The Canadian Doctor Who Discovered Insulin and Gave it to the World for Free

On this day in 1922, a dying 14-year-old named Leonard Thompson received the first purified dose of insulin for his diabetes at Toronto General Hospital in Canada.

Barely six months before Thompson received his life-saving dose, a team of researchers led by his doctor, Frederick Banting of the University of Toronto, discovered that a hormone known as insulin regulates blood sugar, successfully isolating it to treat humans. (As is common with such groundbreaking work, Banting’s colleagues came from various countries and were building on the research of German and Romanian scientists.)

Though widely seen as a modern disease (and it is indeed more common) diabetes is one of the oldest known scourges of humanity; it is described in Egyptian and Indian medical records well over 2,000 years ago. In the 19th century, a 10-year-old child with Type 1 diabetes would typically live for just another year; now, thanks to discoveries like insulin, people with Type 1 diabetes can expect to live almost 70 years.

Until Banting’s achievement, the recommended treatment for Type 1 diabetes was a near-starvation diet, in order to keep sugar from accumulating in the blood. Thompson was just 65 pounds, and probably days from death, before Banting injected him with insulin; another round of shots successfully stabilized his blood sugar levels—and spared him and countless others from enduring such a long, painful, and dangerous treatment.

Banting rightfully won the Nobel Prize in Medicine the following year, along with Scottish team member John James Rickard Macleod. (At age 32, Banting remains the youngest Nobel laureate in the field). Believing that his colleague Charles Herbert Best also deserved recognition as a co-discoverer, the humble Canadian doctor shared his prize money with him.

But more telling of Banting’s character and contributions to humanity was what he did with this groundbreaking—and potentially lucrative—accomplishment: He refused to patent it and make a profit even after being offered $1 million and royalties for the formula. Banting believed that the Hippocratic Oath prohibited him from profiting off such lifesaving treatment, stating that “insulin belongs to the world, not to me”. His co-laureate Macleod likewise turned down the opportunity.

Thus, it was Banting’s teammates Best and James Collip, a Canadian biochemist, who were officially named as inventors in the patent application—but they immediately transferred all rights to their insulin formula to the University of Toronto for just one dollar. All these men believed that insulin should be made as widely available as possible, without any barriers such as cost—something quaint by today’s standards, where the costs of the four leading types of insulin in the U.S. have more than tripled over the past decade, to roughly $250 a vial (some patients need two to four vials a month).

No doubt, Banting and his colleagues would be spinning in their graves.

World AIDS Day

Belated World AIDS Day post: Although HIV/AIDS remains a scourge of humanity—particularly in it’s likely place of origin, Africa—we have made tremendous progress in reducing both infections and rates of death. Being HIV positive is no longer the death sentence it once was—ironically the large number of people living with the disease is in part a testament to the success of treatments and of policies to make them widely affordable and accessible (aided in large part by the much-maligned WHO).

As usual, German data-crunching company Statista lays it all out beautifully in their Instagram (which I highly recommend following).

Even though #worldaidsday has been used to promote awareness of the disease and mourn those who have died from it since 1988, the global epidemic is far from over.

According to data by @unaidsglobal, more than ten million people with HIV/AIDS don’t currently have access to antiretroviral treatment and the number of new infections with #HIV has remained the same compared to 2019 at roughly 1.5 million. When taking a closer look at the numbers, there are enormous regional differences in terms of battling the epidemic. Eastern and southern Africa, for example, combine for 55 percent of all known HIV/AIDS cases, while reducing new infections by 43 percent between 2010 and 2020. Western and central Africa also saw a decline of 37 percent when comparing 2010 and 2020, although it falls short of the benchmark of 75 percent set by the United Nations General Assembly.

