2002 and 2011 and a subsequent decline from 2015 to 2017 thanks to the significant effort of the CPSC, the magnet safety standard, and support from my organization as well as others. The refusal of one high-powered magnet company comply with the CPSC effort in 2012 and its successful lawsuit against the magnet safety standard regulation resulted a major setback for public health efforts and led to the return of these magnets on the market. This led to a reversal of the downtrend when the safety standard was in place and instead a dramatic increase in pediatric ingestions of these dangerous objects. The NICE database does have significant limitations that underestimate the scope and severity of the problem. The database is based only on emergency room visits, can be limited in its ability to detect all magnet ingestions, and it doesn't provide information about the medical manager outcomes of the ingestion. Nonetheless, the data on the health risks that hazardous magnets pose to children were as compelling when the safety standard was finalized in 2014 as they are now. Additional efforts have been taken to obtain magnet ingestion outcomes data. A recent retrospective cohort study about to be published in the journal Pediatrics examined the outcomes of 596 children who had a confirmed high-powered magnet exposure. This was conducted at 25 children's hospitals across the United States. The study found that most children are 55.7% required hospitalization with four patients requiring admission to an ICU. During diagnosis and management, 81.4% of children received more than one radiograph. A total of 276 children and 46.3% required endoscopy and or surgery for magnet removal or treatment of complications. Nearly 10% of patients experienced life-threatening injuries, including perforation, fish cell formation, bowel obstruction, bleeding, infection, twisting of the intestine, and or bowel herniation. This study offers compelling evidence for why the proposed magnet standards should be finalized swiftly. Those who oppose this proposed safety standard will argue that volunteer standards are sufficient to prevent ingestion of hazardous magnets. We valiantly disagree. For nearly two years, NASAGAN was represented on the ASTM Magnets Subcommittee. During that time, concerns voiced by child safety advocates and medical professionals about the insufficiency in marketing labeling standards to prevent magnet ingestors were marginalized. NASAGAN is on record opposing the final ASTM standard specification for marketing labeling adult magnet sets containing loose, powerful magnets on the basis that the standard does not address the product, namely the size and strength of the individual magnets that comprise the sets. And the standard covers marketing, packaging, labeling, warning requirements for magnet sets, which are ineffective in reducing the hazard associated with high-powered magnets. Because incidents of magnet ingestors continue that involve products with warning labels, 14 and older aged labels, instructions, marketing, and packaging that address the ingestion hazard. NASAGAN supports the proposed safety standards and minimum safety standards that is each loose or separable magnet and a product that is subject to the proposal that fits entirely within CPSC's small part cylinder would be required to have a flux index of less than 50. Kilogos millimeter squared. Further, we support the safety standards applicability as proposed to consumer products that are designed market or intended to be used for entertainment jewelry, including children's jewelry, mental stimulation, stress relief, or combination of these purposes, and that contain one or more loose or separable magnets. We appreciate the commission is seeking comment on whether a lower flux limit may be appropriate as well as testing safety data supporting an appropriate flux index limit. As mentioned earlier in my remarks, it is critical for the commission to recognize that the medical management of a magnet ingestion will always be the same because a physician cannot tell with precision by x-ray the size of a small magnet, and there's no way to determine the flux of a magnet through visualization. Not enough is known about the characteristics of lower flux magnets. For example, what is the effect of ingestion of numerous lower flux magnets? We encourage further study in this area. What we do know is that children are undergoing otherwise unnecessary medical procedure, all of which can inherit risk for ingestion of all small magnets. Thank you again for this opportunity to provide comment and support with the proposed main magnet safety standard. I'm happy to take your questions. Thank you, Dr. Abbas. And thanks to Dr. Hopin as well, this panel. We'll now turn to questions from the commissioners. Actually, Dr. Abbas, I may ask you to keep your camera on because I'm sure people are going to be asking you questions as well. Each commissioner will have 10 minutes to ask questions and we can do multiple rounds if necessary. I'll start. I think both your testimony was compelling and the impact on the children who swallow magnets is just