Executive Summary
The account is not currently decision-safe for profitability, ROAS, CAC, or agency-performance evaluation. Media delivery is real and material, but the conversion column does not represent one stable business outcome.
The August Scorecard Shows That the Cancer and Genome Keyword Cluster Can Work
Salesforce-verified data for August 2026 confirms 61 real sales, $41,810 revenue, and a 2.44x ROAS on $17,103 ad spend. Google Ads contributed 37 sales at $335 CPS. The cancer and genome keyword cluster produces genuine demand and real revenue — the infrastructure and governance, not the market, are what need fixing.
Overall Control Rating: Critical remediation required.
This is a control and measurement rating, not a claim that all advertising demand is bad. There is clear market demand and some campaigns may be valuable once outcomes are reconciled.
Three Critical Conditions
GA4 contains 94,792 false purchase events using the repeated dummy transaction ID t_12345, with $116,594.16 of false revenue. Google Ads goals were repeatedly removed, created, recategorized, and switched between primary and secondary. The change log contains 79 conversion/goal-related change events.
Of $160,874.49 visible in the YTD search-terms export, $99,871.46 (62.1%) had zero recorded Google Ads conversions. Clinical-trial, research, symptoms, free-trial, and competitor demand leaked into campaigns labelled Executive Health, Genomics, or Sales.
Executive Health has no joined CRM record of qualified lead, booking, attendance, sale, or revenue. Genomics has one plausible $599 GA4 purchase pending Stripe reconciliation. Platform actions cannot establish return.
Channel Spend Distribution
| Campaign Type | Campaigns | Spend | Platform Conv. | Platform CPA |
|---|---|---|---|---|
| Search | 21 | $229,343 | 1,038.60 | $220.82 |
| Performance Max | 10 | $38,854 | 248.30 | $156.48 |
| Video | 1 | $1,971 | 0 | — |
| Demand Gen | 2 | $1,221 | 0 | — |
Agency Control Assessment
Overall Learnings
Key findings from the independent audit, with critical evaluation of each conclusion against the source data.
WGS Keyword Clusters Are Not Organized Properly
Whole Genome Sequencing terms are mixed with cancer screening, full-body scan, MRI, biomarker testing, calcium scoring, and competitor terms across campaigns. This makes it impossible to isolate WGS purchase intent from informational or unrelated clinical queries.
- Broad-match
biomarker testingkeyword spent $6,920 with zero conversions in the Genomics campaign - Genomics query leaks include "full body scan," "full body mri," "prenuvo scan," "life expectancy calculator," "Natera," "Invitae," and generic educational terms
- The DNA + Heart campaign combined cardiac risk and genomics offers into one campaign spending $18,566
- WGS-sale campaign (the only clean WGS campaign) was paused with just $3,375 spend
The Test Is Only Half Done
The market hypothesis is validated: people searching cancer-related and WGS terms do purchase the $599 genomics product. The client has confirmed real Stripe purchase transactions. However, broken tracking means those purchases cannot be attributed to specific campaigns or keywords — so the test is "half done" in a precise sense: demand is proven, but the optimization loop is broken.
- Client-confirmed: real purchase transactions exist from WGS/cancer search traffic
- WGS-sale campaign: 8 reported conversions, $3,375 spend, $421.93 CPA — best Genomics result
- GA4 attribution is broken — the plausible $599 purchase attributes to
(direct) / (none), not to any Google Ads campaign - No causal link: cannot determine which keywords, ads, or campaigns drove the purchases
- Campaigns ran May – September without any optimization — unacceptable when spending $620/day
- 95.2% of WGS-sale visible query spend had zero reported conversions — the tracking gap, not necessarily zero demand
No Optimization Done on Landing Pages
Landing pages are not matched to keyword intent. Traffic from diverse search queries all routes to generic pages rather than keyword-specific experiences. This wastes the signal from different buyer states and prevents meaningful conversion-rate analysis.
