Most involved in integrative and functional medicine have by now heard of how traffic on scores of integrative health and natural products websites dropped 50%-95% via the cutting stroke of changes quietly made by Google leaders. I summarized and commented on the reporting of others in Self-Interested Whims of the Oligarchs: Google and Facebook Kill Access to Alternative and Integrative Medicine. The bias in the title was my judgement based. More questions than answers remain. I chose to explore further via a colleague of 30 years, medical writer, Erik Goldman. The traffic at his relatively conservative website, Holistic Primary Care (HPC), the hard-copy broadsheet for which he serves as founding editor, was one of those whacked. Goldman, who will host a panel on the Google issues at HPC‘s “Practitioner Channel Forum” (April 23-24 at the TWA Hotel at JFK Airport) offers a look under the covers at Google’s actions that seem to have motivations somewhere between unintended consequences and an external pernicious influences of the first order.
This is Part 1 of a 2 part interview with Goldman and his HPC team on the Google issue.
Cards on the table
I call the Holistic Primary Care site “conservative” for multiple reasons that render it a particularly useful case since the most positive view of Google’s action was that it protects the public from false information. First, Goldman worked from 1990 to 2000 as the New York Bureau Chief for International Medical News Group, a division of Elsevier Health Sciences. His work is firmly grounded in regular medicine. The editorial line does not polarize with knee-jerk disdain for regular medicine. He generally treads carefully around highly controversial topics like vaccines, homeopathy and energy medicine. Check out Goldman’s bio.
Second, Holistic Primary Care‘s business model is to bridge holistic-integrative-functional with conventional primary care. Minding science’s p-values and quality requirements is key. In addition, the Holistic Primary Care site does not sell natural products.
Let the buyer beware: HPC does take advertisements from supplement companies and announces webinars that have natural products industry sponsors. (Of course, sponsorship by pharmaceutical companies with a few more zeros after it is the staff of life for regular medical publications.) The only linked “product” of HPC is its sponsorship of the annual Practitioner Channel Forum noted above that convenes industry executives to explore the practitioner market. In short, while Goldman has interest in the natural products industry thriving, his website does not directly sell any type of product or service. Holistic Primary Care’s core business is its longstanding quarterly print publication which is built on even-handedness with science.
The investment to grow traffic – then most lost overnight
So what impact did Google’s action have for such a site? As I briefly reported here, traffic to HPC dropped 60% almost in one swoop when Google made its change. This, notably, is roughly equal to what happened at the Dr.Weil.com site that is led by the medical doctor whose name is synonymous with “integrative medicine”. There, in contradistinction to HPC, products are sold.
The hit came after HPC made direct investment in growing its online traffic. After nearly two decades of building’s HPC‘s reputation as a hard-copy publication, in the summer of 2017 he and publisher Meg Sinclair began investing routinely in”pulling more attention toward our digital presence.” They started working with “a young tech guy” to make up for their own short suits in that area, Josh Whitehurst at Pinnacle Digital. Goldman said that traffic before Google’s scorching was “building quite nicely.” HPC was “slowly reaching other audiences, new audiences including non-practitioners. We saw the shift in interest.” By late 2018, they starting developing a small new revenue stream by hosting Google AdSense on their site.
Goldman attributes HPC‘s success to the data showing that when people come to HPC they tend to stay around a good while relative to other information sites: “Our read times on our site are always very high – 4 minutes to 5 minutes – with clicks onto multiple items.” With Ad-Sense, sites earn revenue based on traffic, read times, and the number of clicks – ultimately on clicks: “While we weren’t making a windfall, it was real income to us.” Then came the big hit, in March 2019:
Unbeknownst to us, Google made a change and we immediately saw an 88% drop in traffic. On multiple topics [prior to the change], HPC content would pop up in the first 10 or 20 entries of a search return. After the switch we were 5-6 pages in – down in the dog house. At the time it happened, Josh had just begun social media work for HPC on Facebook and Twitter and we think because of that we gained back some of our lost traffic. So instead of being down 80-90% we’re only down 60%. It’s very hard to know what’s going on behind the curtain. We were baffled for months. We re-organized the site some. We didn’t really wake up to the fact that so many others had experienced the downturn at the same time until [the Integrator] article.
