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A mysterious something.

October 24, 2008, 10:01 am

On this day in October 1923, a committee in Stockholm met to consider giving the Nobel Prize in medicine to Frederick Banting, one of the discoverers of insulin.  The Nobel committee’s decision the next day to  honor both Banting and another researcher so infuriated Banting that he considered giving the prize back.  The fight between the prickly Banting and University of Toronto Physiology Professor John Macleod over the Nobel Prize was just one of the many strange and remarkable aspects of the discovery of insulin, a scientific breakthrough that saved the lives of millions of diabetics all over the world and helped usher in the modern era of medical research.

Banting, who would become the first Canadian to win the prize, and Macleod, a Scotsman, were jointly honored for the discovery of insulin the previous year. A struggling surgeon with no research experience, no doctorate, and little knowledge of the scientific literature in the field, Banting had approached Macleod, an eminent researcher, in the fall of 1921 with a seemingly quixotic idea for treating diabetes.  In those days, diabetes was often a fatal illness, especially for children who suffered from the more severe form of the disease (now called Type 1).  Type 1 diabetes usually begins when the sufferer’s own immune system, for  reasons still unknown, destroys the insulin-producing cells of the pancreas, which makes it impossible for diabetics to get the energy from their food.

Banting proposed an innovative research project: to take out dogs’ pancreases to make them diabetic, prepare a serum from the removed organs, and then inject the serum back into the dogs.  If it worked, then he would try the elixir of mashed animal pancreas in humans.  Macleod, who initially was appalled by Banting’s ignorance of previous scientific work on diabetes, nevertheless was intrigued enough to give Banting a filthy, unused laboratory, a small budget to buy dogs, and a medical student to assist him.  Though Banting proved to be a careless researcher, he did succeed in producing an elixir — a “mysterious something” — that dramatically reduced the blood sugar in diabetic dogs.

Once the experiments worked, Professor Macleod took an active interest and began to refine and promote Dr. Banting’s work (and, in Banting’s view, steal credit from the real discoverer of insulin).  A biochemist at the University of Toronto detoxified Banting’s serum, and the researchers tested it in humans beginning in 1922.  The results were dramatic.  Before the discovery of insulin, many diabetics starved to death. Once they received Banting’s serum, children sat up and began eating, walking, laughing, and living.  It was a miracle; it was, the newspapers said, the greatest advance in medicine in decades.  The before and after pictures can make you cry:

The discovery helped to elevate the reputation of medicine in the western world.  Before about 1910, if you were sick, you were better off avoiding doctors than consulting one.  By the 1920s, western medicine was beginning to help more people than it hurt; and insulin was one of the most dramatic examples of how modern scientists could become like gods.  In 1921, thousands of diabetic children in the US and Canada were slowly wasting away; in 1923, thanks to Banting’s potion, they rose from their deathbeds to lead normal, active lives. The experiments also invigorated the anti-vivisectionist movement, as many dogs died in the course of the quest. (The mass producers of insulin shifted to using pigs, whose pancreases were more readily available and whose sacrifice did not excite the same sort of public hostility.)

Yet though the discovery of insulin marked a watershed in the history of medicine, it still took place in a scientific world that seems very distant from us today.  Unlike the scientific discoveries of later years — the atomic bomb, say, or the structure of DNA, or the polio vaccine — insulin was not the product of big science, with well-funded teams of scientists in gleaming laboratories around the world racing each other to a world-changing goal.  It was one doctor and his research assistant, mashing up dog pancreases and straining them through a filter.

One might imagine that Banting would be thrilled to receive the Nobel Prize, the ultimate validation of his work.  But one would be wrong. He might not have a Ph.D., but he did have the temperament of an academic: he reacted with complete, unalloyed fury that he had to share the prize.  In his words:

I rushed out and drove as fast as possible to the laboratory.  I was going to tell Macleod what I thought of him.  When I arrived at the building Fitzgerald [a colleague] was on the steps.  He came to meet me and knowing I was furious he took me by the arm.  I told him that I would not accept the Prize….  I defied Fitzgerald to name one idea in the whole research from beginning to end that had originated in Macleod’s brain – or to name one experiment that he had done with his own hands.*

A witness said Banting was so furious “he could have torn the whole building down.”

Eventually, Banting relented and agreed to accept the prize.  There was his country to consider – “what would the people of Canada think if the first Canadian to receive this honour were to turn it down?”  And there was the reputation of science.

Macleod seems to have regarded Banting as something of a dilettante who happened to get lucky once, and Banting’s future career did nothing to change his mind. Canada’s most honored scientist enjoyed munificent funding from a grateful government, but never produced another significant discovery before he died in a plane crash in 1941.  For the children and adults whose lives were saved by Banting’s miracle elixir, though, that one discovery was more than enough.

*For more, see Michael Bliss, The Discovery of Insulin.

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