James R. Wright Jr.
Calgary, Alberta, Canada
|JJR Macleod circa 1928. Credit: University of Toronto. Via Wikimedia.|
In 1921, Fred Banting and Charley Best, working under the supervision of JJR Macleod, made crude pancreatic extracts from duct-ligated dog, fetal bovine, or whole adult bovine pancreata and used these to treat diabetes in depancreatized dogs. On January 23, 1922, Walter Campbell administered a pancreatic extract purified by biochemist Bert Collip to fourteen-year-old Leonard Thompson at Toronto General Hospital (TGH), sealing the Toronto team’s immortality. How this story has been reported has varied remarkably over time; Michael Bliss’s The Discovery of Insulin, published in 1982, is the current gold standard.1 Although generally recognized as the most important Canadian medical discovery of the twentieth century, the discovery did not bring much joy to its discoverers.2
In 1988, Bliss’s book was used to produce Glory Enough for All, which aired on Canadian Broadcasting Corporation and PBS’s Masterpiece Theater; it won nine Canadian Gemini Awards (analogous to the American Emmy Awards and the British BAFTA Television Awards). Bliss served as consultant, and it accurately depicts our current understanding. It is ironic that, like the strained relationship described amongst insulin discoverers,2 interpersonal differences amongst the film’s producers apparently prevented its release as a DVD; a fuzzy version can be found on YouTube.
Before the 1980s, books describing the history of the discovery had something in common—Banting was the hero and Macleod fared poorly, sometimes portrayed as a villain. Banting famously hated Macleod, as he incorrectly and unjustly believed that Macleod and Collip were trying to steal his glory.1,2 Bliss published Banting: A Biography in 1992, which highlights this complicated relationship.3 In 1993, Bliss published “Rewriting medical history: Charles Best and the Banting and Best myth,”4 which tells a remarkable story of how Best, after Macleod and Banting were dead, not only joined Banting in Macleod-bashing but also worked industriously to elevate his role in the discovery from that of a student assistant, trained and hired by Macleod (and who was there because of a coin toss with another student, Clark Noble5), to a passionate, dedicated foe against diabetes mellitus (DM) who, stoked by the death of a dear aunt a few years earlier, had sought Banting out and provided him sage advice six months before Macleod introduced them.4
Comets Among the Stars,6 a 1973 English movie, and The Quest,7 a 1958 National Film Board (NFB) of Canada movie both dramatically open with a diabetic ward scene at The Hospital for Sick Children (HSC). Comets begins with a busy pediatric diabetes ward with eight live children being starved, one dead child being covered with a sheet, and two empty beds. The Quest opens with parents visiting their young daughter in the HSC diabetic ward, immediately followed by a surgeon telling Banting, “You’ve seen those kids in the wards. A little kid gets diabetes mellitus, there is nothing we can do. It’s a death sentence.” In reality, at the time of the discovery, DM was primarily a chronic disease of adults, pediatric cases were exceedingly rare, and prominent diabetologists, pediatricians, and internists did not believe that childhood DM was fundamentally different than DM in adults.8 In fact, HSC did not even have a diabetic ward, and Banting, although he did surgical training at HSC, once admitted he had never seen a case before Thompson.8 What we now know as Type 1 DM only became common in the decades after the discovery.8,9 Thompson was serendipitously chosen to test pancreatic extracts because he was very ill and had been recently admitted to the TGH diabetic ward.8 The outcome may have been disappointing had they picked an adult patient with what we now know to be insulin-resistant Type 2 DM. Shortly after the discovery became well-known, HSC opened a diabetes ward, as parents of diabetic children from all over North American bombarded Banting with requests for him to treat their children with insulin; these efforts were led at HSC by Dr. Gladys Boyd.10,11
Both movies malign Macleod and elevate Best. Comets implies that Macleod made no intellectual input to the experiments. Macleod, when he agrees the work can be done in his laboratory, tells Banting: “You may commence on the day I leave for my holiday on May 16 and be out of here before I return.” Macleod then tells Best, “I wash my hands of it!” In reality, Macleod played a major role in planning the studies and worked with the pair for a month before leaving for Scotland; the physiologist Macleod even taught the surgeon Banting how to perform canine pancreatectomy. The Quest implies that Macleod was not available once the work began. At the end of the allocated time, Banting tries unsuccessfully to ask Macleod if he can continue. He phones Europe and then tells his cousin Fred Hipwell: “No luck, they’ve tried London, Aberdeen, hum, for all they know, he may as well be in Timbuktu.” Banting then jokes with Hipwell that he will keep working until they throw him out. There is no further mention of Macleod; Collip is never mentioned. The discovery is presented as having taken place without their efforts.
|Charles Best (left) and Frederick Banting (right) circa 1924. Credit: Thomas Fisher Rare Book Library, University of Toronto. Via Flickr. CC BY 2.0.|
In Comets, Macleod is portrayed as nefarious. In Banting and Best’s first meeting after Macleod returned from vacation in Scotland, Macleod insists the experiments need to be repeated and verified. Insisting their results are definitive, Banting says:
“You want to hold us back so that you can forge ahead and then you take the credit for the discovery. You can’t bear to think that I succeeded where you failed. It wouldn’t have been so bad if one of your . . . friends discovered it, but a country doctor, a simple Canadian man who has never heard of [Oskar] Minkowski. My God, the fellow’s not even a gentleman. He wears boots. . . . The world is run by little men sitting in big offices promoting each other, keeping things as they are, people in their places, well no more, you’re in your ivory tower smelling roses and there are people out there rotting on the street smelling of death. How long? How long?”
