In 1921, a discovery was made in Toronto, Canada that would go on to change the course of medical history and save the lives of millions of people. It was at the University of Toronto where a team of researchers, that included Frederick Banting, Charles Best, James Collip and John Macleod, succeeded in isolating and purifying insulin and as a result, were able to successfully treat diabetic patients at Toronto General Hospital. The discovery made a significant impact on the treatment of diabetes and in 1923, Banting and Macleod were awarded the Nobel Prize in Physiology or Medicine for their discovery.
The discovery of insulin is often celebrated as one of the most important moments in Canadian medical history. When visiting Toronto today, you’ll find connections to it in the city. For example, you can visit the graves of Frederick Banting and Charles Best at Mount Pleasant Cemetery (the cemetery was opened in 1876 and has been designated a national historic site). In 2021, Parks Canada also unveiled a commemorative bronze plaque at the University of Toronto, marking the historical significance of the research. And if you’re in London, Ontario you can visit Banting House National Historic Site, a former residence of Frederick Banting’s that now operates as a museum and tells the story of the celebrated Canadian.
The discovery of insulin dates back just over a century and the story certainly doesn’t stop after the work done in Toronto. I sat down with author and historian Stuart Bradwel to discuss his new book Insulin: A hundred-year history, which explores the people and places that make up the entire history of the development of the life-saving treatment. Influenced by his own diagnosis of Type 1 diabetes, Bradwel tells us about the history, his inspiration for writing the book, as well as his hopes for the future.
1. The book is not only a result of your many years of academic work but also a result of your personal experience. What did it mean for you to be able to tell this history?
Yes, I was diagnosed with Type 1 diabetes in 2009 at nineteen, so it’s been fifteen years and counting of dealing with daily injections, blood sugar rollercoasters, and calloused fingers. I’ve promised myself that I will try to change my lancet at least once a month going forward, but I have a feeling that I’m lying to myself – I’m sure any of your readers with diabetes will understand the struggle!
To be honest, even though Insulin was finally published almost a decade and a half later, it is in large part a product of that diagnosis. A lot of the ideas in the book have their origins in scattered thoughts I had in the years immediately after, but as you’d expect they weren’t very cohesive at the time. Luckily, I ended up doing a module on the history of medicine by chance as an undergraduate, and found that I had a real passion for the subject. Learning how to think critically about the meaning of health and medicine in society through a master’s degree and a PhD really gave me the tools I needed to do justice to those ideas.
In that sense, Insulin has been a very long time coming, for me, and the process of writing it started long before I was even aware of it. I am of course delighted to have been given the opportunity to share my ideas with others, but at a personal level there has also been a real sense of catharsis involved with mastering, in some abstract fashion, a condition that is virtually impossible to master physically, and which is likely, one day, to be a contributing factor in my death. It’s a bit of a morbid thought, to be sure, but actually quite an empowering one in my view.
2. Banting is a well-known and celebrated figure here in Canada, but the book also takes a look at the other individuals involved in the discovery phase, who perhaps don’t always get the same recognition. Tell us a bit about why the collective effort was important?
Banting gets the lion’s share of the credit for insulin in most accounts, but in my opinion his contributions can sometimes be a little overstated in comparison to the others.
Insulin would never have gotten off the ground in Toronto without the influence of Banting’s colleagues. John Macleod was in charge of the lab, and without his approval and continued support the project would have been a non-starter. Charles Best provided practical and moral support, particularly during Banting’s occasional crises of faith. Perhaps most importantly, James Collip, a biochemist on sabbatical from the University of Alberta, contributed more, in my view, than anyone else. Joining the team towards the end of 1921, he almost single-handedly transformed Banting’s version of insulin into a refined product suitable for long-term clinical use. Each of these people were vital, and without any of them there is a good chance that the project would have faltered.
However, I think Banting does deserve credit for his self-belief, something that inspired those around him and convinced them to believe in an idea many at the time thought unviable. It would also be wrong not to mention his admirable moral traits: he famously believed that insulin should be accessible to all who needed it, and refused to be seduced by the private pharmaceutical industry despite its best efforts.
3. You discuss how the discovery was the result of the work of multiple individuals in multiple places, but a lot of the history is set in Toronto. Was there something about Toronto or Canada at the time that you think allowed it to happen? Or was it just where these individuals happened to be?
I don’t really think there were any specific circumstances about Toronto that led to the isolation of insulin there. It certainly helped that, by the 1920s, Canada was a relatively stable country that had been left comparatively unscathed by the First World War, so it had a well-resourced public university system that attracted international experts like the Scottish John Macleod. That created an environment where Banting was able to persuade the right people to let him pursue his research, although his theory wasn’t as novel as he initially thought it was, and much of the work done in Toronto was going over old ground.