- $44,092 of advertiser-selected spend sent to
/locations/— a clinic-info page with an email CTA, not a conversion page /CADreturned intermittent internal errors during the audit/hli-whole-body-mri/returned internal errors — $5,083 spent- Executive Health paid traffic split across canonical, UTM, fragment, homepage, and Locations routes
- Multiple Genomics product URLs:
/genomics/,/genome,/CAD— fragmenting analysis - Automatic final-URL expansion sent traffic to unvetted routes
Tracking Is Broken — No Causal Attribution
There is no way to trace spend through to business outcomes. The measurement infrastructure is so compromised that no claim of campaign profitability, ROAS, or customer acquisition cost is defensible.
- 94,792 false
purchaseevents in GA4 using dummy IDt_12345= $116,594 false revenue - 79 conversion/goal change events in the YTD change history
- Google Ads account reports in Eastern Time; GA4 reports in Pacific Time — 3-hour date-boundary mismatch
- No CRM/Stripe reconciliation exists — platform actions ≠ customers
- Raw
email_addresscustom dimension registered in GA4 — PII risk - Three Google Ads accounts linked to one GA4 property without documented ownership
- Google Ads shows 45 purchase actions with only $625.50 recorded value — inconsistent with $599 product
The Process Is Broken — No Main Orchestrator
There is no single accountable owner governing what gets launched, changed, paused, or measured. Changes happen across multiple actors without documented approval, hypothesis, or rollback criteria.
- 875 account changes across 7 users/systems in the audit period
- What was the hypothesis? What is being tested? No experiment register, test calendar, or media plan was supplied to answer these questions
- Calls-from-ads toggled between primary and secondary 4 times (Jan, Mar, May, Sep)
- "Testing" campaigns launched without documented hypothesis, sample size, or success criteria
Never Launch Campaigns Without Tracking in Place
This is both a retrospective finding and a forward-looking principle. Multiple campaigns were running with broken, misconfigured, or absent measurement — spending real budget without any way to know if the spend generated a business outcome.
- Genomics Sales used Maximize Clicks ($620/day budget) while the objective was verified purchases — no purchase tracking in place
- Executive Health lead events effectively stopped after April; only 2 events in May, none Jun–Aug
- Multiple PMax campaigns launched with disapproved assets and no qualified-lead import
- Demand Gen test spent $1,221 with zero conversions and homepage routing — no measurement framework
- Prostate Cancer campaign recorded 236.7 conversions but no eligibility/appointment outcomes were tracked
Campaign Portfolio
All 34 campaigns with audit decisions. Spend, reported conversions, and severity reflect YTD data January 1 – September 13, 2026.
| # | Campaign | Status | Spend | Conv. | CPA | Decision | Severity |
|---|---|---|---|---|---|---|---|
| 1 | Trustini | Leads | Executive Health | Enabled | $64,958 | 270.00 | $240.59 | Rebuild under cap | Critical |
| 2 | Trustini | Leads | Competitors | Search | Enabled | $62,023 | 340.67 | $182.06 | Rebuild & isolate | Critical |
| 3 | Trustini | CPC Manual | Executive Health | Paused | $21,521 | 22.00 | $978.23 | Keep paused | Critical |
| 4 | Trustini | DNA + Heart | Sales | Limited | $18,566 | 9.00 | $2,062.91 | Pause & rebuild | Critical |
| 5 | Trustini | Brand | Leads | Search | Enabled | $14,927 | 54.00 | $276.43 | Controlled continuation | High |
| 6 | Trustini | Sales | Genomics | Enabled | $13,960 | 1.90 | $7,347.60 | Pause & rebuild | Critical |
| 7 | Trustini_Executive_Health_Search | Paused | $12,047 | 93.33 | $129.07 | Keep paused | Critical |
