How to read the silence on a certificate you already hold

Eleven of the twenty replied within the month. Of those, four answered all five questions, three answered between one and three, and four replied to say that the questions did not apply because the products are sold for research use and are not represented as sterile injectables. That last answer is legally accurate and it is the most important sentence in this article, because it describes precisely the gap between what is being sold and what buyers believe they are buying.

The statistics, worked in one paragraph

Suppose a batch of ten thousand vials in which one vial in a thousand is contaminated — a rate that would be a serious finding in any regulated operation and is invisible to any buyer. The probability that a single randomly chosen vial is clean is 0.999. The probability that all twenty sampled vials are clean is 0.999 raised to the twentieth power, which is approximately 0.980. The sterility test therefore passes this batch about ninety-eight times in a hundred.

Push the contamination rate up tenfold, to one vial in a hundred, and the test still passes the batch roughly eighty-two times in a hundred. To reach an even chance of detection at a one per cent contamination rate you would need to sample about seventy containers; to have a reasonable prospect of catching a one-in-a-thousand rate you would need to sample several hundred, which for most batches means testing a substantial fraction of the product.

This is not a criticism of the compendial test, which is designed as a final check against gross failure and performs that function. It is the reason no serious manufacturer treats a passed sterility test as the basis of the sterility claim, and the reason that a research supplier offering to have a vial sterility-tested on request is offering something considerably weaker than it sounds.

The endotoxin limit, calculated

The limit is derived, not looked up. For a parenteral product other than an intrathecal one, the threshold pyrogenic dose is taken as five endotoxin units per kilogram of body weight per hour. The endotoxin limit for the product is that figure divided by the maximum dose per kilogram administered within an hour. For an intrathecal route the threshold falls to 0.2 endotoxin units per kilogram, a twenty-five-fold reduction that reflects the absence of the systemic buffering the bloodstream provides.

Work it for a concrete case. A seventy-kilogram subject has an hourly allowance of three hundred and fifty endotoxin units. A vial nominally containing five milligrams of peptide, reconstituted to two millilitres, from which a fifth of a millilitre is drawn, delivers a tenth of the vial contents. If the whole vial carried three hundred and fifty endotoxin units, that draw would deliver thirty-five — a tenth of the allowance. The limit expressed per milligram of peptide is what a certificate should carry, because it is the only form of the number that survives a change in reconstitution volume.

None of the arithmetic is difficult. What is missing from this trade is not the calculation but the measured numerator.¹

Documentation practice, named and criticised

The Journal tracks the release documentation of twenty companies. On sterility and endotoxin the picture is close to uniform. Every one publishes a purity figure. A minority publish an identity confirmation. Two publish peptide content. On the microbiological attributes, the standard document is silent, and the silence is not annotated: there is no line reading that sterility has not been determined, which would at least be informative.

Some of the practices we would like to see are already in use somewhere in the group. SSA reports peptide content on its certificates, having begun after correspondence with this publication. CPC and SWB describe their fill environment in general terms on request. QST and BCH answered our five questions in full. WXT and FGP declined on the grounds that research-use products are not represented as sterile injectables, which is a legally sound answer that concedes the point of the exercise. Several others did not respond, and we record non-response as non-response rather than as evasion.

What we are criticising is a documentary convention, not the conduct of any company named here. None of the twenty has been shown to us to have misrepresented anything. The convention is that a chemistry certificate stands in for a release package, and it is a convention this trade adopted collectively and could abandon the same way.

Five lines that would change what a certificate is worth

Nothing the Journal asks for here requires a regulator, an inspectorate or a change in the law, and none of it is commercially sensitive. All five items are already known to whoever released the batch.

First, state the fill route: aseptic or terminal, and if aseptic, in what class of environment. Second, state the pre-filtration bioburden result against its specification, or state that bioburden is not determined. Third, state whether the sterilising filter was integrity-tested after use. Fourth, report bacterial endotoxin per milligram of peptide, with the method and the inhibition-enhancement result, or state that it was not determined. Fifth, where a sterility test has been performed, state the batch size, the number of containers tested and the method, so that a reader can do the arithmetic in the section above. Every one of the five is an ordinary element of a release specification for a biological product, and none of them is an invention of this publication.²

A certificate carrying those five lines would remain a one-page document and would be worth several times what the current one is worth, principally because four of the five lines are permitted to say no. A stated negative is a fact a reader can use. An omission is a space a reader fills with an assumption, and the assumption is always more favourable than the truth would have been.

What this article is not asserting

Precision about the scope of a criticism is part of the job, so it is worth spending a paragraph on what is not being said. This piece does not allege that any company named in it has sold contaminated material. It does not allege that any of them has concealed a result, falsified a document or misrepresented a test. It does not claim that the products discussed are dangerous, and it does not claim that they are safe, because neither claim is supportable from the evidence we have.

What the piece asserts is documentary. A certificate describing chemistry is being read as a release package covering microbiology. That mismatch is created by the format of the document rather than by anybody’s intent, and it is closed by adding lines rather than by changing behaviour.

There is also a legal point the Journal has no wish to elide. Research-use-only material is not approved for human use in any jurisdiction, is not required to meet parenteral standards, and is not represented by its sellers as meeting them. Everything in this article about endotoxin limits and sterility assurance describes the framework that would apply to a parenteral medicine. Applying that framework to a research chemical is a comparison, not a compliance requirement, and readers should hold both halves of that sentence at once.

A note on method and sourcing

The compendial material in this article is drawn from the current general chapters of the United States Pharmacopeia and the European Pharmacopoeia, read in the original rather than in summary, and from the international standards on aseptic processing and on laboratory competence. Where a chapter has changed status recently — as the recombinant reagent chapters have — we say so, because a reader consulting an older edition will find a different framing.

Where the Journal reports a number it obtained itself, it states the laboratory’s accreditation status, the method family, whether method suitability was established, and the number of determinations. Where we report what a company told us, we distinguish an answer from a refusal and a refusal from a non-response, because those three things are routinely collapsed in coverage of this trade and they are not the same.

Corrections to this department are handled by the standards desk, which reads every letter and records the outcome in the log. Readers who believe a paragraph here overstates its evidence are asked to write to standards@compoundjournal.com; readers with documents to send, including certificates they would like read, should write to letters@compoundjournal.com. We do not publish correspondents’ names without permission and we do not identify the source of a certificate.

The sterility half is not solvable within the current economics, and it would be dishonest to pretend otherwise. Fourteen days, two media, a destroyed container and a statistical yield that passes most contaminated batches: no commercial testing service can build a product out of that for private buyers, and none has tried. The honest position is that this attribute is not verifiable downstream and must be assured upstream or not at all.