March 2010|Vol 7|Issue 3

March 2010 | Volume 7 | Issue 3



Forum
 
Dispensing Homoeopathic Medicines Needs Quality Assurance?
 
“Homoeo Times” in association with Homoeopathic Medical Association of India, Karnataka state branch organized a forum on “Dispensing Homoeopathic Medicines Needs Quality Assurance?” at Kaveri Hall, Malleswaram Association Club , Bangalore on 17th Jan 2010. Dr.M.R.Srivatsan moderated the forum and Dr.B.T.Rudresh, Dr.Veerabramhasary, Dr.Ramdass, Dr.H.D.Manjunath Kumar were the panelists. We are giving few excerpts from the forum
  Dr. Srivatsan: …we have a very interesting subject for discussion as you are all aware of the topic it is “Dispensing homoeopathic medicine whether it needs quality assurance”. There might be a lot of ideas moving into your system and has to say what exactly this is, what the kind of quality to give and what the discussions has to be done on this topic. . So we will start with the discussion. Now the most important question which arises over here is “Whether homoeopathic medicines are dispensed according to homoeopathic principles?”

Dr. Ramdass: In period of time, there are two things whether it is based on Hahnemann’s concept of dispensing the medicines or the subsequent unison taken place that has taken as over many methods of dispensing the medicine which is standard that is question number one. And if you purely go by Hahnemann’s concept of dispensing he used to prepare the medicine and put only one pill of the drug under the tongue of the patient. That was the concept. I don’t think that is being followed that is to say if is purely Hahnemannian method of dispensing the medicine. I think few people still do that but I’m not sure whether it is widely practiced. It is questionable and whether it is equally efficient that is again questionable. Over a period of time I think the thing again come for discussion.

Dr. Srivatsan: Thank you doctor. Now certain points we have got out of this question whether the homoeopathic medicines are dispensed according to the principles. Now the point is Dr Ramdass is clear. He was telling that single dose and it has to be packed in sugar of milk. This is what explained to us during our studies. And I would like to throw some details about how the homoeopathic medicines have been dispensed all over the world. How many ways and methods it is been dispensed. Here we are talking only how it is been dispensed. Now let me just read out some of modes in which we have been giving these homoeopathic medicines, we are packing these homoeopathic medicines to the patients.

As you all are aware that many doctors they give it as dilution itself, they will ask them to take in drop dose mixed in water or directly. So it is the dilution which we call it as liquid form and many of them still put the sugar of milk, then put the pills on it or the globules and then they pack it. So those packets have been given. Some of them put it in the glass vials or plastic vials and some of them put it in the diskets or tablets. Some triturate the medicine and then give. Some of them put it in the distilled water, then liniments, ointments, oils and few of them seen in Kerela where they administered homoeopathic medicines through olfactory that is inhalation I would like to ask Dr Ramdass to kindly enlighten the audience as to how this homoeopathic medicines have been dispensed in liquid forum and what method have been used and what is the efficacy of it?

Dr. Ramdass: This has originated right from Hahnemann’s time. If you go back to history where he initially started with dispensing of medicine in watery doses where he mentioned about the plussing methods. Of course I’m sure that you all are aware about the advantages of plussing method. Each of us has an experience especially in those cases where the susceptibility requires an elevation, a stimulation or where the patient is highly sensitive like in idiosyncracy cases, where you expect there is an aggravation, the plussing system of method is more helpful. This is one of the commonest thing that is been used. And the other concept that has come across is the dilution system. Dilution is not the same as the plussing system. In plussing system what we normally do, we prepare the solution. Let us say 4 spoonful of water; out of that take 2 teasspoonful add 8 to that and sake it thoroughly. So that it is a succession which gives rise to a higher potency. That is a plussing method whereas in dilution you take 2 teaspoonful, add to another 2. Take 2 from that and add another 2, where there is no question of succession. See again the concept of succession and the trituration, are the 2 process which increase the potency. This is not exactly what the increase in potency, this is just a dilution where the sensitivity of individual is taken care off. These are the 2 major concepts in which the liquid dispensing is carried out.

Dr. Srivastan: Dr B T Rudresh I would like to ask you about dispensing homoeopathic medicines on globules or diskets or tablets. What is your view on this?

  Dr. B.T. Rudresh: I think that is the most appropriate approach of dispensing medicines through globules or diskets or through our lactose or any other sugarcane powder. I think that is the most appropriate way of giving it. Because the first thing is, if I say plussing method and I give it in alcohol or in the dilution method, in liquid form we need more medicine. We need to keep on moving. Suppose if I see 100 patients a day for everybody you should have one more, two more or three more and they should go on doing it. I think instead of that, according to me whatever the mode you take universal application is fine. Bit for me it looks like to give it in globules, or give it in diskets or give it in lactose powder mixed together is more prevail in the society as we have seen atleast. With all other homoeopaths wherever we have seen atleast they have given their powders along with the globules or diskets.