While the number of new infections has dropped from 2.9 million in 2000 to 1.5 million last year, the number of people living with HIV increased from 25.5 million to approximately 37.7 million over the past two decades. According to UNAIDS, the increase is not only caused by new infections, but also a testament to the progress that has been made in treating HIV with antiretroviral therapy, which has vastly improved the outlook of those infected with HIV.

The even more astute data-lovers at Our World in Data vividly convey both the scale of the problem and just how much we have progressed, even in the most hard-hit places:

While in law school, I and some colleagues had the incredible opportunity to meet the hard working and earnest people at UNAIDS headquarters in Geneva. This unique entity is the first and only one of its kind in the world, combining the personnel and resources of nearly a dozen U.N. agencies to offer a comprehensive response to this pandemic. UNAID is also the only initiative to include civil society organizations in its governing structure.

Since it was launched in 1994, UNAIDS has helped millions of people worldwide get antiretroviral treatment for HIV/AIDS, provided millions more with preventative methods. Thanks to their efforts, and those of their partners across the world, the rate of infection and death by HIV/AIDS has stagnated or even declined in many areas, while the rate of treatment has increased.

As with so many other things, the COVID-19 pandemic has weakened the fight against HIV/AIDS, disrupting preventative measures and sapping away at an already-taxed healthcare system. With reports of individuals who seem to have naturally cured themselves of the virus, I have hope that we can regain momentum and maybe even develop an outright cure. Fortunately, the progress of the past several years proves we do not have to wait until then to make a difference to tens of millions of lives.

My Paper: Lessons from Around the World on Drug Decriminalization and Legalization

After decades of tremendous financial and social costs, the punitive drug model is being steadily eroded at home and abroad. Even the conservative law-and-order types who oppose the use of illicit drugs are increasingly accepting that the war on drugs has failed both in its objective (undercutting drug use) and its efficiency (accomplishing little yet reaping a huge economic and human toll).

Even Mexico, which has suffered more than most nations from our appetite for illegal drugs, has gone forward with legalizing marijuana in an effort to undercut a major source of funding for its powerful and vicious cartels. (So now both of America’s only neighbors have fully done away with punitive attitudes towards one of the weaker and comparatively less harmful illicit substances.)

All that being said, I do feel validated in having proposed and written a paper exploring the alternative methods, policies, and cultural attitudes of various countries when it comes to illegal drugs. As the U.S. and other countries question the wisdom of the status quo, it may help to look abroad at those places that were ahead of the curve in dispensing with the punitive approach in favor of more constructive methods. I focus especially on Portugal, which twenty years ago blazed the trail towards decriminalizing all illegal drugs and framing their use as a public health matter rather than a criminal one.

See the source image

As you will hopefully read, many of these strategies are unique to the time, place, or sociopolitical context of the nations that implemented them; nevertheless, there are still useful lessons to glean, and at the very least we can see proof that there are other ways to address the scourge of drug addiction, trafficking, and other associated ills, besides the blunt instrument of police and prisons.

Feel free to leave your thoughts, reactions, and feedback. Thanks again for your time.

The Only Woman Executed in the French Revolution for Her Politics

Olympe de Gouges.png

On this day in 1793, French playwright, journalist, and outspoken feminist Olympe de Gouges (born Marie Gouze) published the Declaration of the Rights of Woman and of the Female Citizen, hoping to expose the failures of the French Revolution to recognize gender equality.

Initially hopeful that the French Revolution would usher equality between men and women, Gouges became disenchanted upon discovering that the key revolutionary tenant of egalite would not be extended to women. In 1791, in response to the Declaration of the Rights of Man and of the Citizenan otherwise seminal work in human rights— she wrote a counter-declaration that proposed full legal, social, and political equality between men and women. She also published her treatise, Social Contract, named after the famous work of Enlightenment thinker Jean-Jacques Rousseau, calling for marriage based upon gender equality.

