Equipment Lifecycle Management in the Eyes of the FDA

The October 2025 Warning Letter to Apotex Inc. is fascinating not because it reveals anything novel about FDA expectations, but because it exposes the chasm between what we know we should do and what we actually allow to happen on our watch. Evaluate it together with what we are seeing for Complete Response Letter (CRL) data, we can see that companies continue to struggle with the concept of equipment lifecycle management.

This isn’t about a few leaking gloves or deteriorated gaskets. This is about systemic failure in how we conceptualize, resource, and execute equipment management across the entire GMP ecosystem. Let me walk you through what the Apotex letter really tells us, where the FDA is heading next, and why your current equipment qualification program is probably insufficient.

The Apotex Warning Letter: A Case Study in Lifecycle Management Failure

The FDA’s Warning Letter to Apotex (WL: 320-26-12, October 31, 2025) reads like a checklist of every equipment lifecycle management failure I’ve witnessed in two decades of quality oversight. The agency cited 21 CFR 211.67(a) equipment maintenance failures, 21 CFR 211.192 inadequate investigations, and 21 CFR 211.113(b) aseptic processing deficiencies. But these citations barely scratch the surface of what actually went wrong.

The Core Failures: A Pattern of Deferral and Neglect

Between September 2023 and April 2025—18 months—Apotex experienced at least eight critical equipment failures during leak testing. Their personnel responded by retesting until they achieved passing results rather than investigating root causes. Think about that timeline. Eight failures over 18 months means a failure every 2-3 months, each one representing a signal that their equipment was degrading. When investigators finally examined the system, they found over 30 leaking areas. This wasn’t a single failure; this was systemic equipment deterioration that the organization chose to work around rather than address.

The letter documents white particle buildup on manufacturing equipment surfaces, particles along conveyor systems, deteriorated gasket seals, and discolored gloves. Investigators observed a six-millimeter glove breach that was temporarily closed with a cable tie before production continued. They found tape applied to “false covers” as a workaround. These aren’t just housekeeping issues—they’re evidence that Apotex had crossed from proactive maintenance into reactive firefighting, and then into dangerous normalization of deviation.

Most damning: Apotex had purchased upgraded equipment nearly a year before the FDA inspection but continued using the deteriorating equipment that was actively generating particles contaminating their nasal spray products. They had the solution in their possession. They chose not to implement it.

The Investigation Gap: Equipment Failures as Quality System Failures

The FDA hammered Apotex on their failure to investigate, but here’s what’s really happening: equipment failures are quality system failures until proven otherwise. When a leak happens , you don’t just replace whatever component leaked. You ask:

  • Why did this component fail when others didn’t?
  • Is this a batch-specific issue or a systemic supplier problem?
  • How many products did this breach potentially affect?
  • What does our environmental monitoring data tell us about the timeline of contamination?
  • Are our maintenance intervals appropriate?

Apotex’s investigators didn’t ask these questions. Their personnel retested until they got passing results—a classic example of “testing into compliance” that I’ve seen destroy quality cultures. The quality unit failed to exercise oversight, and management failed to resource proper root cause analysis. This is what happens when quality becomes a checkbox exercise rather than an operational philosophy.​

BLA CRL Trends: The Facility Equipment Crisis Is Accelerating

The Apotex warning letter doesn’t exist in isolation. It’s part of a concerning trend in FDA enforcement that’s becoming impossible to ignore. Facility inspection concerns dominate CRL justifications. Manufacturing and CMC deficiencies account for approximately 44% of all CRLs. For biologics specifically, facility-related issues are even more pronounced.​

The Biologics-Specific Challenge

Biologics license applications face unique equipment lifecycle scrutiny. The 2024-2025 CRL data shows multiple biosimilars rejected due to third-party manufacturing facility issues despite clean clinical data. Tab-cel (tabelecleucel) received a CRL citing problems at a contract manufacturing organization—the FDA rejected an otherwise viable therapy because the facility couldn’t demonstrate equipment control.​

This should terrify every biotech quality leader. The FDA is telling us: your clinical data is worthless if your equipment lifecycle management is suspect. They’re not wrong. Biologics manufacturing depends on consistent equipment performance in ways small molecule chemistry doesn’t. A 0.2°C deviation in a bioreactor temperature profile, caused by a poorly maintained chiller, can alter glycosylation patterns and change the entire safety profile of your product. The agency knows this, and they’re acting accordingly.

The Top 10 Facility Equipment Deficiencies Driving CRLs

Genesis AEC’s analysis of 200+ CRLs identified consistent equipment lifecycle themes:​

  1. Inadequate Facility Segregation and Flow (cross-contamination risks from poor equipment placement)
  2. Missing or Incomplete Commissioning & Qualification (especially HVAC, WFI, clean steam systems)
  3. Fire Protection and Hazardous Material Handling Deficiencies (equipment safety systems)
  4. Critical Utility System Failures (WFI loops with dead legs, inadequate sanitization)
  5. Environmental Monitoring System Gaps (manual data recording, lack of 21 CFR Part 11 compliance)
  6. Container Closure and Packaging Validation Issues (missing extractables/leachables data, CCI testing gaps)
  7. Inadequate Cleanroom Classification and Control (ISO 14644 and EU Annex 1 compliance failures)
  8. Lack of Preventive Maintenance and Asset Management (missing calibration records, unclear maintenance responsibilities)
  9. Inadequate Documentation and Change Control (HVAC setpoint changes without impact assessment)
  10. Sustainability and Environmental Controls Overlooked (temperature/humidity excursions affecting product stability)

Notice what’s not on this list? Equipment selection errors. The FDA isn’t seeing companies buy the wrong equipment. They’re seeing companies buy the right equipment and then fail to manage it across its lifecycle. This is a crucial distinction. The problem isn’t capital allocation—it’s operational execution.

FDA’s Shift to “Equipment Lifecycle State of Control”

The FDA has introduced a significant conceptual shift in how they discuss equipment management. The Apotex Warning Letter is part of the agency’s new emphasis on “equipment lifecycle state of control” . This isn’t just semantic gamesmanship. It represents a fundamental understanding that discrete qualification events are not enough and that continuous lifecycle management is long overdue.

