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Let's Combinate - Drugs + Devices
Subhi Saadeh
218 episodes
5 days ago
Hello Combi-Nation! Our industry fee complicated sometimes. Drugs, devices, clinical trials, submissions, sterilization validation, design control, risk management, market access reimbursement, the list goes on. My name is Subhi Saadeh. I've spent over a decade in medical device, pharma, and combination product development. My goal is mastery, so this podcast is to ask questions I have to people who may have the answers. Whether you're background is Pharma, Device or both, I invite you to listen and together we can simplify by Combinating!
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Life Sciences
Science
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Hello Combi-Nation! Our industry fee complicated sometimes. Drugs, devices, clinical trials, submissions, sterilization validation, design control, risk management, market access reimbursement, the list goes on. My name is Subhi Saadeh. I've spent over a decade in medical device, pharma, and combination product development. My goal is mastery, so this podcast is to ask questions I have to people who may have the answers. Whether you're background is Pharma, Device or both, I invite you to listen and together we can simplify by Combinating!
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Life Sciences
Science
Episodes (20/218)
Let's Combinate - Drugs + Devices
213 - From Generic Underdog to Billion‑Dollar Exit: How Usman Ahmed Built & Sold a Sterile Injectable Site

What happens when you go all in on a generic injectable that no one else wants, and it turns into a one hundred million dollar product in the first year?


In this episode of Let’s Combinate: Drugs + Devices, host Subhi Saadeh speaks with Usman Ahmad, former CEO of Nexus Pharmaceuticals and now CEO of Quetzal Therapeutics. Together they trace his journey from corporate finance to building a generics powerhouse with his parents, scaling a sterile injectable facility, and ultimately selling it to Eli Lilly for just under one billion dollars.


They discuss the philosophy of finding the "right to win," what most companies miss about manufacturing capacity and equipment selection, how to build a team with deep industry know-how, and why Usman is now focused on bringing therapies to patients with rare diseases.


This is a practical, personal, and strategic look at building something from the ground up, deciding not to sell too early, and learning how to do the hard things with intention.


Topics include:

-How to select the right generic molecules beyond patent expiry

-Early success with isoproterenol and API sourcing

-Why Nexus turned down acquisition offers

-Building a commercial salesforce from scratch

-Designing a facility with high speed prefilled syringe and lyo capacity

-Why most other sterile sites failed

-The billion dollar sale to Lilly

-Launching Quetzal and developing oral arsenic for APL

-The brain-eating amoeba drug and ultra rare disease strategy

-Faith, confidence, and decision making under pressure


Timestamps:

00:00 Introduction and Guest Welcome

00:24 From Wall Street Finance to Pharma

01:42 How Usman Selected Winning Generics

02:58 Early Challenges Building a Generics Company

05:29 Family R&D Expertise and Business Dynamics

11:44 First Generic Launch and Commercial Impact

16:28 Building Sterile Injectable Manufacturing Capacity

18:16 Sterile Facility and Equipment Strategy

22:40 Prefilled Syringe and Vial Line Capabilities

23:07 Big Pharma Interest and Selling the Facility

26:02 Nexus Pharma Services and the Lilly Deal

27:23 Post‑Sale Reflections and New Ventures

28:30 Launching Quetzal Therapeutics and Rare Disease Focus

33:30 New Challenges and Confidence in Drug Development

39:55 Importance of People, Teams, and Relationships

41:40 Books That Shaped Usman’s Thinking

42:29 Where to Connect with Usman


Learn more: https://quetzaltx.com

Connect with Usman: https://www.linkedin.com/in/usman-ahmed-a351b928

More episodes: https://letscombinate.com


Usman Ahmad is the Founder and CEO of Quetzal Therapeutics, and former CEO of Nexus Pharmaceuticals, where he led the company through explosive growth and the billion-dollar sale of its manufacturing facility to Eli Lilly. With a background in finance and a deep passion for healthcare innovation, Usman now focuses on bringing treatments to patients with rare and underserved diseases.


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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5 days ago
43 minutes 30 seconds

Let's Combinate - Drugs + Devices
212 - What 6 of the World’s Biggest Companies Taught Him About Combination Products

In this episode of Let’s Combinate: Drugs + Devices, host Subhi Saadeh speaks with Leonel Venegas, a seasoned quality and regulatory professional who has worked with global leaders including Alexion, Merck, Johnson & Johnson (Ethicon & Cordis), Amgen, and Medtronic.


Leonel shares how integrating Good Laboratory Practices (GLP), Good Clinical Practices (GCP), and Good Pharmacovigilance Practices (GVP) is essential to successful combination-product development. He discusses his journey from chemist to regulatory-affairs expert, uncovering common disconnects between pharma and device cultures, and the critical role of design controls, risk management, and timelines.


