Recently, my brother Howard, a distinguished high school teacher of science in Washington, DC, sent me a present. It was a book he said that I had to read, and he was right! The book tells the fascinating story of the discovery of insulin and its early use in the limited number of patients who were able to obtain the small amounts of this hormone that were produced early after its discovery.1 The history of the discovery of insulin is a fascinating foreshadowing of our current system of modern scientific medicine.
This book reads like a novel, and even though we know the wonderful outcome prior to reading the first page, the authors manage to tell this story in such a gripping and exciting manner that one cannot wait to turn to the next page. The excitement and tension is created by following the lives of a number of individuals, including one patient, Elizabeth Hughes, her original diabetic physician, Frederick M. Allen, and the three physicians involved in the discovery of insulin: Frederick Banting, Charles Best, and John James Rickard Macleod. The narrative also follows the lives of a number of other players in this extraordinary drama that led to the Nobel Prize in Medicine in 1923, as well as the management of a disease that had been universally fatal up to that time.
Elizabeth Hughes was the daughter of one of the most powerful political figures of that time, Charles Evans Hughes. It was Hughes’ political connections that enabled his daughter to be one of the first individuals to receive injections of insulin prepared in Canada by Banting and Best. Elizabeth went on to lead a normal life, obtaining a college degree, marrying, giving birth to 3 children, and living a life of important public service, thereby following in the footsteps of her father. When she died at age 73, she had received over 42,000 insulin injections over a period of 58 years. Elizabeth never spoke about her diabetes once it was controlled with daily insulin injections. The authors speculate that she might have felt guilty because the insulin she received would otherwise have gone to a Canadian child who almost certainly succumbed to the disease without this life-sustaining hormone.
The history of the discovery of insulin involves a number of dramatic events. Frederick Banting was raised on a farm in Ontario, Canada and graduated from the University of Toronto Medical School in 1917. He was a mediocre student, and volunteered shortly after graduation for service in the Canadian military efforts in World War I, where he was wounded. After he returned to Canada following the war, Banting read about early animal experiments with pancreatic extracts. He convinced himself that here lay the answer to the therapy of patients with the then inevitably fatal disease, diabetes mellitus. Banting had a very prickly and forceful personality, coupled with a short temper. Despite this flaw, he was able to convince Frederick Macleod, an esteemed professor of physiology at the University of Toronto, to allow him to conduct canine experiments with pancreatic extracts in Macleod’s laboratory. Banting was joined throughout his experimental journey by medical student Charles Best, who unfortunately, and unjustly, was not included with Banting and Macleod when the Nobel Prize was awarded.
The experiments were not initially successful, and Banting was frequently discouraged and depressed. However, his co-worker Best played a crucial role in keeping Banting from giving up on the quest for the cure for diabetes. As we are wont to say, “the rest is history.” Banting and Best eventually achieved a method for extracting active insulin from canine pancreases. The Eli Lilly pharmaceutical firm of Indianapolis, represented by an insightful research director, George Henry Alexander Clowes, understood early on in the experimental development of insulin that this hormone would lead to an eventual “paradigm shift” in the management of diabetes mellitus. Up to that time, the only therapy available for children with diabetes was a form of starvation diet that enabled these patients to gain a miserable survival of a year or 2. Clowes and the Eli Lilly Company were crucially important to the eventual widespread therapeutic use of insulin. This company worked with Banting and Best and developed an industrial method for extracting large amounts of insulin from bovine and porcine pancreases collected from slaughterhouses where they had previously been discarded. The drama surrounding the early production of insulin by the Eli Lilly Company is one of the most fascinating components of this book.
The history of the discovery of insulin and its use in the earliest patients to receive this life-sustaining therapy makes for a delightful read. I highly recommend this book to our readers. You won’t be disappointed even though you know the outcome prior to turning the first page. As always, I enjoy hearing from our readers on our blog atamjmed.org. I promise to respond.
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-Joseph S. Alpert, MD (Editor in Chief, The American Journal of Medicine)
This article originally appeared in the March 2016 issue of The American Journal of Medicine.
