(Article published in the September 2009 issue of The Homoeopathic Heritage, published by B Jain Publishers, New Delhi, www.bjainbooks.com
Among the various subjects taught in the homoeopathic curriculum, many students consider Homoeopathic Pharmacy as the easiest or the least important one. The reasons could be either this subject is very easy in the examination point of view or the other first year subjects such as Anatomy and Physiology are vaster and difficult to pass. Another reason could be a wrong notion among us, i.e., the making of medicine is the duty of the pharmaceuticals and dispensing is the duty of the pharmacist. Hats off to our pioneers who had used self-made potencies those days!
It is said that a first year BHMS student uses the major part of his brain for studying other subjects like Anatomy and Physiology and less for the Homoeopathic subjects. But the fact we should keep in mind is, knowledge in Pharmacy is very essential throughout our carrier. And, even for competitive exams like PSC, UPSC and MD entrance, a number of pharmacy related MCQs are asked that may be more difficult than answering clinical subjects and other homoeopathic subjects. Hence, those who answer such questions too, usually get the selection.
There are certain misunderstandings or controversies regarding various aspects of pharmacy due to the difference in various pharmacopoeias and even various textbooks of pharmacy. Also there is a difference in the manufacturing process as some pharmacies are using modern automatic potentizers and others are following the old shaking methods. Many pharmacies are using same vial for successive potencies, but Hahnemannian method is to use different vials for making each of the successive potencies.
The future of homoeopathy depends on several factors such as availability of good homoeopaths, facility for proper education and training, support from the government and most importantly the availability of genuine medicines. After detailed case taking and repertorisation, the similimum is selected. But when the medicine given is not genuine, all efforts will be futile. Hence, it is necessary to have genuine medicines prepared and stored under suitable conditions till it reaches the patient. It is said that there is a mushrooming of homoeopathic pharmacies that are not having the basic standards put forth by the authorities. Even if the drug manufacturer keeps up standards, if the local pharmacy shops or clinics do not maintain similar standards that can also affect the quality of medicines. The dispensing room attached with each clinic should also maintain certain qualities. So, right from the cultivation site of drug sources to the manufacture and then to the retail seller and finally the clinics, there should be uniform standards. In order to make this possible, there are many guidelines made compulsory for the drug manufactures, which are monitored by the concerned authorities periodically. Together with them, we doctors are also having our own role to perform. Here are some pharmacy related tips for the doctors.
Pharmacy related tips:
1.Take medicines from companies that manufacture quality medicines under standard conditions.
2.As far as possible try to get the sealed bottles, so that there will be no chance for mislabeling or any sort of malpractices. Apart from that, dust particles may be seen in loose bottles available in the local shops. These loose bottles are not cleaned properly before filling dilutions.
3.It is found that evaporation is faster in untouched bottles; hence purchase such drugs in sealed, small sized bottles.
4.If at all you purchase dilutions in loose bottles, request them to use some quality bottles. Never use bottles in which medicine gets evaporated very easily.
5.Do not keep dilutions in plastic bottles; glass bottles are the best choice.
6.When you purchase loose medicines from local shops, ask them to label the medicine using printed name slips (Printed name slips of homoeopathic medicines are available in the market). Never use pen to label as it gets faded in a few months. Sometimes the over flown medicine can also dissolve the pen ink making it unreadable. Remember, a homoeopathic medicine without label is of no use.
7.Never use substandard plastic bottles for dispensing medicines to your patients. Such bottles are having a typical odor of plastic that can affect the medicine as well as the health of the patient.
8.Dropper should allow the medicine slowly in drop-by-drop. If substandard dropper is used, it can cause rush of medicine leading to wastage and overmedication.
9.Once the bottle is emptied, discard it. Never use it again for refilling.
10.Avoid the use of colored tablets and tablets and globules that contain whitener or starch. It is heard that in order to make the tablets harder and maintain its shape, artificial agents are added by a few pharmacies. We should know that the best tablet is the one that gets dissolved in the mouth very easily. The best alternative is to purchase the triturations in powder form.
11.The room where the medicine is stored should be neat and clean with good air entry.
12.Dilutions, tinctures and vehicles should be kept in separate cupboards.
13.Strong smelling medicines like Camphor Q, KreosotQ, SumbulQ, Balsm peruQ etc. should be kept away from other medicines.
14.When you start the clinic, do not waste money by purchasing all medicines mentioned in the catalogue. After practicing a few months, you will come to know the more frequently used drugs and rarely used ones. The quantity of drugs purchased can also be changed according to the need.
15.The alcohol present in the dilutions is 90%, 91% or 91.5%; remaining is water. Alcohol gets evaporated easily; hence when the bottle is about to become empty, the remaining dilution at the bottom of the bottle contains more water. It should not be used to medicate the globules as the globules get dissolved very easily due to high water content.
16.Water used for cleaning bottles and for dispensing medicine should be free from chemicals and other impurities. For giving LM potencies in water, distilled water is the best as it can be kept for a long time in the closed containers. The distilled water can be purchased from homoeopathic pharmacies.
17.When you give medicine for foreign patients or NRI patients, always give a certificate that includes the name and address of the patient, name of medicine and manufacturer, address, register number and qualification of the doctor. The box in which medicine and the certificate are packed should be sealed and ask the patient to open it only after reaching the destination. When the customs officers do the inspection, the medicine given by us should be in the sealed box. This is for our safety. One more thing, white powder is a suspected item by the customs. Hence whenever you send medicines out of country, avoid sugar of milk and give the medicine either in globules or blank tablets.
18.If a new inexperienced person is appointed in our clinic as a pharmacist, certain points like the following should be taught regarding the peculiarities of homoeopathy:
The names of medicines used in homoeopathy should be taught.
Since we follow binomial nomenclature, drugs having the same genus name should not be altered by mistake. Eg: Aconitum Napellus and Aconitum Ferox; Abies can and Abies Nigra.
Abbreviations used for prescription and abbreviations of drugs should be taught.
There should be no substitute for either a remedy or a particular potency. If the prescribed remedy or the potency is not available, it should not be altered with another one.
Tinctures, dilutions and vehicles (globules, tablets, sac lac) should not be kept together.
Avoid strong smelling perfumes on duty time.
Name of the patient should be written on the bottle before doing the medication.
Avoid smelling of medicines and do not touch the medicine with bare hands.
After medication, the dropper and lid should be closed properly to prevent evaporation and contamination.
Lid/dropper of different medicines should not be altered.
Replace each medicine in the respective place immediately after use.
If the first dose is given in water, the glass should be washed thoroughly before giving medicine to another patient.
Overmedication should be avoided to prevent wastage and easy dissolving of globules.
The spatula and the glass board used for medication and dividing of sugar of milk in to different doses, should be cleaned after every use.
It is essential to make a list of out of stock medicines and other accessories at least once in a week and get those items without any delay.
Homoeopathy is a science that has to be practiced artistically and systematically and the success of this system comes not only in the selection of a similar remedy, but the suitable application of the same in its original and pure form, in required potency and dose so as to get the expected results. And we the young homoeopaths, like our pioneers, should practice it as a passion not as a mere fashion.
Dr Muhammed Rafeeque, BHMS
Family Homoeopathic Clinic