— The search results may be leading consumers to unproven treatments
by Paul Knoepfler, PhD November 7, 2023
After more than 20 years of using Google, why do I now “anti-trust” the search engine?
I’ve found that Google often spits out results that are, in my opinion, flat out bad for public health. They’ve also known about the problem for years, and yet, have not effectively solved it, despite some new policies targeted at the issue.
At the same time a major antitrust lawsuit against them unfolds in a U.S. courtroom, Google has another big, very different kind of trust issue. The two problems are linked and build off of one another.
For background, I’m a cancer and stem cell biologist running a research lab, but I also devote time to educational outreach. These latter efforts include running an educational website about stem cells and other innovative technologies called The Niche which I started in 2010. I’ve regularly written on The Niche about a major public health threat emerging in the stem cell arena. There are now estimated to be around 2,000 clinics marketing unproven stem cell “therapies” in the U.S., with hundreds more internationally.
Many of these clinics’ stem cell offerings are both scientifically unproven and unapproved by the FDA, even though the products often qualify as drugs that require approval by the agency. As a result, what many of these clinics are doing is technically illegal (since 2021) and a growing number of people have been harmed.
Some of the most catastrophic results have included blindness and at least 20 cases of sepsis in the U.S. alone. There also have been infections, such as meningitis elsewhere in the world, and some patients abroad have gotten tumors linked to stem cell treatments. Such stem cell clinic-related harms have been documented in papers, such as one by my colleague Gerhard Bauer, as well as by the Pew Trust which documented 20 deaths. Collectively, consumers are likely wasting hundreds of millions of dollars on what often turns out to be snake oil.
While researching the clinics, I’ve come to believe that Google plays a big role in this public health mess. Many potential customers likely find out about and get recruited to stem cell clinics via Google (the most popular U.S. search engine); this aligns with what patients tell me when they reach out to me for information. For years, Google accepted ads from these clinics, which effectively exposed thousands of patients to risky, unproven medical interventions.
To its credit, Google implemented a new, positive ad policy in 2019. Moving forward, it would no longer accept ads from these clinics. Many of us applauded Google and thought this step could make a significant dent in the problem.
Unfortunately, there is a big loophole. Instead of paying for Google ads, the clinics can just finagle the system via search engine optimization (SEO) to rank their websites at or near the top of Google Search results. It’s been a big success for many clinics as they often dominate Google Search results.
How do the clinic websites do so well in internet searches? Google generally won’t comment on the specifics of its ranking system, but it appears the SEO strategy of many clinics is to portray their websites as educational resources rather than as strictly marketing efforts. They fill up their pages with loads of stem cell-related text and cool images. It is possible that some of the more recent text may even be AI-generated. Despite this veneer, it’s clear to human experts that these websites are just marketing unproven stem cells.
Even so, it appears Google’s algorithm eats it up even though the same web pages are often full of heavy-handed marketing buttons and pop-ups to draw in clinic customers. I also found what appears to be evidence of clinics potentially buying backlinks, which is another SEO strategy — one that Google claims violates its policies– which could lead to SEO penalties.
It appears Google has known about its stem cell clinic search problem for years but hasn’t effectively addressed the issue. As I wrote in STAT in early 2022, I met with Google in 2021 to explain the patient injuries, health risks, and lack of science behind these clinic practices, so Google should be fully aware of situation. Google should also recognize that some of the clinics are breaking the law. Yet, if anything, the stem cell search situation now seems even worse than before based on my own ongoing research with common stem cell-related search phrases on Google.
Google seems to either not care that these clinics are trying to make money from risky offerings or is not taking visible action due to some other unknown reason, perhaps because displaying these search results generates profits. Whatever the motivation, the result is harmful both for the public and the legitimate stem cell research field.
To be clear, there is some very promising stem cell research going on, as shown in dozens of FDA-approved clinical trials. However, in my view, the direct-to-consumer clinics are not part of this legitimate sphere. They are not the real authorities, despite their efforts to seem legitimate and part of the research community. They generally don’t conduct real clinical trials or publish data. In looking over various stem cell clinic websites, I also can’t easily find expert stem cell researchers or physicians on staff. Often, it is just one or a handful of obscure doctors or even chiropractors.
Despite this reality, Google is now so off-base with its stem cell internet search that it often ranks these clinic websites, and others that promote the clinics, higher than the real authorities doing clinical trials or funding stem cell research: the NIH, universities, and other prestigious entities like the Mayo Clinic.
For example, when someone Google searches “stem cells for neuropathy” (or swap in “COPD,” “pain,” “knee arthritis,” etc. for “neuropathy”), stem cell clinic websites are often listed first or in the top few results, right where clinic ads used to appear. Only further down does one find web pages of the institutions that are the true stem cell experts.
Another particularly concerning example is that Google often ranks stem cell clinics as the authorities on stem cell side effects even though the clinics have a clear financial conflict of interest to downplay the risks. I’m not saying that the specific stem cell clinics that tend to rank high up on Google Search have necessarily broken any laws or harmed patient health, but in my view, there is major harm when unproven clinics are so often presented as the topline experts.
In a way, the current situation is worse than when Google allowed the unproven clinic ads. At least then the clinic marketing was labeled as such. Now, Google users just see search results and probably assume they can trust them.
What about my site, The Niche? It does not rank in Google Search like it used to and I have no idea why. However, since The Niche is an educational resource, if it gets outperformed by clinic websites, I won’t lose anything substantial. But I know that Google’s ranking of unproven stem cell clinics so high up in search results can potentially translate to substantial harm. Out of hundreds of patients I’ve communicated with, many say they have been harmed or feel ripped off.
This Google stem cell problem is an important public health issue on its own, but there’s a bigger picture concern here too. Google’s ineffective handling of stem cell-related searches may be a canary in the search engine coal mine. Could Google Search be leading people to marketers of dubious information on a host of other healthcare topics?
Whether it’s anti-aging supplements, homeopathy for autism, energy healing, or other highly questionable health practices, the search engine may steer consumers the wrong way.
Google relies on an implicit kind of consumer trust when we want to search the web. We should wake up and question that faith in Google Search. While the big antitrust case is unfolding, internet users probably have at least as much power to challenge Google’s long-standing alleged monopoly as the government. Especially on healthcare topics, we can simply try other search engines and potentially move on from Google.
Paul Knoepfler, PhD,opens in a new tab or window is a cancer and stem cell biologist, and professor at UC Davis School of Medicine.
Disclosures
Knoepfler receives limited funding from one advertiser (unrelated to clinical use of stem cells) on The Niche, a large fraction of which goes toward expenses of running the site.