There could be a billion reasons.
Illustration: Félix Decombat
By Michael Smith, Jonathan Levin, and Mark Bergen (Bloomberg)
26 September 2017 12:00 PM
In May, scores of people on the front lines of America’s opioid crisis packed the National Association of Addiction Treatment Providers conference in Austin to listen to a Google contractor named Josh Weum. Google LLC doesn’t have anything to do with treating addicts, and the company didn’t send Weum there to talk about helping people get clean. He was explaining how to use Google to cash in on America’s $35 billion addiction treatment market.
Specifically, Weum was part of a panel discussion on ethics. But his job was to promote Google’s giant digital marketing business, and for 14 minutes he threw around such terms as desktop immersion, conquesting, multiscreen dynamic, and PPC (pay per click). At the heart of Weum’s pitch was the product that has made Google’s parent, Alphabet Inc., the second-most valuable company in the world: the AdWords keyword auction system. Through this system, addiction treatment providers (like any other advertisers) bid for search words. If they win, their ads sit atop the free search results; any time someone clicks on an ad, Google gets paid. Weum’s message was simple: AdWords is the most efficient way to the addicts who can afford treatment. “Google is here to help you, as far as growth,” Weum, who gave his title as AdWords ambassador, told the crowd of owners and operators of addiction treatment facilities.
Federal law, including the Affordable Care Act, requires insurers to cover substance abuse treatment—and a single patient can generate hundreds of thousands of dollars in insurance claims for such care. That has produced an online battle for well-insured addicts, and Google sells the weapon of choice. Respected and effective treatment centers work the system, and so do crooks. Last December, a grand jury in Palm Beach County, Fla., investigated fraud and abuse in the addiction industry and found that gaming Google searches is a common tool for criminals to lure addicts into questionable and sometimes dangerous treatment. Six months later, the state of Florida—a national addiction treatment mecca with about 1,500 licensed facilities—enacted law HB 807 to crack down on internet marketing abuses by addiction treatment service providers and to regulate call centers. “The ones at the top of the list aren’t necessarily the most popular, the most successful at treatment,” says Dave Aronberg, Palm Beach County chief prosecutor, who directed the grand jury probe. “It’s often the company that pays Google the most.”
Google says it has always been its policy to block sites that traffic in illegal or unethical activities from advertising or showing up in search results. On Sept. 14 the company went further: It announced plans to stop accepting ads for rehab centers. The sudden announcement came a few days after the tech news site the Verge published a story about how unethical treatment providers, and in some cases criminals, use AdWords to exploit addicts. It described treatment operators who deceive vulnerable patients about treatments, facilities, and even the locations of their clinics. Some advertisers posed as caregivers but were really call centers that sold leads on patients to the highest bidder.
Federal and state laws make patient brokering, or selling access to patients, illegal, under the theory that money shouldn’t take precedence over finding the proper care. But the largely unregulated business of addiction treatment in America is driven by effectively paying to acquire patients, in the form of digital marketing or so-called patient lead acquisition. Google is at the center of it all because most people have no idea how to find help for opioid addiction. So they search, say, “addiction treatment near me,” and Google takes over.
There’s big money involved. A midsize addiction treatment center can easily shell out $1 million a month or more for Google AdWords. Fees per click for the most popular addiction keywords have doubled over each of the past three years. To run ads for the term “drug rehab locations,” AdWords suggested in mid-September that marketers place a minimum bid of $187 per click, according to an analysis of Google data from marketing firm Apttus Corp. The suggested starting bid for “drug addiction treatment program” was $106.71; for “drug rehab detox,” it was $93.24.
Google’s announcement about its new policy suggested that the company had recently become aware of the problem of AdWords abuse. “After conducting a thorough review and consulting with experts, we found a number of misleading experiences that led to our decision to restrict ads entirely in this category until we can find a better way to connect those that need help to reputable treatment centers,” a Google spokesperson said. For insight into the timing, Google directed Bloomberg to Facing Addiction, an advocacy group based in Danbury, Conn. Greg Williams, co-founder of the group, says that around the time of the Austin conference, he went to Google with concerns about advertisers. According to Williams, the group’s work documenting abuses was a factor in the policy change. “When somebody without a dog in the fight came to them with a powerful argument, they heard us out,” Williams says.
But it’s hard to believe the company hadn’t known for some time that its advertiser base was riddled with crooks. All you needed to do was Google it. Aronberg has been accusing AdWords addiction treatment advertisers of crimes for several years, and his grand jury report (PDF) was published nine months before Google took action. Legitimate treatment center customers have been filing complaints about shady operators with Google long before the announcement.
“The ones at the top of the list aren’t necessarily the most successful at treatment. It’s often the company that pays Google the most”
Google has been actively pursuing profits from the business, despite complaints that it’s a magnet for criminals. There’s an entire sales division in Cambridge, Mass., Google Health Systems, that focuses on medical markets, including addiction treatment. It’s sent account executives to peddle AdWords and other services at addiction treatment conferences and webinars. Google may be raking in $1 billion or more a year from addiction treatment advertisers, according to Williams, who based the estimate on average marketing spending. (Google declined to comment on anything related to its revenue sources.) “I thought it just happened organically, that because it’s Google, it would naturally get a lot of companies that would pay to market,” says Aronberg. “I did not realize Google is actively courting the industry, suggesting the right keywords and going to conferences. That’s crazy.”
Anti-Google sentiment was palpable at the Austin conference, especially after Weum told the crowd that it was hard for Google to cut off shady treatment providers unless someone tipped off the company.
As the discussion wound down, Jeffrey Lynne, a lawyer in Boca Raton, Fla., had heard enough. Lynne, who specializes in advising addiction treatment centers, stood up and accused Google of not only enabling a dirty business but actively profiting from it. “Google has a fundamental responsibility to stop making money hand over fist by jacking up these ad prices because of an algorithm,” Lynne said, drawing applause from the crowd. “We need you to step up to the plate,” he said. “Because people are using you to human-traffic our children.”
Weum, who hawked AdWords products for two years at a myriad of industry conferences, including several on addiction treatment, says he was shocked by the sense of outrage from people in the Austin hotel ballroom. “It really felt like I was being blamed for it,” he says. “I felt the full brunt of the anger with patient brokering.” One man sitting next to Weum on the same panel, Dan Gemp, wasn’t surprised. Gemp is chief executive officer of Dreamscape Marketing LLC, a Columbia, Md., company that specializes in running ad campaigns for addiction treatment providers. He’d filed multiple complaints with Google about treatment center operators who did such things as hack his clients’ websites to hijack potential patients. He says he’s seen unethical competitors change clients’ phone numbers on Google My Business directories to siphon off potential patients and usurp clients’ names by bidding for them as AdWords keywords. Gemp’s own presentation at the conference was largely about how to defend against these shady practices. Weum says that before the conference was done, he was thinking about ending his stint as a Google contractor. By the time things wrapped up in Austin, Gemp had offered Weum a marketing job, and in August he took it.
So far, there are still holes in Google’s ad ban. On Sept. 25, 11 days after the policy change was announced, searches for “addict treatment,” “rehab Boston,” and “rehab Vermont” produced four paid ads for treatment facilities at the top of the results. Elisa Greene, a Google spokeswoman, said implementation of the changes would come gradually but declined to offer a detailed timeline.
Gemp says his Google reps have told him the company is zeroing in on 70,000 addiction-treatment-related keywords. It will be both complicated and expensive—if Google successfully cuts off shady operators, it’s going to cost the company money. But then, no one ever said it was easy getting clean.
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