When Hillary Clinton seemed to collapse while getting helped into the back of a black van earlier this month, Jane Orient, a physician in Tucson, Arizona, says it felt like a vindication. In early August, she'd published an op-ed on the Association of American Physicians and Surgeons' website questioning whether Clinton has a traumatic brain injury that would make her unfit for the presidency. And this month, the Association—of which Orient is the executive director—published a survey apparently showing that other physicians believe much the same thing. Almost instantly, that survey made it to Facebook’s coveted Trending Topics section.

For Orient—and the many media organizations that have recently been circulating her work—Clinton's stumble looked like proof that they were right.

There's just one thing: Orient and the Association are not just the broad-based coalition of dispassionate, unbiased medical spectators that the conservative media makes them out to be.

Instead, Orient and the Association of American Physicians and Surgeons, or AAPS, have been unabashedly anti-Clinton for decades. Contrary to its official-sounding name, the AAPS does not represent hundreds of thousands of physicians like, say, the American Medical Association does. Instead, the small non-profit based out of a medical park in Tucson represents a niche group of fewer than 5,000 members, not all of whom are doctors. While it claims to be non-partisan, even Orient admits the group has a guiding "philosophy," one that just so happens to correlate with conservative politics on every issue from vaccine mandates to abortion rights to immigration.

Now, Clinton’s health is the association’s favorite talking point. Orient and others have chimed in on Clinton's pneumonia diagnosis and her persistent cough. "We’re not diagnosing her," Orient says. "We’re just saying questions have been raised."

This isn’t the first time the AAPS has emerged as conservative conspiracy theorists' favorite signal booster; the organization has existed for nearly three-quarters of a century. But today, thanks to algorithms that decide whether stories are newsworthy, a burgeoning conservative media industry that includes the likes of Breitbart and Infowars, and rampant distrust of mainstream media, the AAPS now has a network ready and willing to broadcast its ideas to millions of readers.

The Friendly Fragmented Media

The AAPS has been rooted in conservative ideals since its inception when a group of doctors opposed to "socialized medicine" founded it in 1943. Since then the AAPS has evolved into a catch-all organization for conservative rebuttals to scientific consensus.

So, you think the vaccination debate is settled? The AAPS says vaccinations cause autism. You think HIV causes AIDS? The AAPS has its doubts. You think indoor smoking bans are good? The AAPS suggested they could be harmful. You say President Obama's oratorical skills won him the White House? The AAPS thinks he used a "covert form of hypnosis" to win over the public.

"They're not a national organization that represents any sort of mainstream physicians," says Paul Offit, a pediatrician and director of the Vaccine Education Center at the Children's Hospital of Philadelphia. "They're a political group."

The AAPS’s agenda is well-documented. In 2009, Mother Jones likened the group's members to "Glenn Beck with an MD," citing ties to the Tea Party and its anti-Obamacare activism. In his 2011 book The Panic Virus, Seth Mnookin called the AAPS an "extreme-right-wing group that openly derides 'evidence based medicine,'" noting its involvement in opposing vaccinations.

'They're not a national organization that represents any sort of mainstream physicians. They're a political group.' Paul Offit, Director, Vaccine Education Center

And yet, five years after Mnookin's book came out, the AAPS is still relevant. That’s largely because the current media landscape, fragmented and frenetic, has created the perfect environment for the AAPS to flourish. Under pressure to publish, media outlets increasingly take scientific studies and opinions at face value, without ever double-checking their origins. John Oliver criticized this phenomenon in a recent episode. Meanwhile, unabashedly partisan media sites like Breitbart and Infowars are always looking for evidence that backs up their existing points of view. Orient is now a regular commentator on both.

"Create an organization with a name that sounds official or vaguely like other credible organizations, and you’ll get people in the media taking you seriously without doing two seconds of background research into what this group actually is," says Mnookin, director of MIT's graduate program in science writing. “It’s easier than ever for them to do this because of the Internet.”

That’s even more true now that algorithms like Facebook’s are exercising their own news judgment. This month, the social media giant spread that AAPS survey claiming "most doctors" are concerned about Clinton's health. The algorithm failed to consider that the survey was of 250 of the Association's own members.

Orient acknowledges that within in the AAPS' ranks, "there are not too many people who are favorable to Mrs. Clinton." In fact, in 1993 the AAPS sued Clinton's healthcare task force. Today, its Twitter feed is awash in anti-Clinton rhetoric. So is Orient's.

