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toCovid-19inMayandrolledoutfeaturesspecificallyabout
mentalhealth.Peoplecannowbookvirtual-careappointments
directlyinGoogleMaps.Searchesfortermssuchas“anxiety
disorder”or“PTSD”producebuttonslinkingtoa clinicallyval-
idatedquestionnaireandotherresources.
“AlotoffolkscometoGoogleandask usquestions,”
Feinbergsaidina MayinterviewwithYouTuberDr.Mike
Varshavski.“Youcandoyourown,inessence,screeningfor
depressionandanxiety.Sothenyoucanseethatyou’renot
alone.”ThathewasspeakingonYouTube,Google’sin-house
streamingservice,wasfitting.Thoseself-assessmentshappen
directlyonGoogle,ratherthanonthesitesofwould-becom-
petitorssuchasWebMDorZocdoc.Feinberg,througha rep-
resentative,declinedtocomment.Googlesaysthathedoesn’t
controlpaidads.
TheseGoogle-ownedmental-healthcheckupsonGoogle’s
ownsearchenginecompounda problemmarketershavecom-
plainedaboutfora decade—namely,thatit’sveryhardtoattract
userswithoutpayingGoogleforads.If someonenearGoogle’s
headquartersinMountainView,Calif.,searchesfor“treat
depression,”theymightseeadsforOneMedical,a concierge
healthserviceinwhichGoogleis itselfaninvestor;PlushCare,
a techcompanythatspecializesinonlineprescriptions;and
BetterHelp,a virtualcounselingservice.Totheright,they’d
seeaninformationboxwhereGooglelistsvarioustreatment
options.Theso-calledorganicsearchresults—theold 10 blue
links—comebelowallofthat.Infact,somanysearchresults
arestackedwithadsthatonehealth-careinvestorsayshisfirm
advisesportfoliocompaniesnottobothertweakingwebsitesto
inchhigherinGooglesearchlistings.Onlypaidresultsmatter.
Thishaspropelledanentirelynewkindofcompetitorthatis,
moreorless,theinverseofsomeonelikeRoss:Marketersthat
havea sidelineintherapy,suchasBetterHelpandTalkspace.
WhenRosslosesGoogleauctions,it’smostlytothesetherapy
consolidators.Theyhavehundredsofmillionsinventurecap-
italandcorporatebacking,anduseanUberlikecontractlabor
model,acquiringcustomersandsendingthemtoa sprawling,
nationwidenetworkofcounselorsandcoaches.
Rossholdsa doctorateinclinicalpsychology,whichrequired
sixyearsofgraduateschool.Sheusuallycharges$250anhour.
BetterHelp’stherapistsneedtobelicensedcounselors,clinical
socialworkers,orpsychologistswitha master’sdegreeandat
leastthreeyears’experience.Thecompanychargesfrom$35
to$50a session.(Full-timetherapistsearnfrom$15to$30an
hour.)“Icouldprobablymakemoremoneyworkingatthegro-
cerystore,”Rosssays.“Theypayterribly.It’sabysmal.”
AlonMatas,presidentofBetterHelp,saysretentionis high
amonghiscompany’s11,000therapists.Sometherapistswith
thrivingprivatepracticesinaffluentareascanearnmorethan
theycouldonline,hesays,but“thereareprovidersontheplat-
formwhomakesixfiguresannually.Definitelynot‘abysmal.’”
Googleis,ina way,a co-conspiratorinturningthebusiness
of mental health into a marketing game. BetterHelp’s app has
been downloaded 600,000 times so far in 2020, a 41% increase
from the same period a year ago, according to research
firmSensorTower.Duringthefirstcoupleofmonthsofthe
pandemic, new customers complaining of stress and anxiety
doubled from the year before, Matas says. The app saw a similar
influx of independent therapists joining its platform, many of
whom had no choice but to try online care while the pandemic
shuttered physical businesses. The Google spokesman says a
range of companies and nonprofits have bought search ads
related to mental health. He notes that the company doesn’t set
ad prices and that its auctions operate fairly for all advertisers.
BetterHelp and others like it have another advantage: They
don’t have qualms about asking customers for testimonials to
display on their websites or paying social media influencers to
tout their networks. That helps them boost their rankings on
Google, which favors businesses with reviews. Many licensed
therapists consider that kind of marketing an ethical violation.
One could argue that the rise of these virtual therapy provid-
ers is a positive development, making therapy affordable and
available at a time when everyone seems to need it. But that
would cast BetterHelp, whose parent company brought in more
than $550 million in sales last year, in the role of the scrappy
challenger, and Ross, a sole proprietor, as the incumbent. David
Cicilline, the Democratic representative from Rhode Island who
led the antitrust hearings, challenged Pichai’s contention that
Google helps small businesses. “Google just shows what’s most
profitable for Google,” Cicilline said. Gary Reback, an attor-
ney with Carr & Ferrell LLC who worked on the Microsoft anti-
trust case, watched that and saw a clear signal that the Justice
Department should be more confident to pursue a case against
Google. “There are so many issues, and it looks like Google is
onthebadsideofallofthem,”hesays.Bysummer,Ross’spracticewaspickingupagain.Acouple
of patients who’d left town continue seeing her via video. New
patients are coming in, stressed by the unrelenting pandemic,
dissatisfied with whatever they’d been trying as relief. She’s
even reopened her office for those who truly need in-person
care. To prepare, Ross spent hours searching for Clorox wipes
before finding a reliable supply at her local liquor store. She’s
also improved her video backdrop, adding new wallpaper, a
potted plant, and a smart-looking wooden desk and bookshelf.
Since more people seem to be seeking care, she’s back to pay-
ing Google about $20 a day. She says she’s feeling better about
her business. She’s also telling her patients that she’s preparing
herself for two more years of pandemic dislocation.
Google could be in for even more political hurt. It may
have to pay record fines and make deep changes to its ad
business. Politicians from both parties opened a probe into
a data-sharing arrangement Feinberg’s health division set up
with hospitals. Google has waited more than nine months to
close its $2.1 billion acquisition of Fitbit, which makes fitness
trackers. Regulators, politicians, and critics have denounced
thedeal,worriedabouthandingovera companythattracks
ourbodiestoonethatknowssomuchaboutourminds.To
winapproval,Googlehaspromised that it won’t use any data
from Fitbit’s devices for its primary business of selling ads. <BW>