What “State of Control” Actually Means

Traditional equipment qualification followed a linear path: DQ → IQ → OQ → PQ → periodic requalification. State of control means:

  • Continuous monitoring of equipment performance parameters, not just periodic checks
  • Predictive maintenance based on performance data, not just manufacturer-recommended intervals
  • Real-time assessment of equipment degradation signals (particle generation, seal wear, vibration changes)
  • Integrated change management that treats equipment modifications as potential quality events
  • Traceable decision-making about when to repair, refurbish, or retire equipment

The FDA is essentially saying: qualification is a snapshot; state of control is a movie. And they want to see the entire film, not just the trailer.

This aligns perfectly with the agency’s broader push toward Quality Management Maturity. As I’ve previously written about QMM, the FDA is moving away from checking compliance boxes and toward evaluating whether organizations have the infrastructure, culture, and competence to manage quality dynamically. Equipment lifecycle management is the perfect test case for this shift because equipment degradation is inevitable, predictable, and measurable. If you can’t manage equipment lifecycle, you can’t manage quality.​

Global Regulatory Convergence: WHO, EMA, and PIC/S Perspectives

The FDA isn’t operating in a vacuum. Global regulators are converging on equipment lifecycle management as a critical inspection focus, though their approaches differ in emphasis.

EMA: The Annex 15 Lifecycle Approach

EMA’s process validation guidance explicitly requires IQ, OQ, and PQ for equipment and facilities as part of the validation lifecycle. Unlike FDA’s three-stage process validation model, EMA frames qualification as ongoing throughout the product lifecycle. Their 2023 revision of Annex 15 emphasizes:​

  • Validation Master Plans that include equipment lifecycle considerations
  • Ongoing Process Verification that incorporates equipment performance data
  • Risk-based requalification triggered by changes, deviations, or trends
  • Integration with Product Quality Reviews (PQRs) to assess equipment impact on product quality

The EMA expects you to prove your equipment remains qualified through annual PQRs and continuous data review having been more explicit about a lifecycle approach for years.

PIC/S: The Change Management Imperative

PIC/S PI 054-1 on change management provides crucial guidance on equipment lifecycle triggers. The document explicitly identifies equipment upgrades as changes that require formal assessment, planning, and implementation controls. Critically, PIC/S emphasizes:​

  • Interim controls when equipment issues are identified but not yet remediated
  • Post-implementation monitoring to ensure changes achieve intended risk reduction
  • Documentation of rejected changes, especially those related to quality/safety hazard mitigation

The Apotex case is a PIC/S textbook violation: they identified equipment deterioration (hazard), purchased upgraded equipment (change proposal), but failed to implement it with appropriate interim controls or timeline management. The result was continued production with deteriorating equipment—exactly what PIC/S guidance is designed to prevent.

WHO: The Resource-Limited Perspective

WHO’s equipment lifecycle guidance, while focused on medical equipment in low-resource settings, offers surprisingly relevant insights for GMP facilities. Their framework emphasizes:​

  • Planning based on lifecycle cost, not just purchase price
  • Skill development and training as core lifecycle components
  • Decommissioning protocols that ensure data integrity and product segregation

The WHO model is refreshingly honest about resource constraints, which applies to many GMP facilities facing budget pressure. Their key insight: proper lifecycle management actually reduces total cost of ownership by 3-10x compared to run-to-failure approaches. This is the business case that quality leaders need to make to CFOs who view maintenance as a cost center.​

The Six-System Inspection Model: Where Equipment Lifecycle Fits

FDA’s Six-System Inspection Model—particularly the Facilities and Equipment System—provides the structural framework for understanding equipment lifecycle requirements. As I’ve previously written, this system “ensures that facilities and equipment are suitable for their intended use and maintained properly” with focus on “design, maintenance, cleaning, and calibration.”​

The Interconnectedness Problem

Here’s where many organizations fail: they treat the six systems as silos. Equipment lifecycle management bleeds across all of them:

  • Production System: Equipment performance directly impacts process capability
  • Laboratory Controls: Analytical equipment lifecycle affects data integrity
  • Materials System: Equipment changes can affect raw material compatibility
  • Packaging and Labeling: Equipment modifications require revalidation
  • Quality System: Equipment deviations trigger CAPA and change control

The Apotex warning letter demonstrates this interconnectedness perfectly. Their equipment failures (Facilities & Equipment) led to container-closure integrity issues (Packaging), which they failed to investigate properly (Quality), resulting in distributed product that was potentially adulterated (Production). The FDA’s response required independent assessments of investigations, CAPA, and change management—three separate systems all impacted by equipment lifecycle failures.

The “State of Control” Assessment Questions

If FDA inspectors show up tomorrow, here’s what they’ll ask about your equipment lifecycle management:

  1. Design Qualification: Do your User Requirements Specifications include lifecycle maintenance requirements? Are you specifying equipment with modular upgrade paths, or are you buying disposable assets?
  2. Change Management: When you purchase upgraded equipment, what triggers its implementation? Is there a formal risk assessment linking equipment deterioration to product quality? Or do you wait for failures?
  3. Preventive Maintenance: Are your PM intervals based on manufacturer recommendations, or on actual performance data? Do you have predictive maintenance programs using vibration analysis, thermal imaging, or particle counting?
  4. Decommissioning: When equipment reaches end-of-life, do you have formal retirement protocols that assess data integrity impact? Or does old equipment sit in corners of the cleanroom “just in case”?
  5. Training: Do your operators understand equipment lifecycle concepts? Can they recognize early degradation signals? Or do they just call maintenance when something breaks?

These aren’t theoretical questions. They’re directly from recent 483 observations and CRL deficiencies.​

The Business Case: Why Equipment Lifecycle Management Is Economic Imperative

Let’s be blunt: the pharmaceutical industry has treated equipment as a capital expense to be minimized, not an asset to be optimized. This is catastrophically wrong. The Apotex warning letter shows the true cost of this mindset:

  • Product recalls: Multiple ophthalmic and oral solutions recalled
  • Production suspension: Sterile manufacturing halted
  • Independent assessments: Required third-party evaluation of entire quality system
  • Reputational damage: Public warning letter, potential import alert
  • Opportunity cost: Products stuck in regulatory limbo while competitors gain market share

Contrast this with the investment required for proper lifecycle management:

  • Predictive maintenance systems: $50,000-200,000 for sensors and software
  • Enhanced training programs: $10,000-30,000 annually
  • Lifecycle documentation systems: $20,000-100,000 implementation
  • Total: Less than the cost of a single batch recall

The ROI is undeniable. Equipment lifecycle management isn’t a cost center—it’s risk mitigation with quantifiable financial returns.