horrific. Curious, as you're talking about treatment, obviously in some cases when there's small magnets, you swallow two or more magnets. You said when they're lucky, it passes, it can pass through and maybe because it's a lower, lower strength. When that doesn't happen, I'm curious to you, is the treatment necessitate often going in and actually cutting through the colon in order to get the pieces out as opposed to being able to take them apart and pull them out, trying to get the sense of the harm the children face when you have to be treated under this. I don't know if Dr. Hopin or Dr. Abbas wants to take that question. I can go ahead and take that question. So typically when a patient ingests more than one magnet, we almost always go in endoscopically to try to retrieve it. If it's visualized on x-ray within the stomach or the esophagus, obviously, if it's in the colon, sometimes we'll wait and see if it'll pass. Sometimes if the patient is constipated, we'll give them medications. If there are two magnets and they're in the small intestine, typically the approach is to call the surgeon because the problem is the two magnets on x-ray, when they're meeting together, we have no way to tell if there's bowel trapped in between the two. So unless it's a witnessed ingestion where the parents witness the two magnets together, typically the approach is a laparoscopic procedure where the surgeon goes in and basically attempts to find them in the intestine, brings them out, and has to make a small incision in the intestine to remove them. That's the only way. I mean, there's attempts sometimes to kind of melt them down, but that can be harmful because they don't really know if they're attached to mucosa on the inside of the bowel. You can't really see it from the outside when they do a laparoscopic procedure. So I hope that answers the question that inherently almost always we end up either doing endoscopy or surgery unless we know the magnet is already down in the rectum and it's mixed with some stool and we could try maybe giving the patient some laxatives to try to get it out that way. And as you said, I mean, perhaps you can provide a little bit more detail when you aren't able to get them out, what the implications are for children and how the long-term implications for their health. Well, if the surgeon can't get them laparoscopically, they typically will go to an open procedure, which is a big, huge thing. You know, they have to basically make a large incision and then they go in and pretty much like they have to run the whole bowel by hand to be able to find where the magnets are. And then of course they'd have to see if there's been any damage or any fistula formation or perforation that's happened inside the abdominal space. So it becomes a huge surgery. I mean, it depends if there's been a twist of the bowel and it's lost its blood supply, they might have to do a resection of that bowel. And a lot of times they then end up doing an ostomy temporarily and not reconnecting depending on how much bowel has been lost and how damaged it was. And that could end up leading to obviously IV nutrition where they have to put a central line in. And these are in the severe cases obviously. In most cases, typically it's endoscopy first if it's in the upper GI tract where we can get to it and then subsequently laparoscopic procedure that the surgeon does. As you noted in this piece, our staff saw there were significant decreases in magnet ingestions during the period that the CPSC rules in fact, in fact, and then significant increases after it was vacated. Maybe you can talk a little bit more if that matches your observations as well. Maybe Dr. Hoffman, you can say, I mean, is that consistent with what you found as well that there was an increase after the vacation of the rule? Yeah, absolutely. There's no question. I mean, the data show it and all of our anecdotal personal experience goes along with that. As I mentioned in my testimony, there was a three week period in 2019 where we had three children, young children admitted to the hospital with 36 magnets. These things are incredibly attractive to kids in the same way that they're, you know, if you've ever played with them as an adult, I get the, no pun intended, but the attraction to them. And kids are inherently curious. They explore the world with their mouth very frequently. And so, you know, this is just what we see. The fact that there is, I want to be very clear, I can think of no safe way to expose a child to these magnets. And then constant, close, capable supervision, which is effective when it works. But we know in injury prevention that while supervision is essential, absolutely essential is completely insufficient. It's an important layer of protection, but it can't, it is far from perfect. Because kids are quick and impulsive, if they get to magnets, they will play with magnets. If they play with magnets, they'll put them in their mouth. And if they put them in their mouth, they're going to swallow them. And then we get to the circumstances that Dr. Abbas was talking about. Thank you. I wanted to give an opportunity to my