Homoeopathy means it is been I think projected as globules in a vial. I mean that’s what we have seen even as symbolic way, even as told to us also from the time of students. But then it changed I think some people started giving it in diskets. For example I dispense my medicines with diskets, easy to dispense, easy to take, easy to tell, take one tablet at a time, three times a day. And all the people who now atleast even in urban area or rural areas they are more used to take tablets, they are more used to that. So if we tell take three times a day for three days I think that would suffice more, take one pill a day.

But unfortunate thing is what public aspires? Or what public feels is that there is no uniformity as far as dispensing homoeopathic medicines is concerned. Everybody feels because somebody dispenses it in lactose powder, somebody gives it in vials. I still feel dispensing homoeopathic medicines either in globules or in diskets, according to me it is more viable.

Dr. Srivastan: So out of your experience soaking it on the diskets the efficacy is not lost?

Dr. B.T. Rudresh: No. According to me it is not lost. Even when you are transferring it into the diskets, which I do regularly, I think i have seen. That has worked wonders.

Dr. Srivastan: Thank you Dr. Rudresh. Dr Manjunath Kumar, at government sector how do you feel dispensing in the liquid form or dispensing on the globules or diskets?

Dr. H.D. Manjunath Kumar: To speak from the government sector actually the easiest method we should follow, a comfort zone is more important because plenty of patients we are receiving in a day, we have to dispense in a fast manner so that we require globules and the best method to be dispensed. We get best results also. No where we have gone wrong in dispensing with globules but still I’m having the opinion that it requires, if the case requires. If the patient is more sensitive you have seen there are different methods where people used to dispense homoeopathic medicines. So most of it what we can understand is doctor comfort zone and how easily the patient will be able to accept it.

Dr.B.T.Rudresh: Certainly yes. See, the urban sector have total faith in homoeopathy so that they have come to you. He will take whatever you give and however you give, whatever form you give, it makes no difference as far as the urban sector is concerned. But for him also he will be more happy if he can carry it in his pocket and take it in afternoon after his lunch or in night while traveling. So on that basis he would be more happy to have it, either medicine dispensed in globules in a vial. I have seen most of the patients on the way carrying the homoeopathic medicines and show to me on the roadside from his pocket. So carrying becomes more easy as far as the urban sector is concerned. Thats why they want it in globules or disket form. But they don’t mind taking the medicine in whatever form we give. Because they know that doctor is the best man to decide. We will take whatever he gives. But when it comes to the rural sector their thought is different that always doctor giving same white globules for all condition. So I think at the psychological levels for his comfort zone I would rather prefer to give it tablet form which is more used to rural sector to make him aware that I’m taking some medicine. It is only making him to understand and of course it is not as compromising with homoeopathic principles of dispensing. If you can able to dispense it through the diskets to the rural side he will be more happy. He will be much more happy if you can give it in bottle, the mother tinctures; in 2, 3 bottles, in 2, 3 different colours. But he will be more happier by giving just diskets and I’m very comfortable with them but one thing which we must say diskets are more comfortable both in urban and rural sector. Urban sector will take whatever you give; we are giving in more comfortable form in chewing, in carrying or whatever it is: so that we are giving it in diskets. In rural side they expect the size, shape, quantity, everything matters to him. It really makes sense to him as far as his apprehension and his comprehension is concerned. So if we want to catchup both, I feel the diskets will be more ideal.

Dr.Ramdass: I don’t think there is any problem in either of these there because that one the concept is that we are trying to transfer the medicinal energy into another inert substance. So inert substances as you say is purely a vehicle, it’s a carrier .So anything for example if you have to charge the sugar of milk with alcohol; sugar of milk is likely to dissolve so I don’t know whether how far it is practical to transfer that. Where as if you charge it in the globules and with the globules if you mix it with sugar of milk that’s a different method. I think that is what Dhankare is talking about, that is how it was dispensed. I don’t know whether that is been done in the hospital .See one more thing is there are certain challenges that we encounter , if for example if it is a newborn baby ,now how do you introduce the medicine. I normally ask them, to mix it with the mother’s milk, so this is a practical way of applying medication. And there are some people who are alcoholic, who doesn’t want to give up alcohol but his wife wants him to give up alcohol. Now there are medicines that we give whether it is acid sulph or whatever in potency if you want to give that, so we ask them to mix it with alcohol and give him a peg. I think these are the various methods, so that based on the craving. That is the objective of the treatment.