The conversation also explores GMP and process validation, IDE vs. IND pathways, the challenges of rare-disease programs, and how understanding the cost of quality can reshape testing strategies. Leonel closes by reflecting on becoming a Lean Six Sigma Black Belt and what continuous improvement really looks like in combination-product development.


⏱ Timestamps

00:00 – Welcome & Introduction

00:52 – Integrating GLP, GCP & GMP

02:22 – Challenges in Developing Combination Products

04:02 – Device-Led Combination Products

07:35 – Working with Rare Diseases

09:58 – GMP & Process Validation

15:08 – Clinical Trials: Drug vs Device

19:22 – Cost of Quality & Six Sigma

25:12 – Conclusion & Contact Information


Leonel Venegas is the Founder of Precision Regulatory Consulting LLC and an expert in quality and regulatory affairs with over two decades of experience across six global pharma and medtech leaders, including Alexion, Merck, Johnson & Johnson (Ethicon & Cordis), Amgen, and Medtronic.

He is certified by ASQ as a CMQ/OE, CQE, CBA, and CSSBB, and holds an M.S. in Regulatory Affairs. Leonel specializes in combination products, medical devices, and IVDs, integrating GLP, GCP, GMP, and GVP principles into complex global development programs.

📩 Connect with Leonel: leonel@precisionregulatory.com


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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1 week ago
25 minutes 42 seconds

Let's Combinate - Drugs + Devices
211 - Inside FDA’s Office of Combination Products: History, PMOA, and What’s Next for Combination Products with Mark Kramer

In this episode of Let’s Combinate: Drugs + Devices, host Subhi Saadeh welcomes Mark Kramer, the founding director of FDA’s Office of Combination Products (OCP). Mark takes us on a deep dive into the history of how combination products have been regulated in the U.S., starting with the Safe Medical Devices Act of 1990 and how the process evolved into the formation of OCP in 2002.


We explore questions such as: What challenges did industry and the FDA face in the early days of combination products? How did the “Request for Designation” process come about, and how is regulatory identity determined? What is the “Primary Mode of Action” (PMOA) rule and why does it matter? How do user fees, cross-center coordination, and post-market regulations shape how combination products get to market and are monitored? Mark also highlights current regulatory gapssuch as cross-labeling and site registration issues that continue to impact developers.


Whether you’re working in med-tech, pharma, or regulatory affairs, this episode offers historical perspective, technical insights, and strategic take-aways for navigating the combination-product space. Tune in for a candid conversation with one of the leading figures in this field.


Timestamps:


00:00 Introduction & Guest Welcome

00:35 Historical Background of Combination Products

03:05 Creation of Office of Combination Products (OCP)

04:29 Early Challenges and Developments

04:54 MDUFA, PDUFA, User Fee Programs & Legislative Impact

14:24 Defining Primary Mode of Action (PMOA)

18:35 OCP’s Role & Responsibilities

26:49 Industry Adoption & Challenges

38:48 Regulatory Gaps & Future Directions

46:00 Conclusion & Contact Information


Contact & Resources:

Connect with Mark Kramer on LinkedIn or via email at Mark.Kramer@greenleafhealth.com


Mark Kramer is Principal of the Medical Devices & Combination Products regulatory practice at Eliquent Life Sciences (formerly Greenleaf Health). He has more than 35 years experience at FDA and in regulated industry. At FDA, he established and directed the Office of Combination Products and was a scientific reviewer and later supervisor of the premarket review of devices in a variety of medical discipline areas. Following his FDA career, he served as Regulatory Affairs Executive and Chief Regulatory Strategist at GE Healthcare and then as an independent regulatory consultant for over 10 years before joining Greenleaf. Mark served as a board member of the Regulatory Affairs Professionals Society (RAPS) and in 2021, he was awarded the RAPS Founders Award, the profession’s highest honor, recognizing exemplary regulatory professionals who have shaped regulatory policy and practice and have made a positive impact on the profession.


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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2 weeks ago
46 minutes 24 seconds

Let's Combinate - Drugs + Devices
210 - The 8 Roles You MUST Understand in Pharma & MedTech

I get a lot of questions from students and early-career professionals about what different industry roles actually mean: what does a Quality Engineer do? What’s Regulatory Affairs? How does R&D fit in?


In this video, I walk through eight of the most common roles you’ll find in pharma, medtech, biotech, and diagnostics companies. We’ll talk about what each team does, how they connect, and how to think about which one might fit your strengths and interests.


If you’re trying to figure out where you belong in industry, this one’s for you.


Please like, share, and subscribe if you find it helpful!