colleagues to ask questions as well. So I'm going to stop there. Commissioner Bianco. Thank you, Chairman. I actually understand the issues and I don't have any questions. I appreciate your testimony. It's very clear. And like both of you, I personally am having trouble seeing why the risk here would be reasonable under any sort of circumstances. So I'll pass my time to other commissioners. Thank you. Thank you, Commissioner Feldman. Thank you, Mr. Chairman. Dr. Hoffman, Dr. Abbas, thank you so much for being here today and for your testimony, your very compelling testimony. I want to thank both of you for the work that you've done in the ORR and the advocacy work that you've done as well. I think that I agree with my colleagues so far. This is an issue that has gone on too long. I look forward to being part of the solution. And again, thank you for your testimony and for your advocacy. I have no further questions. Mr. Chairman, I think you were on mute, but I think you were pointing to me. So I'll go ahead. Sorry about that. No problem. Dr. Hoffman, Dr. Abbas, I'd like to mirror that. Thank you for your expert testimony. It was incredibly helpful. Dr. Hoffman, I wrote that last part down where you said the only other way to protect might be constant close capable supervision. I've got a 2-year-old and a 5-year-old. And I know when I'm trying, and I think I'm providing that, they still slide things past me when I'm this far from them. So maybe not even that. But again, thank you all for the expert testimony. I don't have any questions. Once again, thank you, Dr. Hoffman, Dr. Abbas, for your time. And I appreciate you being with us this morning. And look forward to seeing your written submissions as well. That we're going to turn to our second panel. We have three people on the second panel. Nancy Coles is Executive Director for Kids in Danger. Rachel Weintraub is the Legislative Director in General Counsel at Consumer Federation of America and Gabe Knight is a Policy Analyst at Consumer Reports. Welcome all of you to CVSE and look forward to your testimony. Ms. Coles, you are recognized for 10 minutes. Thank you very much. And thank you again for holding this hearing to discuss the safety standard for magnets in the Notice of Proposed Rulemaking. We have seen too many tragic injuries and death since CPSC's previous rule was overturned in 2016. Kit agrees with CPSC's determination that there is an unreasonable risk of injury associated with children ingesting these high-powered loose or separable magnets. The same risk was documented in CPSC's work that led up to that original rule that was overturned. Unlike other small parts, hazards of magnets are often hidden to caregivers and parents. In January of last year, a toddler in Michigan died after ingesting magnets from a set that had been given from her grandmother to her older sister. It was one of three deaths since just 2018. The proposed rule covers consumer products that are designed, marketed, or intended to be used for entertainment, jewelry, including children's jewelry, mental stimulation, stress relief, or a combination of those, and that contain one or more loose or separable magnets. And it would prohibit those magnets in anything that could fit into the small part cylinder. Kit supports this proposed standards. These comments are responding to questions that were raised in the NPR. Kit first learned about the dangers of these small, powerful magnets back in 2005 when a young boy in Washington state died on Thanksgiving Day. Kenny had picked up the small magnets off the floor that had come out of his older siblings' magnetic set and new toy that contained these magnets. Unfortunately, the symptoms were thought to be similar to those other in his house were suffering from the flu, and so his care came too late to save him. Similarly, the child who died in 2021 had symptoms that were echoing those of people in her household who had COVID. No one knew she had swallowed the magnets until her autopsy. By the time symptoms appear, even if they aren't masked by confusion with another illness, the damage has already been done. This is why it is so important to address the hazard through rulemaking. Warnings in education can never be pervasive enough into our homes to eliminate the hazard. At that time of Kenny's death, the ASTM Toy Subcommittee worked quickly to address it in the toy standard, very similar to what is in this rule today. That became federal law in 2009 when the toy standard became mandatory as part of the CPSIA. Unfortunately, with the hazard removed from toys intended for children, it then appeared in magnet sets, which were originally marketed to all ages. While they have more recently been marketed for adults, it is clear their appeal to children is strong and children can manipulate and interact with the product in meaningful ways. That indicate that these do have play value for children and it is probably wrong to be labeling them as adult products. CPSC's original rule only applied to magnet sets. This leaves many other loose and separable magnets uncovered by any standard. We support CPSC's coverage of