| 8 | Trustini_Prostate_Cancer_National | Paused | $11,896 | 236.70 | $50.26 | Separate review | Critical |
| 9 | Trustini | Executive Health | Pmax | Paused | $11,239 | 118.00 | $95.25 | Keep paused | Critical |
| 10 | Trustini - 1m pledge - Leads | Paused | $8,706 | 93.80 | $92.81 | Keep paused | Critical |
| 11 | Trustini | Executive Health | Pmax #2 | Paused | $8,377 | 6.00 | $1,396.09 | Keep paused | Critical |
| 12 | Trustini | PMAX | Sales | Competitors | Limited | $7,484 | 4.00 | $1,871.00 | Pause & rebuild | Critical |
| 13 | WGS-sale | Paused | $3,375 | 8.00 | $421.93 | Retain learnings | High |
| 14 | Trustini | Pancreatic Cancer | Leads | Paused | $2,845 | 0 | — | Keep paused | Critical |
| 15 | Trustini - Executive Health - Leads | Paused | $2,668 | 25.50 | $104.64 | Keep paused | Critical |
| 16 | Trustini | Video Views | Executive Health | Paused | $1,971 | 0 | — | Reclassify awareness | Medium |
| 17 | Google_DGen_August2026 | Paused | $1,221 | 0 | — | Keep paused | High |
| 18 | Trustini | Kits sales | Testing Landings | Limited | $1,036 | 0 | — | Pause; redesign | Critical |
| 19 | Trustini | Executive Health | Top Impressions | Paused | $848 | 3.00 | $282.78 | Keep paused | High |
| 20 | Trustini | Calcium Top Keywords | Sales | Paused | $582 | 0 | — | Keep paused | High |
| 21 | Trustini | DNA Top Keywords | Sales | Paused | $390 | 0 | — | Keep paused | High |
| 22 | Trustini_Leads_PMAX | Paused | $380 | 1.00 | $380.07 | Archive | High |
| 23 | Trustini | Testing | May2026 | Paused | $368 | 0 | — | Archive | High |
| 24 | Google Search Lead Campaigns | Paused | $0 | 0 | — | Archive | High |
| 25 | Trustini_Prostate Appt Booking | Ended | $0 | 0 | — | Archive | High |
| 26 | Trustini_Leads_stop_cancer_PMAX | Paused | $0 | 0 | — | Archive | High |
| 27 | Trustini_Stop_Diseases_Leads_PMAX | Paused | $0 | 0 | — | Archive | High |
| 28 | Leads-Search-Dec3-2024-WBMRI | Paused | $0 | 0 | — | Archive | High |
| 29 | Trustini_Pancreatic Appt_Booking | Ended | $0 | 0 | — | Archive | High |
| 30 | Executive-Health-2025-PMax | Paused | $0 | 0 | — | Archive | High |
| 31 | Trustini_Pancreatic_Cancer_National | Paused | $0 | 0 | — | Archive | High |
| 32 | ExecHealth-Search-Jan2025-AnnualPhysical | Paused | $0 | 0 | — | Archive | High |
| 33 | Trustini_Guide_Longevity_Leads_PMAX | Paused | $0 | 0 | — | Archive | High |
| 34 | Trustini_500off_Dgen | Ended | $0 | 0 | — | Archive | High |
Proposed Consolidation
The 34-campaign inventory should become a smaller, governed operating portfolio.
| Business Line | Operating Campaign | Purpose | Primary Outcome After Repair |
|---|---|---|---|
| Executive Health | Brand Search | Capture brand/service navigation | CRM-qualified inquiry or booked consultation |
| Executive Health | Non-brand Search | High-intent executive health demand | CRM-qualified inquiry or booked consultation |
| Executive Health | Competitor Search | Capped conquest test | CRM-qualified inquiry, reported separately |
| Genomics | Brand/product Search | WGS and product demand | Unique Stripe-verified purchase with actual value |
| Genomics | Competitor Search | Capped comparison test | Unique verified purchase |
| Cardiac/MRI | Separate Search | Service-specific qualified demand | Qualified booking or verified purchase |
| Cancer Programs | Governed portfolio | Eligibility/appointment acquisition | Eligible, booked and attended outcome |
| Awareness | Video/DGen test | Incremental qualified reach | Brand-lift or incrementality measure |
Campaign Details
Expandable audit findings for each active or significant campaign. Click any campaign to see configuration, search-term evidence, and audit decision.
