What we learned building, breaking, and rebuilding a clinical trials company
Author: Tyler Van Horn, CEO, Science 37
Decentralized clinical trials were supposed to be a revolution. Instead, they became a cautionary tale.
The companies still standing learned something the category evangelists didn't: sponsors don't want a revolution, they want results through controlled and proven innovation. Science 37 pioneered a category, raised hundreds of millions of dollars, overdiversified, in the end got caught in its hype cycle, and came out the other side as a different company. This is what we learned.
Decentralized clinical trials were and still are a real answer to a real problem. Sponsors need to enroll their trials, expand patient access, lower site burden, achieve diverse representation, and ensure enough participants complete the trial to achieve its endpoints. It was true in 2015, and it is true today.
The pandemic validated decentralized elements overnight and created demand that looked like a permanent regime change. It wasn't. It was an emergency adoption curve that snapped back as the world reopened. Many companies built and overhired to respond to the demands of the emergency curve, including the version of Science 37 that existed in 2021. As it turns out, COVID didn’t prove the DCT thesis. It proved the emergency use case. The companies that survived the correction are the ones that figured that out before the market did it for them.
The lesson is not that the DCT thesis failed. It’s that we built and scaled for the version of demand that only existed while the world was closed.
Decentralization was sold as a wholesale replacement for the site model. The thesis was a pure-play disruption, and capital flooded into the space. There was a mismatch in expectations. Sponsors were not asking for fully decentralized or virtual trials. In fact, for the vast majority of trials, a fully virtual solution is impractical and ignores the sponsor's desire to have future prescribers participate in the foundational research that brings a new medical device or drug to market. Sponsors were asking for flexibility inside trials that still needed sites, PIs, and the traditional infrastructure they spent the last 30 years building, without additional site burden.
Three types of companies emerged from the hype: pure-play disruptors promising to replace sites entirely, enablement vendors selling technology, services, or tools to help sites go hybrid, and incumbents slapping 'decentralized' labels on products they'd been selling for years.
Science 37 tried to do it all: pure-play disruption plus site enablement plus clinical services. The market had other ideas. By 2023, it was clear which approaches had staying power and which were built for a demand curve that no longer existed.
The lesson isn't that decentralization was fundamentally flawed. It's that the majority of companies built solutions for a market disruption that sponsors had never requested, and trying to be everything to everyone led nowhere.
After the world reopened, the market corrected in 2023. The overdiversified solution set we had built for the COVID emergency was no longer tenable for Science 37 to scale. The market correction was painful - we had to make difficult decisions about our workforce while our team watched competitors struggle or shut down entirely. In March of 2024, eMed took Science 37 private. Going private afforded us the ability to rebuild the operating model around what sponsors actually needed, and gave our team - many of whom had weathered the entire journey - renewed clarity on the mission we were building toward. It worked.
Science 37 today is the company we should have been building all along.
The lesson is not that market corrections are failures. It's that the companies that survive are the ones honest enough to admit when something isn't working and disciplined enough to actually reset.
Science 37 is a modern direct-to-patient clinical trial site that can enroll any patient regardless of geography. We operate under a single FDA Form 1572 and central IRB submission, covering all 50 states as one unified site. Our team of broadly-licensed Principal Investigators, 150+ Research-Grade Nurses, Clinical Research Coordinators, and Site Operations staff conduct assessments primarily in participants' homes, coordinating the full logistics chain including direct-to-patient investigational products, clinical supplies, and clinic-grade devices like spirometers.
With over 200 trials conducted and three recent FDA inspections resulting in No Action Indicated classifications, we've proven this model scales and delivers regulatory-grade research quality. Our performance data demonstrates the impact: we average 150 patients enrolled per trial compared to the industry average of 26 patients at a traditional brick-and-mortar site, with study completion rates of 86.3% versus the industry average of 35.7%.
The model produces measurably more representative trial populations, with 62.4% women enrolled (vs. 49% benchmark) and significantly higher Black participant representation (19.9% vs. 7%).
Where we differ from the hype: we don't add site burden with additional technology, and we don't aim to replace the site network. We're simply one site among many on any given trial, the one that opens access to the 95% of patients who live more than two hours from a research site and are currently unreachable by traditional infrastructure.
The lesson is not that innovation doesn't matter. It's that the innovation that survives is the kind that delivers measurably better results, not the kind that promises to change everything.
Geographic access isn't the same as patient access.
The industry got obsessed with reaching rural patients, but the real access barrier isn't distance. It's convenience. Our highest-performing markets aren't remote areas; they're suburban communities where people have cars and could drive to sites, but choose not to because home visits fit their lives better. The working parent who can't take time off, the caregiver managing multiple family health issues, the parent of a pediatric patient who would rather not expose their child to a clinical environment, the patient whose condition makes travel genuinely difficult. These aren't edge cases. They're the majority of your eligible population.
Retention happens in the first 30 days, not the last 30.
Traditional sites focus on endpoint retention strategies: reminder calls, completion bonuses, patient appreciation events. We learned that 86% retention rates come from eliminating friction at enrollment, not adding incentives at completion. When patients don't have to rearrange their lives for every visit, they don't spend six months looking for reasons to quit. The retention battle is won before the first follow-up visit.
Sponsors don't want decentralized trials. They want trials that work.
The biggest revelation was how little sponsors actually care about the "decentralized" label. That is why we stopped using it. What they care about is enrollment timelines and data quality. Our trials consistently outperform traditional sites on these metrics, but that's the conversation sponsors want to have. Not whether we're sufficiently "revolutionary." The companies that survived the correction focus on results.
Scale changes everything about what's operationally possible.
Running five DCT studies taught us one thing; running 200 taught us something completely different. At scale, you stop optimizing individual patient journeys and start optimizing systems. You discover that the real bottleneck isn't nurse travel time. It's medical record retrieval. You learn that diversity outcomes aren't a recruitment add-on; they're a structural result of removing geographic barriers. You realize that regulatory compliance at scale requires different infrastructure than compliance for pilot studies. The category's early assumptions were based on small-scale proof of concepts, not production operations.
The companies still operating today learned these lessons the hard way. The ones that didn't aren't operating anymore. The lesson is not that the category failed to understand decentralization. It's that most companies never learned the difference between what sounds innovative and what actually works at scale.
The hype cycle taught us expensive lessons. The correction made us apply them ruthlessly. What remains is a company that knows the difference between what sounds transformative and what actually transforms outcomes. We're not the same company that raised hundreds of millions promising to revolutionize clinical trials. We're a company that learned the hard way what sponsors actually need and rebuilt around delivering it consistently.