The CFO Conversation

I’ve had this conversation with CFOs more times than I can count. Here’s what works:

Don’t say: “We need more maintenance budget.”

Say: “Our current equipment lifecycle risk exposure is $X million based on recent CRL trends and warning letters. Investing $Y in lifecycle management reduces that risk by Z% and extends asset utilization by 2-3 years, deferring $W million in capital expenditures.”

Bring data. Show them the Apotex letter. Show them the Tab-cel CRL. Show them the 51 CRLs driven by facility concerns. CFOs understand risk-adjusted returns. Frame equipment lifecycle management as portfolio risk management, not engineering overhead.

Practical Framework: Building an Equipment Lifecycle Management Program

Enough theory. Here’s the practical framework I’ve implemented across multiple DS facilities, refined through inspections, and validated against regulatory expectations.

Phase 1: Asset Criticality Assessment

Not all equipment deserves equal lifecycle attention. Use a risk-based approach:

Criticality Class A (Direct Impact): Equipment whose failure directly impacts product quality, safety, or efficacy. Bioreactors, purification skids, sterile filling lines, environmental monitoring systems. These require full lifecycle management including continuous monitoring, predictive maintenance, and formal retirement protocols.

Criticality Class B (Indirect Impact): Equipment whose failure impacts GMP environment but not direct product attributes. HVAC units, WFI systems, clean steam generators. These require enhanced lifecycle management with robust PM programs and performance trending.

Criticality Class C (No Impact): Non-GMP equipment. Standard maintenance practices apply.

Phase 2: Lifecycle Documentation Architecture

Create a master equipment lifecycle file for each Class A and B asset containing:

  1. User Requirements Specification with lifecycle maintenance requirements
  2. Design Qualification including maintainability and upgrade path assessment
  3. Commissioning Protocol (IQ/OQ/PQ) with acceptance criteria that remain valid throughout lifecycle
  4. Maintenance Master Plan defining PM intervals, spare parts strategy, and predictive monitoring
  5. Performance Trending Protocol specifying parameters to monitor, alert limits, and review frequency
  6. Change Management History documenting all modifications with impact assessment
  7. Retirement Protocol defining end-of-life triggers and data migration requirements

As I’ve written about in my posts on GMP-critical systems, documentation must be living documents that evolve with the asset, not static files that gather dust after qualification.​

Phase 3: Predictive Maintenance Implementation

Move beyond manufacturer-recommended intervals to condition-based maintenance:

  • Vibration analysis for rotating equipment (pumps, agitators)
  • Thermal imaging for electrical systems and heat transfer equipment
  • Particle counting for cleanroom equipment and filtration systems
  • Pressure decay testing for sterile barrier systems
  • Oil analysis for hydraulic and lubrication systems

The goal is to detect degradation 6-12 months before failure, allowing planned intervention during scheduled shutdowns.

Phase 4: Integrated Change Control

Equipment changes must flow through formal change control with:

  • Technical assessment by engineering and quality
  • Risk evaluation using FMEA or similar tools
  • Regulatory assessment for potential prior approval requirements
  • Implementation planning with interim controls if needed
  • Post-implementation review to verify effectiveness

The Apotex case shows what happens when you skip the interim controls. They identified the need for upgraded equipment (change) but failed to implement the necessary bridge measures to ensure product quality while waiting for that equipment to come online. They allowed the “future state” (new equipment) to become an excuse for neglecting the “current state” (deteriorating equipment).

This is a failure of Change Management Logic. In a robust quality system, the moment you identify that equipment requires replacement due to performance degradation, you have acknowledged a risk. If you cannot replace it immediately—due to capital cycles, lead times, or qualification timelines—you must implement interim controls to mitigate that risk.

For Apotex, those interim controls should have been:

  • Reduced run durations to minimize stress on failing seals.
  • Increased sampling plans (e.g., 100% leak testing verification or enhanced AQLs).
  • Shortened maintenance intervals (replacing gaskets every batch instead of every campaign).
  • Enhanced environmental monitoring focused specifically on the degrade zones.

Instead, they did nothing. They continued business as usual, likely comforting themselves with the purchase order for the new machine. The FDA’s response was unambiguous: A purchase order is not a CAPA. Until the new equipment is qualified and operational, your legacy equipment must remain in a state of control, or production must stop. There is no regulatory “grace period” for deteriorating assets.

Phase 5: The Cultural Shift—From “Repair” to “Reliability”

The final and most difficult phase of this framework is cultural. You cannot write a SOP for this; you have to lead it.

Most organizations operate on a “Break-Fix” mentality:

  1. Equipment runs until it alarms or fails.
  2. Maintenance fixes it.
  3. Quality investigates (or papers over) the failure.
  4. Production resumes.

The FDA’s “Lifecycle State of Control” demands a “Predict-Prevent” mentality:

  1. Equipment is monitored for degradation signals (vibration, heat, particle counts).
  2. Maintenance intervenes before failure limits are reached.
  3. Quality reviews trends to confirm the intervention was effective.
  4. Production continues uninterrupted.

To achieve this, you need to change how you incentivize your teams. Stop rewarding “heroic” fixes at 2 AM. Start rewarding the boring, invisible work of preventing the failure in the first place. As I’ve written before regarding Quality Management Maturity (QMM), mature quality systems are quiet systems. Chaos is not a sign of hard work; it’s a sign of lost control.

Conclusion: The Choice Before Us

The warning letter to Apotex Inc. and the rising tide of facility-related CRLs are not random compliance noise. They are signal flares. The regulatory expectations for equipment management have fundamentally shifted from static qualification (Is it validated?) to dynamic lifecycle management (Is it in a state of control right now?).

The FDA, EMA, and PIC/S have converged on a single truth: You cannot assure product quality if you cannot guarantee equipment performance.

We are at an inflection point. The industry’s aging infrastructure, combined with the increasing complexity of biologic processes and the unforgiving nature of residue control, has created a perfect storm. We can no longer treat equipment maintenance as a lower-tier support function. It is a core GMP activity, equal in criticality to batch record review or sterility testing.

