The number of children ingesting rare-earth magnets — powerful tiny balls that are a popular desk toy and can shred a child’s intestines — has skyrocketed in the three years since courts blocked the efforts of federal regulators to force changes to the industry, which largely holds the power to regulate itself.

The nation’s poison control centers are on track to record six times more magnet ingestions — totaling nearly 1,600 cases — this year than in 2016, when a federal court first sided with industry to lift the Consumer Product Safety Commission’s four-year ban on the product. Medical researchers say the only explanation for the spike is the return of these unusually strong magnets to the market after the court ruling.

Now, with the CPSC largely sidelined, magnet industry officials have launched a new effort to prevent product injuries and deaths through voluntary safety standards. Used for thousands of consumer products, these voluntary standards are supposed to reflect a balance between business and safety interests.

But during the creation of voluntary standards for magnets, the priorities of safety groups and regulators have been drowned out by the desires of manufacturers, who often decide which safety options are considered and hold an advantage in voting on which rules will take effect, according to a Washington Post review that included listening to hours of public standard-setting meetings and obtaining emails about the process, along with interviews and documents.

Problems with voluntary safety standards extend beyond magnets, critics say, to other children’s products, including infant inclined sleepers, crib bumpers and furniture at risk of toppling over. In many cases, the CPSC can’t act until the voluntary standards have proved inadequate.

“It makes our jobs harder to have to defer by law to an extremely inefficient and industry-focused process,” said Elliot Kaye, a CPSC commissioner and former agency chairman. The voluntary standards process, he said, “has cost lives.”

In the magnets case, which played out over recent weeks, manufacturers drew clear limits on how far they were willing to go for safety. They would consider only standards that “don’t change the utility, functionality and desirability of the product for adults,” Craig Zucker, who runs a magnet company, said in an email to others on the committee deciding the proposed safety rules.

But safety advocates said that the committee should look at anything that might avoid accidents. Otherwise, Don Huber, director of product safety for Consumer Reports, said in an email to the committee, “I am struggling to see how it will be anything beyond a marginal improvement.”

The magnet makers wanted to rely on written warnings and packaging designs to curb accidental ingestions, according to emails and committee conference calls.

Safety advocates said that wasn’t enough. They wanted the magnets either to be too big to swallow or too weak to cause organ damage. The magnets commonly found in desk toys are made up of sometimes hundreds of magnetic balls, and swallowing just two is a medical emergency, doctors say.

Why not try making them too big to swallow? asked pediatric gastroenterologist Bryan Rudolph during a Nov. 21 call to discuss the standard.

“Because nobody would follow it,” Zucker replied.

'Gruesome' injuries

Other products that pose dangers to children have highlighted the limitations of the voluntary standards process. Before being recalled this year because they were associated with the deaths of dozens of children, inclined sleepers had been covered by a voluntary standard that pediatricians argued failed to follow established guidelines for safe sleep.

A voluntary safety standard also exists for crib bumpers, despite warnings from medical authorities that the products are unnecessary and dangerous.

And safety advocates had been struggling for years to get furniture manufacturers to agree to stricter voluntary standards aimed at preventing furniture tip-overs, a problem responsible for the deaths of at least 200 children since 2000. While standards were modified in prior years, only this year, under pressure from victims’ families, did industry officials tighten the standard to address dangers from smaller furniture.

“It’s a flawed process,” said Nancy Cowles, who sits on several voluntary standard committees as executive director of the advocacy group Kids in Danger. “There are times when it works. But it often feels like we are only slowing down the process.”

Shihan Qu, who heads the company that makes Zen Magnets, said in an interview that he agrees that high-powered magnets are “an inherently dangerous product. That’s what it is.”

Qu said he supports efforts to keep the products away from children. But he disagreed with actions that would either fundamentally change the product or ban it. He previously led the court fight against the CPSC that resulted in the magnet ban being overturned in 2016.

“You can’t just make all small things big so kids won’t choke on them,” Qu said.

Rare-earth magnets are unusually dangerous because they are often 10 times stronger than the ordinary magnets used to hold a shopping list to a refrigerator. If multiple rare-earth magnets — each the size of a BB pellet — are swallowed, they can pull together inside the intestines, potentially causing life-threatening holes and blockages. Emergency surgery is the usual result.

“This is one of the most dangerous products on the market,” said Rudolph, the pediatric gastroenterologist who participated in the standards process.

