When Science Meets Capitalism

Doctors are scientists by nature. Innovation in our world is deliberate, careful, and IRB-approved. We push the boundaries of medicine through years of research and clinical trials.

But what happens when innovation meets capitalism?

I was speaking Dr. Ron Razmi, a former Mayo Clinic cardiologist turned founder and VC, who recently authored the AI Doctor. He will be sharing his journey and advice in a later post. But our discussion touched on the disconnect between innovation and the healthcare system.

Dr. Razmi was discussing how many startups are clueless about the landscape of medicine when they come with new ideas. It takes years to prove the benefit of something, and even then, it needs to fit within existing healthcare incentives.

He used the example of the coronary calcium score. “There is absolutely no question that a higher calcium score means you have a higher risk of a cardiovascular event. If you have a calcium score of zero, it’s very unlikely you’re going to have a cardiovascular event. This has been proven in long-term trials, well-designed, randomized—all of that. People don’t realize, no insurance company pays for a calcium score.”

I asked about the intermediate cases where calcium score is helpful in decision making, and he said there are easier in-office assessments to get the same information. “So, paying for new technology when there are cheaper ways of doing it, that’s how insurance companies make reimbursement decisions.”

This is where innovation without understanding incentives fails.

Physician-led startups know that without a billable code or clear reimbursement pathway, even the best medical breakthroughs won’t get adopted. Investors who don’t get this will burn through millions on digital biomarkers, decision support tools, or new diagnostics that never get paid for. The market isn’t just about proving something works. It’s about proving someone will pay for it.

As Dr. Razmi says, “Having that clinical knowledge where you say, ‘Calcium scores still haven’t been reimbursed with all this evidence. What are you developing? How does this change the decision-making? How long is it going to take for you to do the studies? How long before you can get reimbursement and scale up?’ That kind of thinking you can only do if you’re a physician.”

But then there’s the other side of capitalism. The fast-moving, messy side.

While proven innovations fail to enter workflows, other ideas get mass adoption with zero clinical evidence. The open market seems like one giant, real-time clinical trial for experimental medicine:

• Longevity biohacking: Wealthy individuals experimenting with young blood transfusions, metformin, rapamycin, and hyperbaric therapy. All to the skeptical amusement and concerned curiosity of doctors.

• Whole-body MRI scanning: Companies like Prenuvo and Ezra are offering full-body scans for early disease detection, despite no guideline recommendations and high false-positive risks. There was a running joke in my residency program that a good exit plan from Radiology was running a scam clinic advertising full-body scans to patients and how easy it would be to prey on rich people’s fears.

• Continuous glucose monitors (CGMs) for non-diabetics: There’s no strong clinical evidence that healthy people need to track their glucose, but DTC startups like Levels and January AI built a consumer movement anyway. And it’s proving helpful for many people.

• AI-driven spinal stenosis measurement: A niche area of academic research that’s had millions of dollars poured into startups. Most Radiologists won’t pay for an AI to slightly improve consistency between reads.

• Personalized gut health testing: Companies like Viome and Zoe claim to offer microbiome-based diet plans, but so far, clinical backing is still limited.

Some of this is real innovation happening faster than academia allows. Other parts are pseudoscience burning through consumer cash, emotion, and time. The FDA and regulators will hopefully filter out the harmful ones, but the rest? They may just accidentally push science forward in ways academia never could.

We’ve seen that consistently in other industries. Capitalism significantly accelerated AI research, producing results that would take decades in a university setting. Capitalism had the same effect on advances in space exploration, CRISPR and gene editing, electric vehicles, and telemedicine.

And that’s the lesson.

We roll our eyes at unproven therapies, but sometimes capitalism creates incentives that can drive new frontiers of medicine. People are willing to pay, and in doing so, they’re accelerating research and discovery.

If you’re a physician looking to innovate, you need to understand both sides. You need the rigor of academia, but also the savviness to align your research with incentives that drive adoption.

That’s why I started this newsletter. Doctors should be at the forefront of medical innovation. Not just advising startups, but leading them. Because if we don’t, the future of healthcare will be built by people who don’t understand it.

Best,
Mohammed