Banting and Best and the Sources of Useful Knowledge

BANTING AND BESTAND THE SOURCES OF USEFUL KNOWLEDGE GALE W. RAFTER* The discovery of insulin by Banting and Best in 1921-1922 must be characterized as one of the great scientific and humanitarian achievements of this century. Our understanding of proteins as molecules with unique chemical structures that carry information between cells utiUzing specific receptor sites came about with the availability of insuUn. And while insulin's use in the clinic has not eUminated all of the pathology of diabetes, it has extended die lives of millions of diabetics and aUowed them to lead useful lives. The story ofinsulin's discovery possesses many unusual aspects, not the least of which were the inexperience of both investigators in the laboratory and the brief time they worked on the problem. Their accomplishment becomes even more unusual, almost extraordinary, when it is considered in terms of the contemporary debate on die conduct of biomedical research. Examination of the conduct of biomedical research, in the past usually carried out by philosophers and historians of science, has become important to all of us with the realization that there is not enough money to do everything and that choices must be made. The choices are the support of basic research or the support of research directed toward a specific problem. Because of the impatience of people with the development ofnew treatments for disease, the idea that a larger share of available doUars be spent on research directed toward specific diseases has received more support. Many scientists vigorously oppose this idea and argue that basic findings must precede appUed research. In other words, the clinical investigator makes his contribution by making himselfaware ofbasic science findings and then appUes these findings to die prevention, diagnosis, and treatment ofdisease. The flow ofinformation surrounding the discovery ofinsulin appears to have run in the opposite direction, and the purpose of this paper is to try to "¦Professor of biochemistry, School of Medicine, West Virginia University Medical Center , Morgantown, West Virginia 26506.© 1983 by The University of Chicago. AU rights reserved. 0031-5982/83/2602-0336$01 .00 Perspectives in Biology and Medicine, 26, 2 · Winter 1983 | 281 understand how it happened and to see if it tells us anything about the conduct of biomedical research. Confusion abounds when the terms "basic" and "applied" are used to describe research in the biomedical sciences. In contrast to the physical or mathematical sciences, almost all biomedical research is appUed insofar as its problems are first perceived by observing the living organism. In this paper, distinction between the two research strategies is predicated on why the research was done. Comroe and Dripps [1] have previously used this distinction in defining basic biomedical research as investigation of living organism functions without regard to its immediate relation to specific human disease. Thus the discovery ofinsulin is eminently applied research because Banting and Best set out to find a substance useful in the treatment of diabetes. Their goal was reached in less than a year when their first patient, a young man dying of diabetes, was treated successfully with insulin. Preparationfor Research: Selection of the Problem There was nothing haphazard about Banting's decision to give up medical practice to go into the laboratory and work on diabetes. He showed those quaUties of mind and spirit that we associate with good scientists. It is testimony to his intellectual curiosity that he came upon the problem of diabetes as an orthopedic surgeon reading the medical literature. That he was wilUng to give up medicine, which he had prepared for all his adult life, for an endeavor without promise ofsuccess or rewards attests to his commitment. The nature of the problem itself shows his independence of mind. More mature scientists discouraged him from attempting the research, pointing out that it was unUkely that he would succeed when more experienced investigators had already tried and failed. Despite these protestations, convinced he had something to contribute, and as a physician motivated to be useful to patients, Banting moved ahead. Some critics of appUed research have said that a scientist who selects a problem out of humanitarian concerns, which clearly assigns it to applied research, is sullied by the choice. Other critics believe...