Rudolph said the risks were greater than with other ingestions he sees involving children, such as coins or button batteries.

“These injuries are gruesome,” he said.

Julie Brown, a pediatric emergency-room doctor, said she sees on average one case a month at her hospital, Seattle Children’s. Yet most people don’t understand the risks posed by these magnets, she said, and the injuries can be severe.

“They can make kids very sick,” Brown said.

Accidental ingestion of high-powered magnets emerged as a problem in 2005. The magnets were breaking free from toys. Magnetic construction sets soon were blamed for at least one death and dozens of intestinal injuries, according to the CPSC. In response, a voluntary safety standard was created in 2007 to limit the power of loose magnets in toys and to require powerful magnets to be permanently connected so they can’t be swallowed.

The problem subsided.

But sales of high-powered magnet sets exploded two years later. This time, the magnets were found in desk toys popular for playing or modeling different shapes. And they were not covered by the toy safety standard because they were not meant for children.

In 2011, the CPSC issued its first public warning about the “hidden hazard” associated with “these innocent looking magnets.” The next year, as the ingestions continued, the agency passed mandatory regulations that essentially banned the strong magnet sets. Most companies agreed to stop selling them. But two firms refused. The CPSC asked a judge to force a recall against them.

Zucker, who referred questions from The Post to other industry representatives, ran one of the recalcitrant firms, Maxfield & Oberton, which made popular magnets called Buckyballs. Zucker launched a public-relations campaign painting the agency as overzealous and trying to shut down freedom-loving entrepreneurs. He worked with Nancy Nord, a former CPSC commissioner working as a lawyer for companies facing regulatory action.

“No one is discounting the severity of the injuries,” Nord said in an interview. “But the question is, how do you address the problem?”

Eventually, Zucker stopped selling the magnets as part of an agreement with the CPSC. His company was also voluntarily dissolved.

But the other company, Zen Magnets, and its leader, Qu, kept fighting. He convinced a federal judge that the CPSC made mistakes when it declared the magnets a “substantial product hazard.” And a federal appellate court in 2016 overturned the agency’s mandatory rule that served as a product ban, criticizing the CPSC for “critical ambiguities and complexities in the data” used to justify its actions.

So in late 2016, for the first time in four years, rare-earth magnets were legal to sell.

That ended what appeared to be a successful experiment in injury prevention: Magnet ingestions had fallen by almost half during the four-year timeout, from an estimated 3,617 hospital emergency-room visits in 2012 to 1,907 visits three years later, according to a medical study published last year in the Journal of Pediatric Gastroenterology and Nutrition.

The sudden loss of the 2016 ban left no regulations in place on high-powered magnets. Qu thought this was a problem.

He saw competitors selling magnets with no warnings at all. His Zen Magnets are sold with warnings that include, “These magnets are not a toy for children.” He petitioned the CPSC to ask it to write a mandatory rule requiring warning labels and packaging designs to prevent children from using the product. Safety groups opposed his effort because they said it didn’t go far enough, according to documents and interviews.

But the CPSC was frozen, unable to agree on how to pursue new regulations in light of the court decisions, according to Kaye, who was the agency’s chairman at the time. A CPSC spokesman declined to comment.

Meanwhile, the public was mostly unaware of the debate over magnet safety.

Two magnets swallowed

“I had no idea they were dangerous,” said Sara Cohen, a pediatric nurse and mother in Philadelphia who bought a set of high-powered magnets as a toy for her 7-year-old son, Aaron, for Christmas in 2016.

Three nights later, her son was in a hospital, complaining of stomach pains. An X-ray revealed he’d swallowed two magnetic balls. Surgeons removed one. Rather than make a second incision in his intestines, they decided to monitor the boy. He had frequent X-rays until the magnet passed two months later.

“It never occurred to me that this could happen,” Cohen said.

In February, the same group that worked to defeat the CPSC’s mandatory standards — Qu, Zucker and Nord — turned its attention to drafting a voluntary safety standard.

The process for creating voluntary safety standards for most consumer products is handled through ASTM International, an organization that helps develop technical standards for thousands of products. ASTM officials said that the organization emphasizes a consensus approach designed to allow all parties a chance to influence the outcome.