Macleod warns them not to tell anyone about their work but immediately (and secretly) calls Collip and says: “We’ve had a little success. In fact, I’d go as far as to say we have found it. James, I’m wondering if you would like to join me. Yes, the old firm Macleod and Collip. Excellent, come and see me, I’m putting my whole department on the job.” In this movie, Collip is an elderly Toronto clinician who oversees the treatment of Thompson, rather than a young biochemist on sabbatical from University of Alberta who Macleod had met earlier that year. In neither film is there any mention of Macleod’s critical research to determine the physiological actions of insulin, his experiments definitively proving islets are the source of insulin, his work with Toronto’s Insulin Committee, Eli Lilly, and other entities assuring world-wide accessibility to insulin, or his work with the League of Nations to standardize a unit of insulin.
Both films present Best as an equal colleague volunteering his time, rather than as a paid student assistant who won a coin toss; the savvy viewer is immediately reminded of Bliss’s landmark article on re-writing history.4 Both scripts are heavily influenced by WR Feasby’s interviews while trying to write an ill-fated hagiographic biography of Best. Bliss, who concluded that Best was unhappy about his legacy, showed Feasby’s research to be hugely flawed.4 Best, who had only just completed his undergraduate degree, is presented as an established biochemist and scientific scholar, lecturing Banting on proper scientific method and the importance of knowing the literature. In Comets, before the research is begun, Best is pictured with a stack of textbooks and Banting asks him: “Have you read all of these?” Best replies: “One of us has got to.” Banting: “In German?” Best: “In Russian if necessary.” Banting: “I should have stayed down on the farm.” In reality, neither had attempted a literature review until Macleod chastised them after his return from Scotland.1,12 Sadly, Best’s obvious repeated attempts to alter portions of Leslie McFarlane’s script to elevate his role caused the NFB to curtail its insulin project, resulting in only a thirty-nine-minute short film, The Quest.4
The story of insulin should be told truthfully. Happily, rumors suggest those holding Glory Enough for All’s rights are currently working together to re-broadcast it during the centenary.
- Michael Bliss. The discovery of insulin. Chicago: The University of Chicago Press, 1982.
- James R. Wright Jr, Edwin AM Gale. “Winner’s Curse: the Sad Aftermath of the Discovery of Insulin”. Diabetic Medicine 2021;00:e14677. https://doi. org/10.1111/dme.14677.
- Michael Bliss. Banting: a biography. Toronto: University of Toronto Press, 1984.
- Michael Bliss. “Rewriting Medical History: Charles Best and the Banting and Best Myth”. Journal of History of Medicine and Allied Sciences 48, no. 3 (1993):253-274.
- James R. Wright Jr. “Almost Famous: E. Clark Noble, the Common Thread in the Discovery of Insulin and Vinblastine”. Canadian Medical Association Journal 167, no. 12 (2002):1391-1396.
- Comets Among the Stars. 1973. ATV Colour Production. DVD: ITV plc £145.00.
- The Quest. 1958. National Film Board of Canada. DVD: McIntyre Media, $19.95.
- James R. Wright Jr. “What Was Known About Childhood Diabetes Mellitus Before the Discovery of Insulin?” Pediatric Developmental Pathology – in press https://journals.sagepub.com/doi/10.1177/10935266211042206.
- Edwin AM Gale. “The Rise of Childhood Type 1 Diabetes in the 20th Century”. Diabetes 51, no. 12 (2002):3353–3361.
- Sarah Riedlinger, Dean Giustini, Brenden Hursh. “Part II: The Impact of Insulin on Children with Diabetes at Toronto Sick Kids in the 1920s”. https://hekint.org/2018/05/15/part-ii-the-impact-of-insulin-on-children-with-diabetes-at-toronto-sick-kids-in-the-1920s/.
- Dr. Gladys Boyd. https://definingmomentscanada.ca/stories/dr-gladys-boyd/.
- James R. Wright Jr. “Frederick Banting’s Actual Great Idea: The Role of Fetal Bovine Islets in the Discovery of Insulin.” Islets – in press. https://www.tandfonline.com/doi/full/10.1080/19382014.2021.1963188.
JAMES R. WRIGHT JR., MD, PhD, is Professor of Pathology & Laboratory Medicine, Professor of Pediatrics, and a research scientist at the Julia McFarlane Diabetes Research Centre at the University of Calgary Cumming School of Medicine and a pediatric-perinatal pathologist at Alberta Children’s Hospital.