Informing the homeopathic practice for Turkish pharmacists: reviewing the example of Portuguese community pharmacies
Received18 May 2016
revised21 February 2017
accepted28 February 2017
20 December 2017 (online)
Introduction: Alternative and complementary therapy systems, such as homeopathy, have long been used around the world. Since 1995 homeopathy has been officially recognized in Europe as a system of medicine or a medical specialty. Portuguese community pharmacists have long-standing experience with homeopathic products. By contrast, healthcare professionals in Turkey are less experienced with homeopathic practice although there is a new regulatory setting in place. There are a limited number of studies addressing pharmacists' role within the homeopathic system.
Aim: To investigate the attitudes (knowledge, feelings and behaviour) of experienced Portuguese pharmacy practitioners who deal with homeopathy, and thus to inform Turkish pharmacy practice and policy on homeopathy-related success factors.
Methods: A qualitative cross-sectional design was followed, using semi-structured and face-to-face individual interviews with purposively selected Portuguese pharmacists experienced with homeopathic medicines. Audio-recordings were transcribed verbatim and the transcriptions imported into QSR NVivo v10 software for qualitative coding and analysis. Using a thematic content approach, the extracted codes were grouped and indexed by recurrent themes through a reflective procedure and constant comparison.
Results & discussion: Six general themes emerged, the most relevant being participants' feelings of gratitude for the ability to work in homeopathy; other themes were a helpful regulatory body, clear practice boundaries, scientific support and product quality assurance. Specialized homeopathic education was considered the most important factor for success. This was related to patients' positive perceptions and acceptance, suggesting an increase in public awareness through the pharmacy network.
Conclusions: Portuguese pharmacists' attitudes towards their homeopathic practices highlighted the key elements for success in a field that is usually distant from traditional pharmaceutical education and practice. The present findings provide guidance for Turkish pharmacists willing to expand their professional scope and to embrace complementary medicines.
- 1 Perry R., Watson L.K., Terry R., Onakpoya I., Ernst E. British general practitioners' attitudes towards and usage of homeopathy: a systematic review of surveys. Focus Altern Complement Ther 2013; 18 (02) 51-63.
- 2 Manchanda R.K. Scientific framework of homeopathy evidence based homeopathy. India: Liga Medicorum Homoeopathica Internationalis Publication; 2015: 3-17.
- 3 Eyles C., Leydon G.M., Lewith G.T., Brien S.A. Grounded theory study of homeopathic practioners' perceptions and experiences of the homeopathic consultation. J Evid Based Complement Altern Med 2011. 957506 http://dx.doi.org/10.1155/2011/957506.6.
- 4 World Health Organization. Safety issues in the preparation of homeopathic medicines. Switzerland: WHO Pres,. 2009
- 5 Perry R., Dowrick C. Homeopathy and general practice: an urban perspective. Br Homeopath J 2000; 89: 13-16.
- 6 European Committee for Homeopathy (ECH). Towards another model of health and disease: A new perspective on how to achieve good health for all across the EU. Belgium. Available from:. http://homeopathyeurope.org/wp-content/uploads/2015/08/ModelHealthDiseaseECH.pdf. Accessed on 1 August 2016.
- 7 Calabrese E.J., Jonas W.B. Homeopathy: clarifying its relationship to hormesis. Hum Exp Toxicol 2010; 29 (07) 531-536.
- 8 European Committee for Homeopathy (ECH). The regulatory status of complementary and alternative medicine for medical doctors in Europe. Belgium: CAMDOC Alliance Publication, pp 14e17. Available from:. http://www.icmart.org/files/cam_regulatory_status_2010.pdf Accessed on 5 August 2016.
- 9 Şen B., Gürdal B., Demir I., Akbal Ö. Yeni Kanun Değişikliği İle Eczanelerimize Gelen Tedavi – Homeopati. Türk Eczacılar Birliği Meslek İçi Sürekli Eğitim Dergisi 2013; 29 (30) 54-61.
- 10 Homöopathisches Arzneibuch 2012 4th edn. Deutscher Apotheker Verlag, Amtliche Ausgabe, ISBN 978-3-7692-5838-7; 2012.
- 11 Anick D.J., Ives J.A. The silica hypothesis for homeopathy: physical chemistry. Homeopathy 2007; 96: 189-195.
- 12 European Committee for Homeopathy (ECH). The current regulatory status of homeopathic medicine in Europe. Available from http://www.homeopathyeurope.org/regulatory-status Accessed on 1 June 2016.