additional magnet products and including products with only one small powerful magnet. A small powerful magnet can easily be paired with another magnet from somewhere else or even a small metal part and pose the same risk. We agree with the proposed standard requirement that the magnets in the covered products that meet the definition of a small part must have that flux index of 50 or less. However, research in the NPR points to both the variance in flux among magnets in the same set or same product as well as injuries reported with lower flux magnets and that requires further study once this rule is adopted. We further urge the CPSC to study whether magnets with the flux index of 50 when aggregated continue to have that flux index of lower than 50 or whether the aggregation of these magnets increases the flux index and can pose more serious harm. As many of these magnets are sold in sets, this is a key safety factor. Kid does not believe warning labels are effective in protecting children from the hazards posed by ingesting small powerful magnets. Warnings should always be a last resort for safety. While the risk of swallowing the product is clear given both past data and the design of many products they are tiny cubes and balls that are easily swallowed. The hazard of intestinal damage is not evident to the public. When caregivers believe they know the risk that it's a small part, they're less likely to even read the warning assuming they already know what it says. Warnings have been included on these products and those warnings have not curved any injuries. With these products, the warning is only on the package. It cannot be added to the product itself. So once it's out of the packaging, the warning is lost. We urge CPSC not to rely upon child resistant containers, bittering agents, or any other attempt to deter children, but rather upon an effective standard to eliminate the hazard. Data from CPSC's analysis shows most victims are even above the age where child resistant packaging might be effective. We urge the CPSC to include the use and abuse testing that's in the toy standard to assure that products do not liberate hazardous magnets or magnetic components due to use and play patterns. It has proven effective in the toy standards in the U.S. and elsewhere. We also recommend it's still including the indication that small magnets are in a product and what could happen if they are swallowed even on products that meet the standards but contain magnets. It is often a hidden hazard and it's possible that the magnets could be liberated and swallowed so parents should have information on what action to take. There are many exclusions to the rule, including for educational products, but CPSC should continue to monitor the marketplace to make sure that the hazardous magnets don't reappear under the guise of education. Kids strongly supports the adoption of this standard as included in the Notice of Proposed Rulemaking. This standard will effectively limit exposure to the hazards caused by magnet products currently on the market. Reducing the magnetic force of magnets that can be swallowed is the most robust and successful way to reduce the threat of injury and death to children. We would support the recall, too, of the products currently on the market to remove even more of the dangerous items from home. Thank you. Thank you, Ms. Coles. Ms. Weintraub, recognize you for 10 minutes. Thank you. Good morning, Chairman Bonsare, commissioners Bayoko, Feldman, and Trumka. Thank you for the opportunity to speak to you today. I'm Rachel Weintraub, legislative director and general counsel with Consumer Federation of America, an association of almost 250 nonprofit organizations founded in 1968 to advance the consumer interest through research, education, and advocacy. 10 years ago, CFA similarly submitted comments to the CPSC on rulemaking for magnets, then magnet sets. The past 10 years have illustrated the important beneficial impact of a mandatory standard for magnets and the inadequacy of the voluntary standard to effectively address the known hazard. CPSC strongly supports the CPSC's notice of proposed rulemaking, seeking to develop a safety standard to address the unreasonable risk of injury and death associated with ingestion of loose or separable high-powered magnets. Incident data from the CPSC as well as from pediatric gastroenterologists across the country have documented the serious medical consequences that occur as a result of a child ingesting such high-powered magnets. The unique properties of these magnets cause serious life-threatening injuries when a child ingests one or two or more of these magnets. These injuries are vastly different from and more serious than those that occur from the ingestion of other small parts, as we've heard today. The notice of proposed rulemaking, the commission proposes safety standards for magnets. The safety standard proposed would apply to consumer products that are designed, marketed, or intended to be used for entertainment, jewelry, mental stimulation, stress relief, or a combination of these purposes, and that contain one or more loose or