Georg Ludwig Zülzer, for example, had produced what he called ‘Acomatol’ as early as 1906 in Germany, while researchers like Ernest Lyman Scott and Israel Kleiner had similar successes in the USA in the 1910s. Each of these scientists was kept from taking their work forward by circumstances outside of their control, but what they produced was probably more or less the same thing as what Banting and Best initially created in 1921 – that is to say, insulin. The challenges that emerged regarding consistency and reliability would have been familiar to them, and it was only the assistance of James Collip that allowed the Canadian team to turn a corner. In my view, it wasn’t so much the place that was important, but the right combination of people being in the right circumstances to capture lightning in a bottle.
4. Is Toronto somewhere you’ve ever visited for research?
No, you might be shocked to hear that I’ve never actually been to the city! It wasn’t really necessary for my research, because a huge amount of the important source material has been digitized by the University of Toronto and is available online. Those early years in the 1920s are only a relatively small part of the longer history of insulin that I set out to explore, and I never had any intention of going into them in any major depth, so I was able to consult everything that I needed from the other side of the Atlantic.
The ‘discovery’ period has been covered by quite a few authors over the years though, so there is a lot of work out there for anyone with an interest. Michael Bliss’ The Discovery of Insulin, for example, goes into a lot more detail, and while his book is a little old now – it was first published in 1982 – I’d definitely recommend it as one of the definitive works on the subject.
All that being said, I would absolutely love to visit Toronto one day. If any of your readers happen to work at the university or any other relevant organization and would like to take that as a hint, I certainly wouldn’t want to stop them!
5. If you were to visit one day, is there a site connected to your research you’d like to visit? Or anywhere else?
Speaking as a historian, I would like to see the University of Toronto, and it would be interesting to wander around the various buildings where all of the early work on insulin took place, if only to satisfy my curiosity. I imagine the place looks rather different to how it did in the 1920s! It would also be nice to go for a walk in Mount Pleasant Cemetery, and to visit the graves of both Banting and Best, who are buried there. Even without the insulin connection, I – like many people – find graveyards quite peaceful to visit, and I enjoy the way they connect the past and the present while encouraging a bit of contemplation. There – that’s my official, professional answer!
More realistically, I don’t live and breathe my job. Well, I suppose I do a little, being diabetic and all, but when I’m off the clock it’s quite nice to think about literally anything else. I’d love to go up the CN Tower like a good tourist, of course, and maybe visit the Royal Ontario Museum, particularly for the material it holds on Canada’s Indigenous heritage. The Toronto Island Park looks like a really nice escape from the chaos of the city too. Last time I was in North America I – quite inexplicably – fell in love with black squirrels, which we don’t see many of in the UK. Maybe I could spot some there?
Really though, as I’ve gotten a little older, I’ve discovered that one of the most enjoyable parts of visiting a new city isn’t marching from attraction to attraction, but just relaxing in a new environment. Give me a nice beer and a plate of food and I’ll be happy. As far as I can tell, I wouldn’t find it particularly difficult to make that happen!
6. If you could have people take away one thing from “Insulin” what would it be?
Insulin is a work of history. It explores the development of a pharmaceutical product, and the implications of its introduction to clinical practice. That is an interesting story in its own right, but I want to highlight how it is still relevant to all of us today.
One of the central themes of the book is power. Being diagnosed with diabetes can feel like it strips those affected of control over their lives. It can make them imagine a future dominated by doctors, rules, and routine. In practice, though, insulin allows for a kind of radical subjectivity. I choose how to give it to myself to accommodate my own needs, forcing me to reflect on what is important to me. You know me well enough to appreciate that strict medical advice forms only one part of that process.
People with diabetes have always engaged with these ideas, driving an important conversation about what medicine is, and what it is for. That, I feel, is a great success, and it is good to see the medical profession engaging more productively than ever before with these ideas. Activism and advocacy by those with various disabilities and chronic health conditions – diabetes among them – has been integral in this process.
Finally – the elephant in the room. In too many parts of the world people cannot access the insulin they need to survive. Many of them, like me, would be dead in a week without it. In the USA, for example, the pursuit of profit can have devastating consequences. If I have to choose one thing, I hope that Insulin highlights what has already been achieved by the collective work of normal people, and encourages the reader to wonder what more might be possible.
Insulin: A hundred-year history by Stuart Bradwel is available for purchase at Indigo, Amazon or you can purchase the audiobook from Audible.