- 13 Almeida J. The differential incorporation of CAM into the medical establishment: the case of acupuncture and homeopathy in Portugal. Health Sociol Rev 2012; 21 (01) 5-22.
- 14 Santos V.G.S.D.R. Os Medicamentos Homeopáticos em Portugal. Universidade Lusófona de Humanidades e Tecnologias Departamento de Ciências da Saúde Master Thesis; Lisboa: 2012.
- 15 Official Journal of the European Communities Council directive 92/73/EEC of 22 September 1992. No L 297/8, 13/10/1992. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:31992L0073&from=EN Accessed on 1 June 2016.
- 16 Portuguese Law. Lei do enquadramento base das terapêuticas não convencionais Ministério da Saúde Decreto-Lei n.º 45/2003, de 22 de Agosto. Diário da República I SÉRIE-A: 5391-5392. Available from: http://www.acss.min-saude.pt/wp-content/uploads/2016/09/Lei-n45_2003.pdf Accessed on 1 June 2016.
- 17 Official Journal of the European Communities. Council directive 92/73/EEC of 22 September 1992. No L 297/8, 13/10/1992. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:31992L0073&from=EN Accessed on 1 June 2016.
- 18 Portuguese Law. Ministério da Saúde Decreto-Lei no. 176/2006 de 30 de Agosto. Legislação Farmacêutica Compilada. Estatuto do Medicamento. Available from: http://portalcodgdh.min-saude.pt/images/c/cf/DL176-2006.pdf Accessed on 1 June 2016.
- 19 Portuguese Law. Ministério da Saúde Decreto-Lei no no. 71/2013 de 2 de Setembro Legislação Farmacêutica Compilada. Available from: http://www.infarmed.pt/portal/page/portal/INFARMED/LEGISLACAO/LEGISLACAO_FARMACEUTICA_COMPILADA/TITULO_I/011-F1_Lei%20_71_2013.pdf Accessed on 1 June 2016.
- 20 Barros P., Machado S., Simões J. Portugal health system review. Health Syst Transit 2011; 13 (04) 1-179.
- 21 Esperancinha L.D. Avaliação do Consumo de Produtos Homeopáticos no Interior de Portugal. Health Science Doctoral Thesis Covilha: Universidade da Beira Interior; 2012.
- 22 FENAMAN [National Federation of Medicine Associations] Medicinas alternativas-a escolha vai aumentar Revista Farmácia Distribuição 2007 1 (February): 5–9.
- 23 Ribeiro L. Homeopatia, cura ou fraude?. Visão 2011; 937.
- 24 INFARMED. Portuguese medicine statistics 2013. Available from: http://www.infarmed.pt/portal/page/portal/INFARMED/MONITORIZACAO_DO_MERCADO/OBSERVATORIO/ESTATISTICA_DO_MEDICAMENTO/ESTATISTICA_DO_MEDICAMENTO_ANTERIORES/Estat_Medic_2013.pdf Accessed on 1 March 2016.
- 25 Turkish Regulation. Regulation on traditional and complementary medicine practices. 27 October 2014. Issue of Turkish Official Gazette: 29158. Available from: http://www.saglik.gov.tr/GETATEN/belge/1-48243/main-regulation.html Accessed on 1 June 2016.
- 26 Turkish Law. Eczacilar ve Eczaneler Hakkinda Kanun ile Uyuşturucu Maddelerin Murakabesi Hakkinda Kanunda Değişiklik Yapilmasina Dair Kanun. Law No 6308. 17.05.2012. Issue of Turkish Official Gazette: 28309. Available from: http://www.resmigazete.gov.tr/eskiler/2012/05/20120531-3.htm Accessed on 1 June 2016.
- 27 Green J., Thorogood N. Qualitative methods for health research. 1st edn London: Sage; 2004: 27-50.
- 28 Reynolds GP. Private practice: business considerations. VISTAS articles 2010, Article No: 36. Available from: http://www.counseling.org/resources/library/vistas/2010-v-online/article_36.pdf Accessed on 1 June 2016.
- 29 Solomon E.M., Poggenpoel M., Myburgh C.P.H. Some intrapersonal qualities of SA homeopaths who have established successful private practices. Homeopathy 2015; 104: 182-189.
- 30 Pedersen I.K., Hansen V.H., Grünenberg K. The emergence of trust in clinics of alternative medicine. Sociol Health Illn 2015; 20 (20) 1-15.