Anyone who has laboriously built a business that depends on internet traffic will understand this prima facie evidence that a huge chunk of hard earned real estate was removed by Google with the snap of a finger through a sort of private sector eminent domain.
Why Did Google Do It?
When decisions that influence thousands or millions are foisted on a people without transparent decision processes, the results are invariably speculation and likely, some paranoia. I asked Goldman what he thinks is behind the Google action. He succinctly ticked off what he called “the competing conjectures—none of which can be definitively proven– that boil into three themes”:
Fake news The first is Google is under federal pressure for its role in promulgating fake news and misleading information, so in an effort to don a cloak of virtue, the company is raising the index of suspicion around the content that it serves up through user searches. We all know that there are bogus claims in the natural products and natural health area. By changing their algorithms to shunt traffic away from sites that promote natural medicine, Google can claim that they are protecting public health by minimizing peoples’ exposure to medically controversial content.
Vaccines One way that Google can appear virtuous in the eyes of its own critics in DC is to suppress vaccine dissent. Many—though not all—of the sites hit hard by Google’s algorithm changes have expressed criticism of vaccine policy. Add to this the fact that Google’s parent company, Alphabet, has invested in a UK vaccine company called Vaccitech and it is reasonable to think that Google may have a pro-vaccine bias and an interest in squelching challenges to vaccine policy. Again, none of this has been proven, nor will it likely ever be.
Pharma Relationships Google’s pharma ads generate more money for Google than any other kinds of ads. Therefore, Google is incentivized to shunt traffic to sites that host pharma ads and pharma-friendly content, and away from those that promote non-pharma options. [Editor’s note: To this I added the multiple general business partnerships with pharma that I reported that Google is pursuing.]
Goldman then added “a little sidebar regarding pharma.” Google’s AdSense system, he stated, “is by no means a level playing field.” He shared that Google has just one single category for pharmaceutical and supplement ads. Sites that want to host one sort of ad but not the other must be open to both: “But because pharma companies typically have marketing budgets orders of magnitude greater than supplement companies, it is far more likely that a pharma ad will show up next to an article about natural alternatives than a supplement ad will show up next to an article about drug-based treatments.”
The AdSense platform does allow publishers to block unwanted ads or ads not relevant to the site’s content. But this must be done manually, which can be time consuming and thus expensive.
Goldman then added that advertising on Google is a place where the playing field is not the same. He noted that a year ago he and his web consultant began to note that pharma ads began to pop up on the HPC site. “While there are clearly values from pharma, we felt it could be confusing to people visiting our site for the first time so Josh started blocking them.” He described it as a “whack a mole situation” – the ads kept popping up.
Built-in Economic Bias Unlike the Dietary Supplements Health and Education Act which clearly distinguishes drugs from supplements, Google’s platform combines them. Pharma can greatly outspend supplement companies in bidding for space. “So, without Google directly saying ‘we want bias in favor of pharma, the decision to group the two together gives pharma a leg up.’ So, we can block the whole category, which hurts us, or we can block individual ads case by case, which is also costly and time-consuming.
Goldman and Whitehurst shared some ways that HPC has responded to Google’s algorithm changes and its ad policies. These I will share in Part 2. Meantime, however, the medical writer and longtime observer of healthcare trends immediately pulls out from HPC’s specific concerns to “the much bigger issue of information control. There are some very important issues here.” The concerns have prompted him to put the topic of “Google’s control of the health information landscape” on the main stage at HPC’s Practitioner Channel Conference to be held April 23-24, 2020. Whitehurst will be among those featured on the panel. Goldman clarified his mission: “I want to raise the issue to the industry. I understand many of them have also been hit hard. We will put it out there. If there is enough interest, we can consider what might be done collaboratively. If you know anyone working on this, put me in touch.”
Next: HPC’s Response Strategies
Other Articles in this series: