100th anniversary of the Nobel Prize for the discovery of insulin

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One hundred years ago, on October 25, 1923, the Nobel Prize in Physiology or Medicine was awarded to University of Toronto researchers Frederick Banting and John Macleod for the discovery of insulin.

Banting was the first Canadian to win a Nobel Prize, and at just 31 years old, remains to this day the youngest Nobel laureate in physiology or medicine

The discovery had occurred in 1921 – only two years before – making the period between the discovery and the award one of the shortest in the history of the Nobel Prize.

As stated in Alfred Nobel’s will, the prizes were to be awarded annually “to those who, during the preceding year, have conferred the greatest benefit to humankind.” The benefit of the insulin finding was certainly momentous.

“The prize came so quickly because of the magnitude of the discovery and its global impact,” says Grant Maltman, curator of Banting House National Historic Site of Canada, (under the stewardship of Diabetes Canada), in London, Ontario. “More than a century later, we have better insulin, but we don’t have anything better than insulin to treat diabetes.”

Through more than 30 years as the curator of Banting House National Historic Site, Maltman has acquired extensive knowledge about Banting, the man, and about his research and scientific accomplishments. It is a narrative that is, in many ways, stranger than fiction.

An unlikely breakthrough

“What makes the origin story of insulin so remarkable is that, by all logic, the discovery should not have happened when it did and in the manner that it did,” says Maltman. “A lot of unlikely things had to occur, and serendipity played a huge role.”

In 1920, Banting, trained as an orthopedic surgeon, was struggling to establish a medical practice in London. In July of that year, he had made just $6, so he readily accepted when Western University’s medical school offered to hire him as a demonstrator for $2 an hour.

Later that fall, Banting was asked to deliver a lecture on diabetes, “a subject he admittedly knew very little about,” says Mr. Maltman. “He talks about having just one page of notes related to diabetes from medical school, and he had never treated a patient with diabetes. So, on October 30, he goes to the medical school and reads everything he can to prepare for his lecture on November 1.”

What happened next led to the well-known “Eureka” moment in which Banting was struck by an idea that would lead to his world-changing discovery.

That night as he prepared for sleep, he sat in bed reading a surgical journal article about recent research into the relationship between the pancreas and diabetes.

Banting’s notes from several years later reveal what transpired.

“It was one of those nights when I was disturbed and could not sleep. Finally about two in the morning, after the lecture and the article had been chasing each other through my mind for some time, the idea occurred to me. I got up and wrote down the idea and spent most of the night thinking about it.”

In just 25 words, Banting laid out a novel, surgical approach to isolating the pancreatic extract – not yet named – that could be used to treat and save the lives of people with diabetes.

At that time, the accepted therapy for diabetes was a severely calorie-restricted diet, and the life expectancy of an individual given this treatment was between six months and two years.

“Those 25 words truly changed the world,” Maltman explained.

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Into the lab at the University of Toronto

Banting wanted to conduct his diabetes research at Western, but the university didn’t have the needed capacity at that time. That brought him to the University of Toronto to work with Professor Macleod, head of the physiology department and overseer of a large laboratory.

Banting was not well prepared for their meeting, and Macleod was initially unimpressed. “It’s pretty clear that MacLeod didn’t think Banting was going to succeed,” Maltman says. “But he saw something there and recognized the value of failure in science, that failed experiments allow you to close off that line of inquiry and pursue another path.”

In May 1921, Banting began the research in Macleod’s laboratory and was provided with an assistant, 21-year-old medical student Charles Best. They were later joined by biochemist James Collip, whose expertise led to a process for purifying insulin for human clinical trials.

In January 1922, 13-year-old Leonard Thompson became the first person to receive an insulin injection as treatment for diabetes. His condition improved dramatically, and the major shift had begun. Diabetes, once seen as a fatal disease, could finally be managed.

A Nobel Prize and a new era for Canadian medical science

By 1923, insulin had become widely available in mass production, and the rumours about the insulin discovery receiving that year’s Nobel were intense – exemplified by Banting’s appearance on the cover of Time magazine in August.

“People often find it surprising that Banting and Macleod won the award because we are so used to thinking about the team of Banting and Best,” Maltman says. He explains that Best wasn’t nominated, but Banting was upset all the same. His first reaction, says Maltman, was to declare, “I will not accept their prize.”

But he was persuaded to change his mind by authorities at the university, who stressed how refusing the award would damage Canada’s reputation and the future of its scientific endeavours. “Banting was a reluctant hero, but he understood the stakes. He had strong principles, and if you appealed to his sense of honour and duty, he would step up.”

Banting announced publicly that he would split his share of the award money with Best, and Macleod took the same step with Collip.

Personal connections and enduring legacies

The Nobel Prize and Banting’s accomplishments have rippled through the intervening 100 years, creating deeply personal connections between people touched by diabetes and the man who changed their world.

Maltman has seen the emotional impact that a visit to Banting House can bring. Visitors from more than 80 countries have come to see Banting’s home, often calling it a “pilgrimage.” Many are overcome with emotion when they enter the bedroom where his breakthrough idea was born. Many visitors write “Dear Dr. Banting” letters on recipe cards – individuals who are thriving with diabetes and parents of children with diabetes thank him for saving their child. Diabetes researchers often share they are there to receive the inspiration to make progress in their own work.

The personal legacy is amplified by the historic legacy, Maltman says.

“These developments put Canada on the map in diabetes research and in science more broadly. Banting became a passionate champion for research in this country, inspiring generations of scientists across Canada and beyond.

“I think what he did for research was one of the great legacies. And of course, the ultimate legacy is that millions around the world are alive today because of this revolutionary finding.”

Advertising feature produced by Randall Anthony Communications with Diabetes Canada. The Globe’s editorial department was not involved.