As Quality Leaders, we have two choices:

  1. The Apotex Path: Treat equipment upgrades as capital headaches to be deferred. Ignore the “minor” leaks and “insignificant” residues. Let the maintenance team bandage the wounds while we focus on “strategic” initiatives. This path leads to 483s, warning letters, CRLs, and the excruciating public failure of seeing your facility’s name in an FDA press release.
  2. The Lifecycle Path: Embrace the complexity. Resource the predictive maintenance programs. Validate the residue removal. Treat every equipment change as a potential risk to patient safety. Build a system where equipment reliability is the foundation of your quality strategy, not an afterthought.

The second path is expensive. It is technically demanding. It requires fighting for budget dollars that don’t have immediate ROI. But it allows you to sleep at night, knowing that when—not if—the FDA investigator asks to see your equipment maintenance history, you won’t have to explain why you used a cable tie to fix a glove port.

You’ll simply show them the data that proves you’re in control.

Choose wisely.

Draft revision of Eudralex Volume 4 Chapter 1

The draft revision of Eudralex Volume 4 Chapter 1 marks a substantial evolution from the current version, reflecting regulatory alignment with ICH Q9(R1), enhanced risk-based approaches, and a new emphasis on knowledge management, proactive risk detection, and supply chain resilience.

Core Differences at a Glance

  • The draft update integrates advances in global quality science—especially from ICH Q9(R1)—anchoring the Pharmaceutical Quality System (PQS) more firmly in knowledge management and risk management practice.
  • Proactive risk identification and mitigation are highlighted, reflecting the need to anticipate supply disruptions and quality failures, beyond routine compliance.
  • The requirements for Product Quality Review (PQR) are clarified, notably in how to handle grouped products and limited-batch scenarios, enhancing operational clarity for diverse manufacturing models.

Philosophical Shift: From Compliance to Dynamic Risk Management

Where the current Chapter 1 (in force since 2013) framed the PQS largely as a static structure of roles, documentation, and reviews, the draft version pivots toward a learning organization approach: knowledge acquisition, use, and feedback become core system elements.

Emphasis is now placed on systematic knowledge management as both a regulatory and operational priority. This serves as an overt marker of quality system maturity, intended to reduce “invisible failures” and foster analytical vigilance—aligning closely with falsifiable quality frameworks.

Risk-Based Decision-Making: Explicit and Actionable

The revision operationalizes risk-based thinking by mandating scientific rationale for risk decisions and clarifying expectations for proportionality in risk assessment. The regulator’s intent is clear: risk management can no longer be a box-checking exercise, but must be demonstrably linked to daily site operations and lifecycle decisions.

This brings the PQS into closer alignment with both the adaptive toolbox and the take-the-best heuristics: decisive focus on the most causally relevant risk vectors rather than exhaustive factor listing, echoing playbooks for effective investigation and CAPA prioritization.

Product Quality Review (PQR) and Batch Grouping

Clarification is provided in the revised text on how to perform quality reviews for products manufactured in small numbers or as grouped products, a challenge long met with uncertainty. The draft provides operational guidance, aiming to resolve ambiguities around the statistical and process review requirements for product families and low-volume production.

Supply Chain Resilience, Shortage Prevention, and Knowledge Networks

The draft gives unprecedented attention to shortage prevention and supply chain risk. Manufacturers will be expected to anticipate, document, and mitigate vulnerabilities not only in routine operations but also in emergency or shortage-prone contexts. This aligns the PQS with broader public health objectives, situating quality management as a bulwark against systemic healthcare risk.

International Harmonization and the ICH Q9(R1) Impact

Most significantly, the update explicitly references alignment with ICH Q9(R1) on Quality Risk Management, making harmonization with international best practice an explicit goal. This pushes organizations toward the global baseline for science- and risk-driven GMP.

The effect will be increased regulatory predictability for multinational manufacturers and heightened expectations for knowledge-handling and continuous improvement.

Summary Table: Draft vs. Current Chapter 1

FeatureCurrent Chapter 1 (2013)Draft Chapter 1 (2025)
PQS PhilosophyCompliance/document controlKnowledge management & risk management
Risk ManagementImplied, periodicEmbedded, real-time, evidence-based
ICH Q9 AlignmentPartialExplicit, full alignment to Q9(R1)
Product Quality Review (PQR)General guidanceDetailed, incl. grouped/low-batch
Supply Chain & ShortagesMinimal focusProactive risk, shortage prevention
Corrective/Preventive Action (CAPA)System-orientedRooted in risk, causal prioritization
Lifecycle IntegrationWeakStrong, with embedded feedback

Operational Implications for Quality Leaders

The new Chapter 1 will demand a more dynamic, evidence-driven PQS, with robust mechanisms for knowledge transfer, risk-based priority setting, and system learning cycles. Technical writing, investigation reports, and CAPA logic will need to reference causal mechanisms and risk rationale explicitly—a marked shift from checklists to analytical narratives, aligning with the take-the-best causal reasoning discussed in your recent writings.

To prepare, organizations should:

  • Review and strengthen knowledge management assets
  • Embed risk assessment into the daily decision matrix—not just annual reviews
  • Foster investigative cultures that value causal specificity over exhaustive documentation
  • Reframe supply chain oversight as a continuous risk monitoring exercise

This systemic move, when enacted, will shift GMP thinking from historical compliance to forward-looking, adaptive quality management—an ambitious but necessary corrective for the challenges facing pharmaceutical manufacturing in 2025 and beyond.

The Evolution of ALCOA: From Inspector’s Tool to Global Standard e

In the annals of pharmaceutical regulation, few acronyms have generated as much discussion, confusion, and controversy as ALCOA. What began as a simple mnemonic device for FDA inspectors in the 1990s has evolved into a complex framework that has sparked heated debates across regulatory agencies, industry associations, and boardrooms worldwide. The story of ALCOA’s evolution from a five-letter inspector’s tool to the comprehensive ALCOA++ framework represents one of the most significant regulatory harmonization challenges of the modern pharmaceutical era.

With the publication of Draft EU GMP Chapter 4 in 2025, this three-decade saga of definitional disputes, regulatory inconsistencies, and industry resistance finally reaches its definitive conclusion. For the first time in regulatory history, a major jurisdiction has provided comprehensive, legally binding definitions for all ten ALCOA++ principles, effectively ending years of interpretive debates and establishing the global gold standard for pharmaceutical data integrity.

The Genesis: Stan Woollen’s Simple Solution

The ALCOA story begins in the early 1990s with Stan W. Woollen, an FDA inspector working in the Office of Enforcement. Faced with the challenge of training fellow GLP inspectors on data quality assessment, Woollen needed a memorable framework that could be easily applied during inspections. Drawing inspiration from the ubiquitous aluminum foil manufacturer, he created the ALCOA acronym: Attributable, Legible, Contemporaneous, Original, and Accurate.

