Overtreatment and Overmedication in India: Low-Value Care

The Lift Line

“However, the next stage of medical progress will come not only from discovering more tests, medicines and procedures, but also from learning when not to use them.” (Dr. Chandrakant Lahariya, The Hindu)

Why This Editorial Matters for Your Exam

This Lead article in The Hindu of 14 October 2026 is a signed column by Dr. Chandrakant Lahariya, a practising physician and the author of Pill-Free: You Don’t Need Everything You Have Been Prescribed (2026). It is his argument, not the paper’s view, and his new book is on the same theme, so weigh the case on its evidence.

His claim: India’s health system is tempted to overtreat and overmedicate, through a chain of tests, diagnoses and prescriptions, even as many people still get too little care. He names five drivers and five remedies.

Most GS2 health questions ask about access and spending, the “too little” half. This piece gives you the other half: too much care, why it happens and how to curb it, with a ready GS4 angle on professional ethics and restraint. For background, Lahariya wrote in the Hindustan Times on 2 September about unnecessary surgeries, using gallbladder removal as the tracer; this Lead widens the argument from surgery to tests and medicines.

GS Paper 2: Issues relating to the development and management of social sector services relating to health. GS Paper 4: Ethical concerns and dilemmas in government and private institutions; the professional ethics of doctors and hospitals.

Background and Context

What “overtreatment” means here

Lahariya describes a chain, not a single pill:

1. A test detects an incidental abnormality.
2. That leads to another test, then a diagnosis.
3. Then a prescription that may become permanent. What begins as prevention can end in long-term medication or surgery.

Two words carry the argument. Polypharmacy is the use of many medicines at once; the 2025 study below quotes the World Health Organization’s definition, “the administration of many drugs at the same time or the administration of an excessive number of drugs”. Deprescribing is the planned reduction or stopping of medicines that are no longer needed.

The evidence Lahariya cites

Read the numbers carefully. They come from different studies with different settings and definitions, so one does not confirm the other, and neither measures how much overtreatment exists in India. Lahariya himself cautions: “These figures do not mean that everyone taking several medicines is being overtreated.” His inference is that medication reviews and deprescribing must become routine.

The global movement: Choosing Wisely

The ABIM Foundation’s Choosing Wisely campaign began in 2012 with nine national specialty societies, representing 375,000 clinicians, offering 45 examples of tests or treatments that were commonly used in their fields but lacked strong supporting evidence. By the campaign’s own count, it engaged 80+ specialty society partners and produced 700+ recommendations (lists it no longer maintains on its site), and has reached 30+ countries and has inspired more than two dozen similar campaigns in other countries.

Where this sits in India’s health spending (background)

The column does not cite spending data, but the National Health Accounts (NHA) estimates for 2022-23, prepared by the National Health Accounts Technical Secretariat at the National Health Systems Resource Centre (NHSRC), Ministry of Health and Family Welfare, show who pays for care:

The GDP shares use the new GDP series with base year 2022-23. Two readings matter. Households pay almost as much as the government does, and the OOPE share rose in 2022-23 after a long fall. Where families pay so much themselves, an unnecessary test or medicine is usually a cost they bear, and the same purse must cover the care they genuinely need.

The legal anchors (background)

• Article 47 (Part IV, Directive Principles of State Policy): the State shall regard “the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties”. A Directive Principle guides policy but is not enforceable in a court.
• Clinical Establishments (Registration and Regulation) Act, 2010: passed by Parliament on 17 August 2010 to register and regulate clinical establishments, prescribing minimum standards of facilities and services so that the mandate of Article 47 may be achieved. Notified on 28 February 2012, it came into force on 1 March 2012 in Arunachal Pradesh, Himachal Pradesh, Mizoram, Sikkim and all Union Territories except Delhi. Other States, among them Uttar Pradesh, Rajasthan, Bihar, Jharkhand, Uttarakhand and Assam, adopted it under Article 252(1).
• Jacob Mathew v State of Punjab (Supreme Court, 5 August 2005): the Court drew a clear distinction between “simple lack of care”, which incurs civil liability, and the “very high degree of negligence” required in criminal cases. It saw a need to protect doctors “from frivolous or unjust prosecutions” and directed that the investigating officer obtain “an independent and competent medical opinion preferably from a doctor in government service” before proceeding against a doctor. This is the legal backdrop to Lahariya’s fifth driver, defensive medicine.

