Insulin by Kersten T Hall, review: from jabbing to back-stabbing

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A century ago, a group of pioneering scientists first isolated the hormone insulin, in the hope of using it to treat diabetes. They sold their patents on the process to the University of Toronto for $1, so that this life-saving drug could be kept safe and cheap for all. Just last month, however, Joe Biden tweeted: “Right now, there’s a kid out there whose family can’t afford her insulin because it costs $1,000 per month. The Build Back Better Act would cap their monthly insulin costs at $35. I’m committed as ever to getting it done for them.” How did we get here from there?

The story of insulin over the past 100 years, as the historian of science (and former molecular biologist) Kersten Hall shows in this dense and fascinating book, is also a microcosm of developments in science more widely, and of changes in the politics and economics of healthcare. It has encompassed fierce debates over profiteering, vivisection, genetic engineering, and which of the many researchers involved deserved their Nobel prizes, or had been cruelly passed over. One of the Nobel-winners in medicine, Fred Banting, was so furious that his boss had also been honoured that he threatened to refuse the prize altogether, which if he’d followed through might have been the greatest ever scientific story of cutting one’s nose off to spite one’s face.

Science is, after all, a passionate affair, and the arguments over insulin did not stop once it went into mass production. Over the next half century, the hormone was extracted from the pancreases of pigs and cows, as a by-product of the meat industry, and worked tolerably enough in people. (In healthy humans, the pancreas secretes insulin so as to enable sugar to pass from the blood into the tissues that need it as fuel.) But scientific breakthroughs in the 1970s, explained in vivid detail here, enabled researchers to dream of creating human insulin in the lab. This meant inserting the DNA for human insulin into a bacterium, and using its manufacturing machinery to mass-produce the desired substance. Or, in other words, cloning.

So began public debates about genetic engineering and “playing God” with nature, debates that researchers in the field later admitted they hoped to prevail in by concentrating on insulin as the poster child for their determination to help humanity with this newfangled wizardry. And help they did: the technology behind the mRNA vaccines for Covid-19 descends directly from that research on insulin.

Once actual human insulin could be synthesised in great quantities, there seemed little reason for it to become super-expensive. But science, especially when allied with commerce in the institution of a pharmaceutical company, doesn’t necessarily know when to stop. New forms of insulin “analogues” – slightly different versions of the molecule that still work in the human body – kept being developed, with slight advantages claimed for them. Hall doesn’t quite say that this was because drug companies needed a constant churn of novel products in order to keep their profitable patents, but it’s plain that, if such were your motivation, this is exactly what you would do.

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