Detailed guides to painful problems, treatments & more

The origin story

This place is an unusual business success and many readers are curious to know how it started

Paul Ingraham • 10m read

I make my living from this website, which is a bit surreal. Wringing an income out of the internet seems like an improbable achievement to unlock if you’re not a Tik-Tok star or some other weird gen Z thing I haven’t even heard of yet.

Lucky for me, is almost unavoidable if you consult Dr. Google about your aches and pains. Indeed, I am often baffled and amazed by some of the searches that lead to One way or another, my articles turn up in search results with the likes of WebMD and The Mayo Clinic in dozens of categories, an independent publisher holding his own with, of all things, folksy science education and methodical mythbusting, heavily referenced and often dorky, a website with a bibliography for a heart. How does that happen?

The extremely short version

When I got into massage therapy in 2000 — a major upgrade to my “day job” — I started out writing self-help articles for my clients. It was a popular perk, and almost automatic for me: I had been screwing around with web publishing as a hobbyist for years, so it was a natural project for me to take on.

The articles started to attract a global audience. Turns out people really love “folksy science education,” especially when they have serious problems they are trying to solve.

Once I had an audience, it wasn’t hard to sell enough ebooks to keep it all going and growing… and that’s it in a nutshell. But why did it work? Self-publishing ebooks doesn’t work out for most writers, and almost never with a soft sell.

Early bird gets the top of the search results

I was an early arrival, there just wasn’t much competition back then, and that’s probably the number one reason it all worked out for me. But I would also like to believe that I got a few things right as well as early, things that many other information and health sites seemed to be lacking (then and now):

The “regular improvements” thing was a big deal. Rather than publishing and then abandoning posts like most bloggers, I treated every article like an evolving resource that should be regularly and indefinitely improved. That commitment was distinctive.

The brand was mostly defined by about 2005. As it started to attract readers from around the world, I started to wonder if the traffic might be worth something. I remember telling my wife and mother-in-law about it during a drive on Vancouver Island around that time. “I can probably turn this into a career,” I said, and I was right.

The leap of faith

So I built up some of my content to the point where I felt bold enough to put a price tag on it — and my standards were quite a bit lower then, which made it much easier. The big idea from the beginning was to invest heavily in high quality free content to attract lots of readers, so that a few would pay for access to the best content (see loss leader).

In 2006, I put my first price tag on a “book” about back pain. It wasn’t ready, and I should apologize to those early customers — which wouldn’t take long, because there weren’t many of them. But I was acutely aware of the danger of letting the perfect be the enemy of the good, and so I wanted to get the business ball rolling and then work hard to steadily improve the content quality. Which I certainly did.

At the same time, I also invested heavily in a customized content management system to help me deliver really great footnotes and citations (something that remains tricky for web publishers to this day). I spent thousands of dollars hiring a programmer to do this for me long before I knew it would pay off. It was a strange and brave leap of faith. To this day, the audacity of that expense kind of amazes me.

2007 was exciting

If one book could earn something, then I “just” had to write more of them to earn a decent living. The power of duplication. And I already had several that were close to enough to be ready, so I rapidly rolled out another to try “doubling” my income… and it quadrupled.

Book #2, about runner’s knee, was more compelling to its target market — injured runners are highly motivated! — and I also advertised with Google AdWords, which was still new-fangled. The results were explosive, a dollar-signs-in-the-eyes experience. It was intoxicating! I had spent most of my life dreaming of making a living as a writer, and suddenly it seemed possible for the first time.

I had been writing and planning and building foundations for years, but that dizzying 2nd quarter of 2007 was the true beginning of the business.

After that, I was officially chasing the holy grail: paying the rent without leaving the house. I’d had a strong start, but even in that “exciting” first year I earned only… about $6000 USD. A nice bonus and a potent incentive, but far from a living wage. I still had a lot of work to do.

Hatred, threats, and harassment

Siding with the science is a great way to make enemies.

My audience grew exponentially in the late 2000s. I was busting myths and debunking quackery with a lot of snark and little diplomacy. Many people loved it, but quite a few hated it, and the haters were noisy. My inbox blew up with highly toxic insults and many kinds of threats, some of them legal.

But the big curve ball, the really bizarre didn’t-see-that-coming threat, was being accused of professional misconduct. Why? For disrespectin’ my colleagues! For criticizing their many pseudoscientific beliefs and practices. My professional regulator — the organization that issued my license to practice — conducted an absurd “investigation” of me for three years, until I left the profession of my own free will, disgusted and disillusioned. See Why I Quit My Massage Therapy Career.

Meanwhile, many lesser threats and harassment escalated in proportion to the size of my audience, even as my business grew. It was going well. There was always that, through that whole insane chapter of my life. I published five more books in that period, fanatically striving to level-up as a science writer.

Winning … in a way

Actually making a living from took about five years of feverish workaholism, from 2007 to 2012. In 2009, I wasn’t there yet, but I was confident enough that I felt like I could close my massage practice, which I did at the end of the year.

And then, just two months later, my wife had a serious car accident while travelling alone in Asia, and I had to drop everything and rush to northern Thailand to be with her. It was not clear that she would survive; severe disability was definitely possible too. And I had just quit my day job!

My business passed that critical test. It didn’t just earn enough money to keep us going during an extreme family crisis, but it broke sales records and practically ran itself, thanks to a highly automated, self-serve store.

That test made it clear that the business was sustainable, but it wasn’t until 2012 — eight years after my first glimpses of the potential — that I felt like I was starting to break even and it was officially a success. For at least six of those years, I thought I’d probably lost my damn mind and all my effort was going to be largely wasted.

Not getting rich is a success by the standards of someone who spent his twenties in debt, working shitty day jobs, trying to “make it” as writer and completely failing. For a small one-man shop, it’s been a great little business.

But by mainstream standards? Meh. It’s not all that great even when compared to more successful writers of my general type (enterpreneurial e-book self-publishers). I am pals with three writers who have sold an order of magnitude more books than I have. peaked in 2014 at revenue of about $500/day for a few months, and I felt like I had won a lottery. At that level of earning, if it had continued, I would have gotten small-r rich.

Although still has a lot of traffic, it’s a lot less than it used to be after one of Google’s “core algorithm updates” this spring. Google giveth & Google taketh away.

But it did not continue. Business has been besieged by crises and setbacks ever since — like the domain move disaster in 2015, and then an even worse rank-pocalypse this May. will probably survive. I have no idea if it will ever thrive again. Regardless, I know it will be interesting and rewarding.

Post script: the end of hate mail

Hate mail used to be a major feature of the job. It has declined dramatically over the last decade, even while my audience has greatly increased. In the last year, the toxic feedback has dried up almost completely. What changed?

Tact and diplomacy. I love being snarky, but I have learned to restrain myself, and to avoid criticizing certain kinds of targets in certain ways. is a lot more peaceful and “professional” than it used to be, and I wouldn’t have it any other way now.

But I am nostalgic about my snarky old self. I miss that feisty jerk!

Related Reading

What’s new in this article?

2020 — Substantial revision.

2019 — Publication.