||Sun, Jan-09-22 12:27
Insulin by Kersten T Hall: the story of insulin over the past 100 years
I thought this might be of interest to some of you here:
Insulin by Kersten T Hall, review: from jabbing to back-stabbing
Hormone injections were meant to be an affordable miracle treatment for diabetes. In the US, they now cost $1,000 a month. What went wrong?
A century ago, a group of pioneering scientists first isolated the hormone insulin, in the hope of using it to treat diabetes. They sold their patents on the process to the University of Toronto for $1, so that this life-saving drug could be kept safe and cheap for all. Just last month, however, Joe Biden tweeted: “Right now, there’s a kid out there whose family can’t afford her insulin because it costs $1,000 per month. The Build Back Better Act would cap their monthly insulin costs at $35. I’m committed as ever to getting it done for them.” How did we get here from there?
The story of insulin over the past 100 years, as the historian of science (and former molecular biologist) Kersten Hall shows in this dense and fascinating book, is also a microcosm of developments in science more widely, and of changes in the politics and economics of healthcare. It has encompassed fierce debates over profiteering, vivisection, genetic engineering, and which of the many researchers involved deserved their Nobel prizes, or had been cruelly passed over. One of the Nobel-winners in medicine, Fred Banting, was so furious that his boss had also been honoured that he threatened to refuse the prize altogether, which if he’d followed through might have been the greatest ever scientific story of cutting one’s nose off to spite one’s face.
Science is, after all, a passionate affair, and the arguments over insulin did not stop once it went into mass production. Over the next half century, the hormone was extracted from the pancreases of pigs and cows, as a by-product of the meat industry, and worked tolerably enough in people. (In healthy humans, the pancreas secretes insulin so as to enable sugar to pass from the blood into the tissues that need it as fuel.) But scientific breakthroughs in the 1970s, explained in vivid detail here, enabled researchers to dream of creating human insulin in the lab. This meant inserting the DNA for human insulin into a bacterium, and using its manufacturing machinery to mass-produce the desired substance. Or, in other words, cloning.
So began public debates about genetic engineering and “playing God” with nature, debates that researchers in the field later admitted they hoped to prevail in by concentrating on insulin as the poster child for their determination to help humanity with this newfangled wizardry. And help they did: the technology behind the mRNA vaccines for Covid-19 descends directly from that research on insulin.
Once actual human insulin could be synthesised in great quantities, there seemed little reason for it to become super-expensive. But science, especially when allied with commerce in the institution of a pharmaceutical company, doesn’t necessarily know when to stop. New forms of insulin “analogues” – slightly different versions of the molecule that still work in the human body – kept being developed, with slight advantages claimed for them. Hall doesn’t quite say that this was because drug companies needed a constant churn of novel products in order to keep their profitable patents, but it’s plain that, if such were your motivation, this is exactly what you would do.
The pleasures of this book, meanwhile, lie mainly in the storytelling detail and the gossipy richness of the lives, friendships and feuds glimpsed in the hubbub of decades pursuing the improvement of human health. (One of its major themes is that science is mostly like this, a vast and messy long-term collaboration, rather than a lone genius thinking something up in the patent office.) Surveying the long pre-history of diabetes as a death sentence, we meet the 18th-century Scottish medic Francis Home, who found that the urine of a sufferer was so sweet as to be fermentable into what he described as “a tolerable small beer”. The British psychiatrist Harold Bourne, meanwhile, was the first to speak out courageously in the 1950s against the fashion for treating mentally ill patients with “insulin shock”, or deliberately sending them into a diabetic coma.
We also witness the work of trailblazing women, and the difficulties some men had in coming to terms with it. There is the Oxford mathematician Dorothy Wrinch, who dreamed of finding a strict algorithmic order beneath the natural world, and the physicist Florence Bell, who did early work on DNA. “When the Institute of Physics held a conference in Leeds in 1939,” Hall reports, “Bell’s presentation of her work was reported by the Yorkshire Evening News with the stunned headline ‘Woman Scientist Explains’.” The chemist Dorothy Crowfoot Hodgkin, meanwhile, is the only British woman to have won a Nobel Prize in Chemistry to date. When it was announced in 1964, the Daily Mail’s headline was “Nobel Prize for British Wife”. Hall slyly suggests that it might have been the demands of working under Hodgkin at Oxford that turned one of her young undergraduates off chemistry and steered her into political life as, later, Margaret Thatcher.
And there is that irascible pioneer Fred Banting again. “If there is one thing in modern civilisation that disturbs a research man,” Banting said in 1940, “it is the newspapers. If there is anything that I fear, if there is anything that I loathe, if there is anything that I despise as unfair, untrustworthy, as undependable and as unscrupulous, it is the modern newspapers.” Perhaps it may come as comfort to some readers to find that the age of fake news began long ago.
Insulin - The Crooked Timber: A History from Thick Brown Muck to Wall Street Gold by Kersten T Hall is published by OUP
Before the discovery of insulin, a diagnosis of Type 1 diabetes was a death sentence. One hundred years after a milestone medical discovery, 'Insulin - The Crooked Timber' tells the story of how insulin was transformed from what one clinician called 'thick brown muck' into the very first drug to be produced using genetic engineering, one which would earn the founders of the US biotech company Genentech a small fortune.
Yet when Canadian doctor Frederick Banting was told in 1923 that he had won the Nobel Prize for this life-saving discovery, he was furious. For the prize had not been awarded to him alone - but jointly with a man whom he felt had no right to this honour. The human story behind this discovery is one of ongoing political and scientific controversy.
Taking the reader on a fascinating journey, starting with the discovery of insulin in the 1920s though to the present day, 'Insulin - The Crooked Timber' reveals a story of monstrous egos, toxic career rivalries, and a few unsung heroes such as two little known scientists whose work on wool fibres, carried out in a fume-filled former stable, not only proved to be crucial in unravelling the puzzle of insulin but ushered in a revolution in biology.
It was the author's own shocking diagnosis with Type 1 diabetes that prompted him to sit down and write this book, but this story has lessons for us all about what technology can - and more importantly cannot - do for us. As the world pins its hopes on effective and lasting vaccines against Covid-19, these lessons from the story of insulin have never been more relevant.
Amazon UK: https://www.amazon.co.uk/Insulin-Cr.../dp/0192855387/
Amazon USA: https://www.amazon.com/Insulin-Croo.../dp/0192855387/