The Ayurveda Paradox: How BAMS Graduates Are Fueling India’s Antibiotic Crisis

The Ayurveda Paradox: How BAMS Graduates Are Fueling India’s Antibiotic Crisis

Dr Aakash Kembhavi, MD, PGDMLS, MS (Counseling & Psychotherapy)

About the Author: Dr. Aakash Kembhavi is a double gold medalist and university topper (BAMS 1994, Karnataka University, Dharwad), MD (1998 – Shalya Tantra – IPGTR&A, Gujarat Ayurveda University, Jamnagar), with additional qualifications in Medico Legal Sciences (Symbiosis University of Health Sciences, Pune) and Counseling & Psychotherapy (Kuvempu University, Shivamogga). He has been practicing authentic Ayurveda, Yoga, Naturopathy, and Acupuncture since 1999 through Astanga Wellness Pvt Ltd, Hubli. He brings over 25 years of clinical experience and academic leadership to this discussion. He is a recognized PG and PhD guide at RGUHS Bengaluru, visiting professor at Thames Valley University London, and serves on multiple editorial boards and research councils internationally.

Disclaimer: This article is not intended to offend any individual, institution, or stakeholder in the Ayurveda community. Rather, it is written with deep concern for both the future of Ayurveda as a medical system and the urgent public health crisis of antibiotic resistance. The questions raised here are deliberately probing and designed to make stakeholders uncomfortable—because comfortable conversations have failed to address these critical issues. This discomfort is necessary for accountability and meaningful change.

As someone who has dedicated my life to authentic Ayurvedic practice and education, I believe we owe it to our tradition, our patients, and future generations to confront these uncomfortable truths honestly. This article has been created with AI assistance for transparency in the writing process, but the concerns, observations, and questions reflect real issues documented in peer-reviewed research and policy discussions.

The goal is not to diminish Ayurveda but to strengthen it by demanding excellence, accountability, and honest self-examination from all stakeholders.

The Uncomfortable Truth No One Wants to Discuss: Dr. Devi Shetty, the renowned cardiac surgeon, has issued a stark warning: antibiotics are losing their effectiveness due to rampant abuse, and we risk returning to a pre-penicillin era where routine infections become untreatable. His observations about surgical patients developing resistant infections are chilling. Yet while the medical establishment rushes to blame patient behavior and over-the-counter sales, there’s a massive elephant in the room that the Ministry of AYUSH refuses to acknowledge: the vast majority of BAMS (Bachelor of Ayurvedic Medicine and Surgery) graduates are practicing modern medicine and prescribing broad-spectrum antibiotics without proper training.

This isn’t a fringe issue. This is a systemic failure of staggering proportions.

The Data Doesn’t Lie: Research reveals that BAMS students acquire training in allopathic medicine by working as understudies in allopathic practitioners’ clinics, and later start independent allopathic practice or join smaller hospitals on cheaper salaries. It is also a fact that majority of Ayurveda college faculties irrespective of cadre practice modern medicine. This is a common phenomenon across multiple states.

Let’s be brutally clear: Private BAMS graduates are in high demand in urban areas where nursing homes and hospitals employ them to function as second-line workforce—even managing post-operative and ICU work. These are not trained allopathic doctors. These are Ayurveda graduates practicing modern medicine, prescribing antibiotics, and managing critical care situations for which they have received no systematic training.

The numbers are damning. With over 770,000 registered AYUSH practitioners in India—including approximately 428,884 Ayurveda practitioners—we’re looking at hundreds of thousands of individuals potentially prescribing antibiotics without adequate training in antimicrobial stewardship, pharmacology, or evidence-based allopathic medicine.

The Rural Areas Myth: A Convenient DeflectionThe standard defense is predictable: “BAMS doctors serve rural areas where MBBS graduates refuse to go.”

This argument collapses under the slightest scrutiny.

Data from the National Sample Survey shows that the density of AYUSH practitioners is seven times higher in urban areas compared to rural areas, where the mean density is only 0.2 per 10,000 population. The claim that BAMS graduates primarily work in rural areas is demonstrably false.