Even before the revolution, Gouges was well ahead of her time both ideologically and professionally. She dared write plays and publish political pamphlets at a time when women were denied full participation in the public and political space. After releasing a play critical of slavery, she was widely denounced and even threatened for both her anti-slavery stance and being involved in the male profession of theatre in the first place. Gouges remained defiant: “I’m determined to be a success, and I’ll do it in spite of my enemies”. Unfortunately, threats and outright sabotage from the slavery lobby forced the theatre to abandon her play after just three days.

Heck, even her name was an act of defiance against prevailing social norms, as explained by Columbia College:

…Gouges took on her mother’s middle name, changed the spelling of her father’s and added the aristocratic “de.”  Adding to this already audacious gesture, the name “Gouges” may also have been a sly and provocative joke.  The word “gouge” in Occitan was an offensive slang term used to refer to lowly, bawdy women.  

Unsurprisingly, once the French Revolution came into full swing, Gouges wasted no time in seizing the moment. Aside from her already-bold feminist views, she rigorously supported a wage of policies and rights that proved radical even for the revolution:

She produced numerous broadsides and pamphlets between 1789 and 1792 that called for, among other things, houses of refuge for women and children at risk;  a tax to fund workshops for the unemployed;  the legitimation of children born out of wedlock;  inheritance equality;  the legalization and regulation of prostitution;  the legalization of divorce;  clean streets;  a national theater and the opening of professions to everyone regardless of race, class or gender.  She also began to sign her letters “citoyenne,” the feminine version of the conventional revolutionary honorific “citoyen.”  

Gouges’ opposition to the revolution’s growing and bloody radicalism, and support for a constitutional monarchy, put a target on her back. Above all she openly disliked, Maximillian Robespierre, in effect the most powerful man in the country, going so far as to use the informal tu when referring to him in an open letter. This proved the last straw; she was tried, convicted, and executed for treason as one of only three women to be executed during the Reign of Terror, and the only one executed for her politics.

Nonetheless, Gouges’ legacy lived on for decades, influencing women’s rights movements across Europe and North America: the 1848 Seneca Falls Convention in New York—the first convention dedicated to women’s rights—based its “Declaration of Sentiments” on her “Declaration of the Rights of Woman”. 

International Day of Human Space Flight

Gagarin’s Breakfast (2011), a whimsical take on the first man in space by Alexey Akindinov.

I was so busy reeling from the results of my cursed Bar Exam that I forgot April 12 was also a much happier occasion: International Day of Human Space Flight, which commemorates the 1961 flight of Russian cosmonaut Yuri Gagarin—the first man to enter outer space and the first to orbit the Earth. He spent 108 minutes aboard the Vostok 1, which was basically one big cannonball with rudimentary, if resourceful, technology.

Gagarin subsequently became the most visible and iconic Russian in the world, a far cry from dour and disreputable figures that were more familiar to outsiders. His natural charm and friendliness—both personally and in every media spotlight—earned him the moniker “the Smiling Soviet“, as it contradicted the popular image of Russians as gruff and sullen.

Gagarin’s childhood home in the tiny town of Klushino.

How does one become the first human in space, especially as the son of peasants in a country as seemingly blighted as Soviet Russia? After personally enduring the grief and hardship of the Second World War—including having his home occupied by a German officer, and serving in the resistance—Gagarin returned to normal life; he loved math and science in school, and was fascinated with planes, building model aircraft and eventually a local flying club. Unsurprisingly, he joined the Soviet Air Force, where his confidence and knack for flying were matched only by his astute technical knowledge; as a youth, he worked in a steel factory and later went to vocational school, learning about industrial work and tractors.

As the Soviet space program went into high gear in the 1960s, Gagarin and other talented pilots were being screened for their fitness and aptitude as “cosmonauts”—something no one had ever been before. (There was only so much we could know about the effect of space travel on a human.)

