About National Culture Fund:

• It was set up as a Trust on 28th November, 1996 under the Charitable Endowment Act, 1890.
• Objectives of National Culture Fund:
  • To administer and apply the Fund for conservation, maintenance, promotion, protection, preservation and up-gradation of monuments protected or otherwise;
  • To impart training and facilitate development of a cadre of specialists and cultural administrators
  • To facilitate in providing additional space in existing museums & construct new museums to accommodate or create new & special galleries.
  • Documentation of cultural expressions and forms that have lost their relevance in contemporary scenario and are either fading out or facing extinction.
• Governance of National Culture Fund:
  • It is managed and administered through a Governing Council chaired by the Hon’ble Minister of Culture and has a maximum strength of 25 members to decide the policies.
  • An Executive Committee headed by Secretary (Culture) and has a maximum strength of 11 Members, to execute those policies.
• Benefits to donor: Donations to the National Culture Fund are eligible for 100% tax benefit under Section 80G (ii) of the Income Tax Act, 1961.
• NCF’s activities are covered under Schedule VII No. (v) of the Companies Act, 2013 as valid receptacle of Corporate Social Responsibility (CSR) contribution under:
  • Protection of national heritage, art and culture including restoration of buildings and sites of historical importance and works of art; setting up public libraries; promotion and development of traditional arts and handicrafts.”
• Contribution to NCF: It can receive donations from Corporates, PSUs, Trusts and Individuals for maintenance and preservation of Centrally Protected monuments/ cultural projects through NCF.

Why in news?

Polyfluoroalkyl substances (PFAS) — commonly called “forever chemicals” — have been found in water sources across multiple Indian states, yet India’s water treatment systems and regulatory framework remain ill-equipped to detect or remove them.

With no PFAS-specific drinking-water limit currently in place, this emerging contamination issue carries significant public health and policy implications.

What’s in Today’s Article?

• What Are PFAS?
• Health Concerns: What We Know
• Evidence of Contamination Across India
• Why Treatment Systems Are Failing?
• India’s Regulatory Response: Work in Progress

What Are PFAS?

• PFAS are synthetic chemical compounds containing multiple carbon-fluorine bonds.
• Used widely in coatings, textiles, and industrial products.
• Notorious for resisting degradation — they can contaminate the environment for decades, earning the “forever chemicals” label.
• PFAS have existed for 60 years, yet regulation has lagged behind their spread.

Health Concerns: What We Know?

• In 2025, the International Agency for Research on Cancer (IARC) classified:
  • Perfluorooctanoic acid (PFOA) as “carcinogenic to humans.”
  • Perfluorooctanesulfonic acid (PFOS) as “possibly carcinogenic to humans.”
• Important caveat: Merely detecting PFAS in water doesn’t indicate health risk by itself — risk depends on the type of PFAS, dose, duration, and route of exposure.
  • A February 2026 study found that a mix of 24 PFAS compounds delayed zebrafish egg hatching, inhibited offspring growth, accumulated in blood, and reduced heart rates — raising concerns about broader ecological and health impacts.

Evidence of Contamination Across India

• A 2025 review in the Journal of Hazardous Materials Advances examined monitoring across Gujarat, Maharashtra, Tamil Nadu, and West Bengal.
• Key finding: PFAS contamination is a “legitimate concern,” but its national extent remains poorly defined — partly due to inconsistent testing and analysis methods across research groups.
• IIT-Madras Study (2024)
  • Analysed 14 water samples (2022–23) from groundwater, surface water, and four stages of a water treatment plant.
  • Groundwater near garbage dumps showed the highest PFAS levels.
  • Startling finding: PFAS concentrations were 5% to 103% HIGHER in treated water than raw water — suggesting treatment processes may convert unidentified precursors into more stable PFAS.
  • Researchers noted the 8 target PFAS tested represent only a fraction of potentially diverse fluorinated compounds present — broader testing beyond fixed lists is needed.

Why Treatment Systems Are Failing?

