On The Ethic Of Breakthroughs: The Banting Factor
As a person who has lived for 30 years with Type 1 diabetes, I literally owe my life to God's good graces. The loving support of my family. The expertise of health care providers. And the ethical moorings of Frederick Banting. A Canadian physician whose curiosity gave him the gall to push forward a radical thesis: that insulin extracted from an animal could be injected into insulin-deprived diabetics. Thus saving lives. Including mine.
A 1988 film production, "Glory Enough For All," recounts Dr. Banting's story of struggle against the status quo and his persistence that led to this phenomenal medical discovery. The scripted drama also sheds light on the underpinning ethic that grounded his stewardship of the breakthrough.
But first, let me set the stage:
Type 1 diabetes, to be differentiated from Type 2 diabetes, is an autoimmune condition which renders a person's pancreas incapable of producing insulin---the hormone essential to the metabolic conversion of food's glucose into life-giving energy. Without insulin, glucose is unable to enter cellular structures to nourish the body. With no where to go, it lingers in the bloodstream for much too long. Some glucose is released through the urine, but the buildup that remains in the blood turns toxic. Eventually wreaking havoc on vital organs.
While earliest references to the symptoms of this type of diabetes date back to ancient Egypt, medical knowledge of the disease's mechanics, including an understanding of the hormone insulin, would be several millennia away. In the meantime, humanity had resigned itself to the wasting nature and terminal course of the incurable affliction.
Humanity had resigned itself to the wasting nature of the incurable disease of diabetes. Then Dr. Banting, a struggling general practitioner, stumbles into the story.
The film is set in the early 1900's, when the conventional medical approach to treat diabetics was draconian. Patients were prescribed a stark diet, minimizing their daily intake of carbohydrates to practically zero. Hoping against hope this manipulation would stave off steep spikes of blood glucose and slow the rapid deterioration of the body. These drastic measures of near starvation, at best, bought diabetics little precious time before the inevitable end.
Then Dr. Frederick Banting, a struggling general practitioner, stumbles into the story. Portrayed on screen as a stubborn, swearing and sacrilegious soul. An improbable protagonist entering from stage left.
Teaching at a medical school to supplement his wages, he is conscripted to prepare a lecture. His assigned topic: the debilitating effects of carbohydrates on blood glucose levels in diabetics. This was a condition he was not versed in, much less interested in. For that matter, diabetes was still a shrouded medical mystery. And the absence of the pancreatic secretions, or insulin, in its victims a riddle to solve.
By default Banting delves headlong into studying the malady. Exploring the findings of previous researchers. Bumping into the mystery and its attending riddle.
At first he is startled, then sickened by the disease's ravaging effects. That's when his intellectual curiosity kicks in, leading him to investigate those missing pancreatic secretions in diabetics. This, in turn, prods him on to consider a plausible path to therapy. Albeit one dismissed by the real experts in the day. While most adopted the fatalistic approach to diabetes and acquiesced to its dastardly final act, Banting posited that the pancreatic secretions could be isolated from one species and then injected into another species. Reintroducing the life-giving hormone of insulin into patients hanging on for dear life.
He is startled, then sickened by the disease's ravaging effects. That's when his intellectual curiosity kicks in.
He immediately encountered reluctance and resistance from the bona fide researchers in the medical community. Nevertheless, Banting found a sponsoring but skeptical ally in Dr. J. J. R. Macleod at the University of Toronto. With assistance in the laboratory by Dr. Charles Best, then a medical student, and subsequent contributions by Dr. James Collip, the once-struggling general practitioner and his colleagues launch the experimental quest. Turning the page. On the story of diabetes.
Banting's attempts at extracting efficacious insulin from animals was daring and daunting. At first he fails. He fails again. He continues to fail repeatedly, at a faster clip. But he stubbornly plods on. Finally succeeding in obtaining a suitable sample. The next steps of reintroducing insulin into diabetic animals were just as complex and intricate. And ultimately successful. In essence, Banting was removing the mysterious shroud and solving an essential element in the vexing riddle of the disease. Although not a cure, further clinical tests and trials demonstrated that injections of insulin into humans lacking the hormone now made diabetes a manageable chronic condition.
But even on the heels of this breakthrough, the verdict on Banting's medical research and reputation was still out. Beyond the laboratory he found himself navigating other angles of scrutiny. The politics of medical fame and acclaim. The debates and disputes for the credit of the discovery. The widespread dissemination and distribution of insulin to patients yet to be brokered. In the middle of this swirling competition, contention and controversy comes a poignant moment in the film. With a longer view of what still lay ahead, the ethical Banting is portrayed as invoking this tempered and conciliatory perspective: If collaborative progress to slay the disease goes on untethered, there will be "glory enough for all" to share.
Banting's breakthrough forever turned the page on the story of diabetes. For now at least, until the next breakthrough. Until the cure for Type 1 diabetes. And until Banting's guiding ethic is fully actualized.
The film's epilogue suggests Banting's ethic prevailed. Indeed, at the end of his day, there was glory enough for all to share. He and J. J. R. Macleod won the 1923 Nobel Prize in Physiology or Medicine. The pair later shared the prize with Charles Best and James Collip for their roles in the breakthrough. Most importantly, manufactured insulin became the life-saving medicine he envisioned. With enough glory to extend the lives of millions of Type 1 diabetics. Including mine.
We are just shy of marking the 100th anniversary of Banting's breakthrough. What progress has been made? What of his ethic still prevails?
I believe he would be stunned at the sophistication and scale of today's research platforms focusing on Type 1 diabetes. The synthetic versions of insulin replacing animal insulin, as well as the technological therapies now available to patients, would literally blow his mind. At the same time, I think Banting would be puzzled that the code to the cure has yet to be finally cracked.
For certain the Canadian physician and protagonist would be startled, then sickened, that insulin has become one of the most expensive life-saving liquids sold just across the border from his homeland. In the United States the rate that the price of a vial of the medicine has increased is astronomical. And unconscionable. For example, in 1996 a vial of insulin---that may last two or, perhaps, three weeks depending on the number of daily units required by a Type 1 diabetic---sold for around $21. Just this week I consulted a pharmacy to confirm the going price: that same vial---to which there have been absolutely no improvements in its composition or in its efficacy---is now priced at over $300.
That's a plus 1,300 % increase over a period of twenty-some odd years.
Bottom line: insulin is becoming unaffordable and unaccessible to increasing numbers of insulin-deprived Type 1 patients without adequate health services and coverage. Banting's righteous anger regarding this matter would be justified. He and his collaborative partners revoked all financial gain associated with insulin's widespread production and usage. "Insulin does not belong to me, it belongs to the world," he stated emphatically. Then they sold the patent rights for $1.
What of Frederick Banting's "ethic" still prevails? An ethic rendered partially on the anvil of stubbornness and dogged resolve. One certainly extracted from struggles against the status quo, and ultimately shaped by final acts of humility and serendipity. We know for sure his ethic forever turned the page on the story of diabetes. His pursuit essentially rewrote the plot on the disease itself. Steered in a new direction all the research that has followed. His discovery of insulin as an injectable hormone has altered the life narratives of millions of persons with Type 1 diabetes. Including mine. People who do not have a functioning pancreas---for now at least---until the next breakthrough. Until the cure. And until Banting's grounding ethic is fully actualized. When there will be "glory enough for all" to share.
Follow @JoeMazzu3 on Twitter and Instagram. Visit intentionalconsulting.com to learn more about his business serving nonprofits.