K.M. Venkat Narayan
The physician-epidemiologist shares his approach to navigating public health challenges through humility, curiosity, and dialogue, even when disagreement runs deep.
By K.M. Venkat Narayan, Karen Meurer Bacellar
NAM member K.M. Venkat Narayan’s path to public health leadership began with a long overnight shift and a quiet moment of discovery. As a young physician training in Durham, England, he wandered into the hospital library around 4 a.m., looking for something to read after a string of emergency calls. On a shelf, he spotted a small green book: Clinical Epidemiology: The Essentials by Fletcher and Fletcher. He opened it and read a question that stopped him in his tracks: How did we first know that chest pain radiating down the arm could signal a heart attack?
It wasn’t only the specific question that struck him. It was the kind of thinking behind it. Years earlier, in medical school in India, Narayan had often asked similar questions. He wasn’t interested only in what the facts were, but in how we came to know them. While he and his peers focused con mastering clinical knowledge, Narayan also found himself drawn to the origins of that knowledge — the reasoning, the process, the stories behind how medical understanding is built.
That moment, and the mindset it reinforced, would go on to shape a career spanning clinical medicine, epidemiology, clinical research, global research, and public health policy, fueled not just by data, but by deep philosophical inquiry and a commitment to scientific curiosity.
In this conversation with the National Academy of Medicine, Narayan reflects on what led him to co-author (with Shivani Patel) “Addressing Polarizing Issues in Public Health: Ten Principles for Effective Dialog,” a commentary offering practical guidance for navigating disagreement in science and public health settings. The article outlines ten principles grounded in humility, curiosity, and a commitment to respectful communication. It encourages public health professionals to listen first, avoid assumptions, seek common ground, and remain open to changing their own views. The guidance also includes breaking out of echo chambers, identifying shared goals, exercising patience, and considering win-win solutions. Rather than deepening divides, the piece calls for approaches that prioritize empathy, trust-building, and shared purpose.
Building on those themes, Narayan discusses in this interview why these principles are urgently needed to foster constructive dialogue in today’s complex and often polarized public health landscape — and how that kind of openness and curiosity can lead to better science. He also shares personal stories of epistemological humility, the role of storytelling in scientific communication, and his vision for cultivating “scientific temper” — not just in labs and policy circles, but across all levels of education and society.
The following interview has been edited for length and clarity.
What prompted you to write “Addressing Polarizing Issues in Public Health”?
Narayan: Shivani and I had been reflecting on these issues for years, especially the growing polarization we see in public health. COVID highlighted it, but we see the same divisions around equity, climate change, and the tension between science and cultural or religious traditions. Too often, people become so convinced they are right that they stop trying to understand others.
How have you seen dialogue around public health issues evolve since the article was published?
Narayan: When the article came out, it didn’t create a major stir, but several people reached out to say how refreshing it was. That reaction meant a lot. Even before we wrote it, we had been discussing these issues, and we began noticing that some people were slowly becoming more open to the idea of engaging across perspectives.
Sometimes ideas like this need time. They don’t always spark change immediately. As Malcolm Gladwell described, there may be a tipping point later when they suddenly gain traction. To me, the bigger point isn’t just examples of where these principles were applied and worked, but the cost of not following these principles.
Take the pandemic. That’s a clear example. It was a global crisis, and we had to act quickly. The dominant national response was guided by the Precautionary Principle [a policy approach that encourages taking preventive action when there is potential for serious harm, even if scientific evidence is incomplete or uncertain — essentially a “better safe than sorry” mindset, especially in the face of unknown risks].
At the same time, a group with a different perspective emerged. They argued that policy should not focus solely on immediate health outcomes but also consider the broader consequences, such as the harm caused by school closures, emotional stress on children, and other long-term effects.
At the time, the mainstream policy advocates essentially dismissed and, in some cases, insulted that alternate view. Looking back, that was a mistake. The two sides could have engaged in dialogue. Scientists from both camps could have come to the table. Maybe then the group that pushed back against the mainstream would have understood the urgency behind the early policies — such as concerns about hospitals and crematoriums being overwhelmed. And maybe the mainstream would have acknowledged some valid points about unintended consequences and the need to consider multiple types of harm in public health. Now, with the benefit of hindsight, you can see that both sides had some truth.
How have your principles been applied in your field of diabetes?
Narayan: In my own field of diabetes there’s another good example. For a long time, the dominant narrative was that type 2 diabetes is driven by obesity. I believed that too, based on my work with the Pima Indians and others. But when I visited India, I saw people with BMIs of 17 or 18 developing type 2 diabetes. That couldn’t be explained by obesity. While a large number of people develop diabetes who are obese, a sizeable number also develop diabetes even when thin. Obesity impairs insulin action, and this does not explain why thin and nonobese people develop obesity. They probably do not secrete enough insulin to start with.
I started wondering whether some people develop diabetes because they can’t produce enough insulin to begin with. I recalled a conversation while walking in Cambridge with Ruth Loos when she pointed out something important: the genes associated with diabetes and those with obesity barely overlap. That suggests different biological pathways. Maybe some people develop diabetes primarily due to poor insulin secretion, not insulin resistance.
That idea didn’t catch on easily. At big meetings or European conferences, the message was always the same. It felt like going to church — repetitive and dogmatic. So, I stopped attending the large meetings and focused quietly on generating new data. Now, there’s growing recognition that there are different types of type 2 diabetes. Some are driven more by insulin resistance, others by insulin deficiency. The insulin-deficient variety is likely more common in countries that didn’t go through the Industrial Revolution — places like India, much of Asia, and Africa.
