Show Notes
What happens when a life-saving cure is discovered, and then given away for a single dollar?
In this Tribulations episode, Dr. Ravi Kumar tells the remarkable story of Frederick Banting, the farm boy turned surgeon whose late-night idea led to the discovery of a method for extracting insulin and saved millions of lives. You will travel from the starvation wards of the early 1900s to the sweltering attic lab in Toronto where Banting and Charles Best performed the experiments that changed medicine forever. Dr. Kumar also explores the moral and policy issues that continue to shape insulin access today.
In this episode, you will discover:
- How diabetes went from a fatal disease to a manageable condition.
- The late-night inspiration that drove Banting to isolate insulin.
- The brutal experiments and the first successful treatment in a dying child.
- Why Banting sold the patent for one dollar, and what that decision means today.
- How insulin’s legacy has been both a triumph of compassion and a failure of modern medicine.
Key Takeaways
- Before insulin, type 1 diabetes was a death sentence; starvation diets only delayed the inevitable.
- Banting’s insight to tie off the pancreatic ducts allowed insulin to be isolated intact.
- His team’s discovery turned childhood diabetes from a fatal disease into a chronic, livable one.
- Banting gave away the patent to keep insulin affordable, but modern pricing has drifted far from his vision.
- The story of insulin reminds us that compassion, not commerce, should guide medical innovation.
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Transcript
[00:00 –> 00:13] Welcome to the Doctor. Kumar Discovery Podcast. My name is Doctor. Ravi Kumar, and this is another episode of Tribulations. Today, we’re diving into a story from medicine’s history that has saved countless lives.
[00:14 –> 00:30] This is the story of the discovery and use of insulin to treat diabetes. Now insulin is something we take for granted. Millions depend on it. Yet, it wasn’t always within reach. Before 1921, if you had diabetes, it was a death sentence.
[00:30 –> 00:47] Most patients had what we now call type one diabetes. And once diagnosed, they were given months, maybe a year to live. The only treatment they had at the time was starvation. Patients were put on near fasting diets to lower their blood sugar. And doctors knew they weren’t saving lives.
[00:47 –> 01:10] They were only delaying the inevitable, which was death. Most of those who suffered were children. Their parents had to watch helplessly as their sons and daughters grew weaker every day, begging for food, wasting away, and slowly dying before their eyes. It’s hard to imagine that world, but that’s where our story begins. So before we get into it, I wanna give you a quick disclaimer.
[01:10 –> 01:31] I’m a medical doctor, but I’m not your doctor. This show is for informational purposes only. Especially in the tribulation series, the goal is storytelling and learning, not diagnosis or treatment. Nothing here replaces professional medical advice or consultation with your physician. This podcast is also completely separate from my role as assistant professor at UNC.
[01:31 –> 01:49] And one more quick note, I’m really trying to grow this show so I can reach more people. If you’re willing, please take a moment to leave a written review on Apple Podcasts or Spotify. It makes a huge difference, and it’s the only favor I’ll ever ask of you. And if you’ve already left the review, thank you so much. Okay.
[01:49 –> 02:11] Before we get into the story of how insulin was discovered, it helps to understand what diabetes actually is and what insulin does. This background will make the rest of the story make perfect sense. Glucose is the body’s main fuel. It’s the primary source of energy for nearly every cell we have. Diabetes is, at its core, the inability to move glucose into cells where it’s needed.
[02:11 –> 02:32] There are two main types of diabetes, type one and type two. In both, the result is the same. Glucose can’t enter the cells, but the reasons why are very different. In type one diabetes, the immune system mistakenly attacks the pancreas, specifically the tiny clusters of cells that make insulin. Without insulin, glucose can’t move into the cells.
[02:32 –> 02:57] It stays trapped in the bloodstream while the body’s tissues, starved of energy, begin to break down. In type two diabetes, the body still makes insulin, but the cells stop responding to it. The key is there, but the lock is jammed. This kind of insulin resistance usually develops over time, often from metabolic dysfunction linked to obesity and inactivity. Today, type two is far more common.
