Last March, we noticed a sudden, surprising, and very significant downturn in traffic on our website, www.holisticprimarycare.net. Over the 10-day period in mid-March, the number of visitors to our site dropped by 77%. 
 
Our traffic had been building very steadily over the last two years, thanks to a comprehensive SEO optimization strategy. It seemed very strange that it would suddenly plummet. 
 
In a cyber-age version of, “Was it something we said?” we wondered whether something was malfunctioning on our site, or perhaps some piece of content was suddenly putting people off. 
 
Josh Whitehurst, our IT guy was scratching his head. There’s a very predictable Internet-wide drop in traffic around Spring Break season, and the Easter/Passover holidays. But it’s never so precipitous, or so longstanding. 
 
Weeks went by, then months. During that time, Josh took all sorts of steps to re-index our content with Google. We made some tweaks to the site to optimize searchability and user-friendliness. Still the traffic was down. Like, really down. 
 
It wasn’t until months later, thanks to posts by integrative medicine journalist John Weeks, and GreenMedInfo founder Sayer Ji, that we realized we were not alone. 
 
In roughly the same time period, Dr. Joe Mercola saw a 99% drop in traffic to his popular site, www.mercola.com. Dr. Andrew Weil’s www.drweil.com experienced a 66% decline. GreenMedInfo saw an 81% reduction in the site’s search visibility. MindBodyGreen reported a 55% drop. Lynn McTaggart, producer of the online magazine, What Doctors Don’t Tell You, said her traffic tanked by half.  
 
Joe Cohen, CEO of SelfHacked.com saw a 94% drop. Kelly Brogan, MD, an outspoken functional medicine psychiatrist, reported that her site, which averaged over 225,000 impressions per month, flatlined in early June. 
 
Supplement companies, educational organizations in holistic/functional medicine, and individual practitioners have also taken major hits to their online traffic over the last 6 months. 
 
Google’s Systematic Demotions
What happened? Google changed its algorithms. That’s what. 
 
Google made a series of changes that systematically demoted websites providing information about alternatives to conventional allopathic medicine, or that have links to sites and topics that Google deems problematic. “Detox” and “vaccines” are biggies, but there are others. 
 
Sites and stories that used to appear within the top 10 returns on the first page of a Google search, are now buried on the fourth or fifth pages of a search return, or even further down, where far fewer viewers are likely to scroll. Lower visibility translates into less traffic. 
 
That’s a polite way of saying that Google is refereeing—some would say censoring—certain types of health information. It is not happening via crude, old-school methods like blacklisting specific sites. Rather, it is done through search algorithm changes that preferentially shunt seekers of information about certain topics toward or away from certain sites, based on undisclosed credibility criteria.  
 
Google’s algorithm changes began in June 2018, with further modifications earlier this year. 
 
The company is far from transparent about how its algorithms work and what specific changes it made. As a privately held corporation, it is not obliged to share those details.
 
What we do know is that Google classifies websites hosting health or medical information under its “Your Money, Your Life (YMYL)” category. The company has stated: “We have very high Page Quality rating standards for YMYL pages because low-quality YMYL pages could potentially negatively impact users’ happiness, health, financial stability, or safety.”
 
Google claims that its algorithms are set to evaluate health content based on “Expertise, Authoritativeness, and Trustworthiness,” and that its search returns will favor, “people or organizations with appropriate medical expertise or accreditation.”  
 
In other words, the company’s official position is that any filtering of search results is done for the public good, to protect people from fraudulent, untruthful, or commercially-motivated medical information. 
 
There’s no question the Internet is choked with dubious medical info—false claims, unproven theories, shameless product pimping. 
 
It is also brimming with valid, well-reasoned, and truthful content on a wide range of health topics and medical disciplines. Some of this information falls outside the scope of conventional drug-focused allopathic medicine. But it is not necessarily less valid simply because it is not currently accepted by
the mainstream. 
 
Big Picture: Google the Arbiter
The big issue here, is whether Google—a privately-held search engine platform—should be the arbiter of what information a health-concerned individual can and cannot see. Further, is it fair for the company to mediate the free flow of medical information without disclosing its screening criteria?
 
