100 Years of Insulin: Medical Success, Ethical Mess?

This event is part of the JCB Bioethics Seminar Series 2021-22.

Dr. Andrew Helmers, MDCM, MHSc (Bioethics), MSc, Staff Physician, Department of Critical Care Medicine & Department of Bioethics, The Hospital for Sick Children

Rashad Rehman, BA, PhD Candidate, Department of Philosophy & Joint Centre for Bioethics, University of Toronto; Project-Specific Bioethics Research Volunteer, Mount Sinai Hospital

Insulin's discovery and discoverers are indebted in part to the absence of institutional research ethics processes in the first half of the 20th Century. In 1921, Frederick Banting, Charles Best, and James Collip discovered and purified insulin in the laboratory of J.J.R. Macleod at The University of Toronto. They invoked self-experimentation, in addition to extensive animal work (without oversight), in order to bring their discovery to the bedside with a remarkable rapidity: 14-year-old Leonard Thompson received the world's first injection of insulin in January 1922, at the Toronto General Hospital. This bench-to-bedside transition involved additional data-gathering from vulnerable patients and war veterans, again without any oversight or documentation of informed consent. Their motives were admirable, and their legacy (including the generous surrender of their patents) was generous and life-saving. Their methods would not pass muster at any contemporary research ethics board, yet their altruism and energy in pursuing a treatment for Type 1 Diabetes was - and remains - exemplary. Banting and Best's work serves as a reminder of the virtues and values which pre-dated a formalized research ethics enterprise, values which must continue to inform modern research ethics such that patients are prioritized over patents.
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