How we make money

We also do not sell your health data. Not aggregated, not de-identified, not to insurers, not to employers, not to advertisers. That is a commitment in the health data notice, not a preference.

Member+ subscriptions — paid by readers

A monthly or annual subscription that adds unlimited lab uploads, AI insights over your own data, the evidence question tool and saved protocol tracking. The evidence pages, the grades, the studies behind them, the calculators and the clinic directory are free and stay free: putting the grade behind a paywall would defeat the purpose of computing it.

Clinic listing tiers — paid by providers

Three tiers. The free tier is an unclaimed or claimed listing with the clinic’s services, locations and hours. Paid tiers add photos, practitioner profiles, package details, lead management, response analytics and API access. A paid tier buys presentation and tooling. It does not buy ranking, and a paid listing looks the same to the ranking code as a free one.

The Verified audit fee — paid by providers

A one-off fee per audit cycle for the LLL Verified badge: we check the clinic’s licence with the regulator, confirm the premises and the named medical lead, and review the claims in its listing. The fee pays for the audit, not for the outcome. Audits fail, the fee is not refunded when they do, and the auditors who decide are a separate role that cannot see billing.

Labelled featured placements and city sponsorships — paid by providers

Fixed-duration slots on a city or service page, sold by calendar period and capped at two per page. Every one carries a visible sponsored label, sits in its own block above or beside the organic list, and is never interleaved with it. Impressions and clicks are counted for the advertiser; nothing about the placement is an input to the organic query.

Pay-per-lead — paid by providers

A clinic can prepay a balance and be charged per consult request we pass to it. The charge is per lead delivered, recorded in a ledger the clinic can see line by line, and refundable when a lead is invalid. What a clinic pays per lead does not affect where it appears, and a clinic that stops paying keeps its listing.

Health Data Hub, per active patient per month — paid by providers

Clinics that use the Hub to receive patient-shared data pay per patient who actually shared data that month, metered on counts with no patient identifiers in the billing tables. It requires a signed data agreement, and the patient grants consent per scope and can revoke it at any time. The clinic is the controller of the data it receives and carries the clinical responsibility for acting on it.

Partner and affiliate revenue — paid by retailers and labs

Commission on purchases made through our links, restricted to products whose intervention page carries grade B or better. Details and the grade rule are below.

API and dataset tiers — paid by researchers and businesses

A free tier for low-volume and non-commercial use, a research tier that is free with an academic affiliation and a citation commitment, and a commercial tier priced by call volume. The evidence dataset itself is published under an open licence with a required citation format, so the grades stay checkable by people who are not paying us anything.

The API and dataset tiers, endpoints, rate limits, licence and citation format are on the data and API page. Clinic-side pricing detail is on for clinics.

Directory search lives in one file: apps/web/src/server/services/directory.ts. It runs two independent database queries and returns their results in two separate arrays:

• results is the organic list. Its filter is built from your search — service, country, city, verification, telehealth, language, accreditation — and its order comes from verification status, then quality score, then name, or from whichever sort you chose. Sponsorship records are not joined into that query, so no sponsorship field is available to the ordering at all.
• sponsored is a second query, run only on page one, that adds a condition requiring a currently active sponsorship for this city or service, and takes at most two rows.

The two arrays are handed to the page separately and rendered in separate blocks with the sponsored one labelled. There is no merge step, no boost coefficient and no “sponsored results may appear in the list” caveat — because there is no place in the code where such a thing could happen. If you find one, that is a bug and we want to hear about it at editorial@longlifelist.com.

A clinic’s ranking carries an evidence-alignment factor computed from the grades of the services it actually offers, weighted by the share of its graded menu at each grade, so a large clinic is not punished for breadth. A and B cost nothing. The drag rises from there:

A clinic whose menu is mostly things we believe cause harm falls most of the way down the list. It is not removed: the factor has a floor, so this stays a ranking rather than a ban, and a clinic that disagrees with a grade can dispute the grade — with evidence, through the editorial route, in public — which is the only route there is.

This is the awkward part of the business, so it is worth being explicit: downgrading a popular therapy costs us money, because the clinics selling it are customers. It has happened and it will happen again. The defence is not our good character, it is that the people who can move a grade cannot see commercial data and the people who sell cannot reach a grade.

• Grade B or better, or no link. We do not carry an affiliate link to a product whose intervention page is graded C, D, F, HARMFUL or INSUFFICIENT. If a grade falls below B, the links come down. That rule costs us the most lucrative part of the supplement market, which is the point of having it.
• Labelled at the point of the link. Not in a footer, not on a separate page you have to find. Under the FTC endorsement guides, the ASA/CAP rules in the UK and the ASCI code in India, the disclosure has to be where the click is, and that is where it is.
• Commission never varies by what we say. We do not accept performance-based deals tied to editorial treatment, and we do not accept payment for a review, a placement in a list, or a grade.
• Prices and availability come from the retailer. We do not set them and we do not get a cut of a higher price.

Full terms and the disclosure rules we hold partners to are on the partners page.

• Selling, licensing or brokering health data, including de-identified or aggregated.
• Behavioural advertising based on health interests, on or off this site.
• Selling our own supplements, tests or programmes, which would make every grade suspect.
• Paid editorial, sponsored articles, or advertorial that reads like a review.
• Charging a clinic to correct or claim its own listing, or to respond to a review.
• Charging you to see the evidence, the studies, the grades or the corrections log.
• Paying for reviews, incentivising reviews, or letting a clinic choose which of its patients we invite to review it.

Can a clinic pay to improve its evidence grades?

No. Grades belong to interventions, not to clinics. A clinic listing inherits the grade of each service it offers from the intervention page, and there is no write path from a commercial system to a grade. Only a medical reviewer with a named profile can move one, and every move is published with their justification.

Can a clinic pay to rank higher in the directory?

No. Paid placements are fetched by a separate database query and returned in a separate array from the organic results, which are ordered by verification status, quality score and name. There is no code path that merges the two, so there is nothing for money to influence in the organic order.

Can a clinic pay to have a bad review removed?

No. Reviews are moderated by the trust and safety team against published review guidelines. A clinic can reply publicly to any review and can report one for breaching the guidelines. Whether it is removed is decided on the guidelines, by people with no commercial target, and a clinic’s spend is not visible to them.

Do you take money from supplement companies?

We run affiliate links only to products whose intervention page carries grade B or better, and every such link is labelled at the point of the link. We do not take payment to feature, review or grade a product, and we do not sell our own supplements.

How much of your revenue comes from clinics?

Clinic listings, verification audits, placements and pay-per-lead together are the largest share of revenue today. That is exactly why the separation between commercial systems and the grading engine is structural rather than a policy, and why we publish where it lives in the code.