“What and who defines scientific credibility? There’s not a valid and widely accepted criterion,” said Josh Whitehurst, principal at Pinnacle Digital, who is Holistic Primary Care’s IT consultant. “Google’s front-facing announcement was, ‘This is in the interest of public health, and there’s a lot of fake news out there.’ But there’s a black box here that we’re never going to be able to see into. I do believe that their front-facing reasoning—what they tell us—is not entirely representative of the truth.” 
 
There are some general principles that underlie Google’s ranking of the trustworthiness of medical information—thorough referencing to credible books and journals, good grammar and spelling, citations by and links to authoritative sources. But the company has not disclosed its specific criteria for rating healthcare sites. 
 
In theory, Google’s algorithms apply uniformly and blindly to all information on the web, thus creating a fair, level, and objective playing field. In practice, it’s a different story. 
 
Keep in mind that algorithms do not arise by themselves (not yet, anyway).
 
“Humans with opinions create algorithms,” said Tyler Horsley, principal of Nuclear Networking, a digital marketing agency based in Denver. Horsley’s team is currently working with supplement companies and others in the natural medicine space adversely affected by Google’s algorithms. 
 
Though Google promotes the idea that its algorithms are objective and unbiased, Horsley contends that in reality, these systems are influenced by the people who program them. Often these people have opinions and objectives of their own. 
 
Beyond the algorithms, Horsley said Google is also applying what are termed “manual penalties” to certain topics and certain sites. 
 
This means that actual people employed or contracted by Google review sites that have been red-flagged by the algorithms as potentially problematic. These reviewers assess a site’s “link neighborhood”—the concentric circles of other sites, articles, and opinion-leaders to which the site in question
is cross-linked. 
 
Based on this, and other opaque, undefined factors like “trust flow,” the raters can manually up- or down-grade a website’s search ranking. This in turn affects where in a search return this website’s content will appear.  
 
In other words, your site can be deemed guilty by association. If it contains a lot of links to people or topics that Google has already deemed problematic, it could be downgraded—without your knowledge, and without recourse. 
 
Since Google has not published its specific evaluation criteria, and will not notify you of a downgrade, it is impossible to take remediation steps—should you even wish to do so. 
 
Auto-Search Bias 
Predictive auto-search suggestions are another means by which Google is regulating the information flowing across its platform. This is the function that gives you a list of potential search phrases when you type a word or name into the Google Search bubble. 
 
Google claims its auto-search suggestions are automatically generated by the “data lake”—the vast aggregation of search topics that emerges organically from millions and millions of people using Google to look for information on a particular topic. 
 
According to Zach Vorhies, a former software engineer at Google/YouTube, that data lake is being “poisoned.” 
 
Vorhies left the company several years ago after becoming convinced that Google’s algorithms were unfairly biasing political information toward the Democratic party’s political agendas. He has since positioned himself as a whistleblower, sharing thousands of company documents with rightward leaning political media like the Veritas Project, as well as to the Department of Justice.
 
Vorhies claims there is an orchestrated effort to bias auto-search results. He and others who agree with him have yet to prove that, and it would be easy to dismiss him as a wingnut conspiracy theorist. 
 
However, even a cursory experiment with Google’s auto-search function does raise questions. 
 
For example, I recently typed the phrase “Supplements are” into the search window. Google suggested the following: “bad,” “dangerous,” “scams,” “a waste of money,” “garbage,” “not regulated by the FDA,” “are they good for you,” and “worthless.”
 
Then I typed in, “Pharmaceuticals” and got the following suggestions: “Definition,” “near me,” “companies in NJ,” “in our water supply,” and “jobs in.”
 
If we are to believe Google that its auto-search suggestions emerge organically from the needs and interests of the hive mind, it means that millions of people are actively looking for jobs in the pharma sector, while millions of others want info that proves supplements are fraudulent. 
 
I find this hard to believe.
 
Motivation Theories
What is Google’s motive for deliberately shunting traffic away from sites providing information on natural medicine? 
 
There are several prevailing theories circulating among those of us concerned with these issues. None of these can be definitively proven, and no one possibility excludes the others.
 
The “Appearance of Virtue” theory: Google—like Facebook and other massive online conglomerates—is taking a lot of heat from the federal government, as well as governments outside the U.S., regarding its role in perpetuating fake news. The company is looking for ways to look virtuous. 
 
