Kocher is regularly confronted by sky-high revenue projections in pitch decks for customers that are currently enrolled in a free pilot; “advisors,” who the founders actually met once for coffee; or a pitch deck that lists a well-known hospital as a customer when the reality is that a lone physician, who happens to be a family friend, is playing with the product.

Kocher says he expects hyped-up marketing to a certain extent as part of the job, but it occasionally crosses the line. “Founders are trying to convince you of their vision, I get it,” he says. “But that often leads to [them] getting loose with knowable facts.”

“Founders are trying to convince you of their vision, I get it, but that often leads to getting loose with knowable facts.”

Exaggerating claims. Glossing over failures. Fudging numbers. Getting loose with knowable facts. These things are all commonplace in Silicon Valley and other tech hubs, where dozens of startups are selling a dream to investors and the press in the hopes of breaking through the pack. Health-tech entrepreneurs, who raked in more than $4 billion in 2015 alone, are among the worst offenders.

But entrepreneurs say they have good reasons for doing it. Many founders use buzzwords like “Internet of Things” or “patient experience,” as they have seen investors flocking to trendy categories. Others have seen their competition exaggerate or cherry-pick the facts, so why shouldn’t they? As one health-tech entrepreneur, who requested anonymity, puts it: “Being honest in Silicon Valley is like being the one member of an Olympic team that isn’t on steroids.”

Being honest in Silicon Valley is like being the one member of the Olympic team that isn’t on steroids.

I interviewed a dozen operators at health-tech startups and investors to understand the culture of hyperbole: Is it helping or hurting founders? And at what point does making bold claims or fudging facts become an outright lie? For startups in the medical industry, this can result in real or perceived patient harm, as well as investigations and/or regulatory oversight For this reason, I focused on the health-tech space but recognize that hype isn’t “sector agnostic,” as they say. Here’s what I learned.

Kocher maintains that he’s far more likely to take a second meeting with an entrepreneur that levels with him. After all, he’ll find out anyway about the missteps and challenges if he agrees to finance the company and join the board. And it’s far better to hear it from the entrepreneur up front than find out later, which often results in an atmosphere of mutual distrust.