For four days in January, the biggest names in biotech descend on the J.P. Morgan Healthcare Conference in San Francisco to unveil splashy merger and acquisition announcements, offer out-of-the-box meditations on drug pricing, and schmooze.

But some of the smallest and newest names in biotech are there, too, trying not to get lost in the noise.

These companies aren’t making headline-grabbing presentations or hosting big parties. But the conference gives tiny startups and even small- and mid-size public companies a pivotal — and unmissable — opportunity, executives at three different companies told STAT. For them, the conference is their chance to wow potential investors or partners and to figure out what scientific and financial steps they should take in the year ahead.

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“What I find it possibly most interesting about J.P. Morgan is the sense you get in the streets,” said Dr. Cedric Francois, the CEO of Apellis Pharmaceuticals, adding that he was surprised to see such optimism in hallways and conference rooms of the Westin St. Francis, even after the stock market’s recent tumult.

“I thought it was going to be more doom and gloom after the November and December that we had, but that’s certainly not the case.”

For the smallest, newest companies, the conference acts as something of a corporate debutante ball — a way for executives to introduce their work to biotech’s high society and (hopefully) catch an investor’s eye.

That’s why NeuBase Therapeutics is attending this year. The company, which is working on drugs based on antisense oligonucleotides to treat genetic conditions, announced a reverse merger with Ohr Pharmaceutical on Jan. 3, which would allow its stock to trade publicly.

“We’ve been in stealth mode, quietly building the company, and [we’re ready] to describe our technology to stakeholders and really just announce ourselves and put a flag in the ground,” said Dietrich Stephan, the company’s CEO.

One could announce a company’s existence in a press release — which would probably be cheaper and faster than doing it at a notoriously expensive conclave. But a press release wouldn’t have the same impact as face-to-face meetings, Stephan said, which can help cement a company’s story and potential in a prospective investor’s mind.

“There’s nothing like being able to sit with someone for an hour, face to face,” he said.

The same is true even for companies who already have significant investments (or investors). “There’s no better forum for companies to gain broad exposure to investors than at JPM,” wrote Stephen Berenson, the managing partner of Cambridge, Mass., biotech investment firm Flagship Pioneering (and a former longtime J.P. Morgan employee).

Though the firm typically funds most of the very earliest work for its companies, “it’s almost never too early for our companies to engage with outside investors,” he added. “Those early engagements both expand awareness of the company’s story in the market and create opportunities for our companies to receive constructive feedback from smart investors early in their lifecycle.”

Awareness can be a fuzzy concept at best — but the strategy does seem to work. Apellis Pharmaceuticals, a company developing new drugs that target a part of the immune system called complements, went public in 2017. This January, the Kentucky-headquartered company made its second presentation at JPM.

“There is certainly something to be said for time — for growing up, as a public company,” said Francois, Apellis’ CEO.

“Last year we were in kindergarten — every meeting that we had was pretty much going through an entire deck and introducing ourselves. This year, it’s more Q&A with people who know us well and want to know how things are going.”

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Yet for a first-time executive or to a young company, attending the conference can seem risky. The costs can seem particularly steep, the the competition for attention is brutal, and the returns are rarely immediate.

To be in San Francisco for a few days, companies like NeuBase and Apellis will spend thousands of dollars on hotel rooms, workspaces, and meals. A gallon of coffee costs more than $150 in San Francisco this week, as STAT previously reported. Renting a semi-private meeting space costs more than $14,000; one hotel charged a company hundreds of dollars to rent power strips.

Francois said it was “almost scary and a little bit over-the-top” that companies — plenty of which are far from profitability — are spending so much. “It’s very expensive, even for a company of our size.”

Cost isn’t the only challenge. Apic Bio, a Cambridge, Mass.-based company working on treatments for a type of liver disease and amyotrophic lateral sclerosis, decided to announce a $40 million Series A round on Jan. 7 — the same day that Eli Lilly announced it would acquire Loxo Oncology for $8 billion, and the first official day of the conference.

“As a small company, that’s the big challenge that we face — to be able to have some recognition for that in what’s a very heavy PR week for the whole industry,” John Reilly, the company’s CEO, said.

Even those that come away from this year’s meeting feeling like they’ve accomplished something may still face further challenges. There is already speculation that private companies may struggle to find investors after the recent stock market downturn. Others have bemoaned the loss of an independent Celgene, which frequently partnered with smaller biotech companies.

And ultimately, a lot of the actual work achieved in those pricey San Francisco hotel rooms and meeting spaces could probably have been done at another time or in another way.

“If I had a startup company with a few million dollars in the bank, I don’t think I’d be coming to J.P. Morgan,” said Francois. “You can get a lot of stuff done in a short period of time, but that doesn’t mean you can’t get the same stuff done in a longer period of time.”

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