Turning a death sentence into a long-lasting health condition

The story of insulin's discovery and its first successful administration on January 11, 1922, to 14-year-old Leonard Thompson, marks one of the most profound turning points in medical history. Before this breakthrough, a diagnosis of diabetes, particularly Type 1, was virtually a death sentence. Patients would waste away, often succumbing to the disease within months or a few years, a tragic fate for many, including children. The only 'treatment' involved severe dietary restrictions, often to the point of starvation, which merely prolonged life for a short period without offering a cure or a comfortable existence.

The quest for a diabetes cure gained momentum in the early 20th century. Scientists knew that the pancreas played a crucial role, specifically the 'islets of Langerhans' within it, which were believed to produce a substance that regulated blood sugar. The challenge was to isolate this substance without it being destroyed by the digestive enzymes of the pancreas. This is where the brilliant team at the University of Toronto stepped in: Frederick Banting, a young surgeon, Charles Best, a medical student, John Macleod, a professor of physiology, and James Collip, a biochemist. Banting and Best, working under Macleod's supervision, devised a method to ligate the pancreatic ducts of dogs, causing the enzyme-producing cells to degenerate while preserving the islet cells. From these degenerated pancreases, they extracted a substance they initially called 'isletin,' which was later refined by Collip and named insulin. The successful injection into Leonard Thompson, who was on the brink of death, dramatically improved his condition, proving the efficacy of their extract.

The key stakeholders in this monumental discovery and its subsequent impact are diverse. Firstly, the **scientists and researchers** (Banting, Best, Macleod, Collip) whose dedication and collaborative spirit led to the isolation and purification of insulin. Secondly, the **medical community** worldwide, which rapidly adopted insulin as a life-saving treatment, transforming the management of diabetes. Thirdly, **pharmaceutical companies** played a critical role in scaling up production to make insulin widely available, although issues of accessibility and affordability persist even today. Most importantly, **patients and their families** are central stakeholders, as they are the direct beneficiaries of this treatment, experiencing vastly improved quality of life and extended lifespans. Finally, **governments and international health organizations** like the World Health Organization (WHO) are crucial in policy formulation, ensuring access to essential medicines, and addressing the global burden of diabetes.

For India, the significance of insulin is immense, yet complex. India is often referred to as the 'diabetes capital' of the world, grappling with an escalating epidemic of both Type 1 and Type 2 diabetes. While insulin has saved countless lives, the sheer prevalence of the disease places an enormous burden on India's public health system and economy. The increase in lifestyle-related Type 2 diabetes, driven by urbanization, changing dietary habits, and sedentary lifestyles, is a major concern. The economic impact includes direct healthcare costs (medication, hospitalizations for complications) and indirect costs from lost productivity due to illness and premature mortality.

In response, the Indian government has initiated various policies and programs. The **National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)**, launched in 2010, focuses on health promotion, early diagnosis, management, and capacity building for NCDs. The broader **Ayushman Bharat** initiative, particularly the Pradhan Mantri Jan Arogya Yojana (PMJAY), aims to provide financial protection against catastrophic health expenditures, covering treatment for diabetes-related complications. The **Health and Wellness Centres** under Ayushman Bharat focus on preventive and primary healthcare, including screening for diabetes. Constitutionally, while there's no explicit 'Right to Health,' it is implicitly derived from **Article 21 (Right to Life)**, as affirmed by various Supreme Court judgments. Furthermore, **Article 47** of the **Directive Principles of State Policy (DPSP)** mandates the State to improve public health as one of its primary duties. These constitutional provisions underscore the state's responsibility to ensure access to essential healthcare, including life-saving drugs like insulin.

Looking ahead, the future implications are multi-faceted. Research continues into better drug delivery systems, artificial pancreas technology, and potentially curative therapies like gene therapy or stem cell research. However, the immediate challenge for India and other developing nations is ensuring equitable access to affordable insulin and comprehensive diabetes care. This ties into broader themes of global health equity and achieving **Sustainable Development Goal 3 (Good Health and Well-being)**. The centenary of insulin's discovery serves as a reminder of scientific triumph, but also a stark warning about the ongoing global diabetes epidemic, necessitating sustained efforts in prevention, early detection, and accessible treatment to turn this long-lasting condition into a manageable one for all.