[02:57 –> 03:13] But in the early 1900s, most patients had type one. And for them, the diagnosis was almost always fatal. So what happens when there’s no insulin? Without glucose entering the cells, the body switches to burning fat and muscle for fuel. This produces acids called ketones.
[03:13 –> 03:35] In small amounts, that’s fine. It’s essentially the same process that happens in low carb diets and leads to healthy weight loss. But in uncontrolled diabetes, ketones build up dangerously, turning the blood acidic. That condition is called diabetic ketoacidosis. It causes rapid breathing, fruity smelling breath from acetone, dehydration, and eventually coma and death.
[03:35 –> 04:02] This was the grim reality before insulin. Doctors at the time tried to slow the disease with what was called the Allen Starvation Diet, named after the doctor Frederick Allen. The logic was simple and cruel. If carbohydrates raise blood sugar, stop eating them. So children were fed just 400 to 500 calories a day, mostly fat, almost no carbs, and sometimes even whiskey to add the calories from alcohol without sugar.
[04:02 –> 04:27] They were weighed daily, and if their blood sugar rose, their rations were cut even further. Parents sat helplessly watching their children waste away into skeletons. The metabolic wards of hospitals were filled with the smell of acetone from the children’s breath in what doctors called starvation rooms. These were places where death became kinder than the treatment that delayed it. Meanwhile, scientists were racing to understand what was happening inside the pancreas.
[04:27 –> 04:51] They had already discovered that removing the pancreas from animals caused diabetes, which meant that whatever controlled blood sugar had to come from that organ. But isolating whatever this life saving substance was from the pancreas was almost impossible. Here’s why. The pancreas has two different jobs. One part makes digestive enzymes like trypsin that flow through tiny ducts into the small intestine to help break down food.
[04:51 –> 05:15] Trypsin is incredibly powerful. It can digest almost any protein it touches. The other part of the pancreas, the islets of Langerhans, makes hormones like insulin. Instead of releasing them through ducts, these islets release insulin directly into a network of tiny blood vessels, which carries it into the bloodstream and throughout the body to help cells absorb glucose. In normal physiology, insulin and trypsin never meet.
[05:15 –> 05:50] They work in completely different systems, one inside the blood vessels, the other inside the digestive ducts. But when early researchers tried to grind up the entire pancreas to make an extract, they mixed everything together. Trypsin immediately destroyed the delicate insulin molecules, and the rest of the extract, full of dead tissue, enzymes, and bacteria, made patients violently ill when injected. At this point in the story enters a man named Frederick Banting, who you’ll see was an unlikely hero. He was born on a small farm in rural Ontario, Canada, the youngest of five children.
[05:50 –> 06:06] He wasn’t the top of his class. In fact, he struggled through school, likely undiagnosed with dyslexia. That made reading and spelling a daily battle. But Banting was persistent. Through sheer determination, he worked his way into medical school at the University of Toronto and trained as a surgeon.
[06:06 –> 06:34] When World War I broke out, he immediately enlisted. He wanted to serve on the front lines and got his wish as a battlefield surgeon in France. During the combat, he was hit by shrapnel in his right arm, but refused to abandon his post, continuing to operate on wounded soldiers until he physically couldn’t. He returned home a decorated war hero, but also a man trying to find purpose again. Back in Canada, Banting opened a small surgical practice in London, Ontario.
[06:34 –> 06:53] It failed almost immediately. There wasn’t enough business, and on some days, he earned less than $4. It wasn’t lack of skill. It was just bad timing and bad luck. So to stay afloat, he took a part time job teaching anatomy at the University of Western Ontario, while he lived in a small rented room and scrapped to make a living.
[06:53 –> 07:27] One evening, preparing a lecture on the pancreas for his students, Banting began reviewing the scientific literature. He read about the organ’s two major roles, digestion and hormone secretion, and the mysterious clusters of cells known as the islets of Langerhans, which scientists suspected made a substance called insulin. He also read about why all the previous pancreatic extracts had failed. The powerful enzyme trypsin kept destroying insulin before it could be used, and the leftover debris in those extracts made patients violently ill. Around this same time, Banting had cared for a young boy with diabetes.
