Border Crossing with Venkat Narayan, the doctor interested in everything

K.M. Venkat Narayan, MD, MSc, and MBA, moves across disciplinary borders with the same fluidity with which he has traveled the world. Former chief of the diabetes science branch at the U.S. Centers for Disease Control and Prevention (CDC), Dr. Narayan’s current roles include Ruth and O.C. Hubert Chair of Global Health, director of the Emory Global Diabetes Research Center and professor of epidemiology at the Rollins School of Public Health, and professor of medicine at the Emory School of Medicine. He also leads the U.S. team for the Centre for Control of Chronic Conditions, an international health research partnership located in New Delhi, India.

On switching gears, professionally, early on

I was an unhappy medical student. I found medical school extraordinarily routine, boring – very narrow in its perspective. I enjoyed being a clinical doctor. That part was nice. But the idea of pursuing that alone wasn’t appealing.

Then I was on call one evening, and it was a very long night. [I was] woken up six or seven times – multiple patients – and then I couldn’t fall asleep. So, I go to the library in Dryburn Hospital in Durham, England. And I find this book called Clinical Epidemiology by Fletcher and Fletcher.

The opening paragraph of the book describes chest pain, and then it says, everybody would know this is angina. And the next question is, but how did the first person know this was angina? This was a question that had been bothering me, and I’d asked this question as a medical student to my teachers in India, and I was always told every textbook says that. But what this book taught me is the method that you go about [for] establishing a syndrome is a syndrome – or the symptoms that lead to a diagnosis. Immediately, I decided that this was a subject I wanted to learn.

So, I reached out the next day and found places that were training people in epidemiology and preventative medicine, and that was a major switch I made. That was a very big leap.

On ignoring disciplinary boundaries in pursuit of answers

One thing that I learned from my MBA is that if you are investing in product development, you better also think of the market, because otherwise you’re just spending a lot of money on your product and not making your product available to the market. Your company’s going to fail.

You know, for all the money that is spent on research – it was shocking to me when I was at CDC that less than ten percent of the U.S. public with diabetes gets perfect care for diabetes. We’re not good at implementing. The question is how do you apply marketing principles to improve that? And I think that was a classic example of how cross-disciplinary work comes in.

Ultimately, resources are always limited. So, the question really is, how do you optimize your investment in dollars to maximize the health of a population? That got me into economics. And then more recently – you know, when we started work in terms of setting up diabetes studies in India, our assumptions were very naïve. We basically thought that a lot of what had been found here in the U.S. was going to directly apply to all of the low- and middle- income countries, and we’d just go around implementing all the proven interventions.

But then we started discovering that the pattern of disease in some of these countries is very different. Like, for example, in countries in Sub-Saharan Africa and in India, there are people who are very thin developing type 2 diabetes, and the question is why? So, I’m now beginning to work with geneticists, epigeneticists, molecular biologists, and [researchers in] metabolomics to understand this phenomenon.

On building the Emory Global Diabetes Research Center

One big challenge [of international work] is funding, and especially funding for the first few studies or the initial infrastructure. I think that is the place where Emory really helped me – I mean, the Global Health Institute, you know, the initial funding for us to set up the Global Diabetes Research Center in partnership with India. They gave me the Global Health Institute Distinguished Professorship, which gave me start-up money for four years. These two helped me start the program, build, take the risk, recruit great faculty, and then start getting grants from other places. But that gave me the advantage. I could not have done it without start-up funds from Emory. There’s no chance. There’s no way we could have done it, or we couldn’t have done it at this scale.

I think the second big challenge has always been about developing and strengthening the partnerships, and there we did well. I mean, we chose good partners. We were very selective in how we chose our partners. We wanted partners who are strong, as strong as us, and we wanted to go to places where there was decent infrastructure. We said let’s go to places that are reasonably well-equipped and let’s build that partnership and then spread the wealth.

The third challenge is really about attracting smart people into the field. And there, we have not had problems at all. The excitement of global work has meant that we’ve had a constant stream of doctoral and postdoctoral fellows and junior faculty come our way. I think that’s been fantastic.

On what keeps him crossing borders

I’ve always been somebody who’s been interested in lots of things. Even as a medical student, when everybody else was studying anatomy, I was reading philosophy and English literature and poetry. I enjoy history. I enjoy politics. I enjoy philosophy. I enjoy reading.

That’s a constant theme of my life, the fact of being curious about other areas, other disciplines. I have discovered over time that it’s a great habit, because you make connections that you otherwise don’t make. I’ve always been also very interested in different places, different cultures, different people, etcetera. A lot of new ideas come from the boundaries. We become so focused in a linear way, staying within our disciplines or within our homes or whatever. Yes, it gives us a tremendous amount of stability, and you think you’re growing deep, but in a sense, you’re actually limiting yourself because a lot of the discoveries come chaotically, come from across boundaries, from across disciplines. And I think the moment you isolate yourself from all that, you’re dead.