Breaking Through is Hard To Do

Eli Lilly vacuum drier for turning pancreases into insulin

I happened to be in Manhattan earlier this week and caught the last day of the New-York Historical Society exhibit “Breakthrough: The Dramatic Story of the Discovery of Insulin.” My favorite part was the black-and-white silent movie showing the early insulin-manufacturing process, in which refrigerator carloads of fetal calf pancreases are ground up, pressed, filtered, and purified to produce the life-saving extract. Before 1921, the glands had been a waste product in stockyards around the country. After Eli Lilly and Company began buying them up from meat-packing houses, this offal became a precious commodity overnight; ten thousand pounds of pancreases were needed to make one pound of insulin crystals. (It wasn’t until the 1960s that the first synthetic insulin was produced. Today, most insulin used is biosynthetic recombinant “human” insulin.)

Many of these historical images appear in the recently published Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle (St. Martin’s Press) by Thea Cooper and Arthur Ainsberg.  Their account of this fascinating story is fluidly written and loaded with complex characters and details of a bygone era. They focus on four primary researchers and Hughes, who was the daughter of a prominent politician and the first American to receive insulin treatment for juvenile diabetes. Even though we know the outcome before we even pick up the book, the back story of this hinge point in medical history is compelling reading.

But the book will never have the clout of historian Michael Bliss’s award-winning The Discovery of Insulin, which was just reissued in a 25th anniversary edition (and to which Ainsberg and Cooper are indebted). That’s because Breakthrough is part history and part historical fiction. The authors even cop to fabrications in their preface, admitting that some dialog, incidents, and even a character “have been invented or augmented for narrative purposes.”


The book was a seven-year labor of love for Ainsberg. Speaking in December at the National Museum of Health and Medicine in Washington, DC, the veteran Wall Street executive and Hodgkins Disease survivor said that writing a narrative history about some medical intrigue had long been on his bucket list. In 2003 he read a story in the New York Times about Hughes, the diabetic daughter of an American statesman who participated in the first successful insulin trials in 1922, and knew he’d found his subject.

You would think that one of his first moves would be to contact the survivors of Elizabeth Hughes, who died in 1981. But he purposely chose not to interview her children or those of the researchers because he wanted to avoid “revisionist history.” One event in particular that they probably would have balked at is an imaginary phone call from her father, Secretary of State Charles Evans Hughes, to the president of the University of Toronto, pressuring the school to admit his daughter as a patient. Maybe it happened that way, maybe it didn’t. But there’s no evidence either way, no diary, letter, or log to connect the dots and explain how this desperately sick but privileged American girl “jumped the line” to participate in insulin trials.

I can understand the temptation – it’s maddening when the historical record does not confirm a hunch or technical details interrupt the narrative flow — but I don’t understand why they succumbed when a small caveat (One can imagine the scene…) could have saved them so much trouble–and their credibility.

I find this especially curious since Ainsberg is no shrinking violet and not one to do things by halves. He’s sailed the Antarctic route of his idol Ernest Shackleton and developed a series of lectures on leadership inspired by the explorer’s icebound ordeal. (“Keep Dissidents Close” is one.) His official bio states that he’s been to every baseball stadium and presidential museum in America. And he clearly relishes historical research. When he talked about the thrill of walking into Eli Lilly’s corporate archives, I got the feeling he would have loved to hole up there until the Dodgers returned to Brooklyn.

By now he’s spoken to all three of Hughes’ children. “I think they like the book,” he says with a shrug, “but they don’t like me.”

I wanted to like this book, but with every new conversation or scene, I find myself flipping to the notes to see if it really happened or is a figment of the authors’ imaginations. That’s unfair to readers and to the story’s real-life heroes–reseachers like Charles Best and Frederick Banting, shown here posing with a lab pooch at the University of Toronto 90 years ago, when they found a way to save millions of lives.

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