“The ALCOA acronym was first coined by me while serving in FDA’s Office of Enforcement back in the early 1990’s,” Woollen later wrote in a 2010 retrospective. “Exactly when I first used the acronym I don’t recall, but it was a simple tool to help inspectors evaluate data quality”.

Woollen’s original intent was modest—create a practical checklist for GLP inspections. He explicitly noted that “the individual elements of ALCOA were already present in existing Good Manufacturing Practice (GMP) and GLP regulations. What he did was organize them into an easily memorized acronym”. This simple organizational tool would eventually become the foundation for a global regulatory framework.

The First Expansion: EMA’s ALCOA+ Revolution

The pharmaceutical landscape of 2010 bore little resemblance to Woollen’s 1990s GLP world. Electronic systems had proliferated, global supply chains had emerged, and data integrity violations were making headlines. Recognizing that the original five ALCOA principles, while foundational, were insufficient for modern pharmaceutical operations, the European Medicines Agency took a bold step.

In their 2010 “Reflection paper on expectations for electronic source data and data transcribed to electronic data collection tools in clinical trials,” the EMA introduced four additional principles: Complete, Consistent, Enduring, and Available—creating ALCOA+. This expansion represented the first major regulatory enhancement to Woollen’s original framework and immediately sparked industry controversy.

The Industry Backlash

The pharmaceutical industry’s response to ALCOA+ was swift and largely negative. Trade associations argued that the original five principles were sufficient and that additional requirements represented regulatory overreach. “The industry argued that the original 5 were sufficient; regulators needed modern additions,” as contemporary accounts noted.

The resistance wasn’t merely philosophical—it was economic. Each new principle required system validations, process redesigns, and staff retraining. For companies operating legacy paper-based systems, the “Enduring” and “Available” requirements posed particular challenges, often necessitating expensive digitization projects.

The Fragmentation: Regulatory Babel

What followed ALCOA+’s introduction was a period of regulatory fragmentation that would plague the industry for over a decade. Different agencies adopted different interpretations, creating a compliance nightmare for multinational pharmaceutical companies.

FDA’s Conservative Approach

The FDA, despite being the birthplace of ALCOA, initially resisted the European additions. Their 2016 “Data Integrity and Compliance with CGMP Guidance for Industry” focused primarily on the original five ALCOA principles, with only implicit references to the additional requirements8. This created a transatlantic divide where companies faced different standards depending on their regulatory jurisdiction.

MHRA’s Independent Path

The UK’s MHRA further complicated matters by developing their own interpretations in their 2018 “GxP Data Integrity Guidance.” While generally supportive of ALCOA+, the MHRA included unique provisions such as their emphasis on “permanent and understandable” under “legible,” creating yet another variant.

WHO’s Evolving Position

The World Health Organization initially provided excellent guidance in their 2016 document, which included comprehensive ALCOA explanations in Appendix 1. However, their 2021 revision removed much of this detail.

PIC/S Harmonization Attempt

The Pharmaceutical Inspection Co-operation Scheme (PIC/S) attempted to bridge these differences with their 2021 “Guidance on Data Integrity,” which formally adopted ALCOA+ principles. However, even this harmonization effort failed to resolve fundamental definitional inconsistencies between agencies.

The Traceability Controversy: ALCOA++ Emerges

Just as the industry began adapting to ALCOA+, European regulators introduced another disruption. The EMA’s 2023 “Guideline on computerised systems and electronic data in clinical trials” added a tenth principle: Traceability, creating ALCOA++.

The Redundancy Debate

The addition of Traceability sparked the most intense regulatory debate in ALCOA’s history. Industry experts argued that traceability was already implicit in the original ALCOA principles. As R.D. McDowall noted in Spectroscopy Online, “Many would argue that the criterion ‘traceable’ is implicit in ALCOA and ALCOA+. However, the implication of the term is the problem; it is always better in data regulatory guidance to be explicit”.

The debate wasn’t merely academic. Companies that had invested millions in ALCOA+ compliance now faced another round of system upgrades and validations. The terminology confusion was equally problematic—some agencies used ALCOA++, others preferred ALCOA+ with implied traceability, and still others created their own variants like ALCOACCEA.

Industry Frustration

By 2023, industry frustration had reached a breaking point. Pharmaceutical executives complained about “multiple naming conventions (ALCOA+, ALCOA++, ALCOACCEA) created market confusion”. Quality professionals struggled to determine which version applied to their operations, leading to over-engineering in some cases and compliance gaps in others.

The regulatory inconsistencies created particular challenges for multinational companies. A facility manufacturing for both US and European markets might need to maintain different data integrity standards for the same product, depending on the intended market—an operationally complex and expensive proposition.

The Global Harmonization Failure

Despite multiple attempts at harmonization through ICH, PIC/S, and bilateral agreements, the regulatory community failed to establish a unified ALCOA standard. Each agency maintained sovereign authority over their interpretations, leading to:

Definitional Inconsistencies: The same ALCOA principle had different definitions across agencies. “Attributable” might emphasize individual identification in one jurisdiction while focusing on system traceability in another.

Technology-Specific Variations: Some agencies provided technology-neutral guidance while others specified different requirements for paper versus electronic systems.

Enforcement Variations: Inspection findings varied significantly between agencies, with some inspectors focusing on traditional ALCOA elements while others emphasized ALCOA+ additions.

Economic Inefficiencies: Companies faced redundant validation efforts, multiple audit preparations, and inconsistent training requirements across their global operations.

Draft EU Chapter 4: The Definitive Resolution

Against this backdrop of regulatory fragmentation and industry frustration, the European Commission’s Draft EU GMP Chapter 4 represents a watershed moment in pharmaceutical regulation. For the first time in ALCOA’s three-decade history, a major regulatory jurisdiction has provided comprehensive, legally binding definitions for all ten ALCOA++ principles.

Comprehensive Definitions

The draft chapter doesn’t merely list the ALCOA++ principles—it provides detailed, unambiguous definitions for each. The “Attributable” definition spans multiple sentences, covering not just identity but also timing, change control, and system attribution. The “Legible” definition explicitly addresses dynamic data and search capabilities, resolving years of debate about electronic system requirements.

