Medical Minute – Celebrating the Cure of a Disease

By: Dr. James Lee

Imagine a disease in children with a death rate above that of all birth defects, cancers, or suicides. Imagine a disease that ranked second only to Accidents as the leading cause of death in children aged 15 and under. Imagine a disease that had an average life expectancy of 1 year when diagnosed in a 10-year-old, 4 years if diagnosed at 30 years of age, and 8 years if diagnosed at age 50. Imagine this disease has no real medical treatment and that there were very little doctors could do to treat these patients.

This was the reality of diabetes prior to the 1920’s. Although diabetic symptoms were described as early as 1552 B.C., the cells that produce insulin, islets of Langerhans, were not discovered until 1869. It was not until 1905 that the term hormone was used to describe the chemical messengers of endocrine glands, one of which is insulin. It was well into the 20th century that a dipstick to detect sugar in the urine to help the early detection of diabetes. How was it detected earlier, you may ask? Well, let’s just say it involved “water-tasters” and is why the urine in diabetics is described as sweet, like honey or sugar.

Last November, we celebrated the 100-year anniversary of the discovery of Insulin. The discovery of Insulin is a tale of inspiration, collaboration, altruism, celebration, and controversy. This started with Frederick Banting, a Canadian surgeon, who, prior to WWI, was studying Theology in Toronto. With the start of WWI, he changed his study to medicine and served as a medical officer in England and France during the War. On October 31, 1920, Banting woke up suddenly with a flash of insight as to how he could isolate and use pancreatic secretions to treat diabetes, and even wrote this down in a notebook.

However, Banting was not a scientist and had very little background in experimentation. He knew he would need help to test this theory and approached a top professor in physiology and department head at the University of Toronto, John Macleod. Macleod was not impressed with Banting or his idea initially, but after subsequent meetings, whether by Banting’s enthusiasm, persistence, or something else, Macleod agreed to provide laboratory space and introduced Banting to student assistant Charles Best. In the Spring of 1921, experiments started in dogs and by November 10, 1921, they had successfully treated a dog with diabetes using insulin they had extracted from a dog’s pancreas. In December of 1922, James Collip was brought in to help purify the extract for human use and in January 1922, the first human patient was treated with insulin.

In January 1923, Banting, Best, and Collip were awarded US patents on insulin and their method used to make it. They then sold the patents to the University of Toronto for $1.00 each. A true altruistic gesture, Banting stated, “Insulin does not belong to me; it belongs to the world. Within a year of discovery, insulin was being mass produced by its first manufacturer, Eli Lilly. Also, within a year of discovery, Banting and Macleod were jointly awarded the 193 Nobel Prize in Medicine.

So, we have seen the inspiration, collaboration, altruism, and celebration around the discovery of insulin. What possibly could be controversial. Aside from the work of others in the field and their advancements that made Banting’s work possible, you may have taken notice that Banting and Macleod were given the Nobel Prize. Unfortunately, Best and Collip were not acknowledged for their role. This may partly be due to the limit of three persons named for the Nobel Prize by the committee. However, Banting immediately let Best know he would be splitting his portion of the Prize money with Best. Macleod later split his half of the prize money with Collip. Although contentious, this was hardly controversial.

Reports were that Banting was furious and felt that the award should be shared with Best, not Macleod, as Macleod was in Scotland during the Spring and Summer of 1921. In fact, there are some reports of a personality clash between MacLeod and Banting following Macleod’s return from Scotland. Macleod could not believe how much Banting and Best had accomplished and questioned the accuracy of their data. Banting saw this as questioning his integrity; together with what Banting saw as Macleod’s scorn of his background and ability, further strained the relationship. Interestingly, documentation of the entire story surrounding the discovery of insulin was partly ignored and even suppressed by the University of Toronto to avoid embarrassment to the surviving researchers.

Regardless of how the discovery was made, there is no question about the impact that the discovery of insulin has made on the world: from insulin’s discovery to the altruistic widespread release. Today, diabetes is widespread, affecting over 30 million Americans alone, with another 84 million over 18 having pre-diabetes. It is hard to imagine where we would be without the discovery of insulin.

For more information about this topic, read The Discovery of Insulin by Michael Bliss.

Dr. James Lee serves as the Coroner of Winn Parish. He is a General Surgeon and Surgical Oncologist who has been practicing in Winnfield for over ten years. Dr. Lee attended the University of Colorado for his medical degree. He completed his residency in Surgery at the University of Oklahoma before completing a fellowship in Surgical Oncology and Endoscopy at Roswell Park Cancer Institute in Buffalo, NY. Dr. Lee and his wife Scarlett live in Winnfield with their son and are active in the community.

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