There’s a version of market research that makes sense. You have a product idea, you test for appetite, you validate before you build. That discipline has produced a lot of successful companies. It’s also a poor fit for a specific and common situation: when the problem you’re trying to solve has never had a solution and the people experiencing it have no frame of reference regarding what to ask for.
That was the situation when Justin Fulcher started building RingMD in 2012. Traveling through rural Indonesia, he kept encountering a notable gap. People had smartphones but no meaningful access to healthcare. They weren’t asking for a telemedicine platform. The concept didn’t exist for them in any practical sense. But the need was not hard to see: they needed to speak with a qualified doctor, to get basic medical guidance, to access something most people in wealthier environments take for granted.
The technology founder built a prototype. Not because the market had signaled it was ready, but because the problem was real and the tools existed to address it. That instinct has defined a career that has since taken Fulcher from a telehealth startup operating across fifty countries to public service as a senior advisor and senior staffer at the Department of Defense. His view of what that founding moment required has sharpened in the years since.
“Market appetite is a record of what people have already been offered. It tells you a great deal about existing categories and almost nothing about the ones that don’t exist yet. If you’re trying to build something genuinely new, you’re working in a space the market hasn’t had a chance to form a view on.” That distinction between what the market reflects and what it can anticipate is the foundation of everything that follows.
Need and Demand Are Not the Same Thing
This isn’t an argument against market research. It’s an argument for reading it carefully and understanding what it can and can’t tell you. In established categories, revealed demand is a reliable signal. In categories that don’t yet exist, you’re looking for something different – a need that’s present but hasn’t been expressed, because the product that would express it hasn’t been built yet.
The distinction matters in practice. Telehealth services are a clear example. When Fulcher was building RingMD, the absence of articulated demand for telemedicine in Southeast Asia wasn’t evidence that the demand didn’t exist. It was evidence that the category hadn’t been introduced to those markets. Populations without access to affordable healthcare aren’t in a position to ask for a better version of something they’ve never had. They’re dealing with the absence of it. That absence is itself a signal, though not the kind that shows up clearly in conventional market analysis.
Part of what made that signal hard to read was structural. “The people who most need a new technology are often the last ones whose preferences shape whether it gets built. They’re not in focus groups. They’re not being surveyed. The gap they’re experiencing is visible if you go looking for it, but it won’t come looking for you.”
For Fulcher, going looking for it meant traveling through the region, observing directly, and treating what he saw as a more reliable input than anything a market analysis of an as-yet-nonexistent category could have produced.
How Justin Fulcher Built RingMD Without a Market Signal
RingMD wasn’t built on a market thesis. It was built on an observable gap, a working prototype, and a potentially risky judgment call that the need was real enough to warrant building toward. For several months, it was essentially a hobby project; it was functional code without a company name or a formal structure behind it. Investors came to Fulcher before he went to them, and their interest formalized something that was already operating. By the time RingMD had a proper structure, the product already existed and was being tested. That sequence mattered. What investors were being asked to back wasn’t an idea. It was a working build.
That approach isn’t right for every situation. There are contexts where validating before building is the sensible choice, and founders who skip that step in categories where demand can be tested are taking on unnecessary risk. Fulcher’s argument is narrower: when the category you’re building doesn’t yet exist, and the population you’re building for has never had access to what you’re offering, conventional validation methods don’t give you the signal you’re looking for.
The telehealth startup he built illustrates why. Telehealth had been attempted for decades, but it only succeeded when bandwidth, billing, institutional belief, and back-office conditions aligned. None of those conditions were present in rural Southeast Asia in 2012. The market, by any conventional reading, wasn’t ready.
“There’s a gap between a need and an articulated demand. A need can exist for years, or decades, before someone builds something that gives people the language to express it. Once the product exists, the demand seems obvious in retrospect. Before it exists, you’re working from observation rather than confirmation.” The RingMD prototype was exactly that – an act of observation translated into code, before the language to describe it had formed in the market.
What COVID Confirmed
The COVID-19 pandemic illustrated this clearly, though in a difficult way. When it hit, organizations that had resisted telemedicine for years implemented digital health programs within weeks. Working alongside institutions that had long deferred action, founders and technologists who had spent years building in the space found the structural barriers they had been navigating quietly dismantled almost overnight. The tools hadn’t changed. The clinical case hadn’t changed. What changed was that the organizational cover for treating remote care as a lower priority was removed almost overnight.
Institutional drag, not infrastructure, had always been the real bottleneck. Core systems operate on outdated processes for years, not because the technology isn’t available, but because the conditions required to force a reckoning with those processes rarely arrive. COVID was one of those conditions. Artificial intelligence is now creating another – not by replacing human judgment inside these systems but by optimizing the workflows that have calcified around outdated assumptions.
In regulated environments, technology adoption succeeds when it reduces existing friction rather than creating new complexity. That principle applied to telehealth in 2020, and it applies to AI-assisted government modernization today.
Fulcher was direct about what the pandemic’s acceleration did and didn’t mean. “COVID didn’t create the case for telehealth. It removed the ability to set it aside. The need was the same on both sides of 2020. What changed was how much organizational cover there was for not responding to it.” A decade of adoption was compressed into months because the conditions used to defer action were no longer available. The demand had always been structural. What the pandemic altered was the institutional calculus around acting on it.
The Market as a Lagging Indicator
The broader point isn’t specific to healthcare. Most categories that seem obvious after the fact were not obvious before someone built into them. The absence of prior market appetite isn’t the same as the absence of future market appetite. In many cases, the market forms around the product rather than the other way around. The question a founder has to answer is whether the underlying need is real and whether the technology is capable of addressing it. Market confirmation is useful, but in genuinely new categories, it tends to arrive after the product does rather than before.
Some people look at that pattern and see national decline – evidence that America’s institutions and markets are too slow to serve the people who depend on them. Fulcher’s read is different: it’s an operating condition, and one that founders willing to work ahead of it are positioned to address. When the need is visible and the tools exist, building becomes less a gamble and more a responsibility. The organizations best placed to close that gap are the ones willing to act before the market has formed its view.
That framing shapes how he thinks about what building ahead of the market actually requires. “Building ahead of the market isn’t particularly bold if the need is real and the technology can meet it. The timing feels uncomfortable because there’s no prior signal to lean on. But that discomfort is mostly about the absence of external confirmation, not about the fundamentals of the problem itself.” The discomfort, in other words, is a function of process rather than substance. Mistaking one for the other is where founders who could build into genuine gaps tend to hesitate instead.
Reading Need Directly
What Justin Fulcher learned while building RingMD across nearly fifty countries is that the relationship between need and demand is rarely straightforward. Need is present long before demand forms. Demand forms when someone builds the product that makes the need expressible. The future of telehealth, he has argued, will reward reliability, integration, and durability rather than impressive ideas, and the same is true of any category built ahead of the market’s ability to ask for it. The same logic has carried through to his work in workforce development with the Palmetto Initiative and into his future endeavors in defense technology and national security. That work is just the beginning.
The founders who build durable companies in new categories tend to be the ones who learned to read needs directly rather than waiting for demand to surface on its own. That’s not a faster path or an easier one. It’s a different starting point. And for certain categories of problems, it’s the only one available.