• Conventional biological wastewater treatment cannot remove PFAS.
• Adsorption-based treatment shows potential but low-cost materials for PFAS capture are still under development.
• Testing against a fixed list of PFAS risks missing undetected substances, since precursors can transform into other PFAS over time.
• High-resolution mass spectrometry can help identify PFAS beyond fixed lists, but requires care since PFAS can contaminate samples during collection/analysis itself.

India’s Regulatory Response: Work in Progress

• The Union Environment Ministry has confirmed there is no specific regulation banning PFAS manufacturing.
• India has no PFAS-specific drinking-water limit under the current IS 10500:2012 standard — though this standard is under revision.
• The Bureau of Indian Standards (BIS) has formed a dedicated Working Group on Emerging Contaminants and Forever Chemicals to examine PFAS limits.
• Scope and specific PFAS to be regulated have not yet been finalised; analytical testing methods are also under consideration.
• CSIR-Indian Institute of Toxicology Research (IITR), Lucknow is participating in a UNEP-funded National Implementation Plan to build baseline PFAS data, and has developed capability to detect 50 multi-class PFAS molecules.

Conclusion

India’s PFAS problem is a textbook case of regulation lagging behind contamination. Multiple independent studies have already flagged forever chemicals in groundwater, treated water, and coastal sewage, yet no enforceable drinking-water limit exists, and conventional treatment plants may even be inadvertently creating more stable PFAS compounds.

With global health agencies now classifying key PFAS as carcinogenic, experts agree that waiting for complete exposure data before acting is no longer a defensible position — India needs precautionary interim limits, harmonised testing standards, and a clear accountability framework, well before full contamination mapping is complete.

Why in news?

Speaking at the Bloomberg New Economy Forum 2026 in New Delhi, PM Modi positioned India as a “steady pillar” in a world roiled by conflict and uncertainty.

He declared that India’s reforms stem from conviction, not compulsion, and that the country’s confidence is at an “unprecedented high.” His remarks came against the backdrop of strong growth data and global recognition of India’s economic resilience.

What’s in Today’s Article?

• India’s Economic Momentum
• Key Highlights of PM Modi’s Speech

India’s Economic Momentum

• India’s GDP growth stood at 7.8% in April-June, which PM said “rests on a strong foundation.”
• Recently, the IMF raised India’s GDP growth forecast for 2026-27 to 7% (up from 6.4% in July), citing “stronger-than-expected momentum” backed by resilient domestic demand and robust services activity.
• Last week, the RBI also raised its own growth projection to 7.1%.

Key Highlights of PM Modi’s Speech

• Key Economic Indicators Cited
  • Current account deficit: fell from over 4% of GDP (12-13 years ago) to just 0.61% last year.
  • Foreign exchange reserves: now exceed $700 billion.
  • Banking system: in its strongest position in decades.
  • These strengths have led to sovereign rating upgrades for India.
• Reforms Are Our Conviction, Not Compulsion
  • PM Modi listed India’s major structural reforms as evidence of a deliberate, sustained policy direction:
    • Goods and Services Tax (GST).
    • Insolvency and Bankruptcy Code.
    • Consolidation of 29 labour laws into four labour codes.
    • Decriminalisation of hundreds of minor business-related offences.
  • He termed this continuing momentum India’s “Reform Express,” emphasising: “For us, reforms are not a compulsion. Reforms are our conviction.”
• The Global Challenge: A Crisis of Trust
  • PM identified trust as the defining challenge of the current global moment, warning that things that once connected the world are now being turned into weapons.
  • Key concerns he raised:
    • Supply chains, energy, minerals, payment systems, and technology are increasingly becoming instruments of pressure and dominance.
    • Routes created by decades of globalisation have, in many cases, become chokepoints.
    • Artificial Intelligence (AI) is simultaneously transforming every sector.
    • Many countries face growing challenges from ageing populations.
• India’s Response: “Power to Empower”
• PM Modi framed India’s global engagement through the philosophy of “power to empower” — using its capabilities to benefit the world, not just itself.
• Examples Cited:
  • Affordable and generic medicines supplied globally.
  • Digital identity and payment solutions (referencing India’s digital public infrastructure, e.g., Aadhaar, UPI).
  • Skilled youth and a talent pool supporting global industry.
  • Over 2,000 Global Capability Centres (GCCs) in India providing services to companies worldwide.
• COVID-19 Vaccine Example: During the pandemic, India faced the question of whether vaccine manufacturing benefits would stay confined to a few countries.
  • India “chose the path of empowering humanity,” supplying vaccines to more than 100 countries — turning its manufacturing capability into a source of assistance for other nations.
• AI Impact Summit Reference: Modi noted that India’s AI summit discussed not just AI for humanity, but even how animals could benefit from AI — reinforcing his point: “the more capable and stronger India becomes, the more beneficial it will be for humanity and the world.”
• Governance Philosophy: Empowerment Over Dependency
  • PM extended this philosophy to domestic governance, stating that government authority should not be used to make citizens dependent on the system, but rather to make them capable and empowered.
  • Following this approach, India has lifted 250 million people out of poverty over the past decade — a number greater than the population of many countries in the world.
  • He also noted that India does not confine its capabilities within its own borders, but shares them with the Global South and partner countries, creating wider opportunities for innovation and new talent.