separable magnets. The proposed rule would require loose or separable magnets to be either too large to swallow or weak enough to reduce the risk of internal interaction injuries when swallowed. The proposed rule would require that subject magnets that fit entirely within the small-part cylinder must have a flux index of less than 50. Our common support this proposed standard. The hazard of powerful rare earth magnets first emerged in the mid-2000s when toy building and construction sets contain these powerful magnets, entered the marketplace. The magnets were so strong that they broke out of and detached from the plastic that contain the magnets. Injuries occurred when children swallowed more than one of these powerful magnets that it separated from the plastic toys. And a number of incidents involved children swallowing the toy part that contain the magnet or the magnet itself. Due to this defect and to the resulting serious injuries, the CPSC conducted numerous recalls of these toys in 2007 and 2008. The numerous incidents clarified the seriousness of the injuries that occur when these magnets attract each other inside a child's body. These magnets attract across tissue within the stomach, bowel, and small and large intestines, causing holes, blockages, and killing tissue caught between these magnets. Such injuries are difficult to diagnose and can be fatal if not treated immediately. As a result of this alarming trend, CPSC and consumer advocates worked with ASTM and representatives of the toy industry and testing lab community to quickly develop a voluntary toy standard upon which CPSC's proposed rule is based. Since many magnet incidents were caused by magnets that were not toys, in 2012 the CPSC began a rulemaking to address the magnet ingestion hazard not covered by the toy standard. The rule was issued in 2014, went into effect in 2015, and this rule focused on the size and strength of magnets in magnet sets. The rule, as we know, was struck down by the US Court of Appeals for the 10th Circuit in 2016. The CPSC's incident data before, during, and after this period clearly document how effective the mandatory standard was in reducing incidents associated with these magnets. Specifically, and significantly between 2010 and 2021, the CPSC recalled 18 magnet products. The CPSC documented that the vast majority of those recalled products involved products intended for amusement, including primarily magnet sets and desk toys rather than children's toys or other non amusement products. CPSC's proposed rule accurately describes the serious injuries caused by ingestion of magnets from magnet sets, which can be very grieve and potentially life threatening. When one or more than one of these magnets is ingested, the magnet force of the magnet can interact internally through body tissue with an unrelated magnet or a ferromagnetic object resulting in an internal injury. The CPSC data therefore indicate that even one magnet poses the same risk as numerous magnets. Thus, a single magnet or magnet can trap tissue between them, such as tissue from the intestinal wall, esophageal tissue, and other digestive tissues. This tissue, when essentially caught between the magnetic force, is damaged and could cause serious injury, death of tissue, or death of the person. The longer the damage is not identified and remedied, the more serious and acute the injury. CPSC has estimated that 23,700 ingestions of magnets were treated in emergency rooms and hospitals across the country from 2010 through 2020. In the context of great importance, the CPSC identified significantly fewer emergency department treated magnet ingestions in 2015 than in any of the following years. Likewise, there were significantly fewer emergency department treated magnet ingestions in 2016 than in any of the following years. Overall, 2014 through 2016 had the lowest number of estimated ED treated magnet ingestions. Clearly these incidents significantly correlate to the issuance of CPSC's mandatory standard for magnet sets in 2014 and the revocation of the rule in 2016. We support the CPSC's assessment of the seriousness of these injuries and agree that the data provides evidential support for the promulgation of this proposed rule. We agree that the CPSC's recommendation in the proposed standard that magnets that are smaller than the choke test tube should have a flux index of 50 or less, or they will be prohibited. We believe that the CPSC should further study whether magnets of less than 50 could also potentially cause harm. We're concerned about the data that CPSC has identified that may indicate that magnets of a flux index of less than 50 may have been involved in some serious issues, but we suggest that CPSC move forward with the rule and continue to study this issue after the rule is finalized. I participated in the ASTM subcommittee F-1577 on magnets, while consumer groups, representatives, CPSC staff, pediatricians and gastroenterologists with expertise in treating children who have ingested magnets strongly and repeatedly urged that the standard include performance requirements, that recommendation was overruled by