Technology Integration

Unlike previous guidance documents that treated paper and electronic systems separately, Chapter 4 provides unified definitions that apply regardless of technology. The “Original” definition explicitly addresses both static (paper) and dynamic (electronic) data, stating that “Information that is originally captured in a dynamic state should remain available in that state”.

Risk-Based Framework

The draft integrates ALCOA++ principles into a broader risk-based data governance framework, addressing long-standing industry concerns about proportional implementation. The risk-based approach considers both data criticality and data risk, allowing companies to tailor their ALCOA++ implementations accordingly.

Hybrid System Recognition

Acknowledging the reality of modern pharmaceutical operations, the draft provides specific guidance for hybrid systems that combine paper and electronic elements—a practical consideration absent from earlier ALCOA guidance.

The End of Regulatory Babel

Draft Chapter 4’s comprehensive approach should effectively ends the definitional debates that have plagued ALCOA implementation for over a decade. By providing detailed, legally binding definitions, the EU has created the global gold standard that other agencies will likely adopt or reference.

Global Influence

The EU’s pharmaceutical market represents approximately 20% of global pharmaceutical sales, making compliance with EU standards essential for most major manufacturers. When EU GMP requirements are updated, they typically influence global practices due to the market’s size and regulatory sophistication.

Regulatory Convergence

Early indications suggest other agencies are already referencing the EU’s ALCOA++ definitions in their guidance development. The comprehensive nature of Chapter 4’s definitions makes them attractive references for agencies seeking to update their own data integrity requirements.

Industry Relief

For pharmaceutical companies, Chapter 4 represents regulatory clarity after years of uncertainty. Companies can now design global data integrity programs based on the EU’s comprehensive definitions, confident that they meet or exceed requirements in other jurisdictions.

Lessons from the ALCOA Evolution

The three-decade evolution of ALCOA offers several important lessons for pharmaceutical regulation:

  • Organic Growth vs. Planned Development: ALCOA’s organic evolution from inspector tool to global standard demonstrates how regulatory frameworks can outgrow their original intent. The lack of coordinated development led to inconsistencies that persisted for years.
  • Industry-Regulatory Dialogue Importance: The most successful ALCOA developments occurred when regulators engaged extensively with industry. The EU’s consultation process for Chapter 4, while not without controversy, produced a more practical and comprehensive framework than previous unilateral developments.
  • Technology Evolution Impact: Each ALCOA expansion reflected technological changes in pharmaceutical manufacturing. The original principles addressed paper-based GLP labs, ALCOA+ addressed electronic clinical systems, and ALCOA++ addresses modern integrated manufacturing environments.
  • Global Harmonization Challenges: Despite good intentions, regulatory harmonization proved extremely difficult to achieve through international cooperation. The EU’s unilateral approach may prove more successful in creating de facto global standards.

The Future of Data Integrity

With Draft Chapter 4’s comprehensive ALCOA++ framework, the regulatory community has finally established a mature, detailed standard for pharmaceutical data integrity. The decades of debate, expansion, and controversy have culminated in a framework that addresses the full spectrum of modern pharmaceutical operations.

Implementation Timeline

The EU’s implementation timeline provides the industry with adequate preparation time while establishing clear deadlines for compliance. Companies have approximately 18-24 months to align their systems with the new requirements, allowing for systematic implementation without rushed remediation efforts.

Global Adoption

Early indications suggest rapid global adoption of the EU’s ALCOA++ definitions. Regulatory agencies worldwide are likely to reference or adopt these definitions in their own guidance updates, finally achieving the harmonization that eluded the international community for decades.

Technology Integration

The framework’s technology-neutral approach while addressing specific technology requirements positions it well for future technological developments. Whether dealing with artificial intelligence, blockchain, or yet-to-be-developed technologies, the comprehensive definitions provide a stable foundation for ongoing innovation.

Conclusion: From Chaos to Clarity

The evolution of ALCOA from Stan Woollen’s simple inspector tool to the comprehensive ALCOA++ framework represents one of the most significant regulatory development sagas in pharmaceutical history. Three decades of expansion, controversy, and fragmentation have finally culminated in the European Union’s definitive resolution through Draft Chapter 4.

For an industry that has struggled with regulatory inconsistencies, definitional debates, and implementation uncertainties, Chapter 4 represents more than just updated guidance—it represents regulatory maturity. The comprehensive definitions, risk-based approach, and technology integration provide the clarity that has been absent from data integrity requirements for over a decade.

The pharmaceutical industry can now move forward with confidence, implementing data integrity programs based on clear, comprehensive, and legally binding definitions. The era of ALCOA debates is over; the era of ALCOA++ implementation has begun.

As we look back on this regulatory journey, Stan Woollen’s simple aluminum foil-inspired acronym has evolved into something he likely never envisioned—a comprehensive framework for ensuring data integrity across the global pharmaceutical industry. The transformation from inspector’s tool to global standard demonstrates how regulatory innovation, while often messy and contentious, ultimately serves the critical goal of ensuring pharmaceutical product quality and patient safety.

The Draft EU Chapter 4 doesn’t just end the ALCOA debates—it establishes the foundation for the next generation of pharmaceutical data integrity requirements. For an industry built on evidence and data, having clear, comprehensive standards for data integrity represents a fundamental advancement in regulatory science and pharmaceutical quality assurance.

References

Regulatory Changes I am Watching – July 2025

The environment for commissioning, qualification, and validation (CQV) professionals remains defined by persistent challenges. Rapid technological advancements—most notably in artificial intelligence, machine learning, and automation—are constantly reshaping the expectations for validation. Compliance requirements are in frequent flux as agencies modernize guidance, while the complexity of novel biologics and therapies demands ever-higher standards of sterility, traceability, and process control. The shift towards digital systems has introduced significant hurdles in data management and integration, often stretching already limited resources. At the same time, organizations are expected to fully embrace risk-based, science-first approaches, which require new methodologies and skills. Finally, true validation now hinges on effective collaboration and knowledge-sharing among increasingly cross-functional and global teams.

Overlaying these challenges, three major regulatory paradigm shifts are transforming the expectations around risk management, contamination control, and data integrity. Data integrity in particular has become an international touchpoint. Since the landmark PIC/S guidance in 2021 and matching World Health Organization updates, agencies have made it clear that trustworthy, accurate, and defendable data—whether paper-based or digital—are the foundation of regulatory confidence. Comprehensive data governance, end-to-end traceability, and robust documentation are now all non-negotiable.

