Advocates, Evidence, and the RCT Trap: What Startups and Journals Really Want

In Part 1—Why Pitching a Health AI Startup Feels Like Publishing in a Top Journal—we explored how pitching your healthcare AI startup to venture capitalists mirrors submitting a medical AI paper to a top-tier journal. We showed that both teams and triage matter. 

For Part 2, we take a closer look at what it takes to push a promising idea across the finish line: 

👉 The hidden champions

👉 The real value of peer-reviewed publications

👉 The often unrealistic expectations of rigorous clinical trials

1. The Power of Champions

Behind every successful deal—or published paper—is a champion fighting for it behind closed doors. In venture capital, this is often a partner at the firm who falls in love with your startup and convinces the rest of the team to invest. You might wow a junior associate. But the deal rarely progresses without someone with voting power to advocate for you.

In the publishing world, champions exist too. Often, it's an associate editor who sees your paper's promise, frames it positively to reviewers, and pushes through revisions. One anonymized editor once admitted to "going to bat" for a paper that didn’t follow conventional formats but showed undeniable clinical impact.

💡 TIP: Whether you’re seeking capital or credibility, having someone influential on the inside who believes in your work is often the tipping point.

2. Publications as a Credibility Boost (But Not a Golden Ticket)

Many healthtech founders pursue peer-reviewed publications as a badge of validation. And yes, having a study published in a reputable journal adds credibility. It tells investors and potential partners that your product is rooted in science, not hype.

But that doesn’t always translate to product-market fit. A 2022 study of 224 digital health startups found that 44% had no published clinical trials or regulatory filings, yet many were successfully funded. That same study showed no strong correlation between clinical evidence and total funding.

💡 In short: A well-placed publication might open doors, but it doesn’t close deals. Investors may nod at your JAMA paper, then ask: "How many hospitals are using this today?"

3. The RCT Conundrum: Evidence on a Startup Budget

Randomized controlled trials (RCTs) are the gold standard in medicine, but they’re also expensive and time-consuming. Even lean academic studies can cost hundreds of thousands. Larger Phase II/III trials routinely run into the tens of millions.

For most startups, that kind of spending just isn’t realistic. Timelines are another issue: an RCT can take 12–24 months, during which a startup might pivot twice and go through multiple funding rounds.

The solution? Many founders opt for smaller validation studies—retrospective analyses, pilot programs, or real-world data—to get early traction. These can still be valuable when shared with stakeholders or customers, and might even lead to future publications when resources allow.

💡 TIP: Savvy startups know this is a marathon, not a sprint. They prioritize just enough evidence to support growth milestones, while planning for deeper studies when timing and funding align.

Final Takeaway

Success in either world—venture capital or academic publishing—requires more than a good idea. You need the right people, timely execution, and someone who believes in your work. Peer-reviewed studies can help, but without traction and the right storytelling, they’re just another PDF. 

Likewise, clinical validation is important, but startups must balance ambition with reality. Know your audience, find your champions, and keep your eyes on both impact and momentum.

About HealthUnity

HealthUnity is a diverse collective of AI experts, researchers, strategists, healthcare professionals, and nonprofit leaders dedicated to breaking silos in healthcare. We drive innovation to improve health outcomes and enhance lives globally through open research, generative AI, and data-driven collaboration. Want to stay at the forefront of AI in healthcare? Follow HealthUnity on LinkedIn and join the discussion!

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