Alternative cancer clinics' use of Google listings and reviews to mislead potential patients

The study investigates how alternative cancer clinics present themselves via Google business listings and reviews, an influential first point of contact for prospective patients. Despite offering unproven or disproven treatments often associated with worse outcomes than evidence-based care, many such clinics actively market online and in social media. Misperceptions about harms of conventional therapies and the search for hope—especially among late-stage patients—create demand, with 40% of Americans believing alternative treatments can cure cancer. The authors posit that Google listings and reviews may distort perceptions of clinic qualifications and treatment efficacy. The research addresses: (1) portrayal of clinic expertise/qualifications in Google listings; (2) overall clinic ratings; (3) reasons for positive (4–5 stars) and negative (1–2 stars) ratings; (4) presence of recommendation “call-to-action” statements; (5) reviewer identity and context (e.g., cancer stage); and (6) evidence of reputational management (clinic responses and positive reviews disputing negatives). The purpose is to inform health policy and advertising regulators about an underrecognized vector of unproven medical advertising that may mislead cancer patients.

Prior work documents that alternative cancer clinics promote unproven treatments, often to patients with late-stage disease, and leverage social media marketing, testimonials, and paid ads to attract patients. Regulators have periodically intervened against deceptive claims, and media, clinicians, and patient advocates have warned of false hope and misleading practices. Online reviews are known to influence decision-making for medical providers, yet they are susceptible to fraud and have limited correlation with objective care quality. Google business profiles allow self-description and category selection, potentially enabling clinics to present themselves as conventional cancer centers. Google’s enforcement against deceptive content and fake engagement exists but is limited by scale, with widespread concerns about fake reviews across industries. This context suggests Google listings and reviews could facilitate misleading portrayals of clinic legitimacy and treatment efficacy.

Design: Qualitative content analysis following SRQR guidelines. Sampling: 47 prominent alternative cancer clinics were identified from a prior analysis of paid Meta (Facebook/Instagram) ads targeting cancer patients, itself based on HealNavigator clinic directories and crowdfunding destinations. Data collection: On August 22, 2022, the authors scraped each clinic’s Google business listing (name, description, location/category) and all available Google reviews (overall rating, number of reviews, individual review text and star score) using a custom Data Miner scraper. Review corpus: 1,444 reviews were retrieved; 1,046 contained text. Inclusion focused on relevance to cancer treatment at clinics known for cancer services or where cancer care was a key specialty. Final dataset: 1,136 included reviews, of which 738 had text. Coding: The team developed and refined a coding frame to address six research questions, covering listing categorization (alternative vs. hospital/medical/cancer clinic), overall ratings, reasons for positive/negative reviews, recommendation statements, reviewer identity/relationship and cancer stage, treatments and spending, and reputation management (clinic responses; positive reviews disputing negative ones). One coder (MZ) coded all data; a second auditor (JS) randomly audited 20% of text reviews (n=148) and fully audited all sensitive codes (financial exploitation; misrepresentation of impact on cancer; cure/remission/meaningful life extension claims). Disagreements were resolved by discussion; clinics were anonymized post-analysis.

