The 2014 amendment to the Maharashtra Medical Commission Act almost grants equivalence to MBBS doctors and homeopaths who have undergone the course. (Express File)Doctors across Maharashtra went on a strike last week to protest homeopathic doctors being allowed to prescribe modern medicines after completing a bridge course. While the strike was called off after the Bombay High Court stepped in, the issue is still simmering.The protests began after Dr Neha Siddharth Pawar, 36, early last week became the first homeopathy practitioner from Maharashtra to be registered in the state’s allopathic Maharashtra Medical Council (MMC)— opening the gates for others like her, who have completed the state’s Certificate Course in Modern Pharmacology (CCMP). This was a contentious move, opposed by the practitioners of modern medicine ever since the state Assembly amended the MMC Act in 2014.Even the homeopathy council opposes the move. “Medical practitioners should work in the respective ‘pathies’ that they have trained in — a pathway such as this will only create a shortcut for students who want to study modern medicine but cannot get through into those courses. They will choose homeopathy regardless of their interest in the subject,” said Dr Tarakeshwar Jain, chairperson, National Commission for Homeopathy (NCH).He added: “Once this happens in Maharashtra, other states will demand the same. We have, in fact, already received a request from Madhya Pradesh.”What was the 2014 amendment in Maharashtra? The 2014 amendment to the Maharashtra Medical Commission Act allows the registration of homeopaths who have undergone the one-year bridge course to be registered with the body that regulates allopathic medicine in the state, albeit in a separate register.This almost grants equivalence to MBBS doctors and homeopaths who have undergone the course. The amendment has been challenged in court.“We were told that the token registration [to Dr Pawar] was finally granted by the Maharashtra Medical Council as they were following the processes laid down in the 2014 amendment. The matter is still sub-judice but the court has not granted an interim stay so the body was obligated to give the registration,” said Dr Atharva Shinde, president, Maharashtra Association of Resident Doctors (MARD).He added: “From my conversations with officials, I get the sense that neither the MMC nor the current government is in favour of this step. However, the government cannot go against its own law, so they are waiting for a decision in the court.”When the Act was amended, the government in the statement of objects and reasons for the Bill had cited a shortage of doctors. “There is continuous demand from different sections of society to give permission to Homoeopathic Practitioners to use allopathic medicines in treating patients…. Considering the need of people of the State and to achieve the goal of “Health for All”, the Government considers it expedient to allow the Homoeopathic Practitioners’ who have undergone the course in Modern Pharmacology to practice Allopathy.Why was this decision taken?Officials said behind the official reasoning was another story.Dr Pravin Shingare, who was working in Maharashtra’s department of medical education at the time and later headed it, said that the push came from colleges offering homeopathy courses. “In the 70s, the Ayurveda course was changed by the central council, which regulated it to include modern pharmacology. The council allowed Ayurveda doctors to officially prescribe some allopathic medicines. And this led to Ayurveda colleges flourishing.”Dr Shingare said that homeopathy colleges in the state also wanted to follow suit but were unable to convince the central council that regulated their practice. The colleges then tried to convince the state council, which maintained that changes to the course had to be approved by the central council. Then, they went to the government and politicians.“When a Bill on the subject seemed imminent, the department of medical education intervened and said there should at least be a one-year bridge course in modern pharmacology,” said Dr Shingare.What is the situation nationally?Nationally, practitioners of modern medicine, ayurveda, or homeopathy can practice only their respective ‘pathies’ after registration in their own registers. With modern pharmacology being a part of the Ayurveda curriculum, some states, such as Maharashtra and Uttar Pradesh, allow practitioners to prescribe a limited number of allopathic medicines, such as the ones needed for fever, diarrhoea, or other common ailments seen in primary health centres.When it comes to homeopaths, the national council maintains that the practitioners should not prescribe allopathic medicines.Dr Jayesh Lele, former vice president of Indian Medical Association and former president of the Maharashtra chapter, was one of the key persons to challenge the 2014 amendment in the High Court. “There are several cases in which the Supreme Court has said that such mixopathy cannot be allowed,” he said.He cited the Poonam Verma vs Ashwin Patel case where the court came down on a homeopathic doctor who had prescribed an allopathic medicine, leading to the patient’s death. In Dr. Mukhtiar Chand Vs. State Of Punjab, the court had said there was no scope for a person enrolled in the state or central Register of Indian Medicine to practise allopathy.“Yet, the practice is being revived here with this registration,” said Dr Lele, adding that this could also lead to one person being registered with two different councils, which is not allowed.Are the courses for all practitioners similar?While the process for admission and the course structure for modern medicines and Indian systems have been streamlined to be made similar, substantial differences exist. Admissions to both modern medicine and Indian courses happen through the national selection test, NEET-UG. The consistent trend is that the top scorers go on to study modern medicine.All three courses have several common subjects — usually the ones to understand the human body — including anatomy, physiology, pathology and biochemistry. The courses differ when it comes to the education on treatments. Where the students of modern medicine learn about evidence-based pharmacology and treatments, those studying Ayurveda or Homeopathy study subjects such as Tridosha theory, Panchakarma, or law of similars.What will be the impact of this change? The move could open the door for similar allowances in other states. Dr Jain from NCH said: “A clause in the central regulations grants states the power to allow homeopaths to practise allopathy, but it has to be for a narrow requirement or for a specific duration or adverse event, such as the Covid-19 pandemic. It cannot be open-ended, as has been done by Maharashtra.”The move will also not solve the problem of requirement of doctors in the rural areas. “There are 10,000 people who have passed the CCMP course, most of them from bigger cities in Maharashtra. Would they go to small town and villages to practise medicine now? Also, why should people in these places not have the services of a fully qualified doctor?” Jain said.He added that the 2014 shortage no longer seems to exist. “Maharashtra usually has a bond policy for students, mandating service in rural areas. This bond has now been removed because there was no vacancy in rural areas.”