Why Case Reporting is Important in Homeopathy?

With

Prof. Dr. Chaturbhuja Nayak

President Homoeopathy University, Jaipur and Former Director General, CCRH

by

Dr. Saurav Arora

Founder

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Saurav Arora: Welcome to initiative to promote research in Homeopathy Sir. We would like to know your first encounter with homeopathy and how you got interested in homeopathic teaching and subsequently research?

Prof. C. Nayak: I was profoundly motivated to choose Homeopathy as my career, by my brother-in-law Dr. Natabar Naik, a leading homeopathic practitioner of Orissa. After completion of my D.H.M.S. course in Govt. Homoeopathic Medical College, Bhubaneswar, I joined a homeopathic dispensary as Medical Officer (Homeopathy) under the Govt. of Orissa. Honestly speaking, I found a little scope in this job to achieve my goal. Since I had an aptitude for teaching, I joined as lecturer in Govt. Homoeopathic Medical College, Bhubaneswar. After a short period of service, I got selected to study Dip. N.I.H. course at National Institute of Homoeopathy, Kolkata. Here, I got an excellent exposure to homeopathic education, research and practice, under the guidance of highly experienced and reputed teachers. Huge data obtained from a large number of outdoor & indoor patients of the institute as well as regular weekly case presentations & seminars presented by the students generated a lot of interest how to improve teaching and research in homoeopathy. After Dip. N.I.H. course, I resumed my job in the parent college where I was subsequently promoted up to the post of Principal-cum-Superintendent. During my student/teaching career, I got immense guidance from my teachers on how to improve teaching for the practical benefit of the students in their future career. Since I had a tremendous weakness towards literary activities including publications, I published articles on various aspects of Homeopathy in medical/non-medical journals, magazines, souvenirs and newspapers for the benefit of professionals as well as the common man. For the promotion of research in Homeopathy, I took up research projects funded by Govt. of Orissa and Govt. of India.

In 2004, I joined as a Director (later re-designated as Director General) of Central Council for Research in Homoeopathy (CCRH) under Govt. of India, where my entire attention was focused on various areas of research, like Drug Standardization, Drug Proving, Clinical Research, Clinical Verification and Fundamental Research, as per the mandate of the Council.

SA: You have been in an active academics and homeopathic research for almost four decades? What did you find more interesting and challenging- homeopathic research or teaching?

CN: For me, both teaching and research in homeopathy were interesting as well as challenging. In order to improve the quality of teaching and research, I took initiative to organize seminars/CME programs in Govt. Homoeopathic Medical College, Bhubaneswar, CCRH, Bakson Homoeopathic Medical College and Homoeopathy University, Jaipur. While in CCRH, although more time and attention was given for promotion of research, yet a large number of publications in the form of books and monographs were made which aimed at improving the quality of teaching.

SA: For the majority of us, academic teaching and research seem to be directionally opposite; is there any tangent between them?

CN: Sorry, I do not subscribe to the statement that teaching and research are directionally opposite. Both the areas are inter-related, interdependent and complementary to each other. High-quality teaching helps in preparing standard protocols to conduct research while the outcomes of good research studies disseminated through classroom lectures, make the teaching more interesting, practical and useful. Each of the two areas has its own strengths and merits and both should be promoted in private as well as public sector, to achieve excellence.

SA: Did you find any difficulty in converging academic teaching to homeopathic research or vice versa?

CN: No, I did not find any difficulty in converging academic teaching to homeopathic research or vice versa, while working in Homeopathic colleges as well as CCRH. Rather, I tried to integrate both the areas with the help of my colleagues and experts from other scientific organizations and accomplished this through publications, seminars, workshops and CME programs. Being a member of the Central Council of Homoeopathy (CCH) as well as member of its Education Committee/PG Education Committee & Director General of CCRH, helped me to work for integration of teaching and research, with the support of my colleagues of CCH, CCRH and three homeopathic institutions at Bhubaneswar, Greater Noida and Jaipur.

SA: You have always been a preacher and supporter of homeopathic research. Can you briefly explain the need for evidence-based research in homeopathy?

CN: As you are aware, there is a growing criticism against homoeopathy by some professionals, scientists of other medical and allied disciplines, pharmaceuticals, organizations and media (particularly certain journals). The scepticism against homoeopathy is mainly targeted at similia principle; method of preparation and quality of medicines (dynamization, particularly highly diluted medicines) and clinical effectiveness of homeopathy. To address such criticism and scepticism, there is a great need of evidence-based research in homeopathy. Besides, evidence-based research is required to further scientifically validate homeopathy, strengthen the concepts stated in old homeopathic literature and to inculcate confidence in the minds of practitioners of homeopathy, particularly the neophytes.

Secondly, there are some challenges/ weaknesses within our system of homeopathy, such as various schools of thoughts (classical homeopathy, clinical homoeopathy, complex homoeopathy, isopathy, tautopathy, etc.); low-quality medicines manufactured by some industries; poor expertise, and sub-standard teaching/research etc.

Thirdly, there are some myths about homeopathy for which a part of population is reluctant to get benefits of homeopathy.

Lastly, many peer-reviewed journals having high impact factor do not publish the outcomes of research studies without sufficient evidence.

For all the aforesaid reasons, evidence-based research is the need of the hour.

SA: We have been motivated to practice evidence-based homeopathy, but many of us are not very clear about what this evidence could comprise of? Is it the statement of patients, or reports or scales? Can you briefly put your views on the same?