Conclusion

PM Modi’s address framed India’s economic rise not as an isolated national achievement, but as a contribution to global stability at a time when trust between nations is under strain.

By linking strong macroeconomic indicators, sustained structural reforms, and a deliberate philosophy of “power to empower,” he projected India as both a reliable economic partner and a responsible global actor — one that grows, in his words, “with the world, and for the world,” rather than at anyone’s expense.

Context:

• India-US ties are facing intense scrutiny following the US’s recent announcement suspending the Permanent Labour Certification (PERM) programme for eight global IT companies — including Indian-headquartered firms: Infosys, Tata Consultancy Services (TCS), Wipro, Cognizant, and HCL.
• Washington accused these companies of misusing immigration and labour-certification systems.
• In this context, this article argues this episode is not isolated, but part of a broader pattern of American pressure and unilateralism that India must now firmly resist.

The PERM Suspension: What Happened?

• PERM allows tech companies to hire non-US professionals, serving as a step toward employer-sponsored green cards.
• As per the US government, the named companies had received over 2,30,000 H-1B visa approvals and more than 1,00,000 permanent labour certifications since 2009.
• Indian professionals account for over 70% of approved H-1B petitions annually — making this suspension disproportionately impactful for India.
• This follows a broader pattern of ill-treatment and racist incidents against Indians in the US, straining bilateral relations further.

Trade Ties: A Visible Source of Discord

• Three key friction points define the trade relationship:
  • Trade Surplus Imbalance: India recorded a $33.8 billion trade surplus in bilateral trade exceeding $140 billion in FY 2025-26.
  • Agricultural Market Access: The US seeks entry into India’s dairy and agriculture sectors — a politically sensitive concession India cannot afford to make.
  • Russian Oil Imports: India has refused to halt these despite additional US tariffs and sanctions.
• Despite a February 2026 framework for an interim reciprocal trade agreement, tensions persist.
• Finance Minister Nirmala Sitharaman recently noted that trade negotiations have “plateaued,” with little room for compromise.

Defence Cooperation: Agreements Without Delivery

• Defence has been a key pillar of the relationship, but the critics argue its substance lags its symbolism:
  • Since 2002, India has acquired over $22 billion worth of American military hardware — yet meaningful co-production and technology transfer remain elusive.
  • During PM Modi’s February 2025 Washington visit, the US agreed to expand defence sales/co-production, including Javelin anti-tank guided missiles and Stryker infantry combat vehicles.
  • The two nations signed a 10-year Framework for the US-India Major Defence Partnership in October 2025.
  • However, prolonged delays in supplying GE F404 engines for India’s Tejas fighter aircraft expose the risks of foreign supply-chain dependence.
  • Despite the India-US Defence Acceleration Ecosystem (INDUS-X) (launched 2023), real co-development and tech transfer remain limited.