[07:27 –> 07:54] He had watched that child waste away on the Allen starvation diet, begging for food as his body failed. The helplessness of that experience had haunted him. So on the night before his lecture, Banting lay awake thinking about that boy, about the pancreas, and about the islets of Langerhans. As he flipped through a surgical journal, he came across a short article by a researcher named Moses Barron. Barron described what happened when the pancreatic ducts became blocked.
[07:54 –> 08:22] The digestive parts of the pancreas would wither away, but the islets, the insulin producing part of the pancreas, remained intact. That night, Banting couldn’t sleep. He tossed and churned for hours, caught between the tragedy of that starving child and the possibility of a cure. And then sometime around two in the morning, it came to him. If the ducts could be tied off, maybe the destructive parts of the pancreas would atrophy, leaving only the cells that made insulin alive.
[08:22 –> 08:47] Maybe then insulin could finally be isolated without being destroyed. He got out of bed, lit a candle, and began to write. In his notebook, he scrawled the words that would change medical history. Quote, diabetics, ligate pancreatic ducts of dogs, keep dogs alive till acini degenerate, leaving islets. Try to isolate internal secretions of these and relieve glycosuria.
[08:48 –> 09:20] That single note, just a few words written by candlelight, marked the moment of inspiration that would save millions of lives. Banting had no lab, no funding, and no reputation, but he had an idea that was simple and brilliant. If he could separate the insulin making parts of the pancreas from the insulin destroying part, he might be able to isolate insulin intact and unlock the cure for diabetes. The very next day, Bantine walked into the University of Toronto and began asking if anyone had a bit of lab space he could borrow. Most people brushed him off.
[09:20 –> 09:42] He was an unknown country surgeon with no research background and no funding. But one professor, JJR MacLeod, happened to be preparing for a summer vacation to Scotland. MacLeod listened politely, skeptical that a struggling surgeon could solve a problem that had defeated the best physiologists in the world. Still, he figured, why not? The lab would sit empty anyway over the summer.
[09:42 –> 10:12] So he told Banting he could have the attic space in his lab for eight weeks, a few dogs to experiment on, and a student assistant. Two medical students, Charles Best and Clark Noble, flipped the coin to see who would be Banting’s helper. Best lost the coin flip, and at 22 years old, fresh out of his physiology degree, he became Banting’s assistant. They began work on 05/17/1921 in a sweltering attic lab. There was no air conditioning, no ventilation, and barely any equipment.
[10:12 –> 10:45] Banting was so broke, he slept in the lab to save on rent. The two of them did everything, the surgery, the anesthesia, the blood draws, and the chemical testing, and often worked late into the night surrounded by barking dogs and the smell of ether. Bantain would open each dog’s abdomen, find the pancreas tucked against the stomach. He carefully tied off the pancreatic ducts with silk thread, making sure not to damage the blood vessels that kept the organ alive. The idea was to let the enzyme producing parts of the pancreas wither away while keeping the insulin producing islets alive.
[10:45 –> 11:11] They nursed the dogs for seven to ten weeks while that process happened. When the pancreatic tissue had atrophied, they removed the pancreas and ground the shrunken organ in ice cold saline. They filtered the mixture through cheesecloth to remove the solids and collected a cloudy brown liquid they called isotin. Now they needed to see if it actually worked. They chose a dog, a white terrier mix named Marjorie, lab dog number 410, and surgically removed her pancreas.
[11:11 –> 11:37] Within hours, her blood sugar soared. She became weak, drank excessively, and urinated constantly, classic signs of diabetes. On 07/30/1921, they gave Marjorie her first injection of isotin. Within hours, her blood glucose fell from 400 to two twenty, and soon after to almost normal levels. They kept her alive for seventy days, far longer than any depancreatized dog in history.
