Saturday, September 12, 2009

CPSIA - Tenenbaum Challenge Update!

It's been two days, and still no reply from the CPSC on my rhinestone challenge. Next time I think my challenges need a time limit.

Since I have had two more days to think about rhinestones, I have another challenge for Ms. Tenenbaum: Provide ONE example of a child (not deranged) that has accidentally or inappropriately ingested 50 of anything since the Pilgrims landed at Plymouth Rock in 1620. I don't think it's happened in the United States EVER. [Non sequitur: There is a Plymouth Rock in Wisconsin and when my kids were younger, I used to ask them to tell me how the Pilgrims managed to land in the middle of Wisconsin of all places. Imagine the surprise . . . . Okay, I guess I give hard challenges at times.]

I was discussing the dilemma of rhinestone-eating children with my brother-in-law who is an Emergency Room Physician. He noted that in his 22-year career, he has seen only ONE case of a child ingesting more than one object, namely two quarters. He does see many cases of childhood ingestion of a single object (typically, a coin, spring or a paperclip - no mention of rhinestones but then again, he's only been on the look-out for 22 years). He said that the only cases of multiple foreign body ingestion he sees is pills. I guess the Hot Dog Eating Champ must not have gotten his start in bracelets or earrings. This got me to thinking . . . .

I poked around on the Internet to see what statistics I could find on foreign body ingestion by kids. I didn't want to be embarrassed by the sudden appearance of statistics that showed that children regularly chow down on bracelets, rings and necklaces laced with "dangerous" rhinestones, or that they suck the jewels off their jeans and shoes with regularity. Turns out the Internet is chock-a-block with data on this topic. Interesting . . . .

Here's data from "Foreign-Body Ingestion in Children: Experience With 1,265 Cases", Journal of Pediatric Surgery, Vol. 10, No. 10 (October, 1999), pp. 1472-1476 (I paid $31.50 to bring you this exciting news):

Table 1. The Categorization of Foreign Bodies Ingested by Children

Coins: 271 cases (49% of cases)
Fish bones: 155 cases (28 %)
Metallic objects: 78 cases (14%) [7 batteries, 41 sharp objects (needles, pins, screws, and wires), 30 blunt objects (keys, metal caps)]
Other bones: 16 cases (2.9%) [8 chicken bones, 7 pork bones. 1 duck bone]
Rubber and plastic material: 10 cases (1.8 %)
Glass objects: 7 cases (1.3%) [2 glass objects, 5 glass marbles]
Others: 15 cases (2.7%) [3 (shrimp &crab shell), 1 seed, 1 ginger, 1 denture, 2 wooden material, 7 unknown objects ]

Total: 552 cases (100 %)

This data summarizes the cases with endoscopically or radiologically proven foreign body ingestion. The study covered a period from 1964 to 1997 in one tertiary referral center. No jewels mentioned in the article. Hmmm.

Another article ("Guideline for the management of ingested foreign bodies" from American Society For Gastrointestinal Endoscopy, Vol. 55, No. 7, 2002, pp. 802-806) notes: "The majority of foreign body ingestions occur in the pediatric population with a peak incidence
between ages 6 months and 6 years. In adults, true foreign object ingestion occurs more commonly among those with psychiatric disorders, mental retardation, or impairment caused by alcohol, and those seeking some secondary gain with access to a medical facility. Ingestion of multiple foreign objects and repeated episodes are not uncommon. Edentulous adults are also at greater risk for foreign body ingestion, including of their dental prosthesis." In other words, crazy adults will eat multiples, but not kids. This article mentioned coins and batteries, but did not address jewels or jewelry. Yet another article points to coins and chicken and fish bones as the most common childhood ingestion objects. The American Family Physician, a publication of the American Academy of Family Physicians has an information sheet about accidental ingestion - again, no special mention of jewels or swallowing 50 of anything. There's a lot of articles out there which provide consistent data.

