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[IPp] Rediscovering the First Miracle Drug

Interesting read on the discovery of Insulin. I'm so glad Dr. Banting never
gave up!


Rediscovering the First Miracle Drug
Eli Lilly and Company Archives

Connaught Laboratories produced early doses of insulin.
 By ABIGAIL ZUGER, M.D. Published: October 4, 2010

 Every few months some miracle drug or other is rolled out with bells and
confetti, but only once or twice in a generation does the real thing come

Thomas Fisher Rare Book Library/University of Toronto

*PIONEERING *Elizabeth Hughes and her mother, Antionette, in 1918.
Elizabeth, once the most famous diabetic child in the United States,
received early doses of injectable insulin.

These are the blockbuster medications that can virtually raise the dead, and
while the debuts of some, like the
are still fresh in memory, the birth of the first one is almost
forgotten. It was injectable insulin, long sought by researchers all over
the world and finally isolated in 1921 by a team of squabbling Canadians.
With insulin, dying children laughed and played again, as parents wept and
doctors spoke of biblical resurrections.

Visitors to a new exhibition opening Tuesday at the New-York Historical
Society will find a story made particularly vivid by dramatic visuals, for
insulins miracle was more than a matter of better blood tests. As in
Ezekiels vision of the dry bones, it actually put flesh on living

But the miracle went only so far: insulin was not a cure. In 1921, New York
Citys death rate from
estimated to be the highest in the country, and today the health
department lists diabetes among the citys top five killers. Now though, it
is adults who die, not children. What insulin did was turn a brief, deadly
illness into a long, chronic struggle, and both the exhibit and the book,
Breakthrough, by Thea Cooper and Arthur Ainsberg, on which it is based
highlight the complicated questions that inevitably follow medical miracles:
Who will get the drug first? Who will pay for it? Who will make enough for
everyone? And, of course, who will reward its developers as they feel they

In the first decades of the 20th century, half a dozen different research
groups were hot on the trail of insulin, a hormone manufactured in the
pancreas but difficult to separate out from the digestive enzymes also made

Without insulin the body is unable to use glucose, its primary fuel. Most
diabetic children lack insulin completely, while adults with so-called Type
associated with
obesity <http://www.nytimes.com/info/obesity?inline=nyt-classifier> are
resistant to the hormones action. Either way, sugar and starch in the
into poison, clogging the bloodstream with unusable glucose: the
glucose is eliminated in sweet-tasting urine as the bodys cells literally
starve in the midst of plenty. Insulin-deficient patients are both thirsty
and ravenous, but the more they eat, the faster they waste away.

Before insulin was available, doctors understood enough of this sequence to
cobble together a stopgap treatment: diabetics were put on salad- and
egg-based diets devoid of sugar and starch, with only the minimum number of
to survive. Already thin, these patients became skeletal, but the
excess glucose disappeared from their blood and urine, and they survived far
longer than untreated contemporaries.

Dr. Elliott Joslin <http://www.joslin.org/about/elliot_p_joslin_md.html>,
whose Boston clinic was and remains a renowned diabetes center, recalled
that before insulin one of his dieting patients was just about the weight
of her bones and a human soul.

The other great authority on diet therapy was New Yorks Dr. Frederick
Allen, now long forgotten, who founded a residential hospital for diabetics,
first on East 51st Street in Manhattan, and then in rural New Jersey.

It was to Dr. Allen that the eminent American jurist and Supreme
Charles Evans Hughes turned when his daughter Elizabeth was
diagnosed with diabetes in 1919, at age 11.

Elizabeth Hughes was a cheerful, pretty little girl, five feet tall, with
straight brown hair and a consuming interest in birds. On Dr. Allens diet
her weight fell to 65 pounds, then 52 pounds, and then, after an episode of
almost killed her in the spring of 1922, 45 pounds. By then she had
survived three years, far longer than expected. And then her mother heard
the news: insulin had finally been isolated in Canada.

The unlikely hero was Frederick Banting, an awkward Ontario farmboy who
graduated from medical school without distinction, was wounded in World War
I, then more or less forced himself into a laboratory at the University of
Toronto with an idea of how to get at the elusive substance. Over the
miserably hot summer of 1921 Dr. Banting and his assistant Charles Best
experimented on diabetic dogs, with only limited success until finally dog
No. 92, a yellow collie, jumped off the table after an injection and began
to wag her tail.

Meanwhile, Dr. Bantings mentor and lab director, Dr. John J. R. Macleod,
was summering in Scotland.

Dr. Banting never forgave Dr. Macleod for arriving back in the autumn,
rested and refreshed, and taking over. His bitter hostility lasted years,
long after the Nobel
in 1923 which Dr. Banting refused to attend, for although he shared
the physiology
Dr. Macleod, he would not share a podium.

Meanwhile, mothers all over the globe were writing him heart-wrenching
letters: My dear Dr. Banting: I am very anxious to know more of your
discovery, wrote one, going on to describe her daughters case: She is
pitifully depleted and reduced.

That was from Elizabeth Hughess mother, Antoinette. Charles Evans Hughes
had by that time temporarily left the Supreme Court, and was serving as
secretary of state in President Warren G.
administration. Dr. Banting, unimpressed, replied no, sorry, no insulin
available  for, in fact, the team was having difficulty making enough for
more than a handful of patients.

And then a few weeks later, Dr. Banting changed his mind.

Presumably higher powers had intervened, or perhaps Justice Hughes himself 
a rigid, unsmiling man whom Theodore
nicknamed the bearded iceberg  had pulled strings. Either way,
Elizabeth traveled posthaste to Toronto and the lifesaving injections.

Rachel - email @ redacted
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