The Analysis

Lahariya’s argument runs from the problem, to five drivers, to five remedies.

1. More capable, more tempted. Tests detect illness earlier, scans reveal invisible abnormalities and procedures can save lives within minutes. Yet the same system that can do more is “increasingly tempted to overtreat and overmedicate”.

2. Too much and too little at once. In India, overtreatment coexists with undertreatment: unnecessary interventions are offered to some, while many others still lack essential primary care, affordable medicines and timely treatment.

3. Driver one: excessive testing. Screening and diagnostic tests, used without need, set off a “cascade of care”. He cites the 2016 review in the National Medical Journal of India on routine health-check packages. His line: “The truth is that the ability to test has expanded faster than our ability to decide who actually needs testing.”

4. Driver two: fragmented, specialist-first care. A person with a common problem often goes straight to a specialist or superspecialist; a person with chronic conditions may consult several, each optimising one part of care. “The patient is treated in parts, while the human body does not live in specialties.” This matters particularly in older adults, which is where he places the polypharmacy figures.

5. Driver three: health care as a marketplace. Tests, scans, procedures, supplements and monitoring devices have become products to be sold, sometimes “products in search of potential customers”. Much of Indian health care runs on a fee-for-service model, “which can reward activity rather than restraint”, and many patients feel a consultation is complete only when several medicines and investigations are prescribed. Health insurance, he adds, is a proven route to financial protection but can create ex-ante and ex-post moral hazards, discouraging preventive care and pushing hospitals and patients towards costlier interventions. Years of premiums are no reason to recover the money through an unnecessary procedure.

6. Driver four: patient expectations. Worried people want certainty and something tangible after a consultation. Reassurance can look like inaction, observation can feel inferior to a scan, and lifestyle advice can seem less serious than medication. In crowded clinics, where explanation takes time, doctors may give in to these expectations.

7. Driver five: defensive medicine. Fearing a missed rare diagnosis, a clinician may see another test as the safer option. But every test carries risks, both from the test itself and from finding abnormalities that may never have caused harm.

8. A global problem. Overtreatment was first widely recognised in high-income countries and is now visible across many middle-income nations. That gave rise to Choosing Wisely; between 2012 and 2023, Lahariya notes, specialty societies worldwide published hundreds of recommendations naming tests and treatments that clinicians and patients should question. His reading: medicine “requires stronger mechanisms for self-correction”, and the fix needs individuals, communities, professional societies and policymakers alike.

9. The five remedies.

He closes on incentives: “A health-care system should not make it financially easier to order a scan than to explain thoughtfully why that scan may be unnecessary.” Good medicine acts when action helps; in an age of medical abundance, he argues, it increasingly requires restraint.

Data and Institutions Vault

Prelims-grade facts:

The evidence on older adults:

• Frontiers in Pharmacology, 2021: meta-analysis of Indian studies of adults aged 60+; polypharmacy about 49%, hyperpolypharmacy 31%, PIM use 28%.
• Definitions in that review: polypharmacy is 5 to 9 medicines taken together; hyperpolypharmacy is 10 or more.
• Scientific Reports, 2025: 600 adults aged 60+ in six Indian cities; 33.7% on five or more daily medicines; 28.8% prescribed at least one PIM (STOPP criteria).
• National Medical Journal of India, 2016: review of routine health-check packages; some tests unwarranted, risking false positives and overtreatment.

Campaigns and institutions:

• Choosing Wisely (ABIM Foundation): began in 2012 with nine specialty societies and 45 examples.
• By its own count, Choosing Wisely engaged 80+ society partners and produced 700+ recommendations.
• ICMR: Lahariya wants it, with professional societies, to develop Indian lists of low-value tests, treatments and procedures.

Law and money (background):

• Article 47 (Part IV, Directive Principles): improvement of public health is among the State’s primary duties.
• Clinical Establishments Act, 2010: passed 17 August 2010; in force from 1 March 2012; other States adopt it under Article 252(1).
• Jacob Mathew v State of Punjab (2005): criminal liability of a doctor needs a “very high degree of negligence”; independent medical opinion first.
• NHA 2022-23: OOPE 43.41% of THE and GHE 43.72%; the OOPE share rose from 39.4% in 2021-22.

