The Paris-based media company Aufeminin.com, with brands including the cooking website Marmiton and shopping site My Little Paris, is owned by TF1 Group, parent company of France’s biggest private national television channel. The staff of Doctissimo, a pioneer of online health information for the French public, transferred there last year after TF1 bought it for €15m; they were a bit surprised at Aufeminin’s HQ décor — the reception has luxury armchairs and (possibly fake) cowhides on the floor. ‘Our hosts prioritised appearance over practicality,’ said Doctissimo’s head of content, David Bême as we sat down on garden chairs around a meeting table.

Doctissimo was set up in 2000 by two doctors on the right of the political spectrum, Laurent Alexandre and Claude Malhuret; according to the group’s former president, Valérie Brouchoud, the founders wanted to ‘democratise access to health’ but also ‘get the patient to take responsibility, since an informed patient can have a more constructive dialogue with their doctor and follow a course of treatment more successfully. The patient takes charge of their health.’

This democratisation was idiosyncratic: a 2007 report from France’s National Institute of Health and Medical Research (Inserm) described the typical user of online health sites as ‘a young or middle-aged woman, highly educated, in work, living with a partner, and an experienced Internet user, facing a health problem (her own or of someone close to her)’. Women account for 80% of visitors to the Doctissimo site, and their collective purchasing power makes them an attractive business proposition; the site makes its money from advertising of products and services for women.

‘It’s the woman who’s responsible for family health,’ said Brouchoud. ‘This is partly because women have more frequent medical checkups. They go to the gynaecologist annually, and they have regular consultations when they’re pregnant. Doctissimo has a very large community of pregnant women.’ Bême was enthusiastic about this market: ‘Women are the entry point for health for the whole family. They’re the ones who’ll talk about their own health and their children’s and husband’s.’

Because of strict legal regulation, scope for advertising medicines was limited. Since French people regard healthcare as being free, ‘no one wanted to pay’ for health information online, Brouchoud said. ‘That’s why we created a model exclusively based on advertising and partnerships with traditional advertisers of women’s hygiene and beauty products.’ This business model had implications for editorial content. Doctissimo became known as the primary healthcare reference site in the early 2000s, then diversified. According to a journalist who worked there for several years and requested anonymity, its management ‘put the emphasis on other subjects: psychology, fitness, beauty and so on. As ads were coming mainly from the beauty and personal care sector, it was in our interest to position ourselves for the women’s market. L’Oréal was one of our advertisers.’ Car brands were also happy to advertise their latest model to women on the site. But among Doctissimo’s priorities, Google came before advertising.

‘We devoted a lot of effort to understanding how their algorithm worked. We did a lot of trialling,’ Alexandre said. ‘IT was highly regarded at Doctissimo. I used to say, “The people who’re in the basement at Elle are right at the top at Doctissimo.” Software engineers were more important than journalists. Journalists who could write about a new diet were ten a penny. A software engineer who could master SEO [search engine optimisation] was rarer. We thought a lot about optimising how we wrote our articles to make them more Google-friendly.’

SEO put Doctissimo high in Google’s search rankings, but getting users onto the site was not enough — keeping them there was what mattered. A user spends an average of nine minutes a visit on Doctissimo; this did not happen by chance either. ‘Studying the navigation quickly reveals a strategy of capturing visitors within a closed editorial environment that offers numerous internal links: the only external links are to advertisers’ sites,’ Annelise Touboul and Elizabeth Vercher of the University of Lyon found in a 2008 study.

Alexandre said, ‘When I sold Doctissimo to Lagardère in 2008, we were making millions from advertising.’ Since then, the company has lost 90% of its value, which its founder attributes to Lagardère Active’s under-investment. The site still gets a huge amount of traffic — 11 million unique visitors in January 2019, 80% of them via Google. As a result, Doctissimo’s editorial policy is to cover the subjects people search for most frequently on Google. ‘If we see we don’t have the necessary content, we create it,’ a journalist told me. ‘We also look at topics that are in the news, and what’s being covered elsewhere. We pay close attention to the forums, because that’s another big part of our audience. We create content in response to what people are asking there.’

Advertisers like these forum communities, not just because they help grow the online healthcare market, but because they feed the detailed user profile databases. According to Lucia Lagarrigue, former director of Doctissimo communities at Lagardère Active, and Gilles Achache, of the online marketing agency Scan-Research, ‘Site users provide a great deal of information about themselves: socio-demographic data, changes in the composition of their household, changing consumption habits, interests, advice and opinions (medical conditions, and attitudes to health problems, brands, products and services).’ These data and personal messages are processed using semantic analysis, enabling Doctissimo to offer advertisers a high degree of audience segmentation: ‘an additional level of compatibility to enable you to devise special marketing operations’, through targeted advertorials.

In 2017 the baby-care brand Philips Avent paid for sponsored content aimed at pregnant women. Doctissimo was promoted as ‘the premier site for women’, the ‘top site aimed at women aged 25-49 (top site aimed at mothers)’, with ‘6.6 million members and 30,000 messages posted per day’. Since then the number of active forum users has plummeted to 570,000. Bergamote Bazerolle, Doctissimo’s head of digital, said, ‘We’ve done a lot of cleaning up in the context of the General Data Protection Regulation.’

The focus has now switched from forums and newsletters to mobile apps to capture new users: the apps ‘My pregnancy’, ‘My baby’ and ‘Ovulation’ have jointly achieved over one and a half million downloads on Android. With 120,000 active users a month, Bazerolle said, ‘“My pregnancy” centres on an editorial component and a selection of articles from the site. We also use push notifications when there’s news that concerns pregnant women.’ Doctissimo has plans for voice-enabled apps. ‘A woman could ask directly “Is it OK for me to eat mussels?” ... Anything to do with hypnosis or sleep works well with voice-activation.’

Pregnant women, a market that ‘over-consumes’ according to Bazerolle, are a mine of information. Users enter the kind of personal information that advertisers love in the app: to access the service, they have to provide their due date, their weight and the date of their last period. Combined with data required when signing up for newsletters or forums, and messages posted, these details create ever more precise, and profitable, profiles.

Did TF1 Group buy Doctissimo for access to this data? It already holds data on 23 million Internet users from its online streaming service, MyTF1, which requires users to register for access to content. Nicolas Capuron, group director of new digital businesses, said, ‘Our objective is to extract maximum value from this data, by providing more personalised services on the user side, with high added value, and on the advertiser side, the ability to offer targeted campaigns. Through this high-quality database, we can develop our product [Doctissimo] to fit our communities’ expectations and habits.’

TF1’s acquisition of Doctissimo also allows it to grow its online audience; TF1’s major shareholder Martin Bouygues’s acquisition of Aufeminin in April 2018 put his business in the top 10 companies visited online. TF1 Group has also bought Gamned!, which does automated buying and selling of advertising space, to ‘extract value from data held by its main digital entities (Aufeminin, Doctissimo, Les Numériques, Marmiton etc)’, according to a press release. Gilles Pélisson, chairman and CEO of TF1, said, ‘We will as a result be able to give advertisers the ability to target more precisely and enrich our partners’ dialogue with web users beyond our platforms.’ There are many different ways of selling human attention.

- Sophie Eustache is co-author, with Elodie Perrotin, of Comment s’informer? (How to find information), Ricochet, Tourtour, 2019. Translated by George Miller.

Copyright ©2019 Le Monde diplomatique — used by permission of Agence Global.