Timestamps

00:00 Introduction and Background

01:07 Overview of Industry Roles

02:43 Quality Assurance

06:14 Regulatory Affairs

08:22 Research & Development

09:46 Clinical Affairs

11:07 Manufacturing & Operations

12:09 Quality Control / Analytical Testing

14:05 Supply Chain & Procurement

15:13 Validation & Technical Services

16:39 Career Path Insights and Conclusion


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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3 weeks ago
19 minutes 21 seconds

Let's Combinate - Drugs + Devices
210 - How AI Is Rewriting GMP: Smarter CAPA, PAT, DOE, and Continuous Yield

As AI becomes more integrated into pharmaceutical manufacturing, the question is not just how fast we can adopt it, but how safely. In this episode, Ben Locwin and Subhi Saadeh discuss the intersection of AI, GMP, and Quality 4.0, exploring both the promise and the challenges of applying intelligent systems in regulated environments.


Key topics covered:

- Current applications of AI in GMP, including CAPA and deviation management

- The role of validation and why algorithmic opacity poses regulatory challenges

- How Process Analytical Technology (PAT) enables real-time release decisions

- The importance of Design of Experiments (DOE) for process optimization

Continuous manufacturing and how yield can signal process performance


Chapters

00:00 Introduction to AI in Pharma

00:40 Current Applications of AI in GMP

02:32 Challenges and Validation in AI

03:22 Process Analytical Technology (PAT)

09:50 Design of Experiments (DOE) in Pharma

13:27 Continuous Manufacturing Explained

15:40 Yield Calculation in Manufacturing

22:12 Conclusion and Contact Information


Ben Locwin is a Healthcare Executive, MMA fighter, Jiu Jtisu pro and Quality and Regulatory SME working in medical devices, pharma and other regulated industries.


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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1 month ago
22 minutes 30 seconds

Let's Combinate - Drugs + Devices
209 - ALCOA++ EXPLAINED | What Everyone Gets Wrong About Data Integrity with Monika Andraos

In this episode, I talk with Monika Andraos of Dunamis Compliance about how organizations can navigate group think and approach data integrity the right way.

We cover risk culture, CSV vs. data integrity, ALCOA++, data governance, and practical tips for newcomers.


Key topics include:

• Encouraging diverse perspectives to combat group think

• Why data integrity is broader than CSV

• The pyramid structure: data integrity at the top, CSV & validation as elements

• ALCOA++ and traceability in real-world systems

• Practical CSV and validation workflows

• Common audit pitfalls and how to strengthen governance


⏱ Timestamps

00:00 – Intro: Group Think & Risk Appetite

00:41 – Data Integrity in Consulting

01:41 – Encouraging Diverse Perspectives

02:37 – CSV vs Data Integrity

03:13 – The Role of Data Stewards

03:54 – The Pyramid: Data Integrity, CSV & Validation

04:45 – ALCOA++ and Core Data Integrity Elements

13:59 – Real Examples: CSV & Validation Workflows

17:40 – Common Audit Pitfalls & Data Governance

22:50 – Advice for Newcomers + Wrap-Up


Monika is the Principal at Dunamis Compliance. She has over a decade of experience in formulating and executing strategies for data integrity and data governance assessments and remediation, risk management and computerized system validation within the pharmaceutical sector. She has worked within Quality, Technical Operations, Automation and Regulatory Affairs to execute and deliver compliant system solutions in regulated GXP environments.

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1 month ago
22 minutes 59 seconds

Let's Combinate - Drugs + Devices
208 - How Drugs Are Designed, Targets, Phenotypes, and Structure Based Design

In this episode, Jesse Gordon-Blake, PhD, delves into the intricacies of medicinal chemistry, particularly focusing on drug discovery for ALS (amyotrophic lateral sclerosis). Jesse explains the process of discovering molecules that modulate biological pathways, the difference between structure-based and phenotype-based drug design, and the role computational methods play in drug development. The conversation also explores the challenges of crossing the blood-brain barrier, the importance of validating target response, and the complexities of progressing from a theoretical compound to preclinical studies. Additionally, Jesse touches on the significance of target product profiles, CNS drug design characteristics, and the iterative nature of medicinal chemistry. He concludes by discussing his current projects at Cortex, including fundraising strategies and timelines for drug development.


00:00 Introduction to Medicinal Chemistry

00:37 Drug Discovery Approaches

02:01 Computational Methods in Medicinal Chemistry

03:21 Challenges in ALS Drug Discovery

04:23 Blood-Brain Barrier and Drug Design

05:29 Key Properties for CNS Drug Design

08:58 Day-to-Day in Drug Discovery

09:45 Early Stage Drug Development

12:28 Validating Drug Targets

16:15 From Theory to Animal Testing

22:46 Funding and Timeline Considerations

25:45 Regulatory and Manufacturing Considerations

28:32 Conclusion and Contact Information


Dr. Jesse Gordon-Blake is an independent biotechnology and drug discovery consultant with expertise in medicinal chemistry and neurotherapeutics. He has led efforts in small molecule and peptide therapeutic development, AI-enabled drug discovery, and biotech startup formation, and currently serves as the CSO of Cortexa Therapeutics. He earned his PhD in Medicinal Chemistry from the University of Illinois at Chicago, focusing on developing innovative small-molecule enzyme modulators for Alzheimer’s disease.

https://www.linkedin.com/in/jesse-gordon-blake-phd-52a26274/

https://www.cortexatherapeutics.com/


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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1 month ago
28 minutes 43 seconds

Let's Combinate - Drugs + Devices
207 - What 99.999% Reliability Really Means

In this episode, Subhi Saadeh sits down with Alan Stevens, CAPT, to break down the concept of five nines (99.999% reliability) in medical devices. They cover where the standard came from, why FDA introduced it in their 2020 draft guidance, and what it means for life-saving products like epinephrine and naloxone injectors.


