I have a long title and quite a long talk which is an opportunity in the Banting memorial lecture,
a huge opportunity to discuss an approach to clinical science,
a personal story, in which I will reflect a little on the background of Banting's own professional
development in clinical research. My disclosures are shown here.
Now, the discovery of insulin in 1921, exactly 100 years ago, was very remarkable for a huge
number of reasons. The work that led up to it was less than one year in which Banting
researched the topic. The paper was published less than a year later. The Nobel Prize was awarded
one year after that. This was heralded as a cure for diabetes and I asked the question: where are
we now, exactly 100 years on? The Nobel prize was awarded to Banting and to the laboratory leader
Macleod in Toronto and this was a development of global importance,
huge global importance. Statues were erected, this one in Banting's hometown of London, Ontario.
He had his face on postage stamps all over the world; That's a mark of fame that
few of us can reach. We shouldn't underestimate the importance of this discovery for Canada. He
became a national hero almost overnight. He would rank alongside Alexander Fleming, Alexander Bell,
John Logie Baird, David Hume, William Wallace, Robert the Bruce and Sean Connery all rolled into
one. This was a very major figure for Canada and for the world. The discovery was extraordinary.
It was documented by a book, which I shall refer to, by Michael Bliss,
who many of you remember from his attendances at Diabetes UK meetings. On the photograph here,
the famous one showing Banting on the right with the medical student Charles
Best on the left and their dog Marjorie, that was dog number 33 who survived 70 days without
a pancreas. Charles Bess gave the very first Banting Memorial Lecture in London in 1947.
This story brings to me a lecture, the Willendorf Lecture, given by Jules Hirsch,
another megalithic figure in obesity and metabolic research. He gave it in Jerusalem in 1986. His
title was 'Mutts and moles' and he traced the role of two different character approaches to science:
the dog who sees something and goes for it, on sight, without stopping to regard anything on the
way, will crash through fences, will do damage all the way to get to that target and the mole,
shown life-size here, was inflated by Jules Hirsch to be equal in importance to the dog. The mole,
who has an idea of a target, works quietly underground to reach it, taking perhaps very
much longer but with great security and surety. Those two characteristics Hirsch
regarded as both being important to the scientific process. Now, Banting completed his medical
training in just four years in order to go to the wars. He went to the Western Front where he was
slightly wounded in his right arm and wrote an extraordinary letter with his left arm back to
his mother. He returned back from the Western Front and set up a solo practice in London,
Ontario. His experience was that patching up soldiers and cutting a few things off,
he had really no surgical skills, certainly no medical skills and he had no patience. He was
forced to lecture to medical students for pocket money, something we all feel close to the bone,
and he lectured about diabetes. He read up on the accounts from Minkowski of 30 odd years earlier
when it was shown that removing the pancreas would result in diabetes and he conjectured,
Banting, that there should be something coming from the pancreas which was preventing diabetes.
This was not a new idea. In fact the name insulin had been coined for this many years earlier,
but it had never been discovered. In the middle of one night in October 1920,
Frederick Banting had a dream. That's his bedroom in London, Ontario, and his dream he recorded in
the middle of the night. He wrote 'we ligate the pancreatic ducts of dog, keep the dogs alive till
the acini degenerate, leaving the islets, try to isolate the internal secretion of these to relieve
glycosuria. And you'll notice that he spelt diabetes and glycosuria incorrectly. This was not
his field, not his strength but on that dream, in less than a week, he marched up to the laboratory
of John Macleod in Toronto and he started work exactly 100 years ago in April 1921 dissecting the
pancreas of dogs to leave a pancreatectomised dog and pancreas from which he tried to extract the
secretion that ultimately would be insulin. Dogs feature very strongly in the story. There was a
big personal clash which is documented by Michael Bliss. Macleod, very experienced scientist, he'd
spent 15 years looking for insulin. He'd actually already found it in fish and just wanted to be
able to repeat his experiments in other species including dogs, rabbits and others and he was
attacked with difficulty, at that time, in measuring glucose when he recruited
Collipp to the team because Collipp was a very good biochemist. Macleod wanted reproduceability
in his research. Banting simply wanted to have one experiment which would work and then he could
move on from that. The paper published in March 1922 in the Canadian Medical Association journal
is here. You'll notice that the authors didn't include Macleod and that begs various questions
about the relationships behind the scenes. What it showed was their early experiments treating six
diabetes patients with what appears to be a concentrated internal secretion of the pancreas.
Two of those patients got better. A paper was published and this led to the concept being taken
up by the Connaught Laboratories who ultimately purified the insulin. An extraordinary weak base
or scientific advance but that's what happened and it it occurred because of the extraordinary energy
which Banting threw at this huge problem which had remained for 30 or 40 years.
Bliss' book asks various questions: who had the idea? Who did the experiments?
Who kept that project going and paid for it? Who wrote the paper?
Who created the impact and who should be rewarded? Who should own the patent?
That led to a fight in the laboratory, at the time, between Banting and Collipp because Banting
did not see the value of proper biochemistry and feared that Collipp was going to steal
the patent and give it to a commercial laboratory. He laid out Collipp with a fist in the laboratory.
Not a great start to a scientific career but it was effective and in recognising the role of dogs
in Banting and Best's, work there was an annual Dog Memorial Day at the Banting house in London,
Ontario. It was estimated that he must have sacrificed over 600 dogs in his efforts to
obtain functional insulin. He employed a dog catcher, paying three dollars a dog, no questions
asked. Frederick Banting came in with bravado. He came in with very powerful convictions, absolutely
no scientific knowledge or understanding and he was, in fact, really a rotten scientist but he
made things happen in a big way. His knocking out of Collipp was all about the patent.
At the end of this saga and this very short saga in Toronto in 1921-22 they sold the patent for
insulin to the University of Toronto as a gift to mankind for one pound. A fantastic thing to do.
But I think we should celebrate the dogs. They were the ones who made all this possible
and we take you back to the laboratory where Banting carried out this work.
This is a painting of the laboratory and at the first slide I showed in this talk, those
with good eyesight will spot, but it's signed 'Banting'. Banting was a rotten scientist. He
wasn't much of a doctor. He was a superb artist. He was a one of Canada's greatest oil painters.
These are both by Banting. Here he is painting on a boat. He went on tours up into the arctic
and loved the mountains that he found out there, he painted them avidly. His paintings' colors,
style are very striking, very beautiful and if anyone has a spare one I'd be very grateful.
His mountains are particularly evocative for a mountaineer. Thank you very much indeed.