Exploring the digital gray zone of online medicinal markets emerging from search

This explorative study investigates the emergence of gray zone markets from search engines amidst the global expansion of online markets. With the analytical approach of infrastructural inversion, we examine how the search infrastructure constructs access to a gray zone market including both authorized online pharmacies and unauthorized vendors. Using Sweden and Google Search as a case, we explore the online presence of three products (vitamin D, paracetamol, and Viagra), through search engine result page analysis, web crawling, and network analysis. Infrastructural inversion unveils the typically invisible mechanisms of search engines, considering user queries, algorithmic priorities, SEO practices, and pharmacy regulations. We find gray zones only emerge in searches for erectile disfunction medicinal products and information, where unauthorized vendors successfully competed for visibility in search engine rankings. A complex web of conditions can steer consumers toward gray zone markets, complicating the access to safe and regulated medicinal products. This can expose individuals to risks associated with unverified medicinal products, but also challenges the integrity of the online health information infrastructure.