But let’s address the rural scenario anyway. Even if we accept the premise that some BAMS doctors practice in underserved rural areas, does geographical necessity justify untrained prescribing of broad-spectrum antibiotics?

When an untrained practitioner prescribes third-generation cephalosporins or fluoroquinolones for a simple viral fever—because that’s what they’ve seen others do or because it provides quick symptomatic relief—they’re not filling a healthcare gap. They’re creating a public health catastrophe. Dr. Shetty warns that bacteria have consumed so much antibiotics that they no longer respond to them, and untrained prescribers are accelerating this nightmare scenario.

Wrong.

Multiple states have released notifications permitting Ayurveda and Unani graduates to prescribe antibiotics, anesthetics, and various other contemporary medicines within primary and community health centers, standing in direct opposition to the Supreme Court’s decision. When the Indian Medical Association challenges these orders, High Courts frequently annul them—but new notifications keep appearing.

This regulatory whack-a-mole has created a dangerous situation where BAMS graduates operate in a legal gray zone, sometimes permitted and sometimes prohibited from prescribing allopathic drugs, depending on which state they’re in and which notification is currently in effect.

But the regulatory chaos doesn’t end there. In November 2020, the Central Council of Indian Medicine issued a gazette notification amending the Post Graduate Ayurveda Education Regulations to include training for 58 surgical procedures ranging from general surgery to ENT, ophthalmology, and dental procedures. These included 39 general surgery procedures and 19 procedures involving the eye, ear, nose and throat.

The Indian Medical Association organized demonstrations protesting this notification, and the matter is currently sub judice before the Supreme Court. Most recently, when Andhra Pradesh’s Health Minister approved Ayurvedic practitioners with postgraduate surgical training to perform select surgeries independently in December 2024, the IMA’s state branch strongly condemned the move.

The Uncomfortable Truth About Ayurvedic Surgery Training: Here’s what nobody in the Ayurveda establishment wants to acknowledge openly: Over decades, ALL Ayurveda postgraduates who learned modern surgical techniques have ALWAYS been taught and trained by modern surgeons, who then went on to train other students.

This isn’t speculation. Pioneers like Prof. K.N. Udupa and Prof. P.J. Deshpande, though from Ayurveda backgrounds, received their surgical training from the University of Michigan and Vienna Academy of Medicine respectively. These modern medical institutions welcomed them and trained them well in surgery. These teachers then trained students—including MBBS students—at Banaras Hindu University.

The pattern is clear and undeniable: Modern medicine does all the hard work of developing surgical procedures, techniques, perioperative care protocols, anesthesia management, and complication handling. Then Ayurveda learns these techniques from modern surgeons.

Yes, hardworking Ayurveda surgeons have developed innovative techniques for treating piles, fistula-in-ano, and fissure-in-ano using Kshara Sutra and other methods. These contributions are valuable and deserve recognition. But let’s be honest—that’s about the extent of Ayurveda’s independent surgical innovation in modern practice.

Why is it so hard to accept that present-day surgery in Ayurveda would not exist without modern medicine and surgery?

The issue isn’t that Ayurveda surgeons learned from modern medicine—cross-pollination of knowledge is how medicine advances. The problem is the hypocrisy and the consequences. We learn surgical techniques from modern medicine, we adopt their procedures, we follow their protocols, and then we prescribe their antibiotics—heavily and blindly—without acknowledging our dependence or taking responsibility for the consequences.

If we’re honest enough to acknowledge that our surgical training comes from modern medicine, why aren’t we honest enough to acknowledge that we’re contributing to antibiotic resistance by prescribing antibiotics without proper training in antimicrobial stewardship?

The result of all this regulatory chaos? Confusion, inconsistent practice, and zero accountability—whether it’s about prescribing antibiotics or performing surgeries.

The Educational Failure: Learning by Osmosis: BAMS degree holders generally lack required exposure to essential clinical skills. Think about that. These graduates are entering practice without adequate clinical training even in their own system, let alone in modern medicine.

Yet they’re prescribing antibiotics. They’re managing ICU patients. They’re conducting surgeries.

