Rehan Khan  ( Sindh Healthcare Commission, Karachi. )

This article provides multifaceted information as well as an assessment of how and why homoeopaths engage in quackery, which is neither safe, effective, or legal. The purpose of this study was to investigate the factors that influence the majority of homeopaths in Sindh to promote quackery through allopathic medical system, which is outside the boundaries of a homeopath’s practice license and competency. The study also explains why homeopathy has remained popular in Sindh, Pakistan, despite its limitations and waning popularity in the United States (USA), the United Kingdom (UK), Russia, Australia, Canada, France, Germany, Switzerland, and Spain over the last decade, based on major national clinical research studies claiming that homeopathic medicines are no more effective than a placebo.

Keywords: Homeopathy, Quackery prone homeopaths, Aiding & abetting quackery.

DOI: https://doi.org/10.47391/JPMA.6371

Submission completion date: 02-03-2022

Acceptance date: 18-08-2022

Introduction

The practice of homeopathy was more widely prevalent in the early 20th century than it was in the late 20th century.¹ Homeopathic medications were a part of mainstream medicine in almost 70 countries until many claims were made to challenge its scientific plausibility.² Contrary to co-prescription of homeopathic medicines with allopathic medicines in France, Great Britain, and some northern European countries^3-5 by allopathic physicians, a majority of homeopaths are solely prescribing allopathic medicines in Sindh, Pakistan, which is not safe for public health. Homeopathic medications are a part of mainstream medicine in many Asian countries, including Pakistan. Pakistan is among the countries where homeopathy has a legal standing and it has been integrated into the national health care system,⁶ which is a cause of concern among health professionals because homeopathy has become a contentious topic as it contradicts basic scientific concepts, such as the fact that these medicines are so highly diluted that the active ingredients are undetectable, resulting in a heated debate.⁷ In Pakistan, to get a diploma in homeopathic medical sciences (DHMS), one must undergo four years of training and then take six months of apprenticeship with a qualified homeopath, after which a candidate may be registered with the National Council for Homeopathy (NCH) in Pakistan.⁸ NCH has been among the four state health care regulatory authorities since 1965, which is also recognised by the Sindh Healthcare Commission (SHCC) Act 2013 & Regulations 2017. DHMS must be registered with the NCH in order to run a homeopathic clinic as a legitimate health care practitioner (HCP). About 70,000 homeopaths are registered with the NCH and more than 84 recognised homeopathic colleges exist in Pakistan, while 30 more colleges are awaiting recognition.⁹ In Sindh, 3,778 homeopaths were registered with NCT and 8,643 homeopaths got their registration renewed by July 2019.¹⁰ The Maharashtra government in India allowed homeopaths to practice allopathic medicine for resuscitation and life support, other drugs include sedatives, antimalarials, and antibiotics.¹¹ But in Sindh, the use of allopathic medicines by DHMS, is neither allowed by NCH nor by SHCC. Rather, it is considered a quackery practice. According to the provisions of SHCC Act 2013 & Regulations 2017, if a HCP is giving services beyond his legal scope of practices, i.e. a homeopath is doing allopathic practices and/or prescribing allopathic medicines, he/she will be considered a quack.¹² Homeopathy-quackery has been a subject of 12,200 research studies according to Google Scholars search engine (Accessed; 18-01-2022).

Herein, we would like to report the factors that influence homeopaths for prescribing allopathic medicines, based on observations and estimates made during anti-quackery drives performed in 29 districts of Sindh since the establishment of the SHCC’s anti-quackery department in 2018. Despite the fact that many developed countries, such as the United Kingdom and France, have discontinued subsidising homeopathy, homeopathy remains a regulated health profession in Pakistan. The Spanish government has prohibited universities from offering degree programmes in homeopathy.¹³ Health insurers in Germany have initiated a heated debate about ending homeopathic reimbursement.¹⁴ In 2015, the US Federal Trade Commission announced policy guidelines stating that all homeopathic medicines must either be backed up by actual scientific proof that they work or carry a label stating ‘there is no scientific evidence that the product works’.¹⁵ In 2015, an Australian medical study investigation ruled homeopathy ineffective.¹⁶ The following factors may have contributed to a homeopath’s preference for allopathic practices, which are outside their legal scope of practice and competence.

