Book Review: Breakthrough

Jul 19 2010 Published by under Uncategorized

I envy writers of medical history, especially those who can create a really good read.  Someday, I would love to be able to write a good medical history, but this is not that day.  Today is one of the many days I get to tell you about another good book on medical history written by someone other than me.

The book is Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle.(amzn/b&n/pwll) When I read the preface, I had some reservations.

This book is based on a true story, and relies heavily on primary historical sources and documents.  With one exception, detailed in the section Notes and Sources, all characters are historical figures.  Most dialogue and incidents have been drawn from contemporaneous sources, but in some cases have been invented or augmented for narrative purposes.

This gave me pause, as there is something about authenticity that seems particularly important in both history and medicine.  We've all read histories, and we've all read historical fiction, and most of us have an idea of which is the better read.  One of my favorite authors in the genre, Rebecca Skloot, said in a recent interview:

When you write nonfiction in a way that will hopefully read like fiction, with scenes and dialog, there’s an assumption that you made it up or made some things up. When I do Q&As, people in the audience will ask, “So how much liberty did you have to take?” Not did you take any, but how much? There’s this assumption that it’s impossible to recreate history in a way that reads like a story.


I think it’s interesting that people assume that when they read dialogue that took place in the 1950s, it was made up, because I wasn’t there. But in fact there are ways you can recreate that accurately in reporting. It is absolutely possible to recreate nonfiction in a narrative way and still be factual. It takes a heck of a long time, but it’s worth it.

So it is possible to create compelling and accurate dialog.  But authors Thea Cooper and Arthur Ainsberg chose a particularly difficult protagonist around whom to build a story.

Elizabeth Hughes was the daughter of a powerful American politician in early 20th century America.  She was also one of the world's first insulin patients.   At the time of her diagnosis, the most sophisticated treatment for diabetes involved controlled starvation, a horrific process described in some detail in the Breakthrough. Dr. Frederick Allen, the doctor behind the starvation protocol, believed that something like insulin was just around the corner, and that it was worth putting his patients through the misery of starvation to help them survive long enough to take advantage of this cure.

As we know, he was right.  The heroic and probably-insane Frederick Banting received much of the credit for this discovery, and he was hardly unsung.  Elizabeth Hughes, however, was intentionally unsung.  She hid her diabetes for the rest of her life, and her role as one of the first patients to receive it was buried in time.

The authors' narrative is more than readable, and from the available sources about this intensely private person, they created a complex and likable protagonist.  But some of the motivations attributed to her later silence were part of the "augmentation" of available historical documents.  At one point in the story, the powerful Charles Evans Hughes, Elizabeth's father, is portrayed as betraying his instinctive reticence and sense of duty to call up  Banting and pull some strings to get his daughter the insulin that would save her life.  But this phone call never happened, or at least it's never been documented.

And I can live with that.  The book successfully weaves together the personal struggles of the patients, doctors and scientists living and dying on the edge of one of medicine's greatest discoveries.  It also captures the beginning of the modern pharmaceutical industry, and how Eli Lilly and Company was poised to take advantage of this new discovery.  The scientists in Toronto were working day and night to come up with a process to reliably isolate insulin, but once they did, Lilly was able to turn it into an industrial process, quickly supplying insulin to thousands of diabetics.   Cooper and Ainsberg create vivid images of the solo chemist sweating over borrowed equipment, the industrial might of a large corporation, and Lilly employees spreading across the Midwest to talk slaughterhouses into harvesting pancreases by the ton.

Breakthrough is to be published in Fall of 2010 by St. Martin's Press, so it won't be out in time for a summer read.  But it should be an interesting one to discuss with friends over apple cider, something that many diabetics can enjoy with caution thanks to the discoveries documented in  this book.

An advance proof of this book was provide to me at no cost by the publisher.

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