If the fit is so often wrong, why do growing manufacturers keep choosing platforms designed for the world's largest healthcare companies?
The decision usually comes from a series of reasonable-sounding choices.
“Industry standard” and “best practice” are largely defined by the organisations that spend the most on their quality management technology.

Requirement documents are adapted from templates written for global enterprises, so they accumulate capabilities that few mid-sized manufacturers will ever use.
Consultants may recommend solutions they have implemented previously; vendors position their top-tier offering as the safe choice and, at some point, someone asks why the company doesn't deploy the technology they used in another, larger company.
Oversized technology carries a cost that goes beyond licence fees: validation.