In China, scalpers blocking the supply of popular products, sadly, are common. One industry they plague is in healthcare – with hospitals selling tickets for doctor’s appointments at the open of business (around 7am), scalpers will queue up before the doors open and buy up the tickets, forcing late-comers to pay a surcharge. But there’s another problem with Chinese healthcare that brought to mind Google’s success – though not in a good way.

Why is Google – at least their core search function, anyway – so insanely effective as a business? This is a company that is only fifteen years old, remember. Quite apart from having an immensely useful search engine, their business model is inobtrusive and psychologically sound, in comparison with Facebook for example. Facebook may have a gargantuan amount of data on its users, but using that in a way that isn’t distracting or presumptuous is proving difficult. While Facebook may know that I like John Coltrane, Phillip Larkin and Guinness, I simply don’t want to see adverts for them, or for “similar” products.

Google, on the other hand, delivers advertising (those “sponsored results”) when you are seeking information. This makes a fundamental difference to its efficacy. Instead of blurting out ads when you’re just trying to have a conversation with your buddy from way back, Google gets you when your mind is open to persuasion. This is hugely important. No wonder that there’s a whole industry devoted to getting websites up the Google rankings, and no wonder that people will pay good money to be a “sponsored result”: they get you when you are at your most open to suasion, and thus most susceptible to advertising.

Google’s dominance of the non-Chinese search market (67% of US search, 89% in the UK, and around 88% worldwide – I think only Russia and China have domestic examples which dominate) make it a virtual gatekeeper for information. What’s the annual average rainfall in Lima? How far way is Neptune? Why do birds appear every time you are near? Where can I find a good vet in Beijing? While there might be good local instances of websites able to answer these questions, in general you gotta google it. (Whenever a brand name becomes a verb, you know you’ve made it. Just ask Sellotape.)

Being gatekeeper to the digital world gives Google tremendous power. Fortunately it seems aware of this, and I would argue has comported itself well, considering the temptations. (Although some might disagree). Their support of net neutrality and espousal of freedom of information across borders is laudable. (Of course this presupposes a distinct worldview, which some would argue with, but that’s another argument). But we can see other examples of gatekeeping which aren’t so benevolent.

Take Chinese doctors. They are unfortunately renowned for plugging unnecessary medicines, perhaps at the behest of the drugs companies, perhaps just for the hospital in which they serve. Salaries are low and the business model (that is, the corrupt practises) is endemic. This isn’t to say that all doctors do it, but it’s happened perhaps half the time either myself or my wife have required any medicines. (Similar commercial imperatives can be observed in the American system too, of course). A doctor’s function, at its most basic, is to provide information (diagnosis) and deliver the product (the healthcare) – just like a search query and clicking through to the result. Just like Google, the doctors are the gatekeeper: you go to hospital when ill, seeking information and products to make you better, and they provide that. As with searching Google, you are susceptible to whatever the doctor says. Who would argue a doctor’s diagnosis?

But people aren’t stupid, and trust towards the profession has fallen, leading to rising violence. The medical profession here has encountered significant animosity from the perceived manipulation of its gatekeeper status. To be a gatekeeper is to to be perceived as a neutral dispassionate pathway to a desired outcome. Lose that, and you aren’t a gatekeeper but a roadblock, and liable to get knocked down. Or worse.

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