Should homeopaths be allowed to prescribe allopathic drugs? Maharashtra course raises questions

Three decades after becoming a homeopathic doctor, Tundilal Katre went back to medical school in December 2016 to study conventional western medicine, popularly known as allopathy. Katre runs a private clinic in Jamkhandi, a village of 2,200 people in Maharashtra’s Gondia district. “I was a villager and everyone advised me to become a doctor,” he said. “I didn’t know much and secured admission in a diploma course in homeopathy in medicine and surgery.” He ended up with a sense of regret at his decision to study homeopathy.

So when the Maharashtra government in August2014 gave in to the long-standing demand of homeopathic doctors that they be allowed to practice allopathy, Katre did not miss the opportunity. He became one of 700 homeopaths in the state to enrol in a year-long bridge course that would train them to prescribe a limited number of allopathic drugs like antibiotics, antimalarials, sedatives and drugs used for resuscitation and life support. Such training is already part of the undergraduate degree course for ayurvedic doctors.

Having completed the bridge course, Katre says he is now more confident about giving his patients a range of medicines. “I always prescribed paracetamol but now I know about the complications it can cause if given in certain conditions,” he said. The medicine is a common drug for fever and pain.

Sanctioned by the Maharashtra University of Health Sciences, the bridge course started in December 2016 and is open to registered homeopathic practitioners. No other Indian state offers such a course.

On December 29, Union Health Minister JP Nadda introduced the National Medical Commission Bill, 2017, with a provision for sanctioning bridge courses for homeopaths like the one in Maharashtra. But the Union cabinet removed the provision on March 28 after it sparked much debate among the medical community and was soundly criticised by the Indian Medical Association, the national association of practitioners of modern medicine.

Despite the removal of the provision, the debate continues as the Bill does not stop state governments from starting bridge courses. Pointing out that the amendment to the Bill does not specifically ban bridge courses, the director of the Directorate of Medical Education and Research in Maharashtra, Dr Praveen Shingare, said, “We have decided to continue with the course in Maharashtra. Many state governments want to have a course similar to ours.”

Boost to rural healthcare

Homeopathy practitioners say the bridge course will simply formalise existing practice. Many of them say that even now, allopathic doctors hire them as assistants and informally train them in allopathy. “Homeopaths work in private hospitals under a MBBS doctor and eventually learn allopathy,” said Katre. “It is for the benefit of these doctors that homeopaths like us get trained in allopathy.”

Katre also said the bridge course would not create any conflict between the two branches of medical practitioners, pointing out that the course has trained him to prescribe allopathic drugs but not to handle emergencies.

Many public health activists have also welcomed the bridge course. They say that since homeopaths and ayurvedic doctors are already prescribing allopathic drugs in small clinics that are hard to regulate, it is better to train them to do so. “There is no doubt that there are fewer or no MBBS doctors in villages,” said Dr Anant Phadke, co-convenor of the Jan Arogya Abhiyan, a people’s health movement. “A rigorous bridge course which allows a non-MBBS doctor to prescribe a limited number of allopathic drugs will help address the public health challenge in India.”

‘It encourages quackery’

Allopathic doctors disagree. In their view, allowing homeopaths to practice allopathy will encourage quackery. “A quack is someone who prescribes drugs without having any knowledge about it,” said Dr S Utture, president of the Maharashtra Medical Council. “Homeopaths are prescribing allopathic drugs on the basis of a certificate course, which is quackery.”

The basic qualification required to be registered under the Maharashtra Medical Council is an MBBS or Bachelor in Medicine and Surgery degree. “It is a violation of the MCI [Medical Council of India] Act if homeopaths start treating patients with allopathic drugs,” said Utture. The council has refused to register homeopaths. But the Maharashtra government has assured them that they can practice allopathy despite the Council’s objections.

The Indian Medical Association, too, has moved the Bombay High Court challenging Maharashtra’s decision to have the bridge course.

End of homeopathy?

Meanwhile, there is a section of homeopaths who are conflicted about the benefits of practising allopathy and are against the bridge course.

The Indian Institute of Homeopathic Physicians wrote to the Health Ministry last month urging it not to introduce the bridge course. “Doctors should practice the stream of medicine they have been trained in,” said Dr Ravinder Kochhar, the institute’s national secretary general and a homeopath from Punjab.

Kochhar disagreed with the government’s reasoning that training homeopaths in allopathic medicine can help solve India’s rural healthcare crisis, and said the government should instead “devise ways that allow allopathic doctors to serve in rural areas”.

Kochhar also said members of the institute are of the view that allowing such cross-pathy will eventually kill homeopathy in India. “We have seen this happen to ayurveda in Punjab,” the homeopath said. “Once the government allowed ayurvedic doctors to use allopathy, no ayurvedic doctor practices ayurveda. They don’t know the science anymore.”

‘We are xerox, they are original’

The homeopaths keen to be trained in allopathic pharmacology have their own reasons for enrolling in the bridge course. Dr Anupama Bhagwat, 50, who took the course in Solapur last year, said, “I never prescribed allopathic drugs and even today, I treat all my patients with homeopathy. I did the course to gain knowledge and understand the notes of other doctors my patients have gone to in the past.”

But Bhagwat is now considering prescribing allopathic drugs to her patients. “If a patient is taking homeopathy treatment from me for a skin condition and she has an episode of cough and cold, I should be able to treat her for that also,” she explained. “I cannot send her to another doctor for that.”

For some, it all boils down to survival, since homeopathy is not as popular as allopathy. “When I passed out from college, I wanted to practice homeopathy but for my bread and butter, I started allopathy,” said Dr Abhinandan Shah, who completed the bridge course at the age of 58. “I have little time left to practice and I am a popular doctor in my locality but I still decided to do the course and understand the science well.”

Whatever their reasons for taking the course, one worry remains. As Katre put it, the course may have taught him about allopathy but “at the end, we are xerox, they are original”.