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SHORT COMMUNICATION
A derivation of factors influencing homeopaths to promote quackery in SindhRehan Khan
Abstract
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.6371Submission 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
Sindh Healthcare Commission, Karachi, Pakistan.
Correspondence: Rehan Khan. e-mail: rehanhej@gmail.com
ORCID ID. 0000-0002-9771-7117
Vol. 73, No. 2, February 2023
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
Open Access378
‘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
Open Access
R. Khan
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
J Pak Med Assoc379
A derivation of factors influencing homeopaths to promote quackery in .......
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
Vol. 73, No. 2, February 2023
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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