Healy, D2023-08-092023-08-092022-09Healy D. Reducing medication has become a privilege of wealth in western settings. Indian Journal of Medical Ethics. 2022 Sep; 7(3): 226-2290975-56910974-8466http://imsear.searo.who.int/handle/123456789/222675In 20th century healthcare in affluent settings, generating awareness of the hazards of medication followed a rotten apple script. Find patients with a problem, find the documents that a drug company knew about the problem in private but denied it in public, mention the ghost-writing that concealed the problem and lack of access to trial data, perhaps using a clinician or an ‘insider’ to provide dramatic focus and expose the company to media or legal questioning. The sight of a rotten apple being thrown out of the barrel reassured the public that healthcare was now more ethical than before, and gave bioethicists a case example to use in teaching (1). But what if we have a whole rotten barrel as outlined in this case study? What are the ethics then?Affluent health systemssustainable treatmentmental health referralsadverse medication effectsJournal ArticleIndiaProfessor of Psychiatry, Department of Family Medicine, McMaster University, Hamilton, CANADA.