When it came down to him and 19 other candidates, an Air Force doctor made the following evaluation of him:

Modest; embarrasses when his humor gets a little too racy; high degree of intellectual development evident in Yuri; fantastic memory; distinguishes himself from his colleagues by his sharp and far-ranging sense of attention to his surroundings; a well-developed imagination; quick reactions; persevering, prepares himself painstakingly for his activities and training exercises, handles celestial mechanics and mathematical formulae with ease as well as excels in higher mathematics; does not feel constrained when he has to defend his point of view if he considers himself right; appears that he understands life better than a lot of his friends.

Gagarin was also heavily favored by his peers—even those otherwise competing with him for the glory of first man in space.  When the 20 candidates were asked to anonymously vote for which other candidate they would like to see as the first to fly, all but three chose him

Another favorable factor was, of all things, his short stature (at least partly a product of his rough and impoverished childhood). At just 5’2″, Gagarin could easily fit in the small, rudimentary cockpit of the Vostok 1. (Being the first into space is scary enough—imagine in something that cramped.)

As Valentina Malmy wrote beautifully in the book Star Peace:

He was like a sound amplified by a mountain echo. The traveler is small, but the mountains are great, and suddenly they merge into a single whole. Such was Yuri Gagarin. To accomplish a heroic exploit means to step beyond one’s own sense of self-preservation, to have the courage to dare what today seems unthinkable for the majority. And to be ready to pay for it. For the hero himself, his feat is the limit of all possibilities. If he leaves something “in reserve”, then the most courageous deed thereby moves into the category of work: hard, worthy of all glorification, but — work. An act of heroism is always a breakthrough into the Great Unknown. Even given most accurate preliminary calculations, man enters into that enterprise as if blindfold, full of inner tension.

I can’t wrap my head around being the first person to venture into something as unknown and terrifying as space—to be able put your thumb up in front of you and our big planet as small as your fingernail.

Little wonder why Gagarin became such a worldwide celebrity, touring dozens of countries in the years following his fateful flight. The geopolitical implications melted away in the face of this impressive feat, and the man’s genuine charm and affability—this was something all humankind could celebrate.

Of course, this was still the Cold War: As a living symbol of Soviet triumph, Gagarin could not be risked on another spaceflight, given their inherent danger even today, let alone fifty years ago. Ironically, he died unexpectedly just a few years later during a routine training flight, an event subject to much secrecy and rumor (one conspiracy theory is that newly installed Soviet leader Leonid Brezhnev ordered his death due to being overshadowed by the gregarious cosmonaut at public events).

For his part, the “Smiling Soviet” seemed above such politics, notwithstanding his (likely symbolic) stint as a member of the Soviet legislature. As to be expected, being the first man in space really changes you and puts things in perspective; you’re literally looking down on everything you, and all your fellow humans, have ever known. I wonder if it was surreal or even lonely being the only person with that sort of view.

Despite being banned from the U.S. by the Kennedy Administration—perhaps because his popularity among average Americans undermined the competitive spirit of the Space Race—Gagarin was honored by the Apollo 11 crew (ironically the same mission that ended the race in America’s favor). Astronauts Neil Armstrong and Buzz Aldrin left a memorial on the surface of the moon commemorating him and fellow cosmonaut Vladimir Komarov, the first human to venture into Outer Space, and the first to die there. (Another memorial was left by Apollo 15 in 1971 to commemorate the Americans and Russians who died in space.)

Though untimely and cruelly ironic—an expert pilot dying from a routine flight rather than the first space mission—Gagarin is survived by one hell of a legacy: The almost banal regularity of human spaceflight in the 21st century is a testament to his courageous and spirited embrace of the ultimate unknown.

Happy Anniversary to a Famously Humanist Take on Christmas

On this day in 1843, A Christmas Carol by English author Charles Dickens was first published (first edition pictured below), arguably influencing Christmas as we know it more than any pagan tradition. In fact, the phrase “Merry Christmas” was popularized by the story!

