The conceptual stretching of "direct-to-consumer" in healthcare
What happens when a term meant to clarify gets extended
It’s just semantics, they say.
But semantics matter — especially when the words we use are supposed to help us understand how an industry is changing.
I’ve been studying the direct-to-consumer (DTC) healthcare phenomenon for ~seven years now. And something I’ve been noticing (and quietly griping about) is how the term “direct-to-consumer” is being applied more and more freely, to the point where I’ve lost track of what we’re even talking about anymore.
As someone who finds ambiguity to be fascinating (and deeply frustrating lol), I want to take a little detour into the linguistic and sociological nuances here before getting into why this matters for healthcare and where it leaves us.
Everything is nothing, nothing is everything
What I’m noticing is that DTC is being used in multiple, related but distinct ways in healthcare…and to me, that feels like conceptual stretching in action.
Conceptual stretching happens when people start applying a concept to increasingly different cases, while keeping the same label, weakening its precision and usefulness in the process.
I find that conceptual stretching is most often discussed in political science. For instance, a common example is calling many different kinds of regimes “democracies,” even when they share little beyond holding elections. The term stops being analytically useful because it covers such divergent realities.
That seems to be what’s happening with DTC in healthcare. The term started as a way to describe a specific kind of business model innovation: bypassing traditional intermediaries to engage consumers directly. But now it’s being applied to many models where the business mechanics actually diverge — hence, conceptual stretching.
So when everything is DTC, nothing really is.
It reminds me of how the term digital transformation expanded — DTC in healthcare is becoming polysemous as it gets stretched to describe models that share little more than being consumer-facing.
Word sense disambiguation
I really like this point from Anna Wexler’s work on DIY medicine: the use of a modifier (like DIY or DTC) conveys that there is some departure from the norm. In healthcare, DTC is supposed to tell you that this isn’t the way healthcare traditionally works.
But not all departures are the same. Bypassing insurance is different from bypassing doctors is different from bypassing brick-and-mortar retail. And putting all of those moves under the same label—DTC—obscures what’s actually going on.
The growing polysemy and conceptual stretching of DTC in healthcare has created a situation where we’re now performing word sense disambiguation to figure out what version of “direct-to-consumer” someone means in a given context. And the more stretched the concept becomes, the harder it is to disambiguate, and the more room there is for misunderstanding, misrepresentation, or just confusion.
Why I am pressed about it
You might wonder: does it really matter if DTC is being conceptually stretched?
I think so, and here’s why. From an analytical/research perspective, if the term is stretched to cover many different phenomena, it becomes harder to use it to actually describe or analyze anything. If DTC can mean a cash-pay telehealth platform, a hospital’s marketing campaign, or an OTC medication, then it ceases to clearly identify a specific business innovation. It’s hard to compare “DTC models in healthcare” if they don’t share core characteristics.
The fuzziness also has regulatory implications. DTC telehealth and DTC in pharma raise distinct regulatory issues. If the term is used imprecisely, then it makes oversight and rule-making more difficult.
And, of course, it creates confusion. When someone says “we’re a DTC healthcare company,” do they mean that they are bypassing insurers? Bypassing physicians? Marketing to consumers directly but billing insurance? Simply have a consumer-facing brand?
Depicting the stretching
Okay, so now some examples of how the term has been applied in healthcare:
DTC 1: Pharmaceutical advertising. This is probably the earliest use, where companies marketed directly to patients – think TV ads telling you to “ask your doctor.” Here, the consumer is still dependent on the physician and the traditional healthcare system to actually access the product.
DTC 2: Retail products. A relatively clean example of DTC came with selling glasses directly to consumers, bypassing intermediaries – Warby Parker being the archetype. Here, the company removed both the traditional retail storefront and much of the provider relationship.
DTC 3: Online prescriptions and telehealth. Over time, we began to see prescriptions offered online, initially for lower-acuity conditions like ED or hair loss. At first, this was more about online prescribing than telehealth, but during the pandemic it evolved into comprehensive telehealth platforms. These models vary in whether they accept insurance or operate purely as cash-pay services.
DTC 4: Pharma-owned distribution. More recently, we’ve seen pharmaceutical companies themselves launching direct channels to patients, like LillyDirect and NovoCare – but even these two diverge from each other in how they handle fulfillment and payment.
DTC 5: Over-the-counter products. OTC drugs can be retroactively labeled as DTC, even though they predate the term. They bypass a prescription entirely but are still embedded in traditional retail ecosystems.
DTC 6: Health systems going “DTC.” And now, even hospitals have adopted the label, as with Rush Health offering a cash-pay monthly telehealth subscription embedded within a traditional health system.
What unites these examples is the idea of engaging consumers directly. But the business mechanics, level of disintermediation, and implications are widely different.
Catch-alls
If, once, the idea of direct-to-consumer was useful in terms of describing a genuine business model innovation that bypassed intermediaries to engage consumers directly, it has now been stretched so far it risks becoming meaningless.
That doesn’t diminish the very real innovation happening. A lot of what we’re seeing doesn’t fit neatly into existing categories – so people stick it into this bucket.
But to understand these innovations properly, we need more precision in how we talk about it.
What do you think? Have you seen other examples of DTC in healthcare being stretched? Or are you comfortable with the ambiguity and see it as just part of how language evolves?
A good read