AYUSH students acquire training in allopathic medicine by working as understudies in allopathic practitioners’ clinics, learning through observation rather than structured education. This isn’t medical training—it’s medical mimicry. And when you’re mimicking antibiotic prescribing patterns without understanding pharmacokinetics, microbiology, antibiotic stewardship, or evidence-based treatment protocols, you become part of the resistance problem, not the solution.

Where is the Ministry of AYUSH?Here’s where the irony becomes almost unbearable.

The Ministry of AYUSH has positioned Ayurveda as a potential solution to antimicrobial resistance, advocating for its immunomodulatory and holistic approaches. Various articles and policy documents trumpet Ayurveda’s role in addressing AMR. The ministry promotes Ayurveda as an alternative to antibiotics, emphasizing its gentle, natural approach that strengthens immunity rather than killing microbes.

But what is the ministry doing about its own graduates practicing modern medicine and contributing to antibiotic resistance?

Nothing. Absolutely nothing.

While the Ministry of AYUSH busily promotes Ayurveda as the answer to antibiotic resistance on the global stage, it remains conspicuously silent about the fact that hundreds of thousands of its own graduates have abandoned Ayurvedic practice in favor of prescribing the very antibiotics that are driving the resistance crisis.

This isn’t just hypocrisy. This is willful negligence.

Modern Medicine Must Clean Its Own House—But That Doesn’t Absolve Us: Before we go further, let’s be absolutely clear about something: Modern medicine is rightly acknowledging that antibiotic overuse and misuse within its own system is causing catastrophic problems. MBBS doctors, surgeons, and specialists contribute significantly to antibiotic resistance through unnecessary prescriptions, inadequate patient education, and failure to follow antibiotic stewardship protocols.

This is modern medicine’s problem to resolve. They need to educate their fraternity, enforce stricter prescribing guidelines, improve diagnostic practices, and hold their practitioners accountable. The modern medical establishment bears primary responsibility for addressing antibiotic resistance within their system.

But here’s the question nobody in Ayurveda wants to answer: Why should we add fuel to this fire?

Modern medicine acknowledging its problem doesn’t give us permission to become part of the problem without any responsibility. When a house is already burning, you don’t get to pour gasoline on it and say, “Well, I didn’t start the fire.”

The fact that modern medicine has an antibiotic resistance problem doesn’t justify BAMS graduates—who have received minimal to no training in antimicrobial stewardship, microbiology, or evidence-based allopathic prescribing—adding to the crisis by prescribing broad-spectrum antibiotics indiscriminately.

If modern medicine is struggling to control antibiotic resistance despite having:

  • Rigorous training in pharmacology and microbiology
  • Established protocols for antibiotic stewardship
  • Diagnostic infrastructure to identify pathogens
  • Continuing medical education on resistance patterns
  • Regulatory oversight and monitoring systems

Then what makes anyone think that BAMS graduates practicing modern medicine without any of these safeguards will somehow do better?

We don’t get to hide behind modern medicine’s problems. We need to acknowledge that we’re making those problems worse.

If we in Ayurveda truly believed in our system’s ability to treat infections without antibiotics, we would be demonstrating that capability, not reaching for the allopathic prescription pad at the first sign of a fever. If we believed in building immunity and preventing disease through Ayurvedic principles, we would be proving that approach works, not prescribing third-generation cephalosporins.

The refusal to acknowledge our contribution to antibiotic resistance isn’t just intellectually dishonest—it’s medically irresponsible and ethically indefensible.

Modern medicine must clean its house. Absolutely. But that fact doesn’t exempt us from the responsibility to not trash the neighborhood while they’re doing it.

The System Has Failed Completely - Ayurveda as a medical system deserves to be preserved, studied, and developed. If practiced properly by well-trained Ayurvedic physicians, it may indeed have value in preventive medicine and certain therapeutic applications.

But let’s be honest about what’s happened: The Ayurveda educational system has failed to produce trained Ayurveda healthcare professionals who can practice their own system effectively. Instead, it has produced an army of half-trained practitioners who default to prescribing allopathic drugs—particularly antibiotics—because that’s where they see immediate results, immediate patient satisfaction, and immediate income.