Contamination control is experiencing its own revolution. The August 2023 overhaul of EU GMP Annex 1 set a new benchmark for sterile manufacturing. The core concept, the Contamination Control Strategy (CCS), formalizes expectations: every manufacturer must systematically identify, map, and control contamination risks across the entire product lifecycle. From supply chain vigilance to environmental monitoring, regulators are pushing for a proactive, science-driven, and holistic approach, far beyond previous practices that too often relied on reactive measures. We this reflected in recent USP drafts as well.

Quality risk management (QRM) also has a new regulatory backbone. The ICH Q9(R1) revision, finalized in 2023, addresses long-standing shortcomings—particularly subjectivity and lack of consistency—in how risks are identified and managed. The European Medicines Agency’s ongoing revision of EudraLex Chapter 1, now aiming for finalization in 2026, will further require organizations to embed preventative, science-based risk management within globalized and complex supply chain operations. Modern products and supply webs simply cannot be managed with last-generation compliance thinking.

The EU Digital Modernization: Chapter 4, Annex 11, and Annex 22

With the rapid digitalization of pharma, the European Union has embarked on an ambitious modernization of its GMP framework. At the heart of these changes are the upcoming revisions to Chapter 4 (Documentation), Annex 11 (Computerised Systems), and the anticipated implementation of Annex 22 (Artificial Intelligence).

Chapter 4—Documentation is being thoroughly updated in parallel with Annex 11. The current chapter, which governs all aspects of documentation in GMP environments, was last revised in 2011. Its modernization is a direct response to the prevalence of digital tools—electronic records, digital signatures, and interconnected documentation systems. The revised Chapter 4 is expected to provide much clearer requirements for the management, review, retention, and security of both paper and electronic records, ensuring that information flows align seamlessly with the increasingly digital processes described in Annex 11. Together, these updates will enable companies to phase out paper where possible, provided electronic systems are validated, auditable, and secure.

Annex 11—Computerised Systems will see its most significant overhaul since the dawn of digital pharma. The new guidance, scheduled for publication and adoption in 2026, directly addresses areas that the previous version left insufficiently covered. The scope now embraces the tectonic shift toward AI, machine learning, cloud-based services, agile project management, and advanced digital workflows. For instance, close attention is being paid to the robustness of electronic signatures, demanding multi-factor authentication, time-zoned audit trails, and explicit provisions for non-repudiation. Hybrid (wet-ink/digital) records will only be acceptable if they can demonstrate tamper-evidence via hashes or equivalent mechanisms. Especially significant is the regulation of “open systems” such as SaaS and cloud platforms. Here, organizations can no longer rely on traditional username/password models; instead, compliance with standards like eIDAS for trusted digital providers is expected, with more of the technical compliance burden shifting onto certified digital partners.

The new Annex 11 also calls for enhanced technical controls throughout computerized systems, proportional risk management protocols for new technologies, and a far greater emphasis on continuous supplier oversight and lifecycle validation. Integration with the revised Chapter 4 ensures that documentation requirements and data management are harmonized across the digital value chain.

Posts on the Draft Annex 11:

Annex 22—a forthcoming addition—artificial intelligence

The introduction of Annex 22 represents a pivotal moment in the regulatory landscape for pharmaceutical manufacturing in Europe. This annex is the EU’s first dedicated framework addressing the use of Artificial Intelligence (AI) and machine learning in the production of active substances and medicinal products, responding to the rapid digital transformation now reshaping the industry.

Annex 22 sets out explicit requirements to ensure that any AI-based systems integrated into GMP-regulated environments are rigorously controlled and demonstrably trustworthy. It starts by mandating that manufacturers clearly define the intended use of any AI model deployed, ensuring its purpose is scientifically justified and risk-appropriate.

Quality risk management forms the backbone of Annex 22. Manufacturers must establish performance metrics tailored to the specific application and product risk profile of AI, and they are required to demonstrate the suitability and adequacy of all data used for model training, validation, and testing. Strong data governance principles apply: manufacturers need robust controls over data quality, traceability, and security throughout the AI system’s lifecycle.

The annex foresees a continuous oversight regime. This includes change control processes for AI models, ongoing monitoring of performance to detect drift or failures, and formally documented procedures for human intervention where necessary. The emphasis is on ensuring that, even as AI augments or automates manufacturing processes, human review and responsibility remain central for all quality- and safety-critical steps.

By introducing these requirements, Annex 22 aims to provide sufficient flexibility to enable innovation, while anchoring AI applications within a robust regulatory framework that safeguards product quality and patient safety at every stage. Together with the updates to Chapter 4 and Annex 11, Annex 22 gives companies clear, actionable expectations for responsibly harnessing digital innovation in the manufacturing environment.

Posts on Annex 22

Life Cycle Integration, Analytical Validation, and AI/ML Guidance

Across global regulators, a clear consensus has taken shape: validation must be seen as a continuous lifecycle process, not as a “check-the-box” activity. The latest WHO technical reports, the USP’s evolving chapters (notably <1058> and <1220>), and the harmonized ICH Q14 all signal a new age of ongoing qualification, continuous assurance, change management, and systematic performance verification. The scope of validation stretches from the design qualification stage through annual review and revalidation after every significant change.

A parallel wave of guidance for AI and machine learning is cresting. The EMA, FDA, MHRA, and WHO are now releasing coordinated documents addressing everything from transparent model architecture and dataset controls to rigorous “human-in-the-loop” safeguards for critical manufacturing decisions, including the new draft Annex 22. Data governance—traceability, security, and data quality—has never been under more scrutiny.

