Opinion Medicines can reach you in the blink of an eye. For India’s health, this is bad news
The Drugs and Cosmetics Act restricts the sale of medicines without a licence and prohibits the distribution of misbranded, adulterated, or spurious drugs. Yet these safeguards are routinely bypassed in the digital space
Not only do e-pharmacies require robust legal regulation, but doctors working within these systems also need a clear framework of rights and responsibilities. (Image source: Wikimedia Commons) When my father was a young trainee doctor, with a full head of hair and an abundance of optimism, he often imagined a future where doctors would outnumber patients. In that world, doctors would wander through narrow lanes and cramped neighbourhoods, pushing carts laden with medicines and vaccines like vegetable vendors, loudly calling out to customers. Today, as he stands at the fag end of his medical practice, a version of his dream is coming to life — though not in the way he had envisioned. The pushcart has merely taken on a new form — that of a quick-commerce platform.
Recently, a post on X has created a furore within the medical fraternity. The user applauded the quick-commerce platform Blinkit for coming to her rescue after she fell ill twice in a month. When she failed to produce a prescription, she was connected to a general physician, and a bottle of an “antibiotic tonic” was promptly added to her cart.
In select locations in Bangalore, Blinkit is rolling out a pilot programme where now, users can purchase prescription medicines too, not just over-the-counter drugs. Blinkit is currently advertising a free doctor consultation after ordering from its pharmacy. Quick and hassle-free. For ordinary people, pulled in all directions by the stresses of modern life, a quick fix for every problem appears almost necessary. When time itself has become currency, why endure long, tortuous, sweaty queues outside a doctor’s clinic?
Yet, there are facts that this user may not have fully considered. What troubles me deeply as a primary care physician is the casual prescription of antibiotics where none are indicated. When young interns come to me for training, this is among the very first lessons I emphasise. Many of them view antibiotics as “strong” or superior drugs, the prescription of which gives them the assurance of having been to a “real doctor”. This perception is widespread and deeply ingrained. Data reflect this reality starkly: In 2019, India recorded an average of 412 outpatient antibiotic prescriptions per 1,000 persons per year, and another study found that 76.3 per cent of antibiotic prescriptions across primary and secondary health centres were unneeded.
Closely linked to this is the habit of overprescribing medicines that treat symptoms rather than the disease. In the absence of diagnostic confidence, doctors resort to blanket symptomatic treatment, believing it is safer to treat everything than to risk missing something. E-commerce platforms that promise instant consultations and immediate medicine delivery unquestionably further normalise this method of treatment by lowering the threshold for prescription and removing the pause for clinical reconsideration.
Patients, too, contribute to this cycle. Non-pharmacological measures such as steam inhalation or supportive treatment with paracetamol or antihistamines seem too commonplace to count as “real” therapy. Antibiotics, on the other hand, are seen as magic bullets — something that must be prescribed if the patient has made the effort to consult a doctor. Ironically, the drugs are often abandoned as soon as patients feel better, without completing the prescribed course. This behaviour has fuelled the enormous burden of antimicrobial resistance in the country. A recent Lancet study reported that antibiotic resistance levels in India exceed 83 per cent, among the highest globally, with 23.5 per cent resistance noted even to carbapenems — a last-line antibiotic. This is yet another issue that requires careful counselling.
As a community physician, I have come to appreciate the value of counselling more than any other aspect of care. Patients frequently approach me with the complaint that their doctor did not listen to them. Evidence consistently shows that proper counselling improves medication adherence, enhances symptom control, and reduces complications. Its importance assumes much higher proportions in non-communicable diseases such as diabetes and hypertension, where lifestyle modification is as critical as pharmacotherapy. I often encounter patients on three or four classes of drugs and still uncontrolled levels of disease because no one has explained the role of diet, exercise, and long-term behaviour change to them clearly. Counselling demands time, continuity, and accountability — qualities that sit uneasily within a model built on speed, scale, and instant delivery.
Violations of Schedule H and X restrictions, the risk of counterfeit medicines, uncontrolled access to habit-forming drugs, and the breakdown of the doctor–patient–pharmacist relationship remain serious dangers posed by e-pharmacies. At present, e-pharmacies operate in a legal grey zone. The Drugs and Cosmetics Act (1940), the accompanying 1945 Rules, the Pharmacy Act (1948), the Indian Medical Council Act (1956), and the Information Technology Act (2000) collectively regulate the manufacture, storage, and sale of medicines were not drafted with e-commerce with regard to medicines in mind.
The law is clear on several points: Under Section 42 of the Pharmacy Act, only a registered pharmacist may dispense medicines, and violations carry criminal penalties. The Drugs and Cosmetics Act restricts the sale of medicines without a licence and prohibits the distribution of misbranded, adulterated, or spurious drugs. Pharmacists are not permitted to substitute brands, alter dosages, refill prescriptions beyond authorised limits, or dispense narcotics and psychotropics without strict record-keeping. Yet these safeguards are routinely bypassed in the digital space.
Not only do e-pharmacies require robust legal regulation, but doctors working within these systems also need a clear framework of rights and responsibilities. Physicians employed in such “approve-and-go” models operate under immense pressure — working against time, incentivised by cost-cutting, and expected to manage hundreds of consultations rapidly. This environment encourages quick, superficial decision-making and, at times, the prescription of more expensive or unnecessary drugs.
This is not to suggest that telemedicine and e-pharmacies are without merit. India represents one of the fastest-growing markets in this sector, and these platforms undoubtedly improve accessibility and affordability. They reduce waiting times, allow price comparisons, and offer a degree of transparency previously unavailable. However, these benefits can only be reaped if supported by a strong regulatory framework that prioritises patient safety, ethical prescription, and professional accountability.
Gupta is a doctor and writer
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