It was one of the 20th century's medical miracles and with this retelling of the discovery of insulin (10 months after Caroline Cox's The Fight to Survive: A Young Girl Diabetes and the Discovery of Insulin) it's a gripping narrative as well. In 1918 the youngest daughter of former New York governor and future Supreme Court chief justice Charles Evans Hughes was diagnosed with diabetes. At the time a near deadly starvation diet was the best hope for sufferers but four years later a "pancreatic extract" was showing promise in treating symptoms in animals. Fourteen year old Elizabeth Hughes was among the first wave of patients to benefit from the marriage of dogged research and commercial enterprise on the part of Lilly amp; Co. to manufacture the drug. Author and playwright Cooper and finance veteran turned author Ainsberg bolster the account with impressive sourcing. They also pay particular attention to the complexities of the human drama the indomitable Elizabeth; her visionary parents; the quarrelsome "crazy" and eventual Nobel Prize–winning researchers; and the bold commercial pioneers. And it's those details that make this extraordinary chapter of medical history so memorable. Bamp;w photo insert. (Sept.) " Publishers Weekly Copyright PWxyz, LLC. All rights reserved."
"It was one of the 20th century's medical miracles, and with this retelling of the discovery of insulin (10 months after Caroline Cox's The Fight to Survive: A Young Girl, Diabetes, and the Discovery of Insulin) it's a gripping narrative as well. In 1918, the youngest daughter of former New York governor and future Supreme Court chief justice Charles Evans Hughes was diagnosed with diabetes. At the time, a near-deadly starvation diet was the best hope for sufferers, but four years later, a 'pancreatic extract' was showing promise in treating symptoms in animals. Fourteen-year-old Elizabeth Hughes was among the first wave of patients to benefit from the marriage of dogged research and commercial enterprise on the part of Lilly & Co. to manufacture the drug. Author and playwright Cooper and finance-veteran-turned-author Ainsberg bolster the account with impressive sourcing. They also pay particular attention to the complexities of the human drama--the indomitable Elizabeth; her visionary parents; the quarrelsome, 'crazy,' and eventual Nobel Prize winning researchers; and the bold commercial pioneers. And it's those details that make this extraordinary chapter of medical history so memorable. B&w photo insert. (Sept.)" Publishers Weekly (Copyright PWyxz LLC)
Written with authentic detail and suspense, "Breakthrough" chronicles the making of a medical miracle--insulin for diabetes--that has gone on to save countless lives.
1. A few months after the initial batch of newspaper stories reporting her miraculous
recovery, Elizabeth Hughes chose to disappear from the public eye and keep her diabetes
and treatments a secret for the rest of her life, even from her own children until they were
eighteen-years-old. Why do you think she made that decision? Does looking at the
context of that era and her circumstances help explain it?
2. Elizabeth strives for “normalcy.” How do you define normalcy? Is there such a thing?
3. When Charles Evans Hughes ponders whether he should call President Harding on
Elizabeths behalf, he wonders “[w]as his responsibility to the principles he had sworn to
abide by greater than his responsibility to his daughter? One was broad, the other deep.
Which was the greater good?” (186) What is your opinion?
4. When Banting attempts to secure research funding and a lab, he is rebuffed because his
theories have been tested and failed before. His response is, “Im not trying to be
original. Im trying to find something that works!” (67) What lessons can we learn from
his ultimate success?
5. Discuss the nature of the rivalry between Banting and Macleod. Are such professional
rivalries ultimately productive or counterproductive?
6. Consider these reflections about Charles Evans Hughes: “Living is by necessity a
process of continuous loss. As we live we lose time, we lose innocence, we lose family
and friends, we lose memories and the longer we live the more we lose. Ultimately, we
lose the process of losing itself, which is what living is to begin with.” (212) Do you
agree? How are we defined by our losses?
7. Banting once told an audience, “We do not know whence ideas come, but the importance
of the idea in medical research cannot be overestimated. From the nature of things ideas
do not come from prosperity, affluence and contentment, but rather from the blackness of
despair, not in the bright light of day, …but rather in the quiet, undisturbed hours ofmidnight…when one can be alone to think….” (229) Do you agree with Bantings view
of the nature of ideas? If so, what does this mean for modern scientific breakthroughs?
8. Frederick Allen, like Banting, appeared to place financial compensation second to the
goal of patient treatment. For example, when writing the budget for the Physiatric
Institute, Allen did not include a personal salary in the budget. The New York Times
reported that “patients in all degrees of financial circumstances” could find help at the
Institute. Yet Allen often felt conflicted with his job as a doctor caring for patients, and
raising the funds to keep the Institute open. It says in the book that “he resented the need
to split his time and energy between what he considered to be his real work and that
greedy ancillary endeavor which was the work of supporting the work.” (109) Are these
roles necessarily at odds with one another? Do you think this conflict remains in modern
9. Throughout the book, Antoinette and Charles Evans Hughes are portrayed as sympathetic
parents who dearly love their daughter. Yet, after bringing her to Toronto to be treated by
Dr. Banting—with what was then an experimental treatment that could save her life or
hasten her death—Charles and Antoinette sail for Brazil. It is with Dr. Banting and her
nurse, Blanche, that Elizabeth spends the most crucial and precarious time of her young
life. Were you surprised that her parents would leave her in Toronto? What does this say
about the familial relationships of the time period, and how might that relationship have
affected Elizabeths perception of her disease? Why do you think she didnt stay in
contact with Blanche or Dr. Banting after she recovered her health?
10. Ultimately the intervention of Eli Lilly enables the mass production of insulin in the
book. Considered a radical idea at the time, Lilly believed the future of pharmaceutical
manufacturing lay in fundamental biological research, saying “Ideas dont cure people.
Drugs cure people . . . Thats why we must bring the research scientists and the drug
manufacturers together.” Do you think this statement still holds true today? Would
greater cooperation mean further advancements?
11. We get an extensive overview of the world in BREAKTHROUGH, including the
political and social circumstances, and the myriad of conditions that led to, and at times
hindered, the scientific advancement. What are some of the events that inadvertently
affected this medical breakthrough? How precarious was the discovery? At what point
can it be said that fate intervened?
12. How did reading this book affect, if at all, your view of what its like to live with a
chronic condition? Did it change your view of the research or pharmaceutical production
side of the equation?