Drug alert: The miracle and the menace

Medication safety, self-medication and the weight-loss injection craze

Do I owe an apology to the “Julies and Juhis” for saying no to their unethical request?

By Dr Fiaz Maqbool Fazili

Perhaps I do owe them an explanation, but not an apology.

Especially to those bright, ever-curious young women who keep returning with one more question, one more argument and one more example: “But doctor, my friend takes it. Why can’t I?”

Recently, a young woman in her late twenties, attending a follow-up consultation for subclinical hypothyroidism, asked me to prescribe a weight-loss medicine. Let us call the drug “X” for the purposes of this article. It contains tirzepatide, a dual GIP and GLP-1 receptor agonist that can help manage blood sugar and reduce appetite.

“Doctor, my friend took it and it works,” she said.

It is an increasingly familiar request. A friend, influencer, gym acquaintance, social-media post or television discussion can now become an unofficial prescription.

My answer was simple: No—not without first assessing whether you actually need it.

That “no” is not denial of treatment. It is medication safety.

A medical breakthrough becomes a lifestyle accessory

Recent reporting by India Today and NDTV has highlighted the rapid expansion of demand for GLP-1 medicines such as semaglutide and tirzepatide in India, alongside concerns about unauthorised sales, promotion and suspected counterfeit products.

These developments should not create panic. They should create awareness.

Semaglutide and tirzepatide represent important advances in the treatment of diabetes and obesity. For appropriately selected patients, they can substantially improve glycaemic control, reduce appetite and produce clinically meaningful weight loss.

That is the medical breakthrough.

The problem begins when a legitimate medical breakthrough is hijacked by the cosmetic marketplace.

Weight-loss injections—and increasingly, tablets—have entered the vocabulary of cinema, fashion, hospitality, advertising and social media. For some people, appearance can influence confidence, employment opportunities, social acceptance and even perceived marital prospects.

The weighing scale consequently becomes a measure of “success”.

But the weighing scale records only one number. The human body does not.

The more important questions are:

How much fat was lost?

How much muscle was preserved?

Did strength improve or decline?

Did blood glucose, blood pressure and metabolic health improve?

Did waist circumference improve?

Can the change be maintained?

What happens after treatment is stopped?

And, ultimately, did the person actually become healthier—or simply lighter?

The goal should be healthy body composition, preserved muscle and better overall health, not merely a smaller number on the weighing scale.

“My friend takes it” is not a medical indication

Perhaps this is the most important message.

If a friend benefits from a medicine, it does not mean the same medicine is appropriate for you.

Two people may have completely different BMI, waist circumference, diabetes risk, kidney function, gallbladder history, nutritional status, other medicines, medical conditions and contraindications.

Even highly effective medicines can produce adverse effects. Depending on the drug and individual patient, these may include gastrointestinal symptoms and, more seriously, complications such as gallbladder disease, pancreatitis or kidney injury. Hypoglycaemia can also be a concern in certain treatment combinations.

This is precisely why medical assessment and monitoring matter.

The lesson is not that these medicines are inherently dangerous.

The lesson is that a medicine can be highly beneficial and still require responsible prescribing.

When should these medicines be considered?

These medicines may be appropriate when a qualified clinician determines that the patient meets accepted medical criteria and that the expected benefits outweigh the risks.

Assessment may include:

• BMI and waist circumference

• Diabetes or prediabetes status

• Blood pressure and cholesterol

• Liver and kidney health

• Existing medical conditions

• Current medicines and possible interactions

• Nutritional status

• Previous weight-management attempts

• Individual treatment goals

Medication should be part of a treatment plan—not the entire plan.

For someone without a clear medical indication who simply wants to lose a few kilograms quickly for a wedding, holiday, modelling opportunity or social event, the risk-benefit balance may be entirely different.

That is precisely why a doctor may sometimes say no.

And a responsible “no” should be followed by another sentence:

“Let us find out what you actually need.”

The prescription most people forget: muscles

Modern weight-loss culture repeatedly asks:

“Which injection should I take?”

It asks far less often:

“How will I preserve my muscle?”

Adequate protein, resistance exercise, physical activity, sleep and behavioural change are essential components of sustainable weight management, particularly when weight loss is substantial.

Losing weight is not automatically equivalent to improving health if a significant proportion of the weight lost comes from lean tissue.

