By Daniel Tarade
Catastrophic climate change. CCC. It is a phrase I find myself using more and more. When the Intergovernmental Panel on Climate Change (IPCC) released their 2018 report, shockwaves resonated through my life. A stark warning now hangs in the air; humans have 12 years to cut carbon emissions by 45%. Doing so might keep global warming to only 1.5C above pre-industrial levels. Before I even had time to adjust to the ultimatum, a new rallying cry echoed. If the IPCC recommendation was a tidal wave, the new warning was a tsunami. Rather than dismiss the IPCC report as fear-mongering, this new group exclaims that the next 18 months are critical to maintaining human life on earth. My heart flutters writing these words. Decades of obfuscation and propaganda dripping from the greedy mouths of big oil has led to a populace that is both numb to and uninformed about the real possibility of catastrophic climate change. But this is changing. Radical groups are coming to the forefront of the crisis. The extinction rebellion is exploding. That is not what I am writing about today. Rather, certain individuals are beginning to plan for the worst-case scenario. CCC. How do we continue to feed communities when global trade networks collapse? My good friend, Matt, has founded an organic farm in the Windsor-Essex region with a focus on training and empowering people to grow their own food. A co-operative farming model is the goal. As Matt explained, with a steady food supply, communities stand a fighting chance at staving off extinction. But my consciousness suffers whiplash. My brother is a Type I diabetic. As important as food, he needs insulin to survive. Can a community produce not only its own food but also its own medicines? This article provides a rationale for the possibility of co-operative medicine production with a focus on insulin.
First, what is insulin? It is a protein hormone produced by pancreatic cells. When blood glucose levels increase, the beta cells of the pancreas begin to secrete insulin into the bloodstream. When insulin binds to protein receptors on the surface of muscle, fat, and liver cells, it prompts the uptake of glucose from the blood. The beta cells are destroyed, in error, by the immune system in patients with Type I diabetes. As a result, these individuals cannot produce insulin, suffer hyperglycaemia (too much blood glucose), and a general wasting away. Before insulin therapy was available, the life expectancy of a patient diagnosed with acute onset diabetes was less than four years.[i] The use of insulin had a dramatic impact on quality and longevity of life for the diabetic; one published report highlights the tortuous 14 years one individual suffered before insulin therapy only to live to the age of 88, free of diabetic complications, once insulin became available.[i] Currently, a person with Type I diabetes has a life expectancy 12 years shorter than average.[ii] So definitely more work to do, but a collapse of the insulin supply chain would spell the certain demise for the roughly 25 million people who have Type I diabetes worldwide.[iii] Can non-scientists, independent of the pharmaceutical industry, produce their own insulin? To keep themselves alive?
To tackle the question of non-scientists purifying insulin, we ought to first review how scientists solved the problem. Scientists had speculated that diabetes arose from a defect in pancreatic function since the late 1800s.[iv] In short order, scientists began experimenting with injecting ground up pancreatic matter into patients with diabetes. A grab bag of results followed, including serious side effects due to impurities. The Toronto team of Banting, Best, MacLeod, and Collip began tackling the problem of diabetes in 1921. The group would inject the saline extractions of pancreas (first dogs, later cows) into animals, often observing that blood glucose levels would drop. Less than a year after commencing research, they started a pilot human trial. The first injection of pancreas extract caused an abscess and had little positive effect. In a quick turnaround, the breakthrough came less than two weeks later. A new extract, based on a method devised by Collip, lead to dramatic and immediate results in 14-year old diabetic boy. By 1923, Banting and MacLeod won the Nobel Prize in Medicine; Banting shared his prize money with Best, and MacLeod shared his with Collip. From the beginning, insulin was a challenge of biochemical purification — start with animal pancreas and finish with a pure protein.
Could I, a biochemist-in-training, purify insulin according to these original recipes? Sure. One of the earliest published protocols involves homogenization of cow pancreas and serial precipitation steps using alcohol and acid.[v] In essence, the grinding up of cow pancreas liberates the insulin into the solution. Thousands of other proteins, however, ‘contaminate’ the solution, which can cause side effects and a deleterious immune response in a human. But the biochemical properties of these proteins all differ from one another. For example, some proteins are insoluble in 20% alcohol while other are still soluble. If insulin comes out of solution (i.e. precipitates) under a particular condition, the insoluble material will contain insulin of a higher purity as some contaminants remain in solution. A dozen or so steps are required to obtain insulin of sufficient purity. If provided with all the materials necessary, I am confident I could obtain pure-enough insulin. But what if global trade collapsed and small communities were responsible for producing their own materials from scratch? That would be still more difficult. What are the ingredients for the recipe of insulin? Animal pancreas is easy to procure. Pure ethanol is trivial to distill. Sulfuric acid can be produced from elemental sulfur, but current industrial methods do utilize a vanadium catalyst. Picric acid has been made by alchemists as early as the 1600s. In this way, the many chemicals needed to purify insulin can (theoretically) be made independently of a for-profit and privatized global trade network. Three caveats. One, it would require the conservation of current chemical knowledge; in particular, protocols that predate modern manufacturing techniques. Two, access to raw materials will be a must. If you cannot mine elemental sulfur, you cannot produce sulphuric acid unless you can trade with other communities. Three, expertise in many disciplines would be necessary; geologists/miners to extract raw materials, chemists to synthesize the necessary supplies, biochemists to purifying the insulin, and medical practitioners to monitor those with diabetes.
