- The Washington Times - Friday, September 24, 2010

By Thea Cooper and Arthur Ainsberg
St. Martin’s Press, $24.99, 304 pages, illustrated

The word miracle is one of the most overused in our language and so often engenders a skeptical reaction. But if ever there was a medical miracle, the discovery of insulin and its rendering into a form deliverable to human beings is up there. For not only did this conquer the hitherto universally fatal Type 1 form of diabetes, in which the pancreas no longer produces insulin, but it provided the paradigm for an incurable disease that could be managed so successfully that many of those suffering from it would live on to die eventually of something else.

In any story, medical or otherwise, it helps to have human faces, and the story of insulin has many, starting with those who waged the long struggle to identify just where it came from, immeasurably complicated by the fact that the pancreas is both an endocrine gland and an exocrine gland: the endocrine portions being islands within the larger organ - hence the name insulin for their secretion, from the Latin “insula,” meaning island.

The two main faces that emerge from “Breakthrough,” an enthralling account of the actual conquest of diabetes, are that of the rough-hewn Canadian physician Frederick Banting and Elizabeth Hughes, the privileged and precocious teenage daughter of Charles Evans Hughes, one of the most distinguished members of the American establishment in the 20th century. Not only do these two provide a study in contrast, but their luminous personalities dial up a text already alive with fascinating characters and incidents.

Although this is the authors’ first book, they are adept at telling their complicated, multifaceted story with energy and vividness. Their account of diabetics’ treatment before the production of insulin is harrowing. There was no other way to prolong the lives of those hapless folk, often children, except by essentially starving them to the point where sugar no longer appeared in their urine.

Many people thought that amounted to torturing the patients - as the authors write, it was a real example of the cure being worse than the treatment - but in the early 1920s, with the production of insulin just beyond the horizon, it might buy the patients the essential time. Elizabeth Hughes endured this torturous form of treatment for several years with fortitude - some might say heroism after reading the account in “Breakthrough.” But she was blessed with a sense of destiny. When she met Banting after nearly four years of starvation that had reduced her weight to about 50 pounds, he exclaimed:

“You look sick, but you don’t act sick. Why is that?”

“Well, I know that I’m going to get better,” she replied.

That she did. Although diabetic for the rest of her life, she lived to the age of 74, dying of heart failure. She had managed her diabetes by injecting herself more than 42,000 times with insulin in the previous six decades, sharpening her needles on a whetstone. (Just the kinds of details that abound in this book, making it so absorbing a read.)

But “Breakthrough” is not a fairy tale. It is full of stories of struggle and adversity, of mental and physical suffering. The role played by personality clashes and politicking (both in the groves of academe and in government itself) is related at length and is not a pretty story. By the time Banting won the Nobel Prize, the first Canadian to do so, who did - and did not - share it with him had become such a loaded issue that it poisoned the triumph for all concerned.

The role of Eli Lilly in producing insulin in sufficient quantities and at reliable levels of potency makes for more edifying reading: a symbiosis of enterprise and philanthropy mutually beneficial to both medical practice and research.

The authors are harsh in their condemnation of Hughes for making no effort to use her celebrity to raise money for diabetes causes or otherwise raise awareness of the disease. They postulate that her desire for secrecy might have been linked to feelings of guilt about, in effect, jumping the queue at a time when insulin was a rare commodity by using her father’s position as U.S. secretary of state, knowing that when she did so, another diabetic died.

But they also acknowledge the different zeitgeist that prevailed back then, when there generally was much less openness about disease in general. Still, they cannot help deploring that she did not play a part in eroding such attitudes.

A problematic aspect of “Breakthrough” is the authors’ description of specific scenes involving Hughes, her parents and the various physicians who treated her. They acknowledge in an afterword that these are sometimes composites, while others are just plain imagination or speculation on their part. Such scenes might sit more easily in a fictionalized version of events rather than embedded in what otherwise is a factual account. They certainly add to the vividness and texture of the story, but they may give some readers pause.

Although the insulin used on Hughes and the other pioneers was derived from cattle and pigs, the experiments that proved the drugs’ efficacy by injection was conducted on dogs, which were subjected to operations and to living the rest of their lives without pancreases.

This will appall anti-vivisectionists, but even they might have to acknowledge that Banting’s canine experiments were of enormous benefit to mankind - particularly after reading the book’s account of Banting’s sensitive euthanasia of a dog named Marjorie after she had rendered a particularly crucial service to his process. As he chloroformed her, he poured out a heartfelt torrent of gratitude to the dog. Hughes never ceased to remember and be grateful to her, either: Throughout the rest of her long life, all her beloved pet dogs were named Marjorie.

Martin Rubin is a writer and critic in Pasadena, Calif.

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