The prescription should therefore include:

Protein. Resistance training. Physical activity. Sleep. Behavioural change. Metabolic monitoring. Long-term follow-up—and, where appropriate, medication.

The injection should never become the entire treatment plan.

When should you say “no”?

Say no to self-medication when:

• A friend or relative offers you their medicine.

• An influencer recommends a particular injection.

• You are buying prescription medicines through WhatsApp, Instagram or an unauthorised seller.

• You do not know whether the product is genuine.

• You are using somebody else’s prescription.

• You are increasing or changing the dose without medical advice.

• You are taking the medicine solely for rapid cosmetic weight loss.

• Nobody is monitoring your treatment.

At that point, you are entering a danger zone.

India’s regulatory authorities have intensified action against unauthorised promotion and distribution of GLP-1-based medicines. Reports of suspected counterfeit products also highlight another practical danger: even when a consumer believes they are purchasing the correct medicine, the product itself may be counterfeit, improperly stored or otherwise unsuitable.

Reports concerning product quality and recalls involving some semaglutide products also underline the importance of obtaining medicines through legitimate, regulated channels.

This does not mean that every generic medicine is unsafe. It means consumers should not assume that a medicine purchased outside legitimate channels is genuine or safe.

Treat the patient, not the trend

The fundamental principle should be simple:

Treat the patient, not the trend.

A doctor must sometimes disappoint a patient.

Patients understandably want solutions. But doctors sometimes have to provide something more valuable than what the patient requests: judgement.

A good consultation should ask:

Do you actually need this medicine?

Is it indicated for you?

What are the potential benefits and risks in your particular case?

Do you have contraindications or interacting medicines?

What will happen to your nutrition and muscle during weight loss?

How will we monitor you?

Where will you obtain the medicine?

What is the long-term plan?

Those answers should not come from a gym trainer, friend, celebrity, influencer or WhatsApp group.

They should come from a qualified healthcare professional who understands your medical history and is prepared to follow you through treatment.

Neither panic nor blind enthusiasm

The right message is neither fear nor hype.

Deaths and serious illnesses reported in connection with medicines or suspected counterfeit products deserve investigation and vigilance. But individual reports should not automatically be converted into claims that a particular medicine caused every reported death.

Conversely, dramatic weight-loss testimonials should never be treated as proof that a medicine is safe or appropriate for everyone.

Neither panic nor blind enthusiasm is medicine. Evidence is.

GLP-1-based therapies are an important advance and have legitimate roles in diabetes and obesity management. But their success has created a new temptation: to transform a prescription medicine into a lifestyle accessory.

Some medicines may also be prescribed off-label in particular circumstances, including weight management, but that does not remove the need for careful clinical judgement. Tirzepatide and semaglutide have different pharmacological profiles, indications, contraindications, precautions and potential adverse effects. Anyone considering such treatment should discuss the appropriate medicine, risks, expected benefits and monitoring requirements with a qualified clinician and review the official prescribing information.

The Kashmir connection

Perhaps this is where our familiar “Nadur Monje” analogy is useful.

Crisp, deep-fried lotus-stem fritters are deeply associated with Kashmiri culture, shrines, festivals and special occasions. They are tempting, familiar and widely available.

But something being familiar and enjoyable does not mean it should be consumed every day.

Medicines are different—and the stakes are considerably higher.

A prescription medicine is not “Nadur Monje”. It is not a piece of chocolate that we pick up simply because somebody else enjoyed it.

No apology for saying no

This is not an argument against being healthy, fit or achieving a healthy weight.

Nor is it opposition to medically supervised weight-loss treatment.

It is an argument against self-medication.

Weight-loss medicines are not simply “slim-fit”, “body-fit” or “keep-fit” products. They are medical treatments that require appropriate assessment, prescription and monitoring.

So, the next time someone says:

“Doctor, prescribe me X. My friend takes it.”

Perhaps the most compassionate answer is:

“Your friend’s treatment is your friend’s prescription. Let us first understand your health.”

And to the “Julies and Juhis of the Valley”: no apology for saying no. Only an explanation.

Because sometimes the safest prescription a doctor can write is not a drug.

It is a pause, an assessment and an informed decision.

The author is a Risk Manager and expert on healthcare standards, quality and safety.