Clinic portrayal: Only 6/47 (12.8%) explicitly declared themselves as alternative providers in Google listings; 39/47 (83.0%) were labeled as cancer/medical clinics or hospitals; 2/47 (4.3%) were blank/other. Ratings volume and score: Clinics averaged 30.7 reviews (median 19; range 0–127). Mean rating 4.42 stars (median 4.5; range 3.2–5). Positive reviews: 943/1,136 (83.0%) were 4–5 stars. Reviewer identity among positives: patients (n=442), family (n=93), unspecified (n=38), unrelated (n=17), friends (n=7). When stage reported (n=98), most were stage 4/terminal (79; 80.6%), then stage 3 (14), stage 2 (3), stage 1 (2). Reasons for positive reviews included: treatment quality (n=519; 55.0% of positive reviews), citing non-toxic/holistic/integrative approaches, avoidance of chemo/radiation harms (n=146), personalized care (n=69), latest tech/science (n=43), natural approaches (n=18); quality of non-intervention care (n=420; 44.5%); treatment outcomes documenting improvement (n=316; 33.5% of positives), with 288 (30.5%) alleging cure, remission, or meaningful life extension and 78 (8.3%) alleging symptom/general improvement; facility quality (n=62; 6.6%); and action recommendations urging others to seek care (n=151; 16.0%). Negative reviews: 180/1,136 (15.8%) were 1–2 stars. Reviewer identity skewed toward family (n=60), with few patients (n=17); many negative reviews reported patient death (n=51). When stage reported, most were stage 4/terminal (n=20) or stage 3 (n=3). Spending reported in 37 negatives totaled ≈$1,784,645 (mean $48,233.65; median $25,000), influenced by a $500,000 outlier; currencies varied/unclear. Reasons for negative reviews included: financial exploitation/false hope/ineffective treatments (n=98; 54.4%); treatment worsened condition or disease progressed (n=72; 40.0%), including foregoing conventional care; poor non-intervention care (n=41; 22.8%); misrepresentation of treatment impact (n=23; 12.8%), with claims of cure/remission/tumor reduction contradicted by subsequent testing; less common reasons included poor facilities (n=8), time away from loved ones (n=7), and difficulty accessing treatment (small number). Mortality: 51 deaths reported in negative reviews, five allegedly in clinic custody. Reputation management: Clinics responded to 35 negative reviews, commonly disputing efficacy critiques (n=16), attributing outcomes to disease aggressiveness (n=8), alleging reviewer fraud (n=7), denying promises of cure or selective patient intake claims (n=7), attributing blame to patients (n=6), or denying deceptive testimonials (n=4). Some offered sympathy (n=13), institutional history (n=6), or remediation/apologies (n=6). Additionally, 21 positive reviews explicitly rebutted negative reviews.

The study demonstrates that alternative cancer clinics can leverage Google business listings and reviews to present themselves as conventional cancer treatment providers and to cultivate a highly favorable online reputation. This environment may mislead prospective patients—especially those with late-stage or terminal disease—about clinic legitimacy and treatment efficacy. The predominance of high star ratings and narratives of cure/remission, together with the dearth of clear alternative-labeling, can confer unwarranted credibility. Negative reviews, though fewer, allege financial exploitation, misrepresentation of outcomes, poor care, and instances where patients’ conditions worsened, including reported deaths. Given extensive evidence that online reviews are susceptible to fraud and are poor predictors of objective care quality, and considering Google’s limited capacity to enforce against deceptive content at scale, the findings suggest Google reviews are unreliable indicators for medical decision-making. The results address the research questions by showing: (1) listings frequently omit alternative status; (2) clinics maintain high average ratings; (3) positive reviews focus on perceived treatment quality, care experience, and claimed outcomes, while negative reviews emphasize exploitation and harm; (4) many positive reviews include direct recommendations to seek care; (5) reviewers are often patients or family members, frequently with stage 4/terminal disease; and (6) clinics engage in active reputation management. Collectively, this underscores a harmful online ecosystem that can foster false hope and suboptimal, even dangerous, treatment choices.

This study provides evidence that alternative cancer clinics use Google listings and reviews to appear as legitimate primary cancer providers and to promote persuasive yet unreliable narratives of efficacy. Google reviews, although influential, are not trustworthy indicators of treatment outcomes, and the platform lacks robust safeguards against misleading medical content. Policy recommendations include: requiring alternative clinics to clearly label themselves as such; adding warnings and links to authoritative health information; differentiating recognition of alternative versus conventional health professions in content decisions; warning users that reviews are not medical advice and may not be verified; and deploying targeted enforcement to audit truthfulness for health-related businesses. Broader actions could include demonetizing related YouTube channels, restricting Google Ads, and reducing search priority for such clinics. Future research should examine how social media and other online systems enable patient exploitation, platform policy roles, and how prospective patients encounter and interpret alternative cancer marketing.

Key limitations include: (1) sampling focused on prominent clinics targeting English-speaking patients and may not generalize worldwide; (2) the veracity of Google reviews cannot be confirmed—reviews may contain inaccuracies or fabricated elements; (3) some clinics offer non-cancer services, and rating-only (no-text) reviews were included in overall scores, limiting certainty that all ratings reflect cancer care; (4) reported spending amounts were sparse, influenced by outliers, and currencies were unclear; and (5) not all retrieved reviews contained text (738/1,136), constraining detailed content analysis for a portion of ratings.