CN: I am happy, your question covers the answer to a great extent. The evidence include patients’ versions, laboratory reports relevant to their disease conditions as well as different scales/questionnaires used for outcome assessment of the individual patients/ research studies. Some of the scales/questionnaires are general in nature, i.e. can be applicable to various diseases, to assess the scores (pre-/ post-treatment), e.g. Visual Analogue Scale (VAS) for assessing intensity of pain etc., whereas some scales are disease-specific, i.e. Hamilton Depression Rating Scale (HDRS) for Depression; International Prostate Symptom Score (IPSS) for Benign Hypertrophy of Prostate; Sino-nasal Outcome Test (SNOT) for Chronic sinusitis; Conners’ Parent Rating Scale – Revised (CPRS-R) for ADHD, etc.

Besides, to assess the quality of life in different disease conditions, the general questionnaire developed by WHO, i.e. WHOQOL – BREF can be adopted. Whereas to assess the quality of life in specific disease condition like Rheumatoid arthritis, Quality of Life-Rheumatoid Arthritis (QOL-RA) scale can be adopted.

SA: We have abundant case records with us, but the reciprocally limited number of publications? What according to you can be the reasons?

CN: The main reason for a limited number of publications despite abundant case records is ill-maintained case records with no or fewer evidence (pre-& post-evidences). Busy clinicians usually record case histories of the patients in such a way that they are not suitable for publications. Secondly, although some clinicians have reliable evidence, many of them do not show interest for publication. Thirdly, even if some of the clinicians have both pieces of evidence and interest for publication, they do not write case reports following standard international guidelines, as a result such manuscripts are rejected by the journals.

SA: According to you, why we must publish case reports and case series?

CN: The publications of case reports and case series are essential for the following reasons:

• To present cases of unusual causation, a challenging differential diagnosis, a novel insight into the pathogenesis of the problem, and puzzling clinical features.
• To describe improved or unique technical procedures for therapeutic as well as general management of the patients.
• To present profile of a patient recorded following a standard case–recording format, as per homoeopathic principles.
• To illustrate case-processing, according to the principles of Homoeopathy, which includes analysis and evaluation of symptoms, miasmatic diagnosis, the totality of symptoms etc.
• To demonstrate the unique method (repertorial/non-repertorial) adopted for determining the similimum for the patient.
• To justify which potency, dosage & repetition schedule worked for the patient.
• To justify the first and subsequent prescriptions and present their responses.
• To make an original contribution to the literature.
• To stimulate further research and encourage authors for scholarly writing.
• To benefit the entire medical community and thereby the common man at large.

SA: Any recommended readings to learn more about case reporting and their importance in homeopathy?

CN: While preparing such manuscripts, the authors should follow CARE guidelines (drafted by CARE group consisting of 27 experts and published by 6 authors to develop, disseminate, and implement systematic reporting guidelines for case reports) & HOM-CASE guidelines (modified CARE guidelines for developing a criteria catalog serving as a guideline for authors to improve the quality of reporting clinical case reports in homoeopathy), for which yourself and Dr. RK Manchanda from India have also contributed. Besides, my article titled “Case Reporting In Homoeopathy: Why And How?”, published in the Souvenir of XXIV National Homoeopathic Congress of Indian Institute of Homoeopathic Physician at Nagpur in 2016, may also be referred. The different ways of documenting case series published in various standard medical journals including homeopathy, should be followed.

SA: Your mantra to publish a good case report?

CN: There is no special mantra for publishing a good case report, but I would suggest that the homeopathic institutions, as well as clinicians, should develop standard case recording formats for documenting the profiles of the patients including their pre-/post-evidences, since there is no uniformity in such formats at inter-/intra- university level, inter-/ intra college level. Some institutions have adopted the case recording formats to document all types of cases, whereas some others have developed disease-specific case recording formats. The Central Council of Homoeopathy, the regulatory authority for ensuring quality education and practice in homoeopathy should take initiative to recommend standard case recording format for documenting profiles of the patients, in a scientific way.
Well-documented case reports/ case series adds to the acumen of physicians and benefit the profession as well as patients at large. Such documents not only improve the knowledge of the clinicians, teachers and students but also inculcate confidence in them for dealing with similar cases in future.

SA: IPRH is thankful for your support and encouragement Sir.

Short Biodata with Contact Details

Prof. Dr. C. Nayak is currently the President of the Homoeopathy University, Jaipur (Rajasthan); Chairman of the Homoeopathic Pharmacopoeia Committee, Govt. of India; Chairman of Special Committee on Fundamental Research & member of Special Committee on Clinical Research under Central Council for Research in Homoeopathy (CCRH); member of Drug Technical Advisory Board (Homoeopathy), Govt. of India; Chairman of Scientific Advisory Committee of Delhi Homoeopathy Anusandhan Parishad and Guide for P.G. & Ph.D. courses in Homeopathy. Formerly, he was the Director General of CCRH, an autonomous organization of Ministry of AYUSH, member of International Scientific Committee on Homoeopathic Investigations (ISCHI), member of Education Committee & PG Education Committee of Central Council of Homoeopathy, Director-Professor of Bakson Homoeopathic Medical College, Greater Noida and Principal-cum-Superintendent of one pioneer Govt. Homoeopathic Medical College of Odisha state. Last year, he was conferred with ‘Best Teacher Award’ by the CCRH, sponsored by the Ministry of AYUSH, Govt. of India. Holding all these prestigious positions, Dr.Nayak has been an instrumental personality in the development of homoeopathic education and research in India. Dr. Nayak has always been supportive of scientific and academic activities in Homoeopathy in the field of education and research.

If you are interested in receiving guidance from Dr. C. Nayak regarding publishing case reports, you may contact him at drcbnayak@gmail.com