The words “pharmaceutical company” and “doing the right thing” don’t often belong in the same sentence, if critics are to be believed. Inflammatory rhetoric magnifies the myriad of known examples justifying negative publicity. Therefore, one could perhaps be forgiven for entering the ongoing exhibit at the New-York Historical Society with a measure of skepticism at its latest offering: “Breakthrough–The Dramatic Story of the Discovery of Insulin and the Era of Hope,” co-sponsored by the pharmaceutical company Eli Lilly. The first pleasant surprise comes when the helpful attendant explains that flashing a Metrocard earns one a discounted admission. The second comes while studying the exhibit. For a brief moment one could be transported to an almost-forgotten success story, in which academia and industry collaborated positively towards conquering a hitherto incurable disease, and manufacturing, as well as disseminating, quality-controlled, life-saving medications to sick individuals worldwide.

The narratives, photos, and videos focus mainly on the researchers involved in the prelude to, and actual discovery of, insulin. Diabetes mellitus, the latter word derived from the Latin for “honey,” had affected sufferers for centuries, as evidenced by historical quotes (Aretaeus, the famed second century physician from Cappadocia who practiced in Greece and Rome, referred to diabetes in terms of “the melting down effect on flesh and limbs”) and diagnoses, e.g. descriptions on an Egyptian papyrus of sweet-smelling urine characteristic of the disease. The anatomy and physiology homage to the boomerang-shaped pancreas and histological stains highlighting the islets of Langerhans may only elicit a cursory glance from those already familiar with the subject. For many, it would be the stories of the researchers and their patients that grab attention. Dr. Elliott P. Joslin is acknowledged for making patient involvement and empowerment the key features of diabetes management. One can pause next to a poster of Dr. Frederick Allen, an alumnus of The Rockefeller University who is known for his difficult personality as much as for his research: his work showed that diets below 1000 calories could lower blood sugar levels. The shoulders of these and other research giants formed the platforms for the men who would eventually share the Nobel Prize in Medicine in 1923 for the discovery of insulin, Drs. Frederick Banting and John Macleod.

Snapshots from the exhibit discussing this intriguing history are further elaborated upon in an identically named book upon which the exhibit is largely based, written by Thea Cooper and Arthur Ainsberg. The image of Banting that coalesces from this book and other sources is one of a loner, with no sense of purpose when he first enrolled in freshman classes at the University of Toronto. Yet he is one whose forceful, irascible personality and valor won him the Military Cross during World War I. Contrast Banting’s persona with that of Professor John Macleod, a Scottish recruit to the University of Toronto and world authority on carbohydrates and metabolism, and one begins to grasp why there was discord between the two men who would eventually share the Nobel Prize. At the start of his research, Dr. Banting was already aware of the elusive secretions from the pancreas that could normalize blood sugar levels. However, because of degradation caused by digestive enzymes, no one in the English-speaking world had been able to isolate this secretion. In 1916, the Romanian scientist Nicolas Paulesco was successful in normalizing the blood sugar levels of dogs by injecting them with an extract called “pancrein,” but this success was not yet widely known. So much of Dr. Banting’s early work was conducted in a vacuum with only his assistant, then medical student Charles Best, serving as an immediate sounding board for his ideas. Endless months of apparently fruitless labor by both of them finally paid off when dog 408, a collie, finally responded positively to injections of pancreatic extract. Buoyed by ensuing successes, Dr. Banting drafted a seminal paper titled “The Beneficial Influences of Certain Pancreatic Extracts on Pancreatic Diabetes,” that would eclipse all prior discoveries in the field and change this research area forever.

Enter Big Pharma in the form of Alec Clowes, the man charged with identifying medical projects with commercial potential for Eli Lilly. Perhaps contrary to the needs of today’s investors, Eli Lilly, the grandson of the company’s founder, is described as a man who thought that the future of the company hinged on patenting fundamentally new ideas, not improvements of old ideas. Basing his thoughts on the successful collaboration between inventors George Westinghouse and Thomas Edison, he proposed that basic biological research could provide the source of information enabling pharmaceutical companies to develop and patent entirely new proprietary drugs. Risk was not new to the Lillys. Colonel Lilly built the first plant in 1895 to manufacture gelatin capsules, in essence a more palatable delivery mechanism for unpalatable medications.
The transfer of production rights from Toronto to the Lilly plant in Indianapolis was by no means a straightforward exercise. The University of Toronto already had an agreement in place with Connaught Laboratories, and with the help of Dr. James Collip, the biochemist who had purified the extract, insulin production was first undertaken in Canada. It seemed as if every short-term victory was followed by failure, with batches of variable quality insulin being produced, and insulin shortages becoming a huge issue. Diabetes specialists were also faced with the ethical dilemma of whom to treat and whom to turn away. Through a large monetary investment by Lilly and further interactions between the Canadian group and Mr. Clowes, large-scale production of insulin was finally undertaken at the Indianapolis plant. Celebrities often bring more attention to a cause, and this was the case with Elizabeth Hughes, daughter of the Supreme Court Justice Evans Charles Hughes, who went on to live a full and productive life after receiving insulin.

Fast forward to the present day, and the rising numbers of diabetes sufferers in the developed and developing worlds that seem to overshadow the successes from this positive academic-industry collaboration. In 2006, the United Nations passed a resolution declaring diabetes as serious a health threat as infectious diseases such as HIV/AIDS. As if to reinforce that theme, the exhibit concludes with flickering images of children in the developing world walking long distances to a clinic to receive life-saving medications. The International Diabetes Federation’s Life for a Child Program supports the care of 4000 children in 26 countries worldwide; benefits from the sale of the book on the discovery of insulin will also go towards its activities, described here.

References:

1. Cooper T. and Ainsberg, A.: Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle (St. Martin’s Press, New York, 2010).

2. Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle (Ongoing Exhibit at the New-York Historical Society).