Alan explains how manufacturers can demonstrate reliability through fault tree analysis, robust process controls, and challenge testing—without needing impossible sample sizes.


If you work in pharma, medtech, or quality, this episode will help you understand what “five nines” really means and how to meet FDA expectations while ensuring patient safety.


Chapters

00:00 – What is Five Nines Reliability?

Intro to 99.999% and why it matters for medical devices.

00:33 – FDA Guidance & Common Misconceptions

2020 draft guidance, sample size myths, and industry confusion.

01:17 – How to Demonstrate Reliability

Feasibility, practical approaches, and FDA expectations.

02:31 – High-Stakes Use Cases

Epinephrine, naloxone, glucagon injectors.

04:00 – Fault Tree Analysis Explained

Breaking down failures and linking to design/manufacturing.

05:25 – Why FDA Chose Five Nines

Balancing feasibility, safety, and ISO 14971 influences.

09:02 – Verification vs. Reliability

Design verification testing vs. true reliability demonstration.

23:16 – Key Takeaways for Industry

Closing thoughts on meeting and maintaining reliability standards.


Alan Stevens CAPT is the Global Head of Complex Devices and Drug Delivery Systems at AbbVie within the RA Emerging Technologies, Devices and Combination Products team. Prior to joining AbbVie, Alan spent 20 years at the FDA/CDRH leading premarket review and policy development for drug delivery devices and combination products.


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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1 month ago
23 minutes 35 seconds

Let's Combinate - Drugs + Devices
206 - Will AI Decide Your Next Drug/Device Approval?

Artificial Intelligence is moving fast but how do you regulate it in industries where precision and risk management are everything?


In this episode of Let’s Combinate, Subhi Saadeh sits down with Dominick Romano, founder of Drainpipe.io, to unpack the future of AI in pharma, medtech, and drug/device regulation. The conversation goes deep into how AI could reshape dossier preparation, regulatory submissions, and quality oversight — and what strategies regulators and companies need to make sure speed doesn’t come at the cost of trust.


We explore:

- Why pharma’s unique risk profile makes AI regulation different from other industries

-How ICH guidelines and process validation can be applied to AI systems

-What “combinatorial problem sets” mean for pharma and AI models

-The role of AI in regulatory affairs and dossier preparation

-How regulators may use AI to accelerate reviews and approvals

-The balance between speed, accuracy, and zero hallucinations in regulatory contexts

-The future of AI in quality control, biologics, and beyond


If you work in pharma, medtech, or drug/device combination products, this episode will give you a clear look at how AI could change your world and what needs to happen before it earns the regulator’s trust.


Episode Chapters


00:00 Introduction: Regulating AI in Pharma/MedTech

01:01 Pharma’s Unique Risk Profile

02:14 AI in Regulatory Affairs

03:44 Combinatorial Problem Sets in Pharma

04:24 ICH Guidelines and AI Regulation

08:22 Process Validation in AI

10:20 AI in Regulatory Submissions

15:54 Ensuring Accuracy and Consistency

17:02 Regulatory Agencies and AI

18:28 Accelerating Drug Approval with AI

21:36 Time Savings in Dossier Formation

25:44 AI in Quality Control for Biologics

27:42 Challenges in AI Integration

29:25 The Future of Pharma & MedTech with AI

30:40 Where to Find Dominick Romano


Dominick Romano is the founder and CEO of Drainpipe.io, focused on building trustworthy AI systems for regulated industries like pharma and medtech. A graduate of Full Sail University in video game development, his career spans game design, programmatic advertising, and voice applications before moving into AI. He was named one of Technology Innovators’ Top 50 AI CEOs and has contributed to global initiatives such as the WHO/ITU AI for Health program. Today, he helps organizations explore how AI can be validated and integrated without compromising compliance or trust.