Clamping down on fraudulent medical information would be a quick way to placate Google’s scrutinizers by positioning the company as a protector of public health and well-being. Making a few algorithm changes that squelch information about non-conventional medical alternatives is an easy way to accomplish that goal. 
 
The “Ad Revenue Maximization” theory: Google makes heaps of money from its AdWords and AdSense systems. According to Investopedia, the bulk of Google’s $110.8 billion 2017 revenue came from its advertising services. Pharma ads represent one of the strongest performing categories in Google’s ad universe. 
 
Proponents of this explanation argue that Google would have incentive to shunt traffic toward sites that carry pharma ads and host pharma-friendly content, and away from sites that carry less lucrative ads and present editorial that promotes non-pharma alternatives.
 
The “Suppression of Vaccine Dissent” theory: Many—though definitely not all—of the websites hit by Google’s algorithm changes are well known for their criticism of current vaccine policies. Mercola.com, GreenMedInfo.com, and Kellybroganmd.com have been particularly vociferous in challenging conventional vaccine wisdom. 
 
That, coupled with the fact that Alphabet, Google’s parent company, has invested heavily in partnerships with pharmaceutical and biotech ventures—including a flu shot company called Vaccitech—has led many observers to conclude that Google’s main motive for the algorithm changes is suppression of vaccine dissent. 
 
All three theories are plausible, and all have holes. 
 
Regarding the vaccine suppression issue, while it is true that some of the affected websites have taken prominent “anti-vax” stances, others have not. 
 
Our Holisticprimarycare.net site has very little content about vaccines, and our coverage of the issue has been cautious, balanced, and nuanced. While we do believe it is possible that some vaccines may be harming some people, and that vaccines are definitely not risk-free, all-purpose panaceas, we have never been categorically “anti-vax.” Yet we experienced the same magnitude of lost traffic as did sites that are outspoken in their
vaccine criticism. 
 
Regarding the AdSense theory, we’ll never know for sure if Google is deliberately trying to drive traffic toward pharma ads and pharma-friendly content. It is
certainly possible.
 
As I reported in my column last year, the way in which Google has established its AdSense platform favors Big Pharma over the supplement/nutraceutical industry. 
 
AdSense combines pharmaceutical and supplement businesses under a single header for “Drugs and Supplements.” It basically lumps these two industries—and two types of ads—together into a single group. 
 
In so doing, Google allows drug companies (or shell websites created by them) to leverage their vast spending power to bid up the price of keywords relevant to holistic medicine (and, to be fair, nearly all medical topics) and to increase the likelihood that their ads will show up when readers seek information on healthcare alternatives. 
 
We have seen this happen many times on our site. For example, an online reader searching Google for information about “probiotics after antibiotics” will likely find her way to HPC’s article on this topic. But the ad adjacent to that article could be an ad for a Proton Pump Inhibitor, or an anti-inflammatory drug for Crohn’s Disease. 
 
Google does enable online publishers like HPC to block unwanted ads from appearing on our site. We’ve had to do this many times, and it is time-consuming; it obliges us to monitor our content and our ads constantly, and then track down the sources of each undesired ad. It is a game of whack-a-mole, because the drug companies can easily create new domain names that seem totally unrelated and independent, through which they then bid on ad words and deploy the parent company’s ads. 
 
Of course, there’s nothing stopping a supplement company from paying for ads keyed to words associated with conventional medical diagnoses and hoping that its ads will appear instead of a drug company’s. But given the typical marketing budgets in pharma versus nutraceutical, the odds are against it.  
 
Out of Step with Federal Law 
We believe that in lumping supplements and pharmaceuticals together, Google is out of step with the Dietary Supplement Health and Education Act (DSHEA), which clearly delineates between supplements and drugs. Google is not obliged by law to comply with DSHEA, so there’s nothing illegal about its category smudge. But it is definitely not in alignment with the intent of DSHEA or the FDA’s
enforcement of it.
 
Whatever Google’s specific motives may be, there’s no question that the company’s algorithm changes, its manual penalties, and its AdWord policies have profound influence over the flow of healthcare information. This is already affecting everyone who works in the healthcare field—whether they realize it or not. 
 
Beneath the surface of these issues lies a tense conflict between three deeply engrained, red-blooded American principles: freedom of speech, freedom of the press, and freedom to conduct business as a business sees fit.  
 