Dr. B.T.Rudhresh: Now probably at the end of this discussion, what we would like from the opinion is whether there should be a
1. Universal methods of dispensing to the patients.
2. Should there be guidelines behind all these.
3. Universally accepted norms of dispensing , right now do we have any code of conduct, how to prescribe, how not to prescribe ,what to do all patients feels each one of you give same white pills, we don’t know what you have given. Same thing, for cold also you give the same for cough also you give the same and you give some white pills we take it that’s fine; but we don’t know for what you give. Of course as far as my answer goes you don’t need to know because I have given medicine .But the other point is, now the other question comes is whether as a scientific system of medicine are we maintaining some scientific steps to tell people, look we dispense medicines uniformly, universally acceptable norms within the framework of prescribed norms of homoeopathy.

Dr. H.D.Manjunath Kumar: What I have to add here is I was working about 20 years in rural area; in more the method and more different ways of dispensing you have the better I feel. Because this gives a psychological effect on the patients also. Because I was in a rural area where we were dispensing through only globules and after 10 years I started getting the blame that we are prescribing only one single medicine. For each and every disease we are dispensing a single medicine that was a blame I started getting, then we had to shift on to sugar of milk and other dilution method and all which worked out better. So you have more the method the ultimate aim is to send this dynamic medicine through the root of the tongue to the patient, that’s all. You can any method according to it.

  Dr.Veerabramhasary: … even I have been practicing in rural areas. There also this problem I have been facing, but I educate the patient. The patient comes to me and asks what this sir you have given white pills is, so many diseases I have, and do you think it will work. Then I will educate the patient, these are Homoeopathy medicines, we charge it and give. They will tell, sir if we go to Bangalore they will give so many medicines. They will give syrup, biochemic and they will give so many tablets. But I educate them in rural area, see this is homoeopathy, this is the form of homoeopathy. Globules is the homoeopathy and I also educate it takes time according to the diseases. In urban also so many people will question us whether this white pills will definitely cure us. So initially we have to educate the patients regarding how we dispense the medicines, this is my opinion.

Dr.Srivatsan: Exactly correct Dr.Brahmachary. So now we have come to one understanding that homoeopathic medicines are been dispensed based on the requirement of the patients. As Dr.Ramdass said if the patient is idiosyncratic he requires the dilution method that is the liquid form and otherwise on a comfort zone both doctor and the patient easy to handle the homoeopathic medicines at keeping the quality assurance over there. Dispensing on globules, on tablets and on diskets, so these are all certain methods where we are following and this also depends upon the needs and psychology of the patient.
Have you understood about this aspect, now I would like to have a discussion on how these globules or liquids or the diskets can go into the hands of the consumers that is the patients. So whether you are putting it in the bottle is it good, is it a glass bottle is good or a plastic container is good or packing it in a paper is good or putting it in a paper cover is good or taking a plastic sachet so which are these methods where we can try to a bring a better quality dispensing point over here. So I would like to ask Dr.Ramdass of this aspect.

  Dr. Ramdass: Purity is the criteria basically, now for example if you think of plastic vials which are now abundantly used, I think there are standards of plastic also “Biograde”. So there is one criteria I think we need to keep, see the point any object that can pollute the medicine can reduce the effect of the medication that you are introducing .So hence those substances that can reduce the effect must be avoided. So these are the standard silica glasses, silica is the fundamental thing of the glass. So this can retain the purity of the medicines without spoiling it is the most ideal thing. If that can be done that is number one. (Dr.Srivatsan) Sir what about this amber colored bottles also? Ya see when we expose it to sun’s rays that is the criteria. Some people say that the UV rays are filtered through this, so the purity of the medicines is maintained if it is kept in an amber glass. Whereas this doesn’t have that kind of provision .Hence the best thing is avoid it from the sun’s rays why do u want to expose it to sun’s rays if you are using it in a white. That is why usually the tea could check that we use to get which are the best earlier we use to get, even now it is available

But keep it in a cool and dry place not a damp moist place that is one advantage. And as per as dispensing the medicines in a paper is concerned it has to be print free that is the number one and number 2 preferably if it is a butter paper that is the most ideal, or atleast a plain biodegradable paper would be the most ideal. What about these plastic containers sir? And nowadays many of the doctors are been dispensing through it. See one thing that you have to know if you are dispensing in this don’t charge the medicine in this, ideally speaking only because again the alcohol can stimulate some reaction with the plastic which may get contaminated. Where as if you charge the medicines, dry the globules and then put it in these and dispense it that is a different thing. Purity can be maintained in that way for practical purposes. So this is an observation that has been made. Because plastic has its own medicinal property. So if one goes into the material medica of plastic, I don’t know do you have any idea sir .I don’t have any idea one may do the proving of plastic.

