Thea Cooper and Arthur Ainsberg’s book Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle is about medical science’s triumph over insulin-dependent diabetes. Breakthrough follows one of America’s first recipients of insulin, Elizabeth Hughes, but the book is only partly about her personal story.
The book takes you on a journey through through the lives of the scientists, doctors and patients impacted by diabetes mellitus, their lives revolved around the urgency of a cure. You wonder, sad and anxious, whether particular sick children will survive to see a breakthrough. I found that the most maddening thing is how very close science was to finding the key for so long. They knew a lot about the disease, they knew the pancreas and insulin had some kind of relevancy, and there had been studies and experiments done in the area… but nothing conclusive or seemingly worth pursuing. It seemed like so many people were on the tip of a revelation but no one was able to take those final conclusive steps until Frederick Banting and Charles Best (along with John James Rickard Macleod), who are credited with the cure.
Elizabeth Hughes is only one player in the story and not even really the most interesting one, although following her through the events provides a compelling and personal backbone to the story. Unfortunately for both the authors and the reader, in adulthood Hughes destroyed all letters, photos and articles pertaining to her childhood illness and with it any additional insight that documentation might have provided. Although it is presented in a positive light of her final step to truly living a “normal life” post-treatment, and couldn’t help but wonder what the book would have been had she let those documents survived. There are so many unanswered questions, not just about her illness but about her life and relationships from that period. As a result, the actual information on Elizabeth and her experience is relatively thin for being just a major character within the book. Still, Elizabeth provides the reader with a very particular person to root for rather than another faceless, sickly child and allows the story to feel more emotionally engaging.
The primary critique of the book has been the ficionalised aspects of it. Although the foundation of the book is solid history and good science, there are lots of bits of dialogue and personal thoughts and feelings from [otherwise real] people that are speculation on the part of the authors. Although I am familiar with nonfiction being written in a novel-esque fashion, unlike other books where the dialogue was based off of real diaries and letters, in Breakthrough is almost entirely fabricated. Of course, this is largely a necessity because Elizabeth Hughes intentionally destroyed so many things pertaining to those years of her life; there was little remaining for Cooper and Ainsberg to work with. However, the book is clear and honest about which aspects are speculative, so there is no deception to the reader. I mention it only because I know this is bothersome to some people.
If that particularly issue doesn’t bother you, the book is very worth the read. It is well-researched, interesting and quite informative. Because it is written in the style of a novel, it will be an easy read for even those who are not particularly fond of non-fiction writing. Although I knew a bit about diabetes, I had never read a book in this area before, so I learned a lot from Breakthrough. Although I knew that diabetes was a serious illness that could result in death when untreated, I had no idea the full extent of just how fatal Type I Diabetes was before insulin treatments were developed: children usually died within just a few weeks or months of diagnosis, seldom living beyond a year. It was also horrifying but fascinating to learn about the Allen treatment — one of the few things that could be done to prolong life — where children were literally starved (often to death) in an effort to grant them a few precious additional months to live. It is a tragic story but luckily one that, for at least Elizabeth Hughes and people today, resulted in a happy ending.