the majority of the subcommittee members. The voluntary standard, which was published in March of 2021, does not effectively address the hazards posed by the ingestion of magnets and necessitates the promulgation of an effective rule such as the rule CPSC has proposed. Exactly that rule. We agree with the CPSC analysis that the scope labeling and patch packaging provisions of the voluntary standards are not adequate. The CPSC states that the scope is not broad enough, and we agree with that as well. Further, the standard does not include performance requirements, vastly limited effect its effectiveness that the standard relies on information to encourage consumers to keep magnets away from children is inadequate. Since incident data indicate that children and teens use magnet products intended for older users. In terms of costs, the cost analysis considers the extensive costs of the injuries of children caused by these magnets. Importantly, however, these products continue to pose hazards across the life of the product and ingestions of magnets does not diminish the economic value of the magnets overall. We agree with the effective date of 30 days and believe that the 30 days is reasonably necessary to eliminate or reduce an unreasonable injury of injury associated with the product. Further, given that the incident data is clear documents known hazards, we do not believe that time should have time should be lengthened because it could delay critically important safety benefits of the rule and we've already seen the benefits of one of rules and effect. In conclusion, CFA strongly supports the adoption of the Commission standard as included in the Notice of Proposed Rulemaking for Magnets. The standard will effectively limit exposure to the hazards caused by magnets currently on the market, limiting the size to prevent swallowing and limiting the magnetic force to reduce serious injury are the most robust ways to reduce the threat of injury in depth to children caused by these magnets. Thank you. Thank you, Ms. Weintraub turn now to Miss Knight. Thank you and thank you for the chance to be here today. On behalf of Consumer Reports, the independent nonprofit member organization, I welcome the opportunity to testify in support of the CPSC's Notice of Proposed Rulemaking to establish a mandatory safety standard for magnets. CR supported the CPSC's 2014 safety standard that regulated high small high power magnet sets. The rule was appropriate given the risks these magnets posed to children and teenagers. In November 2016, while I wasn't yet at CR, our organization, partner groups and medical professionals expressed grave concerns about the 10th Circuit Court of Appeals vacating the rule. Sadly, those concerns have proved to be well founded. We commend the CPSC for proposing a rule that would again establish a mandatory safety standard for high powered magnets. Sufficient data exists to demonstrate that the magnets present a serious hazard. It is clear that the agency's previous rule was working to protect children and that a strong rule is needed now. As such, Consumer Reports fully supports the CPSC's proposed rule and urges the agency to finalize it expeditiously. The harm caused by ingesting these high powered magnets is indisputable. When two or more of them are swallowed, they can connect across tissue and cause horrific and sometimes lifelong injuries. CR's mission is to work for a fair, just and safe marketplace for all consumers and to empower consumers to protect themselves. We always strive to provide people with the information they need to keep themselves and their families safe. Just as the CPSC has done, CR has worked for over a decade to inform the public of the dangerous pose by high powered magnets. However, some products simply pose so great a risk to the safety of the public and take a toll so terrible that information campaigns proved to be little more than window dressing. For these products, far stronger measures are needed. The data shows us that high powered magnets are one such product. As long as they remain on the market, they will continue to seriously injure children and put them at risk of lifelong harm and even death. In the United States, five deaths linked to the ingestion of hazardous magnets occurred between November 2005 and January 2021. Three of these deaths, two of which involved young children, occurred after the 10th Circuit vacated the CPSC's rule on magnet sets. Research shows that the CPSC's previous efforts to limit dangerous high powered magnets in the marketplace were effective. Agency staff found that for the periods between 2010 and 2013 and 2017 and 2020, there were an estimated 2,300 ED treated magnet ingestion incidents per year. Comparatively, for the 2014 to 16 period while the rule was in effect, this number was an estimated 1,300 such incidents per year. Others observed similar trends. In a 2021 pediatrics paper examining data from the National Poison Data System between 2008 and 2019, researchers observed a 33% decrease in cases after high powered magnets were removed from the market. The same researchers observed a 444% increase