⚠️ Watch the trap: The 49% and 33.7% figures come from different studies with different definitions (5 to 9 medicines in the review; five or more in the field study), and both measure polypharmacy in older adults, not overtreatment in India as a whole. Article 47 is a Directive Principle, not a Fundamental Right. Indian low-value care lists are Lahariya’s recommendation, not existing policy. And the OOPE share rose in 2022-23; it did not keep falling.

The Debate

Lahariya’s case. Medicine’s power to test and treat has outgrown its habit of asking whether a test or treatment is needed. Incentives (fee-for-service, insurance moral hazard, marketed packages), habits (specialist-first care, patients who expect a prescription) and fear (defensive medicine) all push the same way. The cost falls on the patient’s body, not only the purse, and older adults on many medicines are particularly exposed. Restraint has to be built into the system: a family physician who sees the whole person, prescriptions that expire unless renewed, national lists of low-value care, informed patients and payment for outcomes.

The other side.

• Undertreatment is the bigger gap for many. Lahariya concedes that overtreatment coexists with undertreatment. With households paying 43.41% of health spending out of pocket, a message of restraint must not reach people who already delay needed care, or give insurers and hospitals a cover to deny it.
• Tests save lives too. Early detection is one of medicine’s real gains. The line between a useful screen and a wasteful one differs by age, risk and setting, which is why lists must be evidence-based and Indian, not borrowed.
• Defensive medicine has causes outside the clinic. The Supreme Court in Jacob Mathew noted that many complainants use criminal process “as a tool for pressurizing the medical professional”. Doctors who fear complaints will keep ordering the extra test unless the legal and grievance system also changes.
• Autonomy cuts both ways. Patients may want the scan. Restraint must come through explanation and shared decisions, not paternalism.
• Weigh the evidence and the messenger. The figures cited measure polypharmacy, not the scale of overtreatment, and the author has a book on the subject. Neither point weakens the logic, but an answer should not overstate the data.

The balanced verdict. The goal is right care: neither too much nor too little. Restraint works best where it is built into the structure (primary care, prescription reviews, professional guidance and payment) rather than left to the individual doctor’s courage in a crowded clinic, and where it travels with public investment that closes the undertreatment gap.

How to Think About This

Use a “cascade” lens. Ask at each step of the chain (test, incidental finding, more tests, diagnosis, prescription) who gains, who decides and who bears the risk. Lahariya’s five drivers are the forces that push a patient down that chain; his five remedies are brakes placed at different points: the family physician at the entry, the review date on the prescription, the low-value list in the hospital, the four questions in the consulting room and the payment system behind them all.

For GS4, map the debate onto four principles of medical ethics. Beneficence: act when action helps. Non-maleficence: every test carries risk, so avoid harm from care that is not needed. Autonomy: the four patient questions are informed consent in practice. Justice: money spent on low-value care for some is money not spent on essential care for others. An answer that names the principle, gives the example and proposes the fix will stand out.

Diagram-in-Words

Takeaway Box

• Core idea: modern medicine is increasingly tempted to overtreat and overmedicate; the next stage of progress is learning when not to act, Lahariya argues.
• Know the evidence: polypharmacy about 49% of older adults (meta-analysis, 2021); 33.7% on five or more medicines and 28.8% with at least one PIM (six-city study, 2025).
• Know the drivers: excessive testing; specialist-first, fragmented care; the marketplace and fee-for-service; patient expectations; defensive medicine.
• Know the remedies: the family physician first; review and stop dates; Indian low-value care lists (societies and ICMR); four patient questions; pay for outcomes.
• Mains use: GS2 health services and financing; GS4 professional ethics, restraint and patient autonomy.

Revision Flowchart

Sources: The Hindu, Lead article by Dr. Chandrakant Lahariya, 14 October 2026; Honnekeri B et al., National Medical Journal of India, 2016; Bhagavathula AS et al., Frontiers in Pharmacology, 2021; Das S et al., Scientific Reports, 2025; Choosing Wisely, ABIM Foundation; National Health Accounts Estimates for India 2022-23, NHSRC; Constitution of India, Legislative Department; Operational Guidelines, Clinical Establishments Act, MoHFW; Jacob Mathew v State of Punjab, Supreme Court, 5 August 2005

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