Insulin Wars

This episode of the LRB Podcast explores the complex history of diabetes treatment, from the ancient recognition of the disease to the revolutionary discovery of insulin in the 1920s and the modern era of GLP-1 drugs like Ozempic. Host Thomas Jones speaks with Liam Shaw, an evolutionary biologist and author of *Dangerous Miracle*, about the scientific, ethical, and corporate dimensions of these medical breakthroughs. The story begins with the grim reality of pre-insulin treatments—starvation regimens and quack remedies—before detailing the controversial experiments at the University of Toronto, where Frederick Banting, Charles Best, and James Collip, under the guidance of J.J.R. MacLeod, isolated insulin from animal pancreases. Despite the ethical concerns around animal experimentation, the discovery transformed type 1 diabetes from a fatal condition into a manageable chronic illness. The episode then traces the evolution of insulin production—from pig pancreases to genetically engineered bacteria—and reveals how the promise of lower prices was undermined by patent-driven pricing, especially in the U.S., where insulin costs soared and patients died due to unaffordability. The narrative shifts to the rise of GLP-1 medications, derived from natural sources like the Gila monster and anglerfish, which offer powerful new treatments for both diabetes and obesity but raise concerns about corporate control, long-term safety, and the widening of health inequalities. Shaw critiques the pharmaceutical industry’s model, where innovation is incentivized by patents but often fails to deliver equitable access, especially as these drugs move from medical treatments to consumer wellness products. Key takeaways include: insulin was a life-saving breakthrough but its accessibility has been compromised by profit-driven pricing; genetic engineering promised cheaper insulin but failed to deliver on that promise; GLP-1 drugs like Ozempic represent a medical leap forward but risk reinforcing social inequities by being accessible mainly to the wealthy; the history of medical discovery is deeply entangled with animal suffering and corporate interests; and nature remains a vital source of therapeutic inspiration, from anglerfish to pythons. The episode ends with a cautionary note: while these drugs offer hope, they are not cures, and long-term dependence on pharmaceuticals raises serious ethical and societal questions about autonomy, equity, and the future of healthcare.