The Pakistan Factor

• Pakistan remains a politically sensitive irritant:
  • Since Operation Sindoor (May 2025), President Trump’s repeated claims of having “ended” the India-Pakistan conflict have irked India, though New Delhi has avoided direct confrontation.
  • The US’s courting of Pakistan’s military leadership, particularly Chief of Defence Forces Asim Munir, is a major concern.
  • The Mecca Pact between Saudi Arabia, Pakistan, and Türkiye — reportedly backed by Washington — has raised further security concerns for India.

Technology Cooperation: Promises on Paper

• The 2008 India-US civil nuclear agreement was historic, but its promise of American-designed nuclear reactors in India remains largely unrealised.
• The Initiative on Critical and Emerging Technology (iCET) (launched 2023) aimed to deepen cooperation in AI, semiconductors, defence innovation, and space — but much remains undelivered.
• The India-US TRUST Initiative (Transforming the Relationship Utilizing Strategic Technology), signed in February 2025, similarly raised hopes that remain largely unfulfilled.
• Core challenge: Translating declarations into measurable outcomes.

The Core Argument: Need for Mutual Respect

• India-US relations are entering a phase where India’s strategic restraint and accommodation are increasingly met with American pressure, unilateralism, and disregard for India’s interests.
• Analysts argue that ties between “the world’s oldest democracy and the world’s largest democracy” can only flourish through equality, respect, and trust — not unilateral imposition of will.
• EAM S. Jaishankar’s observation that the US is “deliberately becoming a lonelier power” is cited as potentially carrying deeper significance about shifting global alignments.

Conclusion

• The PERM suspension is less a standalone dispute than a symptom of a deeper pattern — one where repeated US actions on trade, defence, Pakistan, and technology reveal a transactional, often one-sided approach to a relationship both sides call strategic.
• For India, the message is clear: genuine partnership cannot be built on accommodation alone.
• As New Delhi navigates this phase, its challenge will be converting strategic restraint into strategic leverage, ensuring that mutual respect — not unilateral pressure — defines the terms of engagement going forward.

Why in the News?

• The Supreme Court’s recent directions concerning alleged illegal detentions and restrictions on movement during protests in Delhi have renewed debate over preventive detention, prohibitory orders and constitutional freedoms.

What’s in Today’s Article?

• Preventive Detention (Meaning & Legal Framework, Evolution, Constitutional Safeguards, Judicial Precedents, Reforms, Way Forward)

Meaning and Legal Framework of Preventive Detention

• Preventive detention refers to the detention of a person without a criminal trial or conviction, with the objective of preventing an anticipated offence or threat rather than punishing a past act.
• In India, preventive detention may be invoked on grounds relating to public order, national security and other legally specified concerns.
• The National Security Act (NSA), 1980, permits preventive detention where the statutory conditions are met, including when a person’s activities are considered prejudicial to the defence of India, relations with foreign powers or the security of the State.
• Preventive detention is an exceptional power because it restricts personal liberty without the ordinary process of criminal prosecution and conviction.

Preventive Detention and Prohibitory Orders

• Preventive detention and prohibitory orders are distinct legal mechanisms, although both aim to prevent potential harm.
• Preventive detention

• Involves the detention of an individual to prevent anticipated threats.
• Operates under specific preventive detention laws, such as the NSA.
• Is subject to constitutional safeguards and judicial review.

• Prohibitory orders under Section 163 of the BNSS
  • Section 163 of the Bharatiya Nagarik Suraksha Sanhita (BNSS), 2023, substantially retains the approach of former Section 144 of the Code of Criminal Procedure, 1973.
  • It empowers designated Executive Magistrates to issue urgent orders where immediate prevention or a speedy remedy is necessary to avert obstruction, danger to human life or safety, disturbance of public tranquillity, riots or similar threats.
  • Such orders may be issued without prior notice where urgency warrants it, but must state the material facts supporting the decision. They are subject to judicial scrutiny and should be proportionate to the threat involved.
• Key distinction: Preventive detention restricts an individual's liberty through detention, whereas a prohibitory order regulates conduct or movement to prevent an imminent threat.

