i hope this help ease your concerns.
Btw, if i got this total wrong and you did not want to know about click fraud. could a mod delete this so i dont look stupid. lol, god bless censorship!
My campaigns average about 1.1 ctr and when I scan them sometimes I see a 0.0 or 0.1. I know something screwy is going on.
Typically it is the content ads getting pounded with 100's of thousands of impressions where on a normal day they would get maybe 10,000 imps.
Sometimes the imps are associated with more clicks and sometimes they are not. I've contacted G about it but no satisfaction from them.
I typically turnoff content on that campaign for the rest of the day.
Of the 50 or so subjects I campaign for it seems only about 7 have this problem on a recurring basis.
And, I've been struck my impression fraud myself... there are sites out there running what amount to 'content' ads, but they're logged as 'search.' (Opted-out of content; ad found through navigation on third part site - no search executed; dropped CTR from 5%+ to less than 0.1%).
Plus, remember - impression fraud doesn't come without a click penalty... although very few clicks in relation to the impressions, conversion does drop as a result of these impressions. The fraud isn't free.