An operatic version of the Banting story

Breakthrough is about the discovery of vital medical knowledge: insulin. Most CMAJ readers will know the Banting, Best, Collip, MacLeod dysfunctional drive to isolate insulin culminating in 1922 with a product that would save the lives of countless diabetics.1 Many will have read Michael Bliss’ authoritative works, The Discovery of Insulin and Banting: A Biography. In fact, these are the texts that Breakthrough’s authors “read and reread” and “were instrumental in navigating the chronological frame work for [their] narrative.”

So, given all that’s been written already, why do you need to read this book? Simply because it is compelling high opera, with a star cast and it has meticulous references. Sure the authors indulge in artistic license, but that helps the journey. Maybe Dr. Frederick Banting didn’t bury the engagement ring in his front lawn and maybe Charles Evans Hughes, US secretary of state, didn’t phone the president of the University of Toronto, but both events are in keeping with the character of the unpredictable Banting and the integrity of the husband/ father conflicted statesman Hughes.

When I began reading Breakthrough and learned that “some cases have been invented or augmented for narrative purposes” I began thinking with flagrant academic snobbery and righteous Canadian chauvinism, that I would do much better rereading the real story in Bliss’ books. Then I came to Elizabeth Hughes’ mother’s midnight raid on the physiatric institute to rescue her daughter and take her to Banting wherein “she bounded from the car and hurried up the broad alabaster steps.” Well, I had a visceral reaction. I don’t mind a little melodrama, but no one in their right mind would make front steps out of alabaster, a semiprecious pure white gypsum with a hardness of two (2/10). Then I suspended my left brain. The steps weren’t alabaster they looked like alabaster with its sepulchre connotation and inside the institute was Elizabeth Hughes starving to death with diabetes, all skin and bones. To her mother, Elizabeth would be a precious, fragile, alabaster daughter.

Image courtesy of St. Martin’s Press

So I’ve come to think about this book and similar creative nonfiction endeavours not so much as taking liberties with facts, as forcing the reader to think differently and perhaps get closer to the emotional truth of a situation. This is what reflective narrative, such as the articles under the Encounters banner in this journal, is all about. The authors of Breakthrough document their history very carefully and they tell you up front that they are going to tinker to improve the narrative and it works. It also allows them to make the book much richer.

The book consists of four interwoven substories and each chapter ends with just enough suspense to enliven the narrative. There is Hughes, the perky adolescent from a high-profile political US family who is dying of diabetes. She is being treated by the humourless Dr. Frederick Allen who keeps his patients alive by starving them. Then there is the penniless, driven, combative Banting who, against all odds, discovers the cure. Finally there is the medical researcher Dr. Alec Clowes who goes to the dark side and joins Eli Lilly the pharmaceutical firm who has the resources to manufacture insulin in the quantity and quality to save those who are about to die. Ethicists will not be disappointed.

There are mysteries. Once successfully treated, why did Hughes, who died in 1981, make no attempt to help other diabetics? Who was the mysterious Dr. McClintock? And would Banting have made more discoveries if the Canadian government hadn’t given him an annuity?

It is refreshing to see medical history through the eyes of a playwright and financial officer. Due diligence and leadership issues lurk and I liked the artistic writing touches, “listening together to the percussive pendulum of the grandfather clock that stood like a stoic sentry” gave me a clearer sense of a family’s silent suffering as they awaited impending doom. I also realized the importance of visual diversions and wonderment as Elizabeth, too weak to move, lay in the Bermuda sun watching “aerial brigantines.”

You will really enjoy reading Breakthrough and your horizons will be expanded by a story that really matters.