Evolution of Preventive Detention in India

• Colonial period: Laws such as the Rowlatt Act, 1919, and the Defence of India Act, 1939, enabled detention without trial and were used against political opponents and freedom fighters.
• Post-Independence: The Preventive Detention Act, 1950, remained in force until 1969.
• Emergency period: The Maintenance of Internal Security Act (MISA), 1971, expanded detention powers and was widely used during the Emergency of 1975-77 before being repealed in 1978.
• Subsequent framework: The NSA, 1980, established a continuing framework for preventive detention, while the Conservation of Foreign Exchange and Prevention of Smuggling Activities Act (COFEPOSA), 1974, authorised detention for specified purposes.

• Judicial interpretation has increasingly emphasised the protection of personal liberty. In Maneka Gandhi v. Union of India (1978), the Supreme Court held that procedures restricting personal liberty must be just, fair and reasonable.

Constitutional Safeguards Against Arbitrary Detention

• Article 22(4): A person generally cannot be detained under a preventive detention law for more than three months without the constitutionally prescribed Advisory Board review, subject to applicable exceptions and conditions.
• Article 22(5): The detaining authority must communicate the grounds of detention as soon as possible and provide an opportunity to make a representation against the order.
• Judicial review: Courts can examine whether detention orders comply with statutory requirements and constitutional safeguards.
• Fundamental rights: Articles 14, 19 and 21 protect equality before the law, specified freedoms and life and personal liberty, respectively.

Judicial Pronouncements on Preventive Powers

• Babulal Parate v. State of Maharashtra (1961): The Court upheld the constitutional validity of the predecessor to Section 163 BNSS while emphasising that such powers must operate within legal limits.
• Khudiram Das v. State of West Bengal (1975): The Court highlighted the importance of communicating detention grounds, enabling representations and checking arbitrary executive action.
• Ramlila Maidan incident (2012): The Court stressed that prohibitory powers should be used in grave circumstances requiring immediate intervention.
• Mazdoor Kisan Shakti Sangathan v. Union of India (2018): The Court rejected a blanket ban on protests at Jantar Mantar and emphasised regulation rather than complete prohibition.
• Shaik Naznen v. State of Telangana (2022): The Court observed that preventive detention powers are exceptional and cannot be exercised routinely.
• Ameena Begum v. State of Telangana (2023): The Court underscored the importance of enforcing constitutional safeguards under Articles 14, 19 and 21.

Reform Priorities and the Way Forward

• A constitutional approach to preventive detention requires a balance between security imperatives and individual freedom.

• Strict necessity: Detention and prohibitory powers should be used only when legally justified and necessary to address the relevant threat.
• Procedural compliance: Authorities must communicate grounds, facilitate representations and comply with statutory requirements.
• Effective judicial oversight: Courts should scrutinise detention orders and restrictions for legality, procedural fairness and proportionality.
• Protection of peaceful protest: Authorities should regulate assemblies where necessary rather than impose blanket restrictions without adequate justification.
• Accountability and transparency: Clear reasons for restrictions and effective review mechanisms can reduce the risk of arbitrary action.

Context:

• India’s Corporate Social Responsibility (CSR) law has created a major source of private-sector development finance.
• Since its introduction, the framework has mobilised substantial corporate funding for education, healthcare, livelihoods and other social priorities.
• The next challenge is to move beyond expenditure-based compliance towards equitable distribution, strategic collaboration and measurable developmental outcomes.

CSR in India - Achievements and Significance:

• Legal framework: Under Section 135 of the Companies Act, 2013, eligible companies are required to spend at least 2% of their average net profits of the three immediately preceding financial years on CSR.
• Applicability: Companies meeting any one of the following thresholds are covered - net worth of ₹500 crore or more, turnover of ₹1,000 crore or more, and net profit of ₹5 crore or more.
• Resource mobilisation: India mobilised approximately ₹2.6 lakh crore in CSR funds over a decade. In 2024–25, annual expenditure reached ₹40,794 crore, with 29,500 companies supporting around 72,000 projects.
• Developmental contribution: CSR has emerged as a significant source of supplementary funding for social development, demonstrating the potential of corporate participation in nation-building.