Allopathy—a practicality challenge to homeopaths: When compared to allopathy, homeopathic treatments have a number of drawbacks, including the fact that their mechanism of action is unknown because it is based on biophysics, which does not study chemical processes and transformations in live organisms in the same way that biochemistry does. In addition, many homeopathic medicines are very highly diluted, much beyond Avogadro’s number, that they cannot be examined in a laboratory. This indicates that these medicines do not contain even a single molecule of the original material chemically.¹⁷ Homeopaths are not allowed to use the title of doctor, and they require the assistance of allopathic physicians in order to recommend medical tests or investigations. As a result, in order to expedite recovery and avoid lengthy consultations, the public in Sindh appears to prefer allopathic medicines over homeopathic, which could explain why homeopaths offer injections, pain relievers, and other allopathic medicines. Homeopath’s attraction might diminish if patients do not quickly recover from their treatment. Hence, to retain their faith in patients, homeopaths venture into allopathic practices. For example, if a patient with diabetes and high blood pressure consults a homeopath, knowing that these diseases require effective drugs with accurate dose, homeopaths prefer to prescribe allopathic medications to such consultantees. During the SHCC’s anti-quackery campaigns, it was observed that homeopaths are administering Avil and Dicloran injections to their patients. The injections are used as anti-allergic and pain-relieving medication, respectively. Administration of Ringer’s lactate solution (sodium lactate solution) for fluid resuscitation by homeopaths was also observed during field visits. DAQ-SHCC has, therefore, cumulatively sealed more than 200 HCEs on similar grounds since its inception in 2018.

Allopathy—a lucrative challenge to homeopaths: Homoeopaths’ frustration begins when they are in the early phases of establishing a practice, because building a large enough client base and maintaining a consistent revenue takes time. Sindh has a higher prevalence of allopathic medicines used by homeopaths since it has become a lucrative business with maximum investment and profit potential. When homeopaths see public preferences and financial benefits in allopathy, they begin allopathic practices which, although are outside their scope of training/practice as per the provisions of the SHCC Act and Regulations,¹² are continued across the province to attract clients and to avoid being deprived of financial benefits. Homeopaths are frequently heard telling sceptical patients that no healthcare system is flawless. As a result, a combination of allopathic and homeopathic medicines may be useful in treating various illnesses; the combination also increases the patient’s resistance and immunity. To some extent, it is true to say that allopathic and homeopathic medicines can be used simultaneously because homeopathic medicines are given in ultra-highly diluted quantities and so do not interact or interfere with the pharmacokinetics and pharmacodynamics of the conventional medications.¹⁸ However, there are still some hazards, as some medicines may contain high levels of hazardous heavy metals, such as mercury and iron.¹⁹

Effect of excellence and occupational prestige of allopathy: Homeopaths who practice allopathic medicines are usually informally trained for some time under the supervision of a qualified allopathic physician to assist a doctor with dispensing medications on a doctor’s prescriptions, dressings and stitching minor injuries, and administering intravenous fluids. When they see the prestige, value, income, and social status of a doctor they decide to become doctors. Since they are not qualified to be MBBS (Bachelor of Medicine, Bachelor of Surgery) doctors, they enrol in homeopathic medical sciences colleges for diploma, which is relatively doable for them. During anti-quackery campaigns, it has frequently been noticed that quackery-prone DHMS impersonate an allopathic doctor, even utilising the “Doctor/Dr” prefix with their names on the prescription pad, despite the fact that their activities are not in the best interests of the patients.