Dr.Srivatsan: Even today that a scientist they do conduct all kinds of tests in the glass containers only. So the glass is most ideal than the plastic containers. I would like to say a little about these blister packs. See the blister pack is something where you have holes in it where u put the globules or the diskets in it and then it is the foil which covers it and under the heat u press it. Now I would like to ask Dr.Ramdass whether the purity gets disturbed once the heat is used.

Dr. Ramdass: Personally I have not used any blister packing and I’m not used to that and I’m still probably little conservative. But initially when the blister this packing concept came, I thought we are trying to psychological role again with the patients. That this appears more like an allopathic and the patients are comfortable. That was my initial impression.But however that may not be purely altered. So it has its advantages and disadvantages.Advantages are that if you prepare this blister packing of so many medications , it is easier to dispense and easy to carry so that way the patient can pop out the blister area and take out the tablet and pop it into his mouth. So that way it is convenient but the disadvantages is how many medicines, how many thousands of medicines we are going to prepare in blister packing and then dispensing. Whether that is practical I’m not sure. But as per as the heating element is concerned, whether that will have a impact on the medication is something, we are talking of anything, see we are telling that don’t expose the medicines to the perfume bottle, don’t expose the medicines to heat, so whether that has impact on the people who have used it much can be.. But if that is the element that is going to block it, you must as much as possible avoid it, that’s from the purely scientific point of view, I’m coating it across. But practically it may appear pretty good.

One of my experiences is which I had much earlier when I started my practice, there are practitioners, I don’t want to name anybody who is packing, they use to buy these empty capsules(Gelatin capsules), and fill the medicines with five size globules or even powder and then ask the patient to take it. It’s I think purely cheating. I don’t think it is necessary because our medicines are best absorbed sublingually when we say it doesn’t have to really go into the stomach, see allopathic drugs have certain character only where they have to dissolve in the stomach and the capsules are given, injections are given, because the drug can get mixed up with the blood faster. So there are different theme, but not for homoeopathy.



Dr. B.T. Rudhresh: See the main demarcating point is ours are dynamised system and dynamic medicines were dispensed. They are dispensing inert substance, so it makes no difference whether they dispense it through X, Y, Z whatever it is. We say don’t keep it near the perfumes, we say don’t keep it near the high level vaporizing conditions; we say lot of things, why because they are dynamic in nature. The dynamicity and the quality of the medicines can be disturbed, so when we are dispensing, we must be aware that we are dispensing the dynamic medicines and we are not dispensing the inert substances. These two basic things and go to fountain it. Dispense it as far as possible, what Hahnemann has told, with slight modifications to the present day.

Dr.Srivatsan: Thank you Dr.Rudresh. So we have to come to a kind of conclusion with the today’s discussion, that the homoeopathic medicines are being dispensed in different modes and the best method of dispensing, and the best method to carry these homoeopathic medicines to the patients is the glass vials. That is what the Dr.Ramdass and Dr.Rudresh also said, but depending on the needs of the patient, depending on the psychology of the patient and depending with that whether they are urban or rural.So I thank the panelists for having such a wonderful discussion on this aspect and thank all the audience also.

Dispensing Homoeopathic Medicines Needs Quality Assurance?

Homoeo Times in association with Homoeopathic Medical Association of India, Karnataka state branch organized a forum on “Dispensing Homoeopathic Medicines Needs quality Assurance?” at Kaveri Hall, Malleswaram Association Club , Bangalore on 17th Jan 2010. Dr.M.R.Srivatsan moderated the forum and Dr.B.T.Rudresh, Dr.Veerabramhasary, Dr.Ramdass, Dr.H.D.Manjunath Kumar were the panelists. We are giving few excerpts from the forum

 
 



Dispensing Homoeopathy Medicines needs Quality Assurance?-Part-1



Dispensing Homoeopathy Medicines needs Quality Assurance?-Part-2




Dispensing Homoeopathy Medicines needs Quality Assurance?-Part-3




Dispensing Homoeopathy Medicines needs Quality Assurance?-Part-4





Dispensing Homoeopathy Medicines needs Quality Assurance? -Part-5





Dispensing Homoeopathy Medicines needs Quality Assurance? -Part-6




Dispensing Homoeopathy Medicines needs Quality Assurance? -Part-7