As you may know, insulin is no longer purified from bovine pancreas. Modern molecular biology techniques allow for the expression of human insulin in bacteria. These genetically-transformed bacteria can be grown in large vats, making them an excellent source of insulin. Purification has also become easier. In general, the bacteria are transformed with DNA that encodes human insulin with an additional amino acid sequence. The unique biochemical properties of these amino acid ‘tags’ allow for the purification protocols in only three to four steps. The benefits are immense. With recombinant human protein, insulin with different properties can be produced, including those that are slow- and fast-acting. But there are ironies intrinsic to the modern biotechnological process. Although purifying insulin according to these modern protocols would be easier and result in purer protein, the techniques are more dependent on specialized equipment and reagents. Rather than relying on an animal to produce the insulin for you, lab-strains of E.coli bacteria and DNA encoding insulin are necessary. Rather than using salt and alcohol to purify the insulin, pump-driven filtration systems are standard. In fact, to produce recombinant human insulin requires other purified proteins to chop off extraneous ‘tags,’ resulting in a recursive system that would become almost impossible to recreate in post-catastrophe world. At least, not quick enough to save the millions of people who depend on biological medicines for their life.
When researching the purification of insulin, I came across a more pressing concern for the many diabetics living in the US that has lead to a similar interest in community-based purification efforts. In the US, those who cannot afford private health insurance (some 28 million people) find themselves in a bleak situation if diagnosed with Type I diabetes. Since 2012, the cost of an annual supply of insulin has nearly doubled to $5700. This has lead to several people dying after they aged out of their parent’s insurance. In desperation, people have turned to crowd-funding sites like GoFundMe. For their part, GoFundMe has written a “how to” article with a nice green button that allows you to “start a fundraiser for insulin.” If you google “Gofundme insulin,” you are treated to anecdotes like this one by Meg, who writes about losing a dozen friends to insulin rationing. Of course, Shane Patrick Boyle died after their GoFundMe campaign fell $50 short and had to resort to rationing. An enraged people respond. Bernie Sanders joined an ‘insulin caravan” to my hometown of Windsor, Ontario (across the river from Detroit, Michigan), where diabetics could purchase insulin for one-tenth of the price. Others are pursuing the more creative and labour-intensive strategy of producing their own insulin. This is not unprecedented. In 1940, Eva Saxl was living in Japanese-occupied Shanghai when the pharmacies began closing down. A recently diagnosed Type I diabetic, Eva faced a situation that was not dissimilar to some impoverished people living in the US right now. Eva and her husband Victor got their hands on a medical book that outlined the original insulin recipes developed in Toronto and began working in a small laboratory provided for them by a sympathetic chemist. Without a clear way of testing the potency and purity of the insulin, they nonetheless had to inject the risky concoction as Eva’s conventional insulin ran out. And It worked! Eva and roughly 400 diabetics living in Shanghai were kept alive, with no deaths due to impurities. Today, ordinary people are hoping to leverage new biotechniques to democratize the production of human insulin: a truly revolutionary idea.
I believe that is the trick to surviving the climate catastrophe; community resilience needs to be fostered right now. Just as my friend Matt bemoans the arms-length people are kept from the means of food production in today’s society, those battling various illnesses are kept in the dark about life-sustaining therapies that they depend on. This is not a bug but a feature. Proprietary and patented medication can only be made by those with massive amounts of capital, allowing for profit-gouging monopolies. One subversive act is to reverse-engineer these medications that ought to be freely available as a human right. When communities make their own medication, equitable distribution becomes easy. In a decentralized approach, the collapse of international trade is no longer the prologue to widespread chaos, suffering, and death.
If I were stuck in the middle of the woods with a comatose diabetic, could I treat them? No way. But I would hardly be able to start a farm either. Lacking basic biotech implements (bacteria, DNA, etc) or farming equipment (seeds, fresh water) is a death blow for a single individual. But we do have a collective knowledge. Rather than theorize how one might produce their own insulin from scratch, the more productive question is how might we create democratic systems that can survive the collapse of the global capitalist-driven economy. Much like my friend envisions creating a self-sufficient and co-operative farming population in the Windsor-Essex region, we can create our own co-operative laboratories. Driven by the principle of utility, rather than by profit, local and self-contained manufacturing processes can be developed to produce insulin, epinephrine, and other life-saving medication.
[i] Brostoff, J. M., Keen, H., & Brostoff, J. (2007). A diabetic life before and after the insulin era. Diabetologia, 50(6), 1351-1353.
[ii] Copenhaver, M., & Hoffman, R. P. (2017). Type 1 diabetes: where are we in 2017?. Translational pediatrics, 6(4), 359.
[iii] You, W. P., & Henneberg, M. (2016). Type 1 diabetes prevalence increasing globally and regionally: the role of natural selection and life expectancy at birth. BMJ Open Diabetes Research and Care, 4(1), e000161.
[iv] Bliss, M. (1993). The history of insulin. Diabetes Care, 16(Supplement 3), 4-7.
[v] Dudley, H. W. (1923). The Purification of Insulin and some of its Properties. Biochemical Journal, 17(3), 376.