The Constitution guarantees freedom of the press, and free speech in public places. But Google is not a public place, though it may feel like one to those of us who use it very day. 
 
There’s nothing in any law that obliges any publisher or provider of information to make available any and all information that anyone wishes to publish. Nor does the Constitution oblige any content provider to present all types of information with equal prominence. 
 
The owner of a bookstore is free to choose what types of books he or she wishes to sell. The same logic would apply to Google, which is a privately-owned platform for information exchange. Like all corporations, Google has the right to determine—within the bounds set by government regulations—how it wishes to conduct its business. 
 
Just as a publisher has the right to determine what sort of content is presented in its magazine or on its website—without explanation—Google has the right to determine what information is served up by its search platform. This includes the right to censor information that the company deems problematic. 
 
But we as business leaders, practitioners, and health information seekers also have rights and choices. Google may be the dominant search engine, but it is not the only one. 
 
Like many other publishers affected by the algorithm changes, we at Holistic Primary Care are actively developing strategies to restore our traffic. A big part of that effort has been to “de-Googlize” our business as much as possible by indexing our content on other search engines. And there are many. 
 
Our site is now indexed on Bing, Yahoo, DuckDuckGo, Ecosia, ASR, EntireWeb, and more than a dozen others. This takes time and effort, but it does work. Over the last 90 days, we’ve regained roughly 20% of our lost traffic. Almost all of this is new organic traffic directed to us from these alternative search engines. 
 
We are also very fortunate in that the nucleus of our publishing business is, and has always been, our quarterly print magazine reaching roughly 60,000 medical practices nationwide. Print is one medium over which Google has no jurisdiction. As long as there’s a U.S. postal service, we will continue to distribute our natural medicine content to our readers. 
 
Reshaping Healthcare
That said, we know that Google will dominate the Internet for years if not decades to come. And Alphabet, Google’s parent, is rapidly positioning itself as a major player in healthcare itself. It recently acquired FitBit, the popular wearable health tracking company for $2.1 billion. 
 
Alphabet also entered into a partnership with Ascension Health, the world’s largest Catholic hospital and clinic network. The joint venture, called Project Nightingale, will give Google detailed personal medical data—health histories, lab results, diagnostic images, the works—from as many as 50 million patients receiving care in Ascension-owned facilities. Already, 10 million patient files have been transferred. The project is slated for completion by next March. 
 
Nightingale gives Google a massive medical database to feed its emerging artificial intelligence and machine learning systems. The company stated that its ultimate goal is to improve quality of care by bringing greater intelligence to medical decision-making and better interoperability between hospitals. In all likelihood, the company will also mine Ascension’s database for information of interest to pharma, biotech, diagnostic, and device companies, and to further refine Google’s ad targeting. 
 
The scale of the Nightingale data transfer is unprecedented. So is the fact that the personal information transferred to Google was not anonymized. Further, the transfer was not disclosed to either the patients or their practitioners before Ascension and Google went forward with it. There was never an opportunity for patients to opt-in or opt-out. Most people found out when the Wall Street Journal reported on it in early November. 
 
At the same time, an anonymous whistleblower working on Nightingale, raised questions about the security of the data transfer and the project’s HIPAA compliance. Nightingale has already drawn the ire of many in Washington, on both sides of the aisle. 
 
Google’s mediation of health information flow as the company itself gets directly involved in healthcare practice raises profound questions without
easy answers. 
 
It also creates serious challenges for any online publisher, supplement company, medical organization, or practitioner involved in holistic/functional/naturopathic medicine. If ever there was an issue on which the natural products industry needs to come together with a strong and coherent voice, it is this one. 
 
To that end, we will be exploring Google censorship and Digital Survival Strategies for dealing with it, at our 2020 Practitioner Channel Forum, April 23-24, at the TWA Hotel at JFK airport in New York City.
 

Erik Goldman
Holistic Primary Care

Erik Goldman is co-founder and editor of Holistic Primary Care: News for Health & Healing, a quarterly medical publication reaching about 60,000 physicians and other healthcare professionals nationwide. He is also co-producer of the Practitioner Channel Forum, the nation’s leading conference focused on opportunities and challenges in the practitioner segment of the dietary supplement industry.