Who Gets Credit for Medical Discovery?

The work began from an older problem. In 1889, Joseph von Mering and Oskar Minkowski in Strasbourg showed that removing a dog's pancreas produced diabetes, which fixed the pancreas as the organ to study. Decades later, at the University of Toronto, the surgeon Frederick Banting pursued an idea about pancreatic extracts with medical student Charles Best in the physiology laboratory of John Macleod, who supplied space, animals, guidance, and an established setting. In the summer of 1921 the team began systematic work on the extracts.

The first patient was Leonard Thompson, a fourteen-year-old boy with diabetes, who received an insulin injection at Toronto General Hospital on January 11, 1922. The first extract produced an adverse reaction and little benefit. Biochemist James Collip then made crucial progress in purification, and Thompson improved after receiving the refined extract on January 23. The insulin therapy milestone turned diabetes from an often fatal diagnosis into a chronic condition that could be managed.

The 1923 Nobel Prize went to Banting and Macleod "for the discovery of insulin." The award was unusually fast: both men were nominated for the first time in 1923 and won the same year, while Best and Collip were not nominated until 1950 and 1928 respectively. Banting, angered that Best was excluded, shared his prize money with him; Macleod shared his portion with Collip. The dispute shows why credit cannot be solved merely by adding names. The participants disagreed about the relative importance of the initiating idea, laboratory labour, supervision, biochemical skill, and the authority that secured rapid recognition.

Insulin also required clinical care, access to animal pancreases, production at Connaught Laboratories and through pharmaceutical partners, quality control, patents, and distribution. Banting, Best, and Collip assigned their patent rights to the University of Toronto for one dollar each, and the university became a central actor because it coordinated knowledge and ownership. A therapy emerged from an institutional system, not only from a successful experiment.

Earlier researchers had noticed that moulds could inhibit microbes — John Tyndall reported observations in the 1870s, and Ernest Duchesne studied antagonism between mould and bacteria in an 1897 thesis — but these observations did not become a therapy. In 1928, Alexander Fleming investigated the antibacterial effect associated with mould contaminating a culture plate. He isolated the mould, named the substance penicillin, and published the observation in 1929 in the British Journal of Experimental Pathology. The surviving plate story is powerful because a clear zone seems to make discovery visible at a glance.

Yet Fleming could not stabilize or purify penicillin as a therapy, and the substance was largely set aside for a decade. From 1938, Howard Florey, Ernst Chain, Norman Heatley, and a wider Oxford group developed extraction, experimental testing, and early treatment. Heatley devised ingenious laboratory methods for recovering the scarce drug; deep-tank fermentation was developed during subsequent American industrial production. The Oxford team reported protection in mice in 1940 and published its early clinical results in The Lancet in 1941. Albert Alexander, the best-known early patient, improved temporarily but died on March 15, 1941 after the supply ran out, a fate that underscored how far a clue was from a mass-produced drug.

Wartime agencies, chemical engineers, fermentation specialists, pharmaceutical companies, and large numbers of laboratory workers — many of them women — then made production possible at scale in the United States from 1943, and penicillin was used to treat wounded soldiers by the time of the 1944 Normandy landings. The penicillin story became a founding episode of the antibiotic age.

The 1945 Nobel Prize recognised Fleming, Chain, and Florey "for the discovery of penicillin and its curative effect in various infectious diseases." That allocation captured three important roles but not the whole system. Fleming himself stressed that he had found a clue and that an organised team was necessary to bring it to therapeutic use. The heroic accident survives because it offers a cleaner beginning than the industrial history that followed.

Scientific papers have author lists but may hide technicians, participants, or institutional support. Patents reward legally defined invention, not every form of discovery or care. Prizes usually recognise a small number of living individuals, and their rules shape the outcome as much as the committee's judgment: the Nobel Prize can only be given to nominated candidates, and in 1923 Banting and Macleod were nominated for the first time and won the same year, while Best and Collip were not nominated until 1950 and 1928. Museums select objects that can stand for events, while anniversaries favour stories with a clear date and protagonist.

Power affects visibility at every stage. Senior researchers may control publication; metropolitan laboratories may receive credit for knowledge or specimens gathered elsewhere; women and racialised researchers may have less access to posts that convert labour into authorship; patients and experimental subjects may appear only as data. National competition can turn multinational systems into patriotic achievements.

The solution is not to abolish individual biography. People make consequential decisions, and responsibility matters. The better approach is to specify the contribution being credited: proposing, observing, proving, purifying, organising, manufacturing, caring, funding, or implementing. Precision produces a richer and more defensible history.

Discovery stories teach audiences what science is supposed to look like. The lone observer rewards attentiveness; the inspired hypothesis rewards originality; the decisive experiment rewards method. Each model contains truth, but none