in estimated cases per year in the 2018 to 19 period. They noted that cases from 2018 to 19 increased across all age group and account for 39% of magnet cases since 2008. Researchers concluded that these significant increases in magnet injuries correspond to time periods in which high powered magnets sets were sold. And the data reflects the urgent need to protect children via preventative efforts and government action. A study published in February 2022 led by researchers at Nationwide Children's Hospital in Columbus and 24 additional children's hospitals across the country expanded on this research. It examined 596 cases of high powered magnet related injuries that occurred between 2017 and 2019. The study, which looked at patients through age 21, found that over 55% required hospitalization and 10% had a life-threatening condition. Researchers concluded that despite being intended for use by those over 14 years of age, high powered magnets frequently cause morbidity and lead to high need for invasive intervention and hospitalization in children of all ages. Indeed, children of any age are at risk of exposure to these magnets. It would be unrealistic to expect magnets to remain in their original packaging or to assume that simple age grading could keep them out of the hands of younger children. It is also improbable that packaging could clearly indicate to an adult whether all the many tiny magnets that comprise the sets have been returned to the package after each use. Child resistant packaging designed to be difficult for children under 5 to open would simply be inadequate to address the magnet ingestion hazard. This is true not only because many victims are older than 5 or 5 or older, but also because the CPSC's data shows that in a majority of ingestion cases, children did not access full magnet sets, but rather acquired loose magnets in the home, at daycares, at school, or from friends. In examining incidents that involve children under age 8, CPSC staff found that these children often encountered magnets on the floor in furniture in bags or elsewhere or gained access to them for family members such as older siblings. While packaging improvements would be welcome, these magnets, by their nature, are likely to be left around in a number of environments. This stands in contrast to many products that must come with child resistant packaging such as those that are typically stored under the sink or in a medicine cabinet. As proposed, the CPSC should restrict the marketing and sale of these magnets to those in which each individual magnet has a flux index of 50 or less if it fits completely within the agency's small heart cylinder. The agency's 2014 rule on magnet sets similarly codified the strength measurement requirement, and there is compelling data to demonstrate that it was effective in substantially reducing health complications resulting from ingestion. Either the magnets must be weak enough in power so as to not have the ability to reconnect to each other and damage the child's organs once ingested, or they must be too large to be swallowed by a child. The proposed strength measurement and the utilization of the pulse small heart cylinder in combination address both of these factors. Therefore, consumer reports find the proposed strength measurement appropriate. We agree with the scope of the proposed rule and find the CPSC's reasoning and in particular why home and kitchen magnets and educational products should not be included to be compelling. However, researchers at Nationwide Children's have found that in magnetic exposure cases where size could be identified, almost a third, 32.8% of the magnets were larger than five millimeters. Therefore, the CPSC should continue to study whether larger magnets may pose an unreasonable risk of injury and therefore should be brought within the scope of this rule at a later date. The CPSC's estimates of net benefits strike us as reasonably and fairly reached. The economic analysis conducted for this proposed rule clearly indicates that its benefits are likely to exceed its costs, perhaps by a substantial amount yielding monetized benefits of $85 million per year or more. Simply put, this should be an easy call for the CPSC to finalize the rule from a cost-benefit perspective. Furthermore, we find compelling the CPSC's conclusion that none of the considered alternatives to the proposed rule, including safety messaging or packaging requirements, would adequately reduce the risk of injury or death in the absence of a performance standard for the magnets themselves. Sufficient data exists demonstrating the safety hazard that these high-powered magnets pose. Researchers have concluded when they are on the market, injuries decrease, and when they are removed from the market, injuries decrease, and many of these injuries are life-threatening. Regardless of how these high-powered magnets are marketed or how they are packaged, they are attractive to children as something to play with. Children will continue to gain access to them, and as the last decade has demonstrated, they will continue to ingest them. A strong safety standard for magnets