1923 Nobel Prize in Physiology or Medicine – Frederick Banting and John Macleod
What You Will Learn in This Article
You will understand the story of insulin’s discovery and the Nobel Prize awarded just one and a half years later – an unprecedentedly short timeframe. You will also learn how four individuals clashed and why we remember only Banting and Macleod today.
Discovery-Administration-Nobel Prize: A Compressed Timeline of One and a Half Years
The typical time lag between a scientific discovery and the Nobel Prize is 10-30 years. This is because the significance of the discovery must be proven, clinical applications verified, and follow-up research accumulated before the committee can be confident.
Insulin was an exception:
- Summer of 1921 – Banting and Best’s successful dog experiments.
- January 1922 – First human administration, the Leonard Thompson case.
- Spring-Summer 1922 – Expanded clinical trials, with dramatic results reported successively.
- October 1923 – Nobel Committee decision.
One and a half years. The reason the Nobel Committee acted so quickly was that the clinical impact of the discovery was immediate and obvious. Before insulin, the prognosis for children with type 1 diabetes was death within a few months to a year or two after diagnosis. After insulin, these children began to live as we do today. Anyone who saw this contrast would have been convinced.
However, behind this compressed success was a fierce conflict among four individuals.
The Era’s Landscape – Entering the Height of the Roaring Twenties
1923 was the year the Roaring Twenties reached its peak. The American economy was booming, jazz became mainstream culture, and women’s suffrage and new social norms were being established. Although Europe was still struggling with post-war difficulties, it was beginning to regain its footing.
Some key events:
- German hyperinflation – The mark collapsed, and people used banknotes as wallpaper.
- The Beer Hall Putsch (November) – Hitler’s first attempted coup failed. His trial made him famous and sowed the seeds of the Nazi Party.
- Proclamation of the Republic of Turkey (October) – End of the Ottoman Empire, Mustafa Kemal Atatürk’s modernization.
- First BBC broadcast (late 1922) – The beginning of a new era in mass media.
From a medical history perspective, this was the dawn of the hormone era. Insulin became the first hormone to be mass-produced for therapeutic use. Subsequently, thyroxine, cortisol, growth hormone, insulin-like growth factor, and sex hormones were purified and introduced into clinical practice. Insulin was the origin of this trend.
When viewed in conjunction with Korean history, 1923 was the year of the Great Kanto Earthquake (September 1). The earthquake itself was a disaster, but the subsequent massacre of about 6,000 Koreans by the Japanese government and vigilante groups was even more tragic. Innocent civilians, including Korean students and laborers, were killed based on rumors. This incident left a deep scar on Korean-Japanese relations. While insulin was saving children in Europe and North America, Koreans were being massacred in their neighboring country.
The Story of Four Individuals – Their Intense Collaboration
Frederick Banting – The Original Thinker
Banting was born in 1891 in Ontario, Canada. He was a general practitioner in rural western Ontario and supplemented his income by lecturing at a local university because his practice wasn’t doing well. On the night of October 30, 1920, while preparing for a lecture the next day, he read an article that gave him an unexpected insight.
He then wrote to several universities to find a place to experiment with his idea. Most of them rejected him, but Macleod at the University of Toronto was the only one who showed interest. He closed his clinic and went to Toronto.
Banting was stubborn and emotional. He was extremely sensitive about ownership of his ideas and had difficulty acknowledging the contributions of others. This personality was at the root of the later conflict.
Charles Best – The Student Assistant
Charles Best (1899-1978) was a fourth-year medical student at the University of Toronto. When Macleod assigned an experimental assistant to Banting, he was chosen from two students. The legend is that he and Clark Noble decided who would participate in the summer experiment by flipping a coin – if this is true, Noble lost a life-changing coin toss.
Best conducted the crucial initial experiments with Banting. However, as a student, he would not receive the Nobel Prize. This fact remained a lifelong pain for Banting.
John Macleod – The Laboratory Director
John J.R. Macleod (1876-1935) was the head of the Department of Physiology at the University of Toronto. Without him, Banting’s idea would have ended without a laboratory. However, he spent most of the summer of 1921 on vacation in Europe, leaving Banting and Best to conduct the crucial initial experiments. This absence fueled Banting’s resentment over “his share of the Nobel Prize.”
However, Macleod played a critical role in designing the experimental methodology, providing materials, and interpreting the results. The Nobel Committee recognized this and decided to award him a co-prize. Banting was greatly angered by this decision.