Even now, there are debates. Some still argue that obesity is the main driver and that eliminating it is the solution. I’m all for reducing obesity, but the truth is, most people with obesity don’t develop diabetes, and many with diabetes aren’t obese. There’s clearly more to understand. We need to approach this with biological nuance.
In your article, you talk about the importance of epistemological humility. Could you share an example when you had to rethink your own position or approach in the face of an opposing view? You touched on this in the diabetes and obesity discussion, but is there another moment that stands out?
Narayan: There are several, but I’ll share one that really shaped my thinking.
During my early time in America, from 1992 until 2006, all my diabetes research was based in the United States — first at the National Institutes of Health, then at the Centers for Disease Control and Prevention. We had done large epidemiological studies and clinical trials, and I honestly believed we had most of the answers. When I launched the Emory Global Diabetes Research Center in 2007 and began building partnerships in India, I approached it with a kind of missionary zeal. We had the evidence, and we just needed to implement it globally.
But I quickly realized that approach wouldn’t work. Not because the science was wrong, but because context matters. In the United States, it’s rare to see someone with a BMI of less than 22 develop type 2 diabetes. In India or sub-Saharan Africa, it’s not. The local clinical realities are very different. The disease manifests differently in different contexts and may need different approaches to prevention and treatment. At first, I argued from the perspective of my American training, but my colleagues were speaking from deep, on-the-ground experience. That was humbling, and it changed how I thought about translation and applicability of science.
This is an example of how, in our passion, we can become too rigid. I once read that a good scientist should prove themselves wrong at least a few times in their career. I believe that completely.
How can scientists reconcile the importance of data with the need for emotional connection and storytelling, especially in a time when facts alone are often not enough to change minds?
Narayan: That’s a good one. It is a tough question. Even within the scientific community, facts alone often are not enough to change opinions. That is not unique to science. It is just human nature. We tend to accept the facts that align with what we already believe.
My daughter, who is a physicist, and I often talk about this. One of the key differences between religion and science is that religion rests on fixed assumptions, while science is based on assumptions that can be tested and changed. But even in science, it takes time to let go of old ideas.
In polarizing debates, more facts can actually harden positions. Each side digs in. So, the real question becomes, how do things actually change?
Often, it happens through human connection. Let me give you an example. In my advisory group at the Emory Global Diabetes Research Center, people come from very different political and professional backgrounds. The conversation becomes polarized very quickly if I start by asking, “Should we address diabetes through medication or lifestyle? Should it be solved by the government or the private sector?”
But if I begin with a story—for example, telling the group that I once met a woman with a BMI of 17 who had type 2 diabetes—and just leave it there, people become curious. It invites conversation instead of confrontation. Framing a question without pushing an answer often creates more space for thoughtful dialogue.
It is better not to jump into arguments. Instead, bring something interesting to the table. Create a shared space for people to open their minds. It does not always work, but I think it is our best chance.
Stories can also build trust. When I talk to potential donors, I often ask, “What would interest you in supporting diabetes research?” The answers are always different. But just asking, and listening to the personal reasons behind their interest, creates connection. And that can spark real engagement.
What does it mean to be a member of the National Academy of Medicine?
Narayan: It was a tremendous honor to be elected, but I have always felt it is more than that. The National Academy of Medicine is a service and volunteer organization. If you read the 1863 charter that established the National Academy of Sciences, the purpose is clear. It is to serve as independent advisors to the nation. It is about speaking the truth as best we can and keeping science and evidence at the center of shaping the future.
That is what excites me. Every meeting brings together people whose accomplishments are humbling. These are individuals with global vision who have done extraordinary things. That shared sense of purpose defines the Academy’s ethos.
I remember watching a short video about the Academies that highlighted some of the collective contributions: the Human Genome Project, the Manhattan Project, the national parks, and work on climate change. To be part of a community that has shaped so much is incredibly meaningful.
There is also a sense of responsibility. We are here not just to contribute when things are going well, but also when times are difficult. The Academies were founded during the Civil War, when President Lincoln recognized the importance of science in both winning the war and rebuilding the nation. That history reminds us that science is not partisan. It should be seen as a force for both freedom and hope.
The more I reflect on it, the more I see this role as both a privilege and a duty. I know you asked a simple question, and I have given a long answer, but that is what it means to me.
Is there anything else you would like to share?
Narayan: Yes, there is one more thing I would like to share. I don’t know if you’ve read Carl Sagan’s last book, The Demon-Haunted World, but in it, he talks about how modern society is built on the foundations of science. Our systems and progress depend on scientific thinking, yet somewhere along the way, we’ve forgotten to train everyday citizens to think that way.
You don’t have to be a scientist to think like one. What Sagan argues is that if we fail to nurture this mindset, decisions start to be driven more by emotion or ideology than by evidence and reason. That, to me, is incredibly important.
The article we’ve been discussing is really about developing that scientific temper: staying calm, focusing on facts, thinking rationally, and being open to other points of view. It’s also about being willing to step outside of our echo chambers.
So, my question is, how do we teach that kind of thinking to future generations? How do we build that capacity, starting in schools and continuing throughout life?
My co-author Shivani Patel and I are doing a little experiment this fall. We are launching a short course called Scientific Temper. It is a five-day course, three hours each day, online. It is just a pilot. If it works, we will see where it goes. The course will explore questions like, what is science? What is the philosophy of science? What does it mean to think scientifically? It is meant to be accessible and engaging. We are excited to see how it does.
Views expressed are those of the interviewee and do not necessarily reflect the views of the National Academy of Medicine.
