Summary
In an op-ed in The Hindu on 14 October 2026, physician Chandrakant Lahariya argued that Indian healthcare increasingly overtreats and overmedicates some patients even as many others go without basic care. He identified five drivers: excessive testing, fragmented specialist care, fee-for-service payment and insurance incentives, patient expectations and defensive medicine.
He cited research showing polypharmacy in about 49 percent of older Indians and potentially inappropriate medicines in 28.8 percent of cases in one 2025 study. He proposed five reforms, including review and stop dates on prescriptions and Indian lists of low-value care.
This Ethics column places the reader in the doctor's chair. Restraint is a clinical virtue that the system penalises. The duty of non-maleficence - first, do no harm - should prevail, even though choosing it costs revenue, reassurance and legal comfort.
WHY IT MATTERS FOR UPSC & STATE PCS
A Hindu op-ed published on 14 October 2026 by physician and author Chandrakant Lahariya highlighted overtreatment and polypharmacy in Indian healthcare. It called for deprescribing, stronger primary care, India-specific lists of low-value care and payment systems that reward outcomes rather than volume.
Standard News
Restraint Is a Clinical Virtue the System Does Not Reward Imagine a
busy outpatient clinic. Your next patient is a man in his seventies, carrying a bag of medicines prescribed over the years by a cardiologist, a diabetologist, an orthopaedic surgeon and a neurologist. Each specialist looked after one organ.
No one has looked at the whole list. You suspect several of these medicines are now doing more harm than good. Reviewing them properly, explaining your reasoning and following up will take time. It will not earn you more.
And when you tell him you plan to stop some medicines, he may think you have given up on him.
Why doing more is the easy choice The easy answer would be to renew the prescriptions and move on.
Everything in the system nudges that way.
- Payment: Much of Indian healthcare runs on a fee-for-service model, which rewards activity - tests, procedures, prescriptions - rather than restraint.
- Insurance: Insurance can create moral hazard, encouraging costlier care that the patient does not pay for directly.
- Fear: Defensive medicine pushes doctors to order extra tests so they can never be accused of missing something rare.
- Expectation: Many patients feel a consultation is incomplete without a prescription. Reassurance can look like doing nothing. That is why a conscientious doctor might hesitate. The pressures are real and some of them come from the patient.
Why restraint is still the duty The evidence on harm is growing.
In his Hindu op-ed, physician Chandrakant Lahariya cites research showing polypharmacy in about 49 percent of older Indians. A 2025 study found about a third of older adults on five or more medicines, with potentially inappropriate medicines in 28.8 percent of cases.
Each extra medicine adds risks of side effects and drug interactions. Every unnecessary test can uncover harmless abnormalities that trigger more tests and new diagnoses. The core principle of medicine is non-maleficence: first, do no harm.
Treatment that adds risk without adding benefit violates it, however well-intentioned. The cost of ignoring this is not hypothetical. Around 2012-13, investigations found that private hospitals had performed unnecessary hysterectomies on poor women under the government's RSBY health insurance scheme, to claim payouts.
That is overtreatment at its most extreme: the patient's body used as a source of revenue.
The decision Review the list.
Stop the medicines whose risks now outweigh their benefits and give the rest a review date. Explain to the patient why less can be better and write your reasoning down. This costs something real. You lose income and time. The patient may feel less reassured. And without a "safety" test on file, you give up some legal comfort.
Quick Facts
Key numbers & takeaways — revise these first
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A 2021 meta-analysis in Frontiers in Pharmacology found polypharmacy in about 49 percent of older adults in India.
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A 2025 study in Scientific Reports found about one-third of older Indians taking five or more prescribed medicines, with potentially inappropriate medicines in 28.8 percent of cases.
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A 2016 review in the National Medical Journal of India found that routine health-check packages often include unwarranted tests.
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Polypharmacy usually means taking five or more medicines at the same time.
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The Choosing Wisely campaign began in 2012; by 2023, nearly 80 specialty societies had issued close to 700 recommendations on tests and treatments to question.
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Lahariya proposed that every prescription carry a review date and, where appropriate, a stop date.
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He proposed that ICMR and professional societies develop Indian lists of low-value tests and treatments.
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Investigations around 2012-13 found unnecessary hysterectomies performed on poor women under the RSBY health insurance scheme.
Connect the dots for your UPSC preparation.
Standard news covers the event. Log in to read our comprehensive analysis and uncover the hidden constitutional, structural, and ethical dimensions of this topic:
The full dilemma from the doctor's chair, naming exactly what is lost by restraint - income, the patient's reassurance and legal cover - and what is lost by doing more.
How non-maleficence, Kant's principle of treating persons as ends and virtue ethics each apply to this specific choice.
The RSBY hysterectomy case in depth, as the extreme end of a payment system that rewards volume.
A defended resolution with concrete practices: review and stop dates, structured medication reviews and documented reasoning in place of defensive tests.
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