- 31 National Health and Medicinal Research Council. NHMRC information paper: evidence on the effectiveness of homeopathy for treating health conditions. Canberra: National Health and Medicinal Research Council Publication. Australia 2015
- 32 Campbell C. Talk about homeopathy: discursive strategies as ways to continually marginalise homeopathy from mainstream acceptance. PhD thesis Queen Margaret University; UK: 2009.
- 33 Shahjahan R. Standards of education, regulation, and market control: perspectives on complementary and alternative medicine in Ontario, Canada. J Altern Complement Med 2004; 10 (02) 409-412.
- 34 Gilmour J.M., Kelner M., Wellman B. Opening the door to complementary and alternative medicine: self-regulation in Ontario. Law Policy 2002; 24: 149-174.
- 35 Ventola C.L. Current issues regarding complementary and alternative medicine (CAM) in the United States (Part 1: the widespread use of CAM and the need for better-informed health care professionals to provide patient counseling). P T 2010; 35 (08) 461-468.
- 36 Turkish Ministry of Health. Sağlık Alanı Sertifikalı Eğitim Standartları: Homeopati. Standart No. 19. Date: 02.10.2015. Available from: http://www.saglik.gov.tr/TR/dosya/1-100236/h/homeopati-standart–1.pdf Accessed on 1 June 2016.
- 37 Johnson T., Boon H. Where does homeopathy fit in pharmacy practice?. Am J Pharm Educ 2007; 71 (01) 00 Article 07.
- 38 Schultz S.J., Hotham E.D., Evans A.M. Australian pharmacists' uncertainty about homeopathic products in community pharmacy. Focus Altern Complement Ther 2014; 19 (01) 9-15.
- 39 What do pharmacists do? Available from: http://www.rpharms.com/ipharmacist/what-do-pharmacists-do-.asp Accessed on 1 June 2016.
- 40 Pinto C.G., Teixeira I. Pricing and reimbursement of pharmaceuticals in Portugal. Eur J Health Econom 2002; 3: 267-270.
- 41 Turkish Decision. Beşeri Tibbi Ürünlerin Fiyatlandirilmasi Hakkinda Tebliğ. Issue of Turkish Official Gazette: 29559. 11 December 2015. Available from: http://www.resmigazete.gov.tr/eskiler/2015/12/20151211-3.htm Accessed on 1 March 2016.
- 42 Turkish Regulation. Sosyal Güvenlik Kurumu İlaç Geri Ödeme Yönetmeliği. Issue of Turkish Official Gazette: 29620. 10 February 2016. Available from: http://www.resmigazete.gov.tr/eskiler/2016/02/20160210-7.htm Accessed on 1 June 2016.
- 43 Turkish Regulation. Türk Eczacıları Deontoloji Tüzüğü. Issue of Turkish Official Gazette: 12961. 27 July 1968. Available from: http://www.mevzuat.gov.tr/MevzuatMetin/2.5.610314.pdf Accessed on 1 June 2016.
- 44 Turkish Law. Eczacılar ve Eczaneler Hakkında Kanun. Law No. 6197. 18 December 1953. Issue of Turkish Official Gazette: 8591. Available from: http://www.mevzuat.gov.tr/MevzuatMetin/1.3.6197.pdf Accessed on 1 June 2016.
- 45 Rossi E., Picchi M., Stefano M.D., Marongiu A.M., Scarsini P. The homeopathic choice for children: a qualitative research on the decision making process of the families. Homeopathy 2015; 104: 176-181.
- 46 Shah S.F.H., Mubeen S.M., Mansoor S. Concepts of homeopathy among general population in Karachi. J Pak Med Assoc 2010; 60 (08) 667-670.
- 47 Tandon M., Prabhakar S., Pandhi P. Pattern of use of complementary/alternative medicine (CAM) in epileptic patients in a tertiary care hospital in India. Pharmacoepidemiol Drug Saf 2002; 11: 457-463.
- 48 Viksveen P., Steinsbekk A. Changes in patients visiting a homeopathic clinic in Norway from 1994 to 2004. Homeopathy 2005; 94: 222-228.
- 49 Patriani Justo C.M., dé Andrea Gomes M.H. Conceptions of health, illness and treatment of patients who use homeopathy in Santos, Brazil. Homeopathy 2008; 97: 22-27.
- 50 Steinsbekk A., Nilsen T.V.L., Rise M.B. Characteristics of visitors to homeopaths in a total adult population study in Norway (hunt 2). Homeopathy 2008; 97: 178-184.
- 51 Lohre A., Rise M.B., Steinsbekk A. Characteristics of visitors to practitioners of homeopathy in a large adult Norwegian population (the HUNT 3 study). Homeopathy 2012; 101: 175-181.