Executive Health & General Health
Audit Finding
The campaign is materially buying clinical-trial/research intent that does not match a premium Executive Health program. Search Partners, bilingual reach, and broad affluent-geography targeting enlarge that risk. 62.0% of visible query spend ($28,000 of $45,157) had zero reported conversions. Examples include "we need you clinical trials" ($3,081; zero conv.) and "paid clinical trials for seniors" ($1,678).
Decision
Rebuild under a temporary spend cap. Use campaign-specific qualified-lead goals, Google Search only during recovery, one language per campaign, audited locations, and separate exact/phrase commercial themes. Add clinical-trial, paid-study, research-participant, employment, symptoms, and free-intent exclusions.
Success gate: 30 stable post-cutover days plus CRM evidence for qualified inquiry, booked consultation, attendance, sale, and revenue.
Audit Finding
True competitor intent, clinical-trial demand, and generic research demand are combined. "All languages" is not aligned to the observed English experience. Leading zero-conversion queries: "clinical trials in my area" ($2,047), "prenuvo" ($1,971), "clinical research near me" ($1,950). 44.6% of visible query spend had zero reported conversions.
Decision
Split named competitors into their own capped campaign; move research and clinical-trial themes out of Executive Health. Require CRM quality and revenue by competitor before increasing bids.
Audit Finding
This is the most defensible active campaign. Brand traffic contains multiple intents — clinic navigation, company info, products, jobs, and specific services. Sending all brand demand to Executive Health can misroute users. 35.7% zero-conversion query spend. Call quality proxy is the strongest in the account (89.1% lasting ≥60 seconds).
Decision
Controlled continuation. Separate brand by service and navigational intent, protect exact brand terms, suppress employment/investor/research intent, and report brand independently from non-brand.
Genomics, DNA & Cardiac
Audit Finding
Two different offers and intents are combined. 96.7% of visible query spend had zero conversions. Dominant queries are generic/informational ("calcium score," "dna test," "heart attack risk"). The destination /CAD intermittently returned an internal error.
Decision
Pause immediately. Separate cardiac and genomics propositions, repair and monitor the destination, use tightly controlled exact/phrase intent, and optimize only to backend-confirmed purchase.
Audit Finding
Maximize Clicks with $620/day budget, nationwide reach, and zero negative keywords predictably maximized traffic rather than verified $599 purchases. All visible query spend had zero conversions. MRI/scan intent is not genomics purchase intent. Sep 7–13 alone: $4,207 for 2,419 clicks and zero conversions.
Decision
Pause immediately. Rebuild around WGS/product-specific commercial intent, add exclusions, cap CPC/spend, reconcile the one plausible $599 GA4 purchase to Stripe, and make a unique successful payment with actual value the primary bidding event.
Audit Finding
Product alignment is better than the generic Genomics campaign, but no-negative coverage and 95.2% zero-conversion query share prevent a positive conclusion. The 8 platform actions require payment reconciliation. Themes included human genetics and 23andMe — showing some commercial adjacency.
Decision
Keep paused while retaining useful WGS/competitor learnings. Relaunch only with verified purchase value, negatives, a dedicated offer page, refund tracking, and a written break-even CAC. This is the best Genomics campaign — build from here.
Cancer Programs
Audit Finding
High reported conversion volume and low CPA cannot be interpreted without eligibility and appointment outcomes. Short-call prevalence (67.5% under 60 seconds), brand mixing, and Search Partners + Display expansion create material quality risk. This must not be rolled into Executive Health or Genomics reporting.
Decision
Separate service-line review required. Join keyword and call data to eligibility, appointment booking, attendance, and revenue or program value.
Performance Max Campaigns
Audit Finding
Low reported CPA is outweighed by severe intent mismatch. Cross-network automation found inexpensive trial-seeker actions, not proven premium-health buyers. Geography includes locations in France requiring validation. PMax opacity makes diagnosis harder while conversion signals are corrupt.
Decision
Keep paused until a verified qualified-lead import is the only bidding goal. PMax should remain off during measurement recovery.