This gets even more interesting if you check out Ms. Tenenbaum's citations in her statement supporting her vote to reject the exclusion request on rhinestones, crystals and glass beads. From her statement: "Moreover, emergency room data collected through NEISS shows that jewelry is one of the top five items ingested by children." Wow, that's a shocker, isn't it? In my house, the top five items ingested by children are potato chips, bagels, pop tarts, hamburgers and fries.

I thought I would check out the NEISS data, just for kicks. One CDC report summarizes the data as follows: of 17,537 choking incidents among children under 14 years of age in 2001, the percentages break down as follows: 29.6% Solid Food, 19.0% Candy/Gum, 18.7% Other Non-Food, 12.7% Coins, 9.0% Unknown, 7.6% Liquids, 3.4% Unspecified Food. The category including jewelry is Other Non-Food, which is described as "Includes toys, marbles, balloons, puzzle pieces, paper, pen caps, tape, screws and other hardware, keys, plastic, cellophane, plants, rocks, jewelry, hair accessories, soda can tabs, and other specified nonfood items". Hmmm. Seems quite unlikely that jewelry is the fifth largest category of ingested items.

Another report from the Commonwealth of Massachusetts hinted that the NEISS data Ms. Tenenbaum may have been referring to was from 2000-2005. You can't run a query on six years of data at once on NEISS. I ran a query for 2005 to see what I would find. The number of ingestion incidents reported were 2205. The number of incidents coded to jewelry (class 1616) was 125 or 5.7%. This is similar to the data provided by the Massachusetts report (6.6%) so I decided lazily to accept it as directionally representative of the data apparently used by Ms. Tenenbaum. Of the 125 cases, however, 30 were for kids 6-22 months old, 41 for kids 2-6 years old. 15 for kids 7-12 and the balance for older kids through adults. Thus, the number of cases reported in 2005 for the targeted 0-6 age group was not 5.7% but instead 71/2205 or 3.2%.

The data is difficult to interpret, although there are short case descriptions for each line of data. I would guess with high confidence that many (if not most) of the 71 target market cases are either beads (not relevant here but classified as jewelry all the same) or adult jewelry (several cases of swallowing nose rings and tongue rings). Many of the reported cases are not certain but noted simply as "possible" swallowings - and thus cannot be rigorously considered part of the "hard" data. This is consistent with the other literature that discusses ingestion of foreign bodies - many cases cannot be confirmed. For this reason, I strongly doubt that 3.2% of all ingestion cases in 2005 can be fairly applied as evidence supporting a ban on rhinestones. There were apparently no cases of a child eating a drawer full of jewelry in 2005, either. Notably, there were a couple cases of a child actually swallowing a bracelet. I guess it's possible. Anyhow, the data does not support the likelihood of a child EVER ingesting 50 rhinestones. It is farfetched.

The conclusion I reach is that any contention that swallowing 50 rhinestones is a real risk or a real health problem is simple nonsense. It is offensive to me that our regulators are using data they may not understand or which is "dirty" (muddied with inappropriate or irrelevant entries, tending to mislead the viewer of the data). Given the apparently ridiculously low or nonexistent risk of swallowing 50 rhinestones, the CPSC safety regulators seem to be defending their legal conclusion simply for its consistency with the CPSIA but dressing it up with misleading fear mongering data to make it appear that they are actually making a rational decision. This may please Mr. Waxman and the consumer groups who apparently think the business community is evil, but it is wrong. As I said in an earlier post, this approach may bring short term benefits to the agency, but in the long run, the sacrifice of integrity and reputation will be extremely costly to all concerned.

If I am mistaken, Ms. Tenenbaum, please correct me.

1 comment:

Wacky Hermit said...

Stop it, Rick! You're making them do math! You can't expect anyone in DC to do something so complicated. Do you want their poor little heads to explode?

...that last was supposed to be a rhetorical question. ;)