Yesterday I went to the New York Historical Society’s exhibit Breakthrough: The Dramatic Story of the Discovery of Insulin (through January 31; $12 for adult non-members). I know–the title is breathless and leads the witness. But forgive the curators. The “drama” was certainly real, but that’s not what I found most compelling. I was struck by:
- How many primary documents still exist: lab notebooks, correspondence among the principals, prototypical vials and syringes from over the decades, fan letters from diabetes patients to Dr. Elliott Joslin, a silent film describing early insulin production from pigs and cattle, etc.
- What a brutal, inexorable, miserable disease diabetes was before insulin. 86% of children presenting with under age 16 died in ketoacidosis. Of course, as Joslin noted, with the advent of insulin, the era of coma gave way to the era of complications.
- How fast it all happened–even (especially?) by today’s standards. As described by Janice Hopkins Tanne, in 1920 Frederick Banting had the idea to use “pancreatic extracts” to treat diabetics. A few months later he persuaded the University of Toronto’s John Macleod to let him study the problem in animals. By the end of 1921 they had presented their stunning results on dogs. In 1922 the first human patient was treated with insulin. A few months later Lilly agreed to make the stuff on a large scale. 1923: Banting and Macleod won the Nobel. Bada bing.
- All this despite much backstabbing and subterfuge in the lab. More on that can be found here.
Joslin was one of the great translators of basic science to the clinic. He pioneered self-management. He saw empowered patients not as a risk or as a threat to his stature, but as a necessity if they were to improve and maintain their own health. “Teaching is cheaper than nursing,” he said. Today millions of diabetics routinely manage their own glucose levels. How long before millions of others routinely manage their own pharmacogenetic drug responses?