Key Challenges in CSR Implementation:

• Geographical concentration:
  • CSR funds tend to flow towards states with a greater concentration of corporate headquarters and industrial activity.
  • Maharashtra received ₹8,631 crore, Gujarat ₹4,549 crore, Karnataka ₹3,395 crore and Delhi ₹2,753 crore in 2024–25.
  • This concentration may leave regions with greater developmental deficits relatively underfunded.
  • Corporate location can become a stronger determinant of fund allocation than the actual needs of underserved communities.
• Fragmentation of projects:
  • The large number of CSR projects reflects widespread corporate participation but may also result in fragmented, repetitive and short-term interventions.
  • Isolated projects may generate immediate benefits without addressing structural problems.
  • Lack of coordination can lead to duplication of efforts and underutilisation of collective resources.
  • The central question is whether individual projects collectively produce measurable improvements in development indicators.
• Expenditure versus outcomes:
  • CSR accountability often focuses on the amount spent rather than the lasting change created.
  • Financial compliance alone cannot establish whether interventions have improved learning outcomes, healthcare access, livelihoods or community resilience.
  • Differences in project objectives and impact-assessment methods also make comparisons difficult.

Reforms for the Next Decade of CSR:

• Shift towards outcome-based accountability:
  • Supplement expenditure reporting with measurable output, outcome and impact indicators.
  • Standardise assessment methodologies to improve comparability, transparency and accountability.
  • Conduct credible impact evaluations to identify effective interventions and enable evidence-based decision-making.
• Promote collaborative and long-term investments:
  • Encourage companies to pool funds and expertise around common development priorities and geographical areas.
  • Develop district-level or sector-specific interventions supported by shared objectives and results frameworks.
  • Move from scattered projects towards integrated programmes addressing systemic challenges in education, health, agriculture and livelihoods.
• Align CSR with corporate competencies:
  • Companies should contribute not only financial resources but also their technical knowledge, professional networks and managerial expertise.
  • Agricultural and food-processing companies, for instance, can support farmer productivity, value-chain development and climate-resilient agriculture.
  • Such alignment can improve implementation quality, scalability and the long-term sustainability of interventions.
• Ensure equitable and complementary development:
  • Give greater attention to underserved regions and communities with significant development gaps.
  • Use needs-based planning to complement corporate priorities with local development requirements.
  • Strengthen coordination with public institutions without allowing CSR to replace the government's primary responsibility for public expenditure and welfare delivery.

Conclusion:

• India's CSR experiment has demonstrated that corporate regulation can mobilise substantial private capital for public good.
• Its next phase must focus not merely on how much companies spend, but on how effectively their contributions improve people's lives.
• India should build a strategic CSR ecosystem based on evidence, collaboration and long-term impact, complementing public expenditure, and strengthening inclusive development.
• This will also demonstrate that corporate profitability and social responsibility can reinforce each other.

Context

• Modern medicine has achieved remarkable progress in early diagnosis, disease prevention and life-saving treatment.
• However, technological advances have also encouraged overtreatment and overmedication, exposing patients to unnecessary tests, procedures and prolonged medication.
• In India, this problem coexists with under-treatment, as many people still lack essential primary care, affordable medicines and timely treatment.
• The challenge is to ensure that medical interventions meet genuine patient needs rather than commercial interests or misplaced expectations.