Left-hand page shows Mr and Mrs Fezziwig dancing; the right-hand page shows the words "A Christmas Carol. In Prose. Being a Ghost Story of Christmas by Charles Dickens. With illustrations by John Leech
Wikimedia Commons

Dickens was ambiguous about religion; while he was likely a Christian and admired Jesus, he openly disliked rigid orthodoxy, evangelicalism, and organized religion. (He once published a pamphlet opposing the banning of games on the Sabbath, arguing that people had a right to pleasure.)

To that end, a Christmas Carol placed less emphasis on faith and observance and instead focused on family, goodwill, compassion, and joy. Dickens sought to incorporate his more humanist approach to the holiday, constructing Christmas as a family-centered festival that promotes generosity, feasting, and social cohesion. Some scholars have even termed this “Carol Philosophy”.

So when religious and nonreligious folks alike think of loved ones and the “Christmas spirit”, they are basically channeling Dickens’ once-unique take on the holiday. (Though in his time, other British writers had begun to reimagine Christmas as a celebratory holiday, rather than a strictly religious occasion.)

The Seeds of the International Order

Posted @withregram • @ungeneva

Geneva, capital of the world, was crowded to capacity today when representatives of nearly half a hundred nations from every corner of the globe gathered to attend the first meeting of the assembly of the League of Nations.

One hundred years ago this week, the first session of the assembly of the newly established League of Nations was held in the Reformation Hall in Geneva. The meeting brought together representatives of 42 countries representing more than half of the world’s population at the time.

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Archive photo/League of Nations

Though the League of Nations is better known for its abject failure to prevent World War II—which led to its replacement by the United Nations in 1945—it is difficult to understate its bold and audacious vision: For the first time in our bloody and divided history, there was a sense of cooperation and community among our fractured civilizations. The League set in motion the growing global consciousness and interconnectedness we see to this day (however tenuously). It also brought attention to issues that were long overlooked or dismissed by most societies: poverty, slavery, refugees, epidemics, and more. It thus laid the groundwork for organizations that aid tens of millions of people worldwide.

Ironically, despite its failure to stop the bloodiest war in history, the League’s successor, the UN, has been credited with preventing any large interstate conflicts to this day—in part because it created a League-induced forum for countries to duke it out at the table rather than the battlefield (to paraphrase Eisenhower). We got a hell of a ways to go, but we have to start somewhere, and this 100-year experiment with internationalism and pan-humanism pales to thousands of years of constant war and repression.

Thank you for your time!

The Swedes Who Saved Millions of Lives

Meet the Nils Bohlin and Gunnar Engellau, whose work at Swedish carmaker Volvo has helped save millions of lives worldwide.

Engellau, Volvo’s president and an engineer himself, helped push for a more effective seatbelt, after a relative died in a traffic accident due partly to the flaws of the two-point belt design—which was not even standard feature in cars at the time. This personal tragedy drove Engellau to find a better solution, hiring Bohlin to find a solution quickly.

There were two major problems with the historic two-point belt design, which crosses the lap only. First, because the human pelvis is hinged, a single strap fails to restrain the torso, leaving passengers vulnerable to severe head, chest and spinal injuries; positioned poorly, the belt can even crush internal organs on impact. Second, they were notoriously uncomfortable, so many people chose not to wear them. Bohlin’s innovation was to find a design that resolved both problems at once.

After millions of dollars and thousands of tests through the 1950s and 1960s, Volvo became the first carmaker in the world to standardize the three-point safety belt we now take for granted. More than that, Volvo pushed hard for the seatbelt to be adopted in its native Sweden, which like most places was initially resistant to having to wear seatbelts.

But Volvo didn’t stop there. While it patented the designs to protect their investment from copy-cats, the company did not charge significant license fees to rivals or keep the design to itself to give their cars an edge. Knowing that lives were at stake worldwide, Engellau made Bohlin’s patent immediately available to all. Having sponsored the costly R&D, they gifted their designs to competitors to encourage mass adoption. It is estimated that Volvo may have lost out on $400 million in additional profits, if not more.

