A literature analysis of research published by healthcare unicorns has found that many high-profile startups, digital health included, have few or no peer-reviewed papers.

The review, which sought published research data from 18 current and 29 exited healthcare unicorns, specifically highlighted the risk of “stealth research” among these startups in light of the recent and highly publicized fraud perpetrated at blood sample diagnosis company Theranos. By engaging in “stealth research” that keeps the wider medical and scientific community from evaluating research data, the authors argue that investors, the healthcare industry and the public alike may not be able to avoid the fallout of another bad actor.

Topline data

Among the 425 and 413 papers from current and exited unicorns that were identified by the researchers, just 8 percent and 11 percent, respectively, were considered to be “highly cited” (50 or more citations). Twenty-two of the 47 startups included had no highly-cited papers.

In particular, the researchers identified digital health startups as some of the worst offenders — Outcome Health, GuaHao and Oscar Health had no peer-reviewed papers whatsoever, while Clover Health and Zocdoc only had one each. On the other hand, 23andMe led the pack with 107 articles, 16 of which were highly cited.

Additional analyses assessing whether a unicorn’s valuation amount or leadership had any impact on publications found no significant correlations.

How it was done

The researchers conducted their systematic examination by collecting a list of venture capital-backed unicorns from the CBInsights platform, and searching through the PubMed database for any papers that had been coauthored with the companies’ direct participation. To gauge the impact of any identified research, the team also collected each paper’s citation count from the Web of Science database.

What’s the trend

New investments in digital health are skyrocketing, with 2018 already setting new records by Rock Health, StartUp Health and MobiHealthNews’ counts. The year has already gotten off to a quick start as well, with major rounds from Clover Health, Pear Therapeutics and EarlySense announced over the past few weeks.

In conclusion

“Startups are key purveyors of innovation and disruption. Consequently, holding them to a minimal standard of evaluation from the scientific community is crucial. Participation in peer review, with all its limitations, is the best way we have to uphold this standard. We are not arguing that startups should divert excessive resources to having peer-reviewed papers. However, when their products are destined to affect patient health, they should neither be solely doing marketing. Confidential data sharing with potential investors or regulators cannot replace more open scrutiny by the scientific community,” the authors concluded.