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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2 months ago
31 minutes 59 seconds

Let's Combinate - Drugs + Devices
205 - Why Less Than 20% of Companies Have Started Quality 4.0

Nearly two-thirds of companies believe Quality 4.0 will transform their operations in the next five years yet fewer than 20% have started, and most haven’t even reached the planning stage. In this conversation, Larry Mager breaks down what Quality 4.0 really is, why life sciences lag other industries, and how to move from compliance-only thinking to a business-driving quality strategy. We cover digital twins, data continuity, culture change, and Larry’s Quantum Quality Management (QQM) framework as a practical roadmap.Timestamps00:00 Introduction to Quality 4.000:20 Defining Quality 4.001:39 The Role of Quality Professionals02:50 Industry Examples & Cultural Differences04:04 Implementing Quality 4.0 (people, process, tech)08:49 The Digital Twin Concept (why legacy EQMS falls short)13:34 The Importance of a Roadmap 30:28 Quantum Quality Management (5-phase framework)35:05 Final Thoughts & Contact InformationLarry Mager is the Founder and Principal at MGMT-CTRL, where he specializes in applying strategic quality management that goes beyond mere compliance. With three decades of experience in the medical device industry, Larry has held leadership roles spanning quality systems, operations management, CAPA, supplier control, risk management, lean manufacturing, and continuous improvement. He is also the architect of the Quantum Quality Management (QQM) framework, a phased methodology that marries people, process, and technology to help organizations adopt Quality 4.0, drive operational excellence, and use quality as a strategic business advantage.Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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2 months ago
35 minutes 15 seconds

Let's Combinate - Drugs + Devices
204 - The Dictionary & Thesaurus of Combination Products (Finally Explained) with Susan Neadle

In this episode of Let’s ComBinate: Drugs + Devices, we welcome back Susan Neadle, author of The Combination Products Handbook. Susan explores the persistent and evolving challenge of terminology in combination products—a problem that continues to create confusion and regulatory risk even in 2025.


Susan emphasizes the need for alignment on terminology and regulatory expectations, highlighting that true progress requires a science- and risk-based perspective. The discussion also covers how GMP requirements are interpreted differently in pharma versus medtech, the ongoing challenges of global harmonization, and why cohesive language is essential for compliance, inspection readiness, and effective product development.


Episode Chapters

00:00 Introduction and Welcome

00:25 The Lexicon Problem in Drug-Device Combination Products

01:01 Historical Efforts and Challenges

02:12 Regulatory Frameworks and Definitions

04:47 Industry and Regulatory Alignment Issues

06:55 Science and Risk-Based Perspectives

10:08 Terminology and Definitions in Practice

14:05 Global Regulatory Differences

17:22 Challenges in Harmonizing Standards

23:13 Key Terms and Their Impact

32:23 Conclusion and Contact Information


Susan Neadle is a recognized international Combination Products, Medical Device, and Digital Health expert with over 35 years industry experience. She has just published “The Combination Products Handbook: A Practical Guide” through Taylor & Francis Group/Routledge/CRC Press. Her leadership, innovation, and best practices have been recognized with several awards, including the 2022 ISPE Joseph X. Philips Professional Achievement Award for extraordinary contributions to the industry; 2021 TOPRA Award Finalist for Regulatory Affairs Excellence; and the Johnson Medal, Johnson & Johnson’s highest honor for excellence in Research & Development. Susan retired from a distinguished and impactful career at Johnson & Johnson and is now Principal Consultant at Combination Products Consulting Services LLC, providing international quality, regulatory affairs, and design excellence services, to the biopharma, biotech, and medical device industries. She continues to fulfill her passion in this space as Chair of the ISPE Combination Products CoP, and Lead Author in Combination Products Working Groups through ASTM International and AAMI standards committees. Susan teaches curricula in Combination Products through UMBC, AAMI, and DIA, as well as customized training upon request. She is also active in multiple industry working groups including CPC, AFDO/RAPS, DIA, TOPRA and PQRI, and enjoys speaking at a variety of industry forums. Susan can be reached at sneadle@combinationprod.com


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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2 months ago
32 minutes 44 seconds

Let's Combinate - Drugs + Devices
203 - Drug Delivery, Platforms, IP Battles, Supply Chain Risks with Jim Collins

In this episode of Let’s Combinate, Subhi Saadeh sits down with Jim Collins, a leader in drug delivery with over 30 years of experience at Eli Lilly, Sanofi, and now as an advisor and board member.

Jim shares the history of combination products before the term even existed, from insulin pens in the 1990s to modern platforms and on-body injectors. We cover IP battles that reshaped the industry, supply chain risks that pharma still underestimates, and why platform strategy is one of the most important decisions a company can make today.


Timestamps:

00:00 – Introduction & Guest Welcome

02:00 – Building Lilly’s device organization and launching insulin pens

06:00 – Early “wild west” days of drug delivery vs. today’s structure

07:00 – Intellectual property as a competitive weapon

10:30 – How Lilly, Novo, and Sanofi shaped the IP landscape

13:00 – Device differentiation in the generic space

17:00 – Portfolio vs. molecule decisions in platform strategy

20:00 – Three reasons to develop your own platform

23:00 – Supply chain risk and geopolitical considerations

26:00 – Black Swan risks and lessons for pharma companies

28:00 – Strategic suppliers vs. transactional vendors

33:00 – Drug-device integration inside companies

37:00 – Building organizational capability and governance

38:00 – Future trends: large volume autoinjectors and connected devices

43:00 – Impact of tariffs and supply chain positioning

45:00 – Where to find Jim Collins


Guest Bio:

Jim Collins is a veteran of the drug delivery field with more than 30 years of leadership experience. At Eli Lilly, he built and led the device organization, overseeing the launch of insulin pens, the Forteo Pen, and the Trulicity platform. Later, at Sanofi, he led drug delivery innovation and platform development, including devices for Dupixent. Today, Jim serves as a board member for Enable Injections and advises startups, helping the next generation of innovators navigate IP, supply chain, and platform strategy.