Instead, literally millions of people have been spared injury and death by this now-ubiquitous seatbelt we take for granted. All because a couple of Swedes decided to put people over profits (which isn’t to say they didn’t reap any financial incentive, but proved you can do both).

The World Food Programme

To many observers, especially in the United States, this year’s winner of the Nobel Peace Prize may seem uninspired, if not unfamiliar. It is an organization, rather than a person, and its work is probably not as widely known and appreciated as it should be.

Yet the United Nations World Food Programme (WFP) is no less deserving of the honor (especially since over two dozens entities have won the Peace Prize before, including the United Nations itself). It is the largest humanitarian organization in the world, and the largest one focused on hunger, malnutrition, and food insecurity, providing critical food assistance to nearly 100 million people across 88 countries. Tens of millions would starve without its fleet of 5,600 trucks, 30 ships, and nearly 100 planes delivering more than 15 billion rations, at just 61 cents each. Remarkably, WFP does all its work based entirely on voluntary donations, mostly from governments.

Laudable as all that might be, it’s fair to ask what this work has to do with peace? Two-thirds of WFP’s work is done in conflict zones, where access to food is threatened by instability, violence, and even deliberate war tactics. Amid war and societal collapse, people are likelier to die from starvation, or from opportunistic diseases that strike their malnourished immune systems. Since its experimental launch in 1961, WFP has delivered aid to some of the most devastating and horrific natural disasters in history, including the Rwandan genocide, the Yugoslav War and the Indian Ocean tsunami in 2004. (It became a permanent UN agency in 1965, having proven its worth by mustering substantial aid to earthquake-stricken Iran in 1962, initiating a development mission in Sudan, and launching its first school meals project in Togo.)

As The Economist points out, the focus on hunger is a sensible one: Not only have famine and malnutrition destroyed millions of lives across history, but they remaining pressing concerns in the face of the pandemic, climate change, and renewed conflict.

Governments everywhere are desperate to bring an end to the pandemic. But hunger has been growing quietly for years, and 2019 was the hungriest year recorded by the Food Security Information Network, a project of the WFP, the Food and Agriculture Organisation and other NGOs, which since 2015 has been gathering data on how many people worldwide are close to starvation. The rise was largely a consequence of wars in places like South Sudan, Yemen and the Central African Republic. This year, thanks to the covid-19 pandemic, things are likely to be far worse. Rather than war, this year it is the dramatic falls in the incomes of the poorest people that is causing hunger. There is as much food to go around, but the poor can no longer afford to buy it. The number of hungry people might double, reckons the WFP, from 135m in 2019 to 265m at the end of this year.

Unfortunately, despite the increased (and likely to increase) need for its services—more people face hunger than at anytime since 2012—the agency’s precarious budget, ever-dependent on the whims of donors, is declining. Again, from the Economist:

Last year the organisation received $8.05bn from its donors, by far the biggest of which is the United States. This year so far it has received only $6.35bn. Many countries, such as Britain, link their aid budgets to GDP figures which have fallen sharply. Britain provided roughly $700m of the WFP’s funding in 2019. This year its aid budget will fall by £2.9bn ($3.8bn). Under Mr Trump America had turned away from funding big multilateral organisations even before the pandemic hit, though the WFP has escaped the fate of the WHO, to which Mr Trump gave notice of America’s withdrawal in July. In Uganda food rations for South Sudanese and Congolese refugees have been cut. In Yemen the WFP has had to reduce rations by half.

WFP estimates that seven million people have already died from hunger this year, and will need almost seven billion dollars over the next six months to avert looming famines worldwide. WFP’s head, a former U.S. Republican governor, is using the agency’s higher profile from the Nobel Prize to urge more funding from governments and especially billionaires (whose collective health increased by over ten trillion this past year).