has already been proven effective, and it is vital, once again, for the CPSC to institute such a standard. As the independent agency that consumers rely on to help keep their families safe from unreasonable product hazards, it is imperative and core to the CPSC's mission for the agency to finalize a strong safety standard without delay. Thank you for your consideration of our comments. Thank you, Ms. Knight, and thanks to the rest of the panel. At this point in time, we're going to turn to questions from the commissioners. As in last time, each commissioner will have 10 minutes to ask questions with multiple rounds if necessary. Again, thank you all for your testimony. I just want to follow up on one or two things. Ms. Weintraub, you had talked about your engagement with the ASTM subcommittee on magnets and about, in your view, that the voluntary standard is insufficient. Can you just elaborate on that a little bit more as to why you think that the voluntary standard is insufficient and is it likely to improve anytime in the near future? Sure. So first, CFA, along with KID and Consumer Reports, and AAP and NASFAGAM participated in the Voluntary Standard Committee. I believe Dr. Hoffman said it was for two years. It was a very intense and extensive period where we worked independently but also collectively to try to ensure that the voluntary standard would be effective and that it would include performance requirements. And again and again and again, we were rebuffed. And even though I, you know, especially with AAP and the gastroenterologists who had direct evidence and important information that was incredibly compelling, we were unable to successfully change the direction of the standard. It was frustrating and disappointing, which really necessitates, I think, a strong mandatory standard such as what the CPSC is proposing. That standard was published in 2021 and there's now an effort to work on performance standards for magnets. We are in the very beginning stages. So while that's promising, it is the beginning. And we've been through this before. I think the best path forward would be for the CPSC to continue what it's doing and promulgate a mandatory standard. I think, you know, that impacted also the ultimate direction of this second revision to the magnet voluntary standard. But again, you know, it took over two years to get to the point that, you know, we were really disappointed by the scope and breadth of the standard. So I think it's imperative that the CPSC continue to move forward on this rulemaking as quickly as possible. And I believe each of you in the last panel had noted that when there was a mandatory rule in effect, there was a significant drop in injuries for children across the board. And then when the decision was vacated saw an increase from the data that we have. So if we rely upon the process, there was no standard. Would you anticipate that the number of injuries would continue to be high? I would. I would. And I think this is a rare gift from the perspective of consumer advocates. We're often looking for this type of data. We don't always see it because sometimes it takes a while for products to leave the marketplace that are not compliant. They remain in people's homes, but this data was incredibly stark about how incredibly important the mandatory standard was. So yes, until mandatory standard is again in place, I would not expect that we would see a decrease in the incidents. Thank you. I would just comment, Ms. Coles, I recognize the comments that you had on labeling of warnings and, you know, Ms. Knight, also the focus that you had on the impact of the data, but also and how it is as harm children based on for and after the court decision. I also recognize that my colleagues are there and I've been doing a lot of talking. So I just want to give them a chance to go through. So, Commissioner Biacco, do you have questions? I don't. And Alex, as usual, you've covered many things that I would have followed up on. So I appreciate everyone's presentation and the follow up answers to the questions that have already been asked and will be asked. So thank you very much. Thank you, Commissioner. Commissioner Feldman. Thank you, Mr. Chairman. I just want to offer again my thanks and appreciation to everybody on the panel for your presentation testimony today and also for your advocacy on this issue throughout the dependency. So thank you for that. Thank you for being here today. I have no further questions. Thank you, Commissioner Feldman. Commissioner Trumka. I just like to thank the distinguished panel for your important and comprehensive testimony. I don't have any questions. Thank you. Well, apparently the panel did covered everything very fully and answer all the commissioners questions in advance. So, thank you again to all the witnesses who came before us today on this rulemaking. The testimony has been instructive and I'm sure it's going to be helpful as the staff begins to develop the final rulemaking package. Once again, I'd urge all interested stakeholders to submit comments in the proceeding. And with that, the hearing is adjourned. Thank you.