The document discusses several recent "pro-industry" initiatives by the FDA and CMS that are intended to improve responsiveness to industry but have disappointed many companies. It outlines initiatives by each agency, as well as two joint initiatives, including improved information sharing between the agencies. However, the document notes that industry remains doubtful about the initiatives due to ongoing costs, uncertainty, and limitations of some programs. Barriers to successful implementation of the initiatives include limited agency budgets, staffing challenges, and lack of stable leadership.