Compounding client’s ignorance through impudence: The quacks, despite being exposed among clients by the accountable anti-quackery teams, remain popular because desperate and ignorant patients believe they are receiving good healthcare at an affordable price, despite the fact that they are visiting a quack doctor who is unqualified for the services he is providing. This attitude of the clients makes it simple for quacks to stay in business, reducing the impact of anti-quackery campaigns. Unfortunately, the public’s belief in quackery might lead to their avoiding scientifically plausible medical care from a qualified physician. Clients who are very old and ignorant are unconcerned about homeopath’s allopathic practices. They don’t care if anti-quackery teams educate patients about anti-quackery laws and the harms that homeopaths can create through their malpractices.

Simple client’s ignorance in the general population: Health care literacy raises public acceptance of a responsible institution’s intervention to prevent malpractice. The general public in Sindh is unable to distinguish between homeopaths and allopaths because homeopaths who practice allopathy never disclose their credentials. They never say that they are a “Homeopathic Clinic” or that only homeopathic remedies are prescribed. The council with which homeopaths are registered (NCH) forbids any homeopath from practising allopathy. The majority of the public is unaware of the existing anti-quackery regulations or the fact that prescribing allopathic drugs by a homeopath is considered quackery under the SHCC Act and Regulations.

The persistent popularity of homeopathy in Pakistan: Germany is known as “the birthplace of homeopathy” and India “the homeland of homeopathy”. Switzerland was the first European country, which integrated homeopathy into its state healthcare system. The popularity of homeopathic treatments is waning, according to a recent literature assessment, as state healthcare systems in Australia, France, the UK, the USA, and many other European countries have decided to exclude them from public health reimbursement plans.^4,5 In 2015, a significant Australian study examined over 1,800 research publications and concluded that homeopathy is completely ineffective.¹⁶ Despite this, homeopathy and the dispensing of homeopathic treatment is still popular in Pakistan and adjacent countries. The persistent popularity of homeopathic practices may be due to nosocomephobia (fear of hospitalisation), tomophobia (an abnormal fear of surgical procedures), and pharmacophobia (irrational fear of medicines or drugs) among the general public. Homeopaths claim to remove many ailments without surgery, which is also their selling point, to create awareness of their services and to inspire their clients for a long consultation. It has been discovered that the majority of homeopathic consultees feel that homeopathic remedies have no side effects and are persuaded of their curative abilities. Patients seek out such homeopaths because of their scientific knowledge, and homeopaths continue to do so since no one questions the scientific validity of their dubious and off-label drugs. Another factor for homeopathy’s enduring popularity is its accessibility and affordability when compared to allopathic treatment.

Conclusions

Due to a variety of reasons, quackery-prone homeopaths are deceiving the public with their illegal allopathic practice. Quack physicians profit from people’s sufferings by employing a powerful tool of desperation and ignorance, which develops in patients as a result of (1) avoiding habits such as testing and inquiring into things, and/or (2) a deliberate intent to visit a quack because they are satisfied with the services provided and pay a lower price. This study could aid accountable institutions in developing regulations by identifying grey areas that allow quacks to escape obligations such as practicing outside of the legal scope of practice of homeopaths. Pre-visit appointments—a few hours or even a day before —is a psychological ploy used by non-quackery prone homeopaths to indicate that a physician is well-known and busy at the same time since he serves several clinics.

Recommendations

The current regulatory framework for homeopathy and homeopathic products should be reviewed by the government. The Drug Regulatory Authority of Pakistan must bound pharmaceutical companies not to sell allopathic medicines (such as intravenous infusions and other antibiotics) to homeopathic clinics and/or homeopaths. Accountable institution must subtly put across its recommendation to the NCH to cancel the registration/license of those homeopaths, whose services are not in line with anti-quackery laws. Creating public awareness about relevant laws which restricts homeopaths to practice allopathy is also recommended, otherwise it will exacerbate the struggling health care system of Sindh and the community will abet these quackery practices in the future as well. Homeopathic quacks never disclose their scope of services on their name plate, displayed on the premises. They must be bound by the accountable institution to display “homeopathic clinic” on the premises and that allopathic treatments are not given.

Disclaimer: None.

Conflict of Interest: None.

Funding Sources: None.

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