Health Packages and Tests

• Unnecessary Testing and Overdiagnosis
  • The expansion of diagnostic technology has increased testing without always improving clinical decisions.
  • A 2016 review in the National Medical Journal of India found that routine health-check packages often include unnecessary tests, leading to false-positive results, anxiety, overdiagnosis and unnecessary treatment.
  • Incidental abnormalities can trigger further investigations and interventions that offer limited benefits.
• Fragmentation of Health Care
  • India's excessive reliance on specialist and super-specialist services can result in duplicated investigations, conflicting prescriptions and poor coordination.
  • Patients with chronic conditions may consult several specialists who treat individual diseases without considering overall health.
  • Integrated and coordinated care is essential to prevent unnecessary interventions.
• Polypharmacy Among Older Adults
  • Polypharmacy refers to the use of multiple medicines, commonly five or more simultaneously.
  • A 2021 review reported polypharmacy in approximately 49% of older adults in the Indian studies examined.
  • A 2025 study found that roughly one-third of older adults took five or more prescribed medicines, with potentially inappropriate medicines identified in 28.8% of cases.
  • Although multiple medicines may be necessary, inappropriate prescribing increases the risks of adverse reactions and drug interactions.
  • Regular medication reviews and deprescribing can help discontinue unnecessary medicines safely.
• Commercialisation of Health Care
  • India's fee-for-service model may encourage additional tests and procedures because providers earn revenue from the services delivered.
  • Patients may also expect prescriptions or investigations after every consultation.
  • Health insurance offers financial protection but can encourage unnecessary expenditure when patients or providers favour costly interventions because another party bears the immediate financial burden.
  • Such moral hazard can increase waste, although patients continue to bear the physical risks.
• Patient Expectations and Defensive Medicine
  • Patients often associate scans and medicines with effective treatment, while reassurance and lifestyle advice may appear inadequate.
  • Doctors working under time pressure may respond to these expectations.
  • Defensive medicine also encourages unnecessary testing when clinicians fear missing rare diagnoses or facing legal consequences.
  • However, tests can produce false-positive results, anxiety and further unnecessary procedures.

Choosing Wisely Movement

• The international Choosing Wisely movement promotes informed decisions about medical tests and treatments.
• Between 2012 and 2023, nearly 80 specialty societies worldwide published close to 700 recommendations identifying interventions that clinicians and patients should question.
• The movement emphasises that good medicine requires appropriate treatment rather than simply more treatment.
• Addressing overmedicalisation requires cooperation among patients, doctors, professional organisations, hospitals, insurers and policymakers.

Objectives of Choosing Wisely Movement

• Strengthen Primary Care and Family Medicine
  • India must strengthen accessible and affordable primary health care and restore the family physician as the first point of contact for non-emergency needs.
  • General physicians can coordinate treatment, reconcile prescriptions and refer patients to specialists when necessary, reducing duplicate investigations and excessive medication.
• Make Prescription Reviews Routine
  • Every prescription should include a review date and, where appropriate, a stop date.
  • Older adults and patients taking five or more medicines should undergo structured reviews assessing effectiveness, interactions, duplication and opportunities for safe deprescribing.

The Path Forward for India

• Identify Low-Value Medical Interventions
  • The Indian Council of Medical Research (ICMR) and professional medical societies should develop India-specific lists of low-value tests, treatments and procedures.
  • These recommendations should be integrated into medical education, accreditation and hospital quality-improvement programmes.
  • Hospitals should assess not only whether necessary treatment was provided but also whether unnecessary interventions were avoided.
• Empower Patients Through Informed Decisions
  • Patients should participate actively in medical decisions by asking four questions:
    • Why do I need this test or treatment?
    • What happens if I wait?
    • What are its benefits and risks?
    • What alternatives are available?
    • Shared decision-making improves communication and helps patients make informed choices.
• Reform Payment and Insurance Systems
  • Payment systems and insurance policies should reward clinical outcomes, continuity of care and appropriate treatment, rather than the volume of services provided.
  • Financial incentives should encourage preventive care and thoughtful clinical judgement.

Conclusion

• Medical progress must improve health outcomes without exposing patients to avoidable harm.
• India needs stronger primary care, evidence-based guidelines, regular medication reviews and informed patients to balance undertreatment with overtreatment.
• Ultimately, good medicine requires action when it helps and restraint when it does not.
• Recognising when not to test, prescribe or operate is essential to building a safer, more affordable and equitable health-care system.