Chandrakant Lahariya | India Is Both Overmedicated and Massively Undertreated

India has a peculiar healthcare problem. Some people are getting too much medicine, while others are not getting enough. In one part of the country, patients are being over-tested, over-scanned, over-supplemented and over-prescribed. In another, millions still struggle to obtain a basic consultation, a blood pressure check, a timely diagnosis or an essential medicine. One India is drowning in medical intervention. The other is waiting for it.

Consider two patients. The first lives in a large city and visits a private hospital because he feels tired. A battery of tests is ordered. Vitamin D is low, uric acid is slightly high, cholesterol is borderline, and several numbers are highlighted in red. Within days, he has acquired new diagnoses, new tablets, supplements and advice to repeat the tests in a few months. The second patient lives in a small town or village. His blood pressure has been high for years, but nobody has monitored it regularly. Diabetes is diagnosed late. Medicines are taken intermittently because they are not always available or follow-up is difficult. He reaches a hospital only when a stroke, kidney problem or another serious complication occurs. Both patients are victims of the same health system. One receives more medicine than he may need. The other receives less than he certainly needs.

This is one of the central paradoxes of Indian healthcare today. Half the problem is overtreatment and the other half is undertreatment. In urban India, healthcare is increasingly driven by the assumption that more must be better. More tests appear to mean greater thoroughness. More scans suggest greater caution. More medicines create the impression of more active treatment. But good medicine has never been about doing the maximum. It is about doing what is necessary.

Not every abnormal number is a disease. Not every disease requires an immediate drug. And not every prescription makes a person healthier. A raised uric acid level is not the same as gout. A low vitamin D result does not automatically make someone ill. A single cholesterol value cannot define cardiovascular risk. Age, blood pressure, diabetes, smoking, family history, body weight and physical activity all matter. Clinical decisions must be made by looking at the whole person, not one number printed in bold on a report.

Yet medicine is becoming increasingly report-centred rather than patient-centred. The patient may say, “I feel perfectly well”, while the laboratory report says that one value is outside the normal range. Too often, the number wins. That is how overdiagnosis begins. One test leads to another. A minor abnormality gets a medical label. The label generates a prescription. The prescription then continues for months or years, sometimes without anyone asking whether it was necessary in the first place.

This is not harmless. Unnecessary medicines can cause side-effects. Excessive testing can generate false-positive results and incidental findings. Scans may detect abnormalities that would never have caused disease but now trigger anxiety, repeated investigations and even procedures. Costs rise, worry increases and a healthy person starts living like a patient. More healthcare is not always better healthcare.

But move away from the better-served pockets of the country and the picture changes dramatically. Primary care remains uneven. Hypertension often goes undetected or poorly controlled. Diabetes is diagnosed late. Pregnant women, older people and those living with chronic illnesses may not get regular follow-up. Mental health services remain thin. In many areas, even uninterrupted access to essential medicines cannot be taken for granted.

The contradiction is extraordinary. In one city, a person may be undergoing a third MRI for a minor complaint, while somewhere else another person has never had his blood pressure measured properly. One family spends thousands of rupees every month on vitamins, protein powders and supplements of questionable value. Another struggles to obtain one inexpensive medicine that could prevent a stroke. These are not two separate health problems. They arise from the same failure to ask a simple question: Who needs what?

The solution is not merely more hospitals, more machines and more specialists. India needs stronger primary healthcare and greater emphasis on clinical judgement. We need doctors who see people rather than laboratory panels; clinicians who know when to investigate, when to wait, when to advise lifestyle change and when specialist intervention is genuinely necessary.

We also need to restore the distinction between fast medicine and slow medicine. Fast medicine saves lives. A heart attack, stroke, severe infection, major trauma or another emergency demands quick decisions and aggressive treatment. But every medical problem is not an emergency. Borderline cholesterol, mildly raised uric acid, age-related changes and minor abnormalities without symptoms often allow time. Diet can be improved. Weight can be reduced. Physical activity can increase. Sleep, smoking, alcohol use and stress can be addressed. The patient can be observed before another pill is added.

Good medicine does not always mean doing something. Sometimes it means deliberately not doing something unnecessary. Not prescribing an antibiotic for a viral infection is good medicine. Not ordering an MRI for uncomplicated back pain can be good medicine. Not recommending a supplement simply because a laboratory value is outside a reference range can also be good medicine.

But restraint should never become neglect. If a person genuinely needs antihypertensive treatment, it should not be delayed. Diabetes should be diagnosed and treated properly. Vaccines should reach those who need them. Serious symptoms should be investigated promptly. India, therefore, has to fight two battles at once: unnecessary medicine for some and inadequate medicine for others.

Citizens need to understand that every test is not useful, every supplement is not beneficial and every abnormal report does not demand a tablet. At the same time, the health system must ensure that people who genuinely need care receive timely diagnosis, affordable treatment and essential medicines.

The problem is not medicine. The problem is medicine without proportion. When a necessary drug is unavailable, healthcare has failed. When an unnecessary drug is prescribed, healthcare has also failed. The real goal is neither more medicine nor less medicine. It is the right medicine, for the right person, at the right time. India does not need a healthcare system that treats more. It needs one that treats it better.

Chandrakant Lahariya is a practising physician and author of the book, Pill-Free: You Don’t Need Everything You Have Been Prescribed.