Regulatory BodyDocument TitlePublication DateStatusKey Focus Areas
EMAReflection Paper on the Use of Artificial Intelligence in the Medicinal Product LifecycleOct-24FinalRisk-based approach for AI/ML development, deployment, and performance monitoring across product lifecycle including manufacturing
EMA/HMAMulti-annual AI Workplan 2023-2028Dec-23FinalStrategic framework for European medicines regulatory network to utilize AI while managing risks
EMAAnnex 22 Artificial IntelligenceJul-25DraftEstablishes requirements for the use of AI and machine learning in the manufacturing of active substances and medicinal products.
FDAConsiderations for the Use of AI to Support Regulatory Decision Making for Drug and Biological ProductsFeb-25DraftGuidelines for using AI to generate information for regulatory submissions
FDADiscussion Paper on AI in the Manufacture of MedicinesMay-23PublishedConsiderations for cloud applications, IoT data management, regulatory oversight of AI in manufacturing
FDA/Health Canada/MHRAGood Machine Learning Practice for Medical Device Development Guiding PrinciplesMar-25Final10 principles to inform development of Good Machine Learning Practice
WHOGuidelines for AI Regulation in Health CareOct-23FinalSix regulatory areas including transparency, risk management, data quality
MHRAAI Regulatory StrategyApr-24FinalStrategic approach based on safety, transparency, fairness, accountability, and contestability principles
EFPIAPosition Paper on Application of AI in a GMP Manufacturing EnvironmentSep-24PublishedIndustry position on using existing GMP framework to embrace AI/ML solutions

The Time is Now

The world of validation is no longer controlled by periodic updates or leisurely transitions. Change is the new baseline. Regulatory authorities have codified the digital, risk-based, and globally harmonized future—are your systems, people, and partners ready?

Transparency in GMP Pharmaceutical Oversight

I think it is unfortunate that two of the world’s most influential regulatory agencies, the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA), have taken markedly different approaches to transparency in sharing Good Manufacturing Practice (GMP) observations and non-compliance information with the public.

The Foundation of Regulatory Transparency

FDA’s Transparency Initiative

The FDA’s commitment to transparency traces back to the Freedom of Information Act (FOIA) of 1966, which required federal agencies to provide information to the public upon request. However, the agency’s proactive transparency efforts gained significant momentum under President Obama’s Open Government Initiative. In June 2009, FDA Commissioner Dr. Margaret Hamburg launched the FDA’s Transparency Initiative, creating new webpages, establishing FDA-TRACK performance monitoring system, and proposing steps to provide greater public understanding of FDA decision-making.

EMA’s Evolution Toward Transparency

The EMA’s journey toward transparency has been more gradual and complex For many years, EU inspectorates did not publish results of their inspections, unlike the FDA’s long-standing practice of making Form 483s and Warning Letters publicly accessible. This changed significantly in 2014 when the EMA launched a new version of the EudraGMDP database that included, for the first time, the publication of statements of non-compliance with Good Manufacturing Practice.

The EMA’s approach to transparency reflects its commitment to transparency, efficiency, and public health protection through structured partnerships with agencies worldwide 1. However, the agency’s transparency policy has faced criticism for being “marred by too many failings,” particularly regarding pharmaceutical companies’ ability to redact clinical study reports.

FDA’s Comprehensive Data Infrastructure

The FDA operates several interconnected systems for sharing inspection and compliance information:

Form 483 Database and Public Access
The FDA maintains extensive databases for Form 483 inspectional observations, which are publicly accessible through multiple channels. The agency’s Office of Inspections and Investigations provides spreadsheets summarizing inspection observations by fiscal year, broken down by product areas including biologics, drugs, devices, and other categories.

FDA Data Dashboard
Launched as part of the agency’s transparency initiative, the FDA Data Dashboard presents compliance, inspection, and recall data in an easy-to-read graphical format. The dashboard provides data from FY 2009 onward and allows access to information on inspections, warning letters, seizures, injunctions, and recall statistics. The system is updated semi-annually and allows users to download information, manipulate data views, and export charts for analysis.

Warning Letters and Public Documentation
All FDA-issued Warning Letters are posted on FDA.gov in redacted form to permit public access without requiring formal FOIA requests. This practice has been in place for many years, with warning letters being publicly accessible under the Freedom of Information Act.

EMA’s EudraGMDP Database

The EMA’s primary transparency tool is the EudraGMDP database, which serves as the Community database on manufacturing, import, and wholesale-distribution authorizations, along with GMP and GDP certificates. A public version of the database has been available since 2011, providing access to information that is not commercially or personally confidential.

The EudraGMDP database contains several modules including Manufacturing Import Authorisation (MIA), GMP certificates, Wholesale Distribution Authorisation (WDA), and Active Product Ingredient Registration (API REG). The database is publicly accessible without login requirements and is maintained by the EMA with data populated by EEA national competent authorities.

Non-Compliance Reporting and Publication

A significant milestone in EMA transparency occurred in 2014 when the agency began publishing statements of non-compliance with GMP . These documents contain information about the nature of non-compliance and actions taken by issuing authorities to protect public health, aiming to establish coordinated responses by EU medicines regulators.

A major difference here is that the EMA removes non-compliance statements from EudraGMDP following successful compliance restoration. The EMA’s procedures explicitly provide for post-publication modifications of non-compliance information. Following publication, the lead inspectorate authority may modify non-compliance information entered in EudraGMDP, for example, following receipt of new information, with modified statements distributed to the rapid alert distribution list.

This is unfortunate, as it requires going to a 3rd party service to find historical data on a site.

CategoryFDAEMA
Volume of Published InformationOver 25,000 Form 483s in databases83 non-compliance reports total (2007-2020)
Annual Inspection VolumeEvery 483 observation is trackable at a high levelLimited data available
Database Update FrequencyMonthly updates to inspection databasesUpdates as available from member states
Dashboard UpdatesSemi-annual updatesNot applicable
Historical Data AvailabilityForm 483s and warning letters accessible for decades under FOIANon-compliance information public since 2014
Information ScopeInspections, warning letters, seizures, injunctions, recalls, import alertsPrimarily GMP/GDP certificates and non-compliance statements
Geographic Distribution of Non-ComplianceGlobal coverage with detailed breakdownsIndia: 35 reports, China: 22 reports, US: 4 reports
Real-Time AccessYes – monthly database updatesLimited – dependent on member state reporting
Public AccessibilityMultiple channels: direct database access, FOIA requestsSingle portal: EudraGMDP database
Data Manipulation CapabilitiesUsers can download, manipulate data views, export chartsBasic search and view functionality
Login RequirementsNo login required for public databasesNo login required for EudraGMDP
Commercial ConfidentialityRedacted information Commercially confidential information not published
Non-Compliance Statement RemovalForm 483s remain public permanentlyStatements can be removed after successful remediation

While both the FDA and EMA have made significant strides in regulatory transparency, the FDA clearly shares more information about GMP observations and non-compliance issues. The FDA’s transparency advantage stems from its longer history of public disclosure under FOIA, more comprehensive database systems, higher volume of published enforcement actions, and more frequent updates to public information.

My next post will be on the recent changes at the FDA and what that means for ongoing transparency.