• Hani J Marcus, Christopher J Payne, Archie Hughes-Hallett, Adam P Marcus, Guang-Zhong Yang, Ara Darzi, and Dipankar Nandi.
• The Hamlyn Centre, Institute of Global Health Innovation, Imperial College, London W2 1NY, UK Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK hani.marcus10@imperial.ac.uk.
• BMJ. 2016 May 20; 353: i2587.

Objective To investigate the regulatory approval of new medical devices.Design Cross sectional study of new medical devices reported in the biomedical literature.Data Sources PubMed was searched between 1 January 2000 and 31 December 2004 to identify clinical studies of new medical devices. The search was carried out during this period to allow time for regulatory approval.Eligibility Criteria For Study Selection Articles were included if they reported a clinical study of a new medical device and there was no evidence of a previous clinical study in the literature. We defined a medical device according to the US Food and Drug Administration as an "instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article."Main Outcome Measures Type of device, target specialty, and involvement of academia or of industry for each clinical study. The FDA medical databases were then searched for clearance or approval relevant to the device.Results 5574 titles and abstracts were screened, 493 full text articles assessed for eligibility, and 218 clinical studies of new medical devices included. In all, 99/218 (45%) of the devices described in clinical studies ultimately received regulatory clearance or approval. These included 510(k) clearance for devices determined to be "substantially equivalent" to another legally marketed device (78/99; 79%), premarket approval for high risk devices (17/99; 17%), and others (4/99; 4%). Of these, 43 devices (43/99; 43%) were actually cleared or approved before a clinical study was published.Conclusions We identified a multitude of new medical devices in clinical studies, almost half of which received regulatory clearance or approval. The 510(k) pathway was most commonly used, and clearance often preceded the first published clinical study.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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