Audit Finding
Neither clean competitor conquesting nor controlled sales acquisition. All visible query cost had zero conversions. Leakage includes "glp1 free trial," cancer donation, and brand terms. High budget, cross-network opacity, and invalid bidding signals create material risk.
Decision
Pause. If competitor acquisition is retained, begin with tightly matched Search, dedicated comparison pages, and verified purchase outcomes before considering PMax expansion.
Legacy, Testing & Zero-Spend Campaigns
Eleven additional campaigns produced zero spend in the audit period. Their configurations create accidental-reactivation risk. Decision: Archive all after preserving settings and historical data. Includes: Google Search Lead Campaigns, Prostate/Pancreatic Appt Booking, stop_cancer PMAX, Stop_Diseases PMAX, WBMRI leads, Executive-Health-2025-PMax, Pancreatic_Cancer_National, Jan2025 AnnualPhysical, Guide_Longevity PMAX, and 500off DGen.
1-Week Remediation Sprint
Everything below must be completed within 7 days. This is a measurement-recovery program — no scaling until the sprint is verified.
- Freeze all conversion-goal changes — named owner required for any modification
- Exclude 94,792 false
t_12345purchase events from reporting and bidding - Remove raw
email_addresscustom dimension from GA4 — PII risk - Define canonical conversion events: one Genomics purchase, one Executive Health qualified-lead/booking
- Demote newsletter, generic forms, page views, CTA clicks, and unqualified calls to secondary
- Pause clinical-trial/research leakage in Executive Health and Competitor campaigns
- Stop traffic to erroring destinations (
/hli-whole-body-mri/,/CAD,/locations/for acquisition) - Reconcile Stripe payments — match every GA4 transaction to Stripe order, status, refund, net revenue
- Pause active DNA + Heart, Genomics Sales, and competitor PMax campaigns
- Build attribution chain: Click ID → campaign → query → landing page → lead → qualification → booking → attendance → sale → revenue
- Run controlled end-to-end test per business line: data-layer event → GTM tag → GA4 DebugView → Google Ads conversion → CRM/Stripe record
- Align timezone reporting: Google Ads (Eastern) and GA4 (Pacific) must use one consistent zone
- Replace exact-negative sprawl (3,883 assignments) with governed shared lists
- Shared exclusion themes: employment, free/cheap, clinical trials, symptoms-only, academic, irrelevant locations
- Separate campaigns by business line: Executive Health, Genomics, MRI, cancer, clinical research, competitor, brand
- Each business line gets its own budget, conversion events, and reporting
- Rebuild Genomics around WGS intent: exact/phrase commercial keywords, capped broad tests, Stripe-verified purchase as bidding signal
- Cap and rebuild the two large Executive Health Search campaigns with qualified-lead goals
- Split named competitors into their own capped campaign
- Google Search only during recovery — no PMax, no Display expansion
- Establish offline conversion imports: qualified lead, booked consultation, attended assessment, and sale — imported back to Google Ads
- Resume automated bidding only on validated, sufficiently frequent outcomes
- Archive all zero-spend and redundant legacy inventory after exporting settings
- Assign a named owner with approval authority over conversion definitions, campaign launches, and budget allocation
- Verify all rebuilt campaigns fire conversion events end-to-end
- Confirm CRM/Stripe join populates for each active business line
- Establish weekly reporting cadence: marginal CPA/ROAS by verified outcome, per business line
- Document success gates: 30 stable post-sprint days required before any scaling or PMax reactivation
Portfolio Decisions — Effective Immediately
- Continue Brand Search only under controlled, separately reported operation.
- Cap and rebuild the two large Executive Health Search campaigns rather than accepting their reported CPA.
- Pause the active DNA + Heart, Genomics, competitor PMax, and landing-test campaigns pending outcome repair.
- Keep paused all currently paused PMax, Demand Gen, cancer, and legacy Search campaigns.
- Archive the no-spend and redundant legacy inventory after exporting settings.
- Do not approve scaling until a privacy-safe CRM/payment join makes campaign → query → landing page → qualified outcome → revenue traceable.