Subhi Bio:

Subhi Saadeh is a Quality Professional and host of Let’s Combinate. With a background in Quality, Manufacturing Operations, and R&D, he has worked in large medical device and pharma organizations to support the development and launch of hardware devices, disposable devices, and combination products for vaccines, generics, and biologics. Subhi serves as International Committee Chair for the Combination Products Coalition (CPC), as a member of ASTM Committee E55, and previously on AAMI’s Combination Products Committee. For questions, inquiries, or suggestions, visit letscombinate.com or connect on LinkedIn.

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2 months ago
45 minutes 50 seconds

Let's Combinate - Drugs + Devices
202 - Becoming an Expert in the Work Nobody Wants to Do/Design, Risk, and the Messy Middle of Combination Products w/Joey Frechin

In this episode of Let's Combinate, host Subhi Saadeh is joined by long-time friend and Senior Technical Program Manager Joey Frechin, who brings a wealth of experience in med tech consulting.

They discuss the intricacies of risk assessments for medical devices and drugs, focusing on differences and improvements in methodologies over the years. Joey shares insights on the challenges of aligning risk processes across different organizations and the importance of adaptable strategies. He also recounts his unique career path that blends design engineering with extensive process and risk management expertise.

The conversation covers trends such as the shift toward off-the-shelf platforms and the balancing act between innovative design and market readiness. Joey emphasizes the value of stepping into roles and tasks that others may overlook, which has been key to his professional growth.


00:00 Welcome and Introduction

00:49 Discussing Risk Assessments in Med Tech

04:34 Challenges in Aligning Risk Processes

09:44 Understanding P1 and P2 in Risk Management

12:55 Joey's Career Journey and Strategic Choices

24:12 Trends in Combination Product Design

31:48 Conclusion and Where to Find Joey


Joey Frechin is a technical program lead in the medical device and combination product development space.

https://www.linkedin.com/in/joey-frechin


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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2 months ago
32 minutes 12 seconds

Let's Combinate - Drugs + Devices
201 - Inside a $300M FDA Remediation, Lessons from Zimmer to EpiPen Warning Letters, 99.999% Reliability and Quality 4.0

In this episode of Let’s ComBinate, Subhi Saadeh sits down with Jeff Gensler, a quality and regulatory leader with 30+ years in MedTech, pharma, and combination products.

Jeff takes us inside FDA warning letters, consent decrees, and massive remediation efforts—including the 1,400 DHF Zimmer Biomet project and achieving 99.999% reliability with the EpiPen. He shares the CAPA playbook he’s refined over decades, the high-stakes negotiations with FDA, and the critical role of containment, third-party reviews, and inspection readiness.

The conversation shifts to Quality 4.0 how electronic batch records (EBRs), AI, and digital systems can move quality from reactive to preventive. Jeff also introduces his new Quality 4.0 Consortium, designed to bring proven digital solutions to small and mid-sized pharma companies.


Timestamps:

00:00 – Introduction & Guest Welcome

00:42 – Facing a Warning Letter: The Zimmer Experience

02:05 – Remediation Strategies & Challenges

06:03 – Orthopedic Industry Insights

09:58 – Transition to Pfizer & Meridian

12:54 – Navigating FDA Negotiations

16:18 – Balancing Risk & FDA Visibility

16:55 – Implementing Quality Systems & Processes

18:15 – Leveraging Third-Party Reviews & Audits

20:26 – Inspection Readiness & CAPA Processes

25:08 – Mergers, Acquisitions & Facility Upgrades

27:32 – Digital Transformation in Quality Management

31:12 – The Future of Quality Systems & AI Integration

33:01 – Benefits of Electronic Batch Records

34:13 – Conclusion & Contact Info


Jeff Gensler is a veteran quality and regulatory executive with more than 30 years of leadership experience in MedTech, pharmaceuticals, and combination products. Over his career, Jeff has navigated some of the industry’s most complex compliance challenges, including FDA warning letters, consent decrees, and large-scale quality system remediations. He has held senior leadership roles at Zimmer Biomet, where he oversaw the remediation of 1,400 design history files involving $300M in resources and 1,500 contractors, and at Pfizer’s Meridian Medical Technologies, where his team achieved 99.999% reliability for the EpiPen through advanced quality processes and close FDA engagement. Jeff later served as Vice President of Quality at Kindeva Drug Delivery, where he helped lead a state-of-the-art facility buildout recognized by ISPE as a Facility of the Year finalist. A recognized advocate for modernizing quality systems, Jeff has championed Quality 4.0, integrating electronic batch records, AI, and advanced analytics to shift organizations from reactive to preventive quality management. Most recently, he founded the Quality 4.0 Consortium, a collaborative platform bringing proven digital solutions to small and mid-sized pharma companies.