Research confirms that continued dependence on inadequately trained practitioners is fraught with dangers of incorrect diagnosis and irrational drug use, resulting in the spread of multi-drug resistance.

Every time an untrained BAMS graduate prescribes a broad-spectrum antibiotic for a self-limiting viral infection, they’re not just failing an individual patient. They’re contributing to a crisis that could push humanity back to a pre-penicillin era where routine surgeries become deadly and simple bacterial infections routinely kill.

Questions That Demand Answers: The stakeholders in this crisis need to answer some very uncomfortable questions:

To the Ministry of AYUSH:

  • Why are you promoting Ayurveda as a solution to antibiotic resistance while ignoring that your own graduates are major prescribers of antibiotics?
  • What concrete steps have you taken to prevent BAMS graduates from practicing allopathic medicine without proper training?
  • Why has there been no systematic study of antibiotic prescribing patterns among BAMS graduates?
  • How can you justify promoting “crosspathy” while simultaneously claiming Ayurveda’s purity and effectiveness?

To BAMS Colleges and Universities:

  • Are you preparing students to practice Ayurveda, or are you essentially running informal allopathic training programs?
  • What percentage of your graduates actually practice traditional Ayurveda after graduation?
  • Why aren’t you tracking graduate outcomes and prescription patterns?

To State Medical Councils:

  • Why do you continue issuing notifications allowing AYUSH practitioners to prescribe allopathic drugs despite Supreme Court rulings?
  • What oversight mechanisms exist to monitor prescribing patterns?
  • What actions have you taken against BAMS graduates who practice beyond their competency?

To BAMS Graduates Themselves:

  • Did you enroll in Ayurveda education to practice Ayurveda, or to obtain a medical degree through an easier route?
  • Do you feel adequately trained to prescribe antibiotics and manage acute medical conditions?
  • Are you comfortable being complicit in the antibiotic resistance crisis?

The Path Forward: Accountability, Not Excuses: The solution isn’t to ban BAMS graduates from practice. The solution is accountability and honest acknowledgment of the problem:

  • Enforce existing regulations: Either BAMS graduates practice Ayurveda exclusively, or they obtain proper allopathic training through bridge courses with rigorous standards—not weekend workshops, but genuine medical education.
  • Transparent data collection: Track antibiotic prescribing patterns among all practitioners, including AYUSH graduates. Publish the data. Let sunlight be the disinfectant.
  • Reform BAMS curriculum: If the system cannot produce graduates capable of practicing traditional Ayurveda, then the educational system itself needs fundamental reform. Either train them properly in Ayurveda, or acknowledge that the degree has become meaningless.
  • End the charade: The Ministry of AYUSH must stop promoting Ayurveda as an antibiotic alternative while tolerating its graduates being antibiotic prescribers. Pick one position and defend it honestly.
  • Consumer protection: Patients have successfully taken legal action against AYUSH practitioners for misrepresentation when they believed they were receiving treatment from an MBBS doctor. This needs to become the norm, not the exception. Patients deserve to know exactly what qualifications their healthcare provider possesses.

The Uncomfortable Conclusion: Dr. Shetty’s warning is clear: if we continue on this path, we will run out of effective antibiotics and return to a pre-penicillin era. This isn’t fear-mongering. This is medical reality.

Every stakeholder in the Indian healthcare system—from the Ministry of AYUSH to individual practitioners, from medical councils to educational institutions—must confront this crisis honestly. The BAMS graduates practicing modern medicine without adequate training aren’t heroes filling healthcare gaps. They’re undertrained practitioners contributing to one of the gravest public health threats of our time.

The time for comfortable narratives and convenient deflections is over. The antibiotic crisis is real. The contribution of inadequately trained practitioners—including BAMS graduates practicing beyond their training—is real.

The question is simple: Will we continue to ignore this problem until antibiotics stop working entirely, or will we have the courage to demand accountability from all stakeholders, equally and without exception?

The bacteria are waiting. They’re getting stronger every day. And they don’t care about our regulatory confusion, our political sensitivities, or our convenient myths about rural healthcare access.

They only care about survival. And right now, thanks to rampant, untrained antibiotic prescribing, they’re winning.

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