Google search and the mediation of digital health information: a case study on unproven stem cell treatments

Abstract

Google Search occupies a unique space within broader discussions of direct-to-consumer marketing of stem cell treatments in digital spaces. For patients, researchers, regulators, and the wider public, the search platform influences the who, what, where, and why of stem cell treatment information online. Ubiquitous and opaque, Google Search mediates which users are presented what types of content when these stakeholders engage in online searches around health information. The platform also sways the activities of content producers and the characteristics of the content they produce. For those seeking and studying information on digital health, this platform influence raises difficult questions around risk, authority, intervention, and oversight.

This thesis addresses a critical gap in digital methodologies used in mapping and characterising that influence as part of wider debates around algorithmic accountability within STS and digital health scholarship. By adopting a novel methodological approach to Blackbox auditing and data collection, I provide a unique evidentiary base for the analysis of ads, organic results, and the platform mechanisms of influence on queries related to stem cell treatments. I explore the question: how does Google Search mediate information that people access online about ‘proven’ and ‘unproven’ stem cell treatments?

Here I show that, in spite of a general ban on advertisements of stem cell treatments, users continue to be presented with content promoting unproven treatments. The types, frequency, and commercial intent of results related to stem cell treatments shifted across user groups including geography and, more troublingly, those impacted by Parkinson’s Disease and Multiple Sclerosis.

Additionally, I find evidence that the technological structure of Google Search itself enables primary and secondary commercial activities around the mediation and dissemination of health information online. It suggests that Google Search’s algorithmically-mediated rendering of search results – including both commercial and non-commercial activities - has critical implications for the present and future of digital health studies.