The CPSC’s role is limited. Agency employees had been barred by agency regulations from taking leadership positions or voting on proposed standards until 2016, when the commissioners decided to relax the rules. Since then, CPSC staff have been allowed to take on larger roles with the blessing of the agency’s executive director. Permission was granted for magnets.

As a result, a CPSC staff member wrote a letter to the magnets committee in October saying that the agency didn’t think warnings and packaging changes were enough to address the potential danger.

ASTM guidelines also are designed to prevent manufacturers from gaining too much control. With magnets, still, the companies had a head start, meeting for several months before safety advocates joined the process.

“They’d already started by the time we learned about it,” said Cowles, of Kids in Danger.

The committee discusses proposed safety rules before voting. Each member has one vote. Product manufacturers are not allowed to account for more than 49 percent of voters.

But the number of voters is fluid. It can change as people join or leave the committee, according to ASTM officials. And ASTM said it does not share the voting roster publicly, making it hard to detect changes in a committee’s composition.

The magnets committee had 36 voting members shortly before year’s end, according to Nord, the committee chairwoman. That included nine members listed as producers, such as magnet makers. Nord said she included herself as a producer because of her role working with companies.

But an earlier version of the magnets committee roster, reviewed by The Post, showed 33 voting members. Eight were listed as producers. An additional 10 of 15 voters listed as “general interest” members had ties to industry. For example, Nord was listed as a general interest member. She later said she never listed herself in that category.

But according to that roster, that meant 18 of the 33 voters — 55 percent — either were magnet manufacturers or had ties to industry.

Both versions of the roster were consistent on one point: Each had just four voters listed as safety advocates, including the CPSC and the American Academy of Pediatrics. Their power is helped by ASTM rules that require all “no” votes to be addressed. Objections can be dismissed by a two-thirds vote of the committee.

The process often feels “predetermined,” said Ben Hoffman, a pediatrician in Portland, Ore., who leads the academy’s Council on Injury, Violence and Poison Prevention.

'A huge trade-off'

In late November, the magnets committee held a conference call, which a Post reporter listened to with the committee’s knowledge. The committee members were close to finalizing the wording of the voluntary standard. Once they agreed on a standard, it would be taken up by a larger committee for all consumer products.

The magnets committee began with a focus on using warnings and packaging to prevent accidental swallowing by children. But then it explored other ideas.

One person suggested moving away from spherical shapes. Another wondered whether colored magnetic balls looked too much like candy.

Then Rudolph, the gastroenterologist, brought up size.

“How large would these have to be in order not to be swallowed?” Rudolph asked.

The answer was 1.25 inches in diameter — a little smaller than a ping-pong ball, but also six times larger than the existing magnetic balls.

Qu, in an email to committee members, had said there was a practical problem with making them so big: They would be “so strong that they would sever fingers if two magnets were to snap together.”

That spurred a discussion about ways to dial down the magnets’ strength.

But the magnet producers said that wasn’t technically feasible.

On the conference call, Rudolph said that changing the size or strength of the magnets was the only way to avoid the injury patterns.

“It’s the one thing that will really, we think, protect children,” he said.

“If you have some real data to show that these other things won’t make a significant dent,” Qu replied, “then please do show it.”

Another committee member, Al Kaufman, a senior vice president of the Toy Association, jumped in to say that a standard that changes the product so much is unlikely to be followed by manufacturers.

Rudolph didn’t give in.

“It’s a huge, huge trade-off that we’d be giving up by not taking that route,” he said.

Kaufman spoke up.

“I think we’ve got a disagreement that we’re not likely to resolve with regard to size,” he said.

But he eventually threw his support behind the magnet industry’s proposal.

“I think half a loaf is better than none,” Kaufman said.

Others agreed with him.

That sounded like a final concession to the safety advocates on the call.

“So what we’re admitting,” Cowles said, “is that there is no way to make this product not be an ingestion hazard.”

In early December, the voting members of the magnets committee received a ballot containing a proposed voluntary standard for magnets sets. The votes are due in early January.

The proposed new standard would require safety warning labels and packaging changes, including a way to visually check that all loose magnets are inside.

But, if approved, the proposed standard would leave the magnets themselves untouched.

They would still be just as small and powerful as ever.

Correction: An earlier version of this story implied voluntary safety standards that aim to prevent furniture tip-overs were not tightened until this year. The standards were modified in prior years, but this year for the first time the standard included smaller furniture. A graphic also was updated to reflect the magnet sets were effectively banned in 2012.