Is it cake? New bordeline guideline rundown

Here the regulatory version of “IS IT CAKE??” 🍰 - if you know the show! Featuring the European Commission’s updated guidance on borderline products published this month.

As someone whose specialty is borderline products and who loves RA developments on the edge, I spent hours digesting its 24 examples of what is or isn’t a medical device - as opposed to drugs, cosmetics, IVD, personal protective equipment (PPE), biocides,..

Frankly, I found half of the examples straightforward, and the other half.. I either struggle to understand the reasoning, disagree or find it inconsistent. Here the main reasons:

INTENDED USE vs MODE OF ACTION, WHO WINS?
MDR defines and classifies medical devices based on the former, while this guidance mostly hedges on the latter. When conflicts arise, this guidance gives priority to the mode of action. There are two, in my opinion, conflicting examples with devices that claim prevention of disease: an STI prevention app and medical examination table covers (i.e. paper roll). The first is not MD, despite processing medical records, using algorithms to assess risk, alerting peers regarding their potential for infection - because “no action on data other than communication”. The second is MD, regardless of its make - because “acts as a mechanical barrier”.

ANYTHING BUT Class I, EVER..
The myth of Class I devices continues. Only one example from here comes out as Class I MD: a rescue bag for patient transport - because "aims to support and protect, [..] avoids worsening of health". Arguably, PPE and Product for Emergency Rescue regulations could be sufficient, so what does Class I MD status really add here? On the other hand, why couldn’t some other low risk examples be Class I (e.g. STI app above, medical calculator for recurrent math)?

It's a continuous learning process for all, and access to practical guidance of this type is very helpful for the health sector as a whole - actually something that FDA does way better (writing style and formal consistency in this manual is quite disappointing).

If we held a geeky RA pub quiz on these examples, how would RA professionals, national authorities and notified bodies score? That would be interesting.