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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3 months ago
34 minutes 25 seconds

Let's Combinate - Drugs + Devices
200 - MedTech and Pharma After 200 Episodes…..

In this milestone episode, I reflect on what it’s taken to record, edit, and release 200 episodes focused on medical devices, pharma, and combination products.


I share three hard-earned lessons not just about the industry, but about how we grow, lead, and keep learning inside it. From the sheer scope of the work to the surprising, non-linear paths people take, and the difference between credentials and true insight this episode is about what finally clicked… and what still hasn’t.


It’s a thank-you to you, the listener, and a reminder that mastery isn’t a finish line it’s a mindset.


👉 Got ideas for future episodes? Reach out at letscombinate.com


Timestamps

00:00 – Introduction and Podcast Journey Overview

01:18 – Reflecting on 200 Episodes

02:57 – Lesson 1: The Vastness of the Industry

07:56 – Lesson 2: Clarity and Intention in Careers

12:34 – Lesson 3: Expertise vs. Insight

16:08 – Conclusion and Future Plans


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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3 months ago
17 minutes 8 seconds

Let's Combinate - Drugs + Devices
199 - How Modeling Can Cut in Half for Combination Products, V&V 40, and Cutting Dev Time with Mark Burchnall

In this episode of Let’s Combinate, host Subhi Saadeh is joined by Mark Burchnall, Director of Engineering at PSN Labs, to break down the evolving role of mechanical modeling and simulation in medical device and combination product development.


Mark, an expert in mechanical modeling & finite element analysis (FEA) and a licensed professional engineershares how modeling can dramatically reduce prototyping cycles, support regulatory submissions, and lower test burden when applied appropriately.


Mark disucsses:

Why modeling is often misunderstood

When it can replace (or complement) traditional testing

What makes a model “credible” under ASME V&V 40

How to build internal processes for regulatory-grade models

And what every skeptic (or startup) needs to know before adopting modeling


⏱️ Timestamps:

00:00 Introduction and Guest Welcome

00:17 Mark's Expertise in Mechanical Modeling

01:28 Subhi’s Foundational Experience

04:09 The Importance of Modeling in Engineering

05:44 Challenges and Misconceptions in Modeling

10:52 Life Cycle and Inputs of a Model

16:21 Types of Models and Their Applications

17:49 Numerical Solvers and Sensitivity Analysis

21:28 CAD, Fluid Properties, and Starting a Model

22:00 Defining the “Question of Interest”

23:21 Modeling Cycle and Initial Steps

24:35 Verification and Validation in Modeling

25:40 Assessing Model Risk and Credibility

31:43 Regulatory Guidelines and Industry Practices

39:15 Implementing Modeling in Product Development

42:17 Conclusion and Contact Information


Mark is a product development consultant with over 15 years of experience in the Medical and Combination device sectors. As the Director of Engineering at PSN Labs, Mark leads the engineering department, offering invaluable support to clients in new product development, computational modeling and simulation, test method development, functional prototyping, contract manufacturing, and on-market remediation. His team specializes in designing devices that incorporate various design principles, including manufacturing, assembly, sustainability, biocompatibility, reprocessing, and reliability. Mark’s background encompasses the development of innovative healthcare solutions in areas such as drug delivery, surgical robotics, pharmaceutical packaging, and catheters. His expertise ensures patient safety and regulatory compliance throughout the design process. Mark holds a Bachelor of Science in Mechanical Engineering from Purdue University and a Master of Science in Mechanical Engineering from the University of Cincinnati.


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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3 months ago
42 minutes 37 seconds

Let's Combinate - Drugs + Devices
198 - QMSR Explained, ISO 13485 Compared, and 5 Key Things You Might’ve Missed

In this episode of Let's Combinate, host Subhi Saadeh highlights five critical aspects of the FDA's new Quality Management System Regulation (QMSR) that you may have missed. Subhi explains the historical context of QSR and ISO 13485, their 1996 origins, and the drive for harmonization that began in 2018. Key insights include the alignment with ISO 13485, additional FDA-specific expectations, the continued importance of risk management, the removal of certain industry exemptions, and the urgent two-year compliance timeline ending in February 2026. Subhi emphasizes the necessity of updating internal quality management systems and training staff to meet these new regulatory requirements.Timelines:00:00 Introduction to FDA QMSR00:29 Historical Context and Timeline02:22 Key Takeaway 1: Harmonization with ISO 1348504:06 Key Takeaway 2: FDA's Additional Expectations05:18 Key Takeaway 3: Risk Management Expectations06:18 Key Takeaway 4: Removal of Exemptions07:44 Key Takeaway 5: Compliance Deadline09:13 Conclusion and Final ThoughtsSubhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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3 months ago
10 minutes 51 seconds