Orient takes issue with the idea that the AAPS should be treated any differently than any other mainstream medical association. It does, after all, have all the trappings of one. It has an email list of roughly 5,000 and collects some $800,000 a year in membership dues. Though the group doesn't disclose a list of members, the list of officers named on its IRS filings include working physicians in private practice, such as Melinda Woofter, an Ohio-based dermatologist who serves as its president. The group has also included notable people like Senator Rand Paul, himself a physician. And it has its own medical journal, the Journal of American Physicians and Surgeons, or JPANDS.

The group may be small, but to Orient, size is irrelevant. "Truth is not a function of numbers or revenue. If we had only ten members, just enough for a minyan, would our opinions be less credible for that reason?" Orient wrote in an email, using the Hebrew word for a quorum of ten Jewish men needed to say certain prayers.

Facebook spread an AAPS survey claiming 'most doctors' are concerned about Clinton's health.

That’s valid. But the difference between the AAPS and, say, the American College of Physicians, is that while the American College of Physicians spends more than $12 million a year producing educational courses, guidelines, and assessment tools, the AAPS is almost entirely a media operation, According to its 2015 IRS filings, the group spent more than half of its roughly $900,000 in revenue on "dissemination of pertinent information" and publication of the Journal of American Physicians and Surgeons.

Orient is the only person who collects a paycheck from the AAPS, according to the group’s Form 990. An independent public relations executive, Tricia Erickson, distributes most of the group’s op-eds to media and publishes them on her own site, TheConservativePundit.net.

And while the Thomson Reuters IP & Science Journal Citation Reports, which ranks journals, lists the American College of Physicians' Annals of Internal Medicine at number 5 in the General and Internal Medicine category, the AAPS’ journal isn't listed at all. It is, however, included on an oft-cited list of “potential, possible, or probable predatory scholarly open-access journals” put out by a librarian at the University of Denver.

Of course, the AAPS is far from the only publisher on that list. But its impact is particularly potent this election, because its articles and viewpoints plug right into the dominant narrative that Trump and his followers are promoting this election cycle.

"They've written articles claiming immigrants are bringing disease and crime into the country," says David Gorski, managing editor of ScienceBasedMedicine.org, noting articles like this one which begins, "A flood of illegals has massively surged at our southwestern borders."

Symbiosis on the Internet

Then there’s the fact that Orient has never actually examined Clinton or Trump. Groups like the American Psychiatric Association have warned doctors against speculating about candidates they’ve never treated. But that hasn't stopped Orient and her colleagues from aggressively dissecting Clinton’s health through a combination of public records about Clinton’s history of blood clots and concussions, statements made by Clinton associates, and, in particular, YouTube videos.

Many of these videos are carefully edited to show Clinton purportedly having seizures on the campaign trail or losing her train of thought. Some of them have millions of views. "A lot of people have been taking videos that raise questions," Orient says. "The ones where she loses her train of thought. She has unusual head motions and eye motions, prolonged inappropriate laughter, and a state of confusion that it takes her a while to recover from."

Which videos, specifically? "Look," Orient says, "it’s all over the Internet." In her view, that makes it her job to ask questions. "Do you think Americans are supposed to turn a blind eye to the possibility that they'd be electing a commander in chief with neurologic damage precluding her ability to think clearly, who is simply used as a cover for someone unknown to decide weighty matters like war?"

What's key here is Orient's careful presenting of these ideas as questions. She stops short of diagnosing Clinton directly—she couldn't, of course, without directly examining the candidate herself. But as a physician, Orient's opinion still seems to carry weight.

And once she's talking about it, the media can, too. Because an idea is "being discussed" some outlets will inevitably use that as grounds to cover it. "That passive construction doesn't acknowledge it’s out there because media organizations are talking about it and putting it out there," Mnookin says.

Orient has not applied the same standard to Trump. Wrongly or rightly, people with medical degrees have speculated baselessly about Trump's mental state and medical records. But the AAPS has conducted no survey on Trump's fitness for the presidency, nor does it plan to. "Why would we?" Orient asks. "There are lots of polls we could do, and we didn't do. People who think Donald Trump has a psychological issue ought to do a poll."

And if they did, we're confident there are plenty of liberal-leaning publications that would eagerly write about it. That doesn't mean they should.