James Collip – The Master of Purification
James Collip (1892-1965) was a biochemist at the University of Alberta. He was invited by Macleod to solve the problem of purifying the initial insulin extract. Banting and Best’s original extract caused significant side effects in the first human administration. It was only after Collip significantly improved the purification method that the second administration was successful.
Collip was the person who actually made insulin into a form usable in clinical practice, but he did not receive the Nobel Prize.
Distribution of the Nobel Prize Money and the Conflict
Banting was furious when he heard about the Nobel Prize. His partner, Best, would not receive it, and instead, Macleod, who he had resented for his absence, would receive it. He split his share of the prize money with Best. Macleod, in turn, split his share of the prize money with Collip. This redistribution of the prize money was a polite protest by the two laureates against the Nobel Committee’s decision.
This story teaches us that great discoveries are often the result of the conflicting collaboration of many people. The fact that we remember only Banting and Macleod today is due to the Nobel Committee’s decision, not because they were the only ones who made the discovery.
The Significance – Restoring Lost Hormonal Signals
The Picture of Type 1 Diabetes
Type 1 diabetes was already well-defined clinically long before we understood the cause we know today – autoimmune destruction of pancreatic beta cells:
- Onset in young age
- Rapid weight loss
- Severe thirst and polyuria
- Glucose in the urine (diabetes mellitus)
- Diabetic ketoacidosis, coma, and death
The cause is insulin deficiency, but the substance insulin itself was not yet established, so the deficiency could not be defined. Banting’s experiment defined this deficiency and, at the same time, provided a way to fill it.
How Insulin Works
If we summarize insulin’s function with a CS analogy, it would be like this: Cells take glucose from the blood and use it for energy. However, most cells do not expose glucose transporters (GLUT4) on the cell surface without insulin. Insulin is the key that sends the signal “absorb glucose” to the cells.
This is similar to a trigger signal for a garbage collector in software. Insulin is a systemic signal that says, “There is a lot of glucose in the blood, so absorb it and store it in the cells.” Without this signal, the cells will not absorb glucose even if it is abundant in the blood, and it will continue to accumulate. This is the cause of hyperglycemia, which eventually leads to various complications.
Insulin also sends a storage command to the liver: “Store glucose as glycogen.” And it sends a command to fat cells to “create and store fat.” In other words, insulin is an anabolic signal.
However, this analogy breaks down here. Software garbage collectors are fully automatic and predictable, but the insulin system has different sensitivities for each individual, at different times, and in different situations. Today, we understand insulin resistance (type 2 diabetes) from the perspective of these individual differences.
Clinical Impact
Within a few months of the first insulin administration, children with diabetes around the world began to recover. There are famous photographs of children recovering. The children who were reduced to skin and bones before insulin, and the chubby children who recovered a few weeks later – this contrast imprinted the impact of insulin on the world.
The University of Toronto granted the insulin patent to the university for $1 and made it available to the world. If this decision had not been made, access to insulin would have been extremely limited. It is recorded as a representative example of a decision to make a drug accessible to the public.
Why It Matters
Banting and Macleod’s Nobel Prize established the principle that hormone deficiencies can be treated with hormone replacement. This principle has led to the development of a large field called hormone replacement therapy. Hypothyroidism is treated with thyroxine, adrenal insufficiency with cortisol, menopause with estrogen, and growth disorders with growth hormone – all are based on this principle.
On a larger scale, it is the precedent for making scientific discoveries into public goods. The University of Toronto’s $1 patent transfer is a precedent for many decisions, including the open access production of penicillin and the public distribution of the polio vaccine. While insulin is still a subject of access debates today (the issue of the price of modern insulin analogs), the debate itself is a result of the expectations created by the original decision.
We are left with a lesson: “Great discoveries often arise when stubborn ideas meet careful experimentation.” Banting’s stubbornness and Macleod’s caution – the two had completely opposite personalities and often clashed, but that clash led to the discovery. If it had been only stubbornness, it would have ended without experimentation, and if it had been only caution, it would have ended without a crucial attempt.
Even now, as you read this sentence, millions of children with type 1 diabetes around the world are alive because of insulin. Their lives are rooted in the notes of a sleepless general practitioner in Canada on the night of October 30, 1920.
Summary of Insulin Signaling and Clinical Recovery: Insulin is a hormone that sends a signal to cells to absorb glucose. In case of deficiency, blood glucose levels rise, but cells remain starved, leading to ketonemia. Insulin administration restores this entire circuit.
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