Let's Combinate - Drugs + Devices
197 - Quality Agreements Explained: How to Protect Yourself When Things Go Wrong

In this episode of Let’s Combinate, host Subhi Saadeh breaks down the critical role of quality agreements in the pharmaceutical and medical device industries.A quality agreement is a written document that defines GxP responsibilities between parties—such as sponsors, product owners, and contract partners. It doesn’t cover business terms like payments or IP: instead, it focuses on quality responsibilities and operational accountability.

Subhi explores regulatory expectations from the FDA, ICH Q10, and ISO 13485, emphasizing that even when work is outsourced, responsibility always stays with the product owner. He outlines five key sections every quality agreement should cover:

-Deviation & Non-Conformance Handling

-Change Control

-Audits & Regulatory Inspections

-Complaint Handling & Field Actions

-Documentation & Record Retention

This episode highlights common pitfalls, vague language to avoid, and why quality agreements must be clear, specific, and actionable especially when something goes wrong.


⏱️ Timestamps

00:00 – Intro: Why Quality Agreements Matter

01:23 – What Is a Quality Agreement?

03:24 – Regulatory Expectations (FDA, ICH Q10, ISO 13485)

04:51 – FDA’s Quality Agreement Guidance Explained

06:34 – Common Pitfalls & Misunderstandings

08:00 – The 5 Critical Sections Every Agreement Needs

12:34 – Final Thoughts: Make It Real. Make It Work


Subhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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4 months ago
13 minutes 50 seconds

Let's Combinate - Drugs + Devices
Combi Crumbs: Clinical Trials 101 – From Safety to Strategy

From Episode 195 with Archana Sah


In this clip of the larger interview with Archana Sah, she covers the critical phases and elements of clinical trials—from phase one focusing on safety to phase three assessing effectiveness in diverse populations. Key aspects include the importance of the trial design, the role of comparator arms, regulatory requirements, patient recruitment, and the cultural preferences that influence trial protocols. The episode provides an in-depth look at how data is collected and analyzed to ensure the safety and efficacy of new drugs.00:00 Introduction to Clinical Trials00:26 Phases of Clinical Trials02:09 Designing Oncology Trials04:00 Protocol Design and Regulatory Approval05:27 Patient-Centric Considerations06:25 Vendor Roles and Statistical Analysis

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4 months ago
8 minutes 21 seconds

Let's Combinate - Drugs + Devices
196 - How to Win Your First 90 Days in Pharma and MedTech

In this episode, I go over 8 lessons to maximize your first 90 days in Life Sciences. These include understanding the impact of their roles, adopting a professional mindset, passing the first 90-day test, avoiding the 'silent trap,' finding mentors, valuing feedback, mastering systems, and taking responsibility for their careers. Subhi emphasizes that these lessons can significantly accelerate growth and career advancement for newcomers to the industry.Link to course: subhisaadeh.gumroad.com/l/6figurebiomedical00:00 Introduction: Starting Your Career Journey00:54 Lesson 1: Your Role Can Have a Big Impact02:55 Lesson 2: Adopting a Professional Mindset04:06 Lesson 3: The First 90 Days Are Crucial05:09 Lesson 4: Avoiding the Silent Trap06:35 Lesson 5: Finding the Right Mentors07:14 Lesson 6: Embrace Feedback as Fuel07:51 Lesson 7: Mastering the Systems08:47 Lesson 8: Taking Responsibility for Your Career09:19 Conclusion and Additional ResourcesSubhi Saadeh is a Quality Professional and host of Let's Combinate. With a background in Quality, Manufacturing Operations and R&D he's worked in Large Medical Device/Pharma organizations to support the development and launch of Hardware Devices, Disposable Devices, and Combination Products for Vaccines, Generics, and Biologics. Subhi serves currently as the International Committee Chair for the Combination Products Coalition(CPC) and as a member of ASTM Committee E55 and also served as a committee member on AAMI's Combination Products Committee.For questions, inquiries or suggestions please reach out at letscombinate.com or on the show's LinkedIn Page.

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4 months ago
9 minutes 38 seconds

Let's Combinate - Drugs + Devices
Hello Combi-Nation! Our industry fee complicated sometimes. Drugs, devices, clinical trials, submissions, sterilization validation, design control, risk management, market access reimbursement, the list goes on. My name is Subhi Saadeh. I've spent over a decade in medical device, pharma, and combination product development. My goal is mastery, so this podcast is to ask questions I have to people who may have the answers. Whether you're background is Pharma, Device or both, I invite you to listen and together we can simplify by Combinating!