[11:37 –> 12:00] When they finally ran out of the extract, her blood sugar rose again and she died. She died because they simply had no more isotin to give her. The success was undeniable, but the process was brutal. Each preparation took weeks and they needed to sacrifice dog after dog. Banting, who had grown up surrounded by animals on his family farm, was deeply disturbed by the dog’s suffering and sacrifice.
[12:00 –> 12:29] He knew there had to be a better way, more humane and faster. That’s when he and Bess tried something new. Instead of operating on a dog and waiting for the pancreas to degenerate, they went to a slaughterhouse and collected the pancreases of fetal calves. This tissue was rich in insulin but contained very little digestive enzyme. They ground the pancreases in cold alcohol and acid, reasoning that the alcohol would denature the small amounts of trypsin before it could destroy the insulin.
[12:29 –> 12:57] To Banting’s surprise, it worked, and it worked better than the previous method. The alcohol denatured the trypsin, the cold stopped any further enzymatic activity, and the insulin, which turned out to be a remarkably stable little protein, survived intact. By the 1921, Banting and Bess finally had a reliable way to produce insulin in larger quantities. And for the first time, they began to think about seriously testing it in humans. But the early extracts were still rough.
[12:58 –> 13:22] Murky mixtures full of dead cells, proteins, and bacteria. When injected into animals or volunteers, they caused fever, abscesses, and pain. It was clear that insulin was there, but the impurities made it too dangerous to use. That’s when MacLeod stepped back into the picture. Seeing how far Banting and BEST had come, he suggested bringing in a professional biochemist named James Bertram Collip from University of Alberta.
[13:22 –> 13:38] Collip was everything Banting wasn’t. Banting was impatient, instinctive, impulsive, and bold. Was methodical, quiet, and precise. But together, they were the perfect balance. One driven by inspiration, the other by meticulous control.
[13:38 –> 14:13] Through the 1921, Collip worked diligently in the lab. He experimented with alcohol purification, discovering that at certain concentrations, unwanted proteins clumped together and fell out of solution. By carefully adjusting the alcohol levels, he could remove the contaminants while keeping insulin dissolved. Then he reversed the process precipitating the insulin, washing it, and redissolving it until he had a clear potent extract. By early January nineteen twenty two, Collip had something extraordinary, a batch of insulin pure enough to test in humans.
[14:13 –> 14:32] Their first volunteer was Leonard Thompson, a 14 year old boy with type one diabetes. He was barely sixty five pounds, skeletal, and fading fast on the Allen Starvation Diet. His father, a Toronto city worker, agreed to the experimental injection. He’s dying anyway, he said. We have nothing to lose.
[14:32 –> 14:51] On 01/11/1922, Banting injected Leonard with their first crude extract. It failed. The boy developed an abscess, his blood sugar didn’t budge, and the team was crushed. But Collip refused to give up. He returned to the lab, adjusted his purification process again, and produced a new crystal clear solution.
[14:51 –> 15:08] A few days later, they tried once more. This time it worked. Within twenty four hours, Leonard’s blood sugar dropped from five twenty milligrams per deciliter to 120. The ketones in his urine disappeared. He began eating real food again, gaining weight, and regaining strength.
[15:08 –> 15:35] Within weeks, the transformation was astonishing. The pale, starving boy now had color in his cheeks and energy in his voice. Leonard Thompson would go on to live another thirteen years, dying not from diabetes, but from pneumonia. And with that single injection, the world entered a new era of medicine, an era in which diabetes would no longer be a fatal disease. Many more patients were treated, and the results were nothing short of miraculous.
[15:36 –> 15:49] Word spread quickly. Newspapers called it the Toronto Miracle. And remember, this was in the age before the Internet. News traveled by telegram, by letter, and by word-of-mouth. Yet within weeks, the story of insulin raced across the world.
[15:50 –> 16:15] By February 1922, doctors, journalists, and desperate families all knew about the miracle cure for diabetes. Soon, families began pouring into Toronto, some traveling hundreds of miles carrying their dying children in their arms. By spring, Toronto General Hospital was overwhelmed. The wards were filled with scenes of desperation. Parents weeping, children too weak to stand, many only hours from death.
[16:15 –> 16:38] Banting was heartbroken. Everything he had done was to save lives, and now he was watching children die faster than he could make the insulin that might save them. He and his small team were still grinding up calf pancreases by hand, purifying small batches one at a time. Colb and Bess worked furiously at the bench, but they simply couldn’t keep up. For every child that was treated, 10 more arrived.
[16:38 –> 17:07] They had to ration the doses, making agonizing decisions about who would receive life saving insulin and who wouldn’t. Banting barely slept. He spent his days in surgery, his nights in the lab, exhausted and tormented by the thought that every day of delay meant more children were dying. He realized that if insulin was truly going to save lives, it couldn’t stay locked inside a university lab. It needed to be mass produced immediately and at scale.
[17:07 –> 17:45] That conviction led to one of the most selfless decisions in medical history. Banting went to the University of Toronto and offered to give them the patent to hold it, as he said, quote, entrust for humanity, end quote. He wanted the university to license insulin only to a company that could make it in large quantities under strict quality standards at fair prices, and he insisted that any profits be used from further medical research, not personal gain. He told Best and Collip to each sell their share of the patent for $1, and he did the same himself. Kolop resisted.
[17:45 –> 18:07] He had worked tirelessly on the purification process and believed that scientists had every right to profit from their discoveries. And he wasn’t wrong. Many scientists up to this point in history had become very wealthy from their discoveries. He even went as far as to withhold details of his purification method for a time, hoping to secure his own patent. This led to a bitter clash with Banting.
[18:07 –> 18:24] Banting, who was still so poor he couldn’t afford rent, saw things differently. He had watched dying children in hospital beds, seen parents begging for help. He couldn’t stomach the thought of making money from their desperation. He said, insulin doesn’t belong to me. It belongs to the world.
[18:25 –> 18:46] No one should profit from a discovery that saves lives. It would be immoral. Eventually, MacLeod stepped in and persuaded Collip to release his claim. The University of Toronto took ownership of the patent and began searching for a company that could produce insulin on an industrial scale. That’s when they found Eli Lilly and Company in Indianapolis.
[18:47 –> 19:19] Lilly had the chemists, the equipment, and the supply chains to do what the Toronto lab couldn’t. Their chemist, George Walden, improved colub’s purification process, scaling it up and standardizing production. By 1923, Eli Lilly was producing insulin in mass quantities and shipping vials across The United States. The University of Toronto licensed Conat Labs to make insulin for Canada and Novo Nordisk for Europe. The companies made profits, but the drug was affordable and accessible, just as Banting had intended.
[19:19 –> 19:42] Banting, Best, and Collip had given away one of the most valuable medical discoveries in history for a single dollar each. They had chosen humanity over wealth. In Banting, the farm boy, the struggling surgeon who couldn’t pay his rent, had changed the course of humanity and medicine forever. In 1923, the Nobel Prize in Physiology or Medicine was awarded to Frederick Banting and J. J.
[19:42 –> 20:05] R. MacLeod, but not to Charles Best and James Collip. Banting was furious. He had worked in MacLeod’s lab, yes, but MacLeod had been vacationing in Scotland during the entire 1921 while Banting and Best made their critical discovery. To Banting, it felt like theft, that someone who wasn’t even present for the breakthrough was now sharing credit for it.
[20:05 –> 20:29] The Nobel Committee, however, saw things differently. They viewed MacLeod as the senior scientist, the one who had provided the lab, the oversight, and the academic legitimacy. Banting could barely contain his anger, but he made a bold and generous gesture. He announced that he would split his share of the prize money, about $25,000 at the time, with Charles Best. In response, MacLeod quietly shared his half with Collip.
[20:29 –> 20:46] The four men never worked together again, and Banting and MacLeod barely spoke after that. Looking back, each of them played a role. Banting had the idea and the passion. Best provided the technical skill and perseverance. Collip purified insulin so it could be used safely in humans.
[20:46 –> 21:06] And MacLeod, for all his distance, had provided the space and structure for their work to happen. Together, they had transformed diabetes from a death sentence into a manageable condition. By the mid nineteen twenties, newspaper headlines around the world read, cure for diabetes found, medical miracle. But it wasn’t a cure. Insulin didn’t eliminate the disease.
[21:06 –> 21:26] It simply kept patients alive. It churned a rapid, agonizing death into a chronic condition that required daily management. Yet for families in the 1920s, that was still a miracle. Children who once faced certain death could now grow up eating real food, living full lives. And for Banting, that was enough.
[21:26 –> 21:45] He had been a poor country doctor who refused to profit from his discovery. He gave insulin to the world so that no one would ever again have to watch their child starve to death. When he sold the patent to the University of Toronto for $1, he said, insulin doesn’t belong to me. It belongs to the world. For much of the world, that promise has held true.
[21:45 –> 22:11] Across India, Europe, Africa, and Asia, insulin remains inexpensive and widely available. Millions of people with diabetes live long, healthy lives because Banting and his colleagues chose generosity over wealth. But in The United States, that gift has been betrayed. Between 2002 and 02/2013, insulin prices tripled. A vial that once cost 35 or $40 now costs over a $120.
[22:11 –> 22:39] And by 02/2016, some vials reached $300. Many people with type one diabetes need two or three vials a month. That’s nearly 1,000 for medicine that was once meant to be affordable and accessible. Today, just three companies, Eli Lilly, Novo Nordisk, and Sanofi control 90% of the world’s insulin supply. Through a process called evergreening, they make tiny tweaks to formulations, extend patents indefinitely, and keep prices high.
[22:39 –> 22:59] In The US, middlemen like pharmacy benefit managers inflate those prices even more. Generic versions are scarce, and when the old affordable insulins lost patent protection, most stop being produced altogether. The consequences have been devastating. One in four Americans with diabetes admits to rationing their insulin. Some have died from diabetic ketoacidosis.
[23:00 –> 23:27] People like young adults, even teenagers forced to stretch doses because they couldn’t afford refills. In response, some states like Colorado, Illinois, and New Mexico have passed laws capping insulin co pays at a $100 a month. And in 02/2022, Medicare began capping costs at $35 a month for seniors under the inflation reduction act. These changes are helping slowly, but they’re also a reminder of how far we’ve drifted from Banting’s vision. Think about it.
[23:28 –> 23:49] A man who was too poor to pay rent discovered one of the greatest medical breakthroughs in history and then gave it away for $1 so that no one would suffer. And a century later, people are still dying because they can’t afford it. In my opinion, that’s not just a policy failure. It’s a moral failure. How do we honor the gift that Banting, Bess, Culp, and MacLeod gave the world?
[23:49 –> 24:23] How do we honor the dogs who suffered in those early experiments or all the scientists who made incremental contributions to our understanding of insulin and never received any credit for it. The discovery of insulin stands among medicine’s greatest triumphs. Yet, its legacy holds a mirror to both sides of our nature, our capacity for compassion, and our tendency towards greed. Every time someone rations their insulin, every time a parent has to choose between rent and a vial of medicine, the story of insulin is rewritten. And right now, we’re writing a chapter that Frederic Banting would be ashamed of.
[24:23 –> 24:44] Banting gave insulin freely to the world, believing that compassion and altruism should guide science and medicine. Will we protect that belief or let it fade into history? A century later, that question still waits for an answer. So I hope you enjoyed that episode. On our next one, we’re taking a deep dive into GERD, or what most people call indigestion.
[24:44 –> 25:16] It’s one of the most common medical problems in the world and also one of the most mistreated. Medications are handed out carelessly, often creating more dependency than relief. The truth is most people don’t have to live with constant reflux, but they don’t know how to get control of it without becoming slaves to the medication. We’ll break down why reflux happens, how to reduce your dependence on antacids and proton pump inhibitors, and how to restore real gastrointestinal balance. It’s a topic that’s personal to me because I used to be one of those patients.
[25:16 –> 25:26] I was stuck on a proton pump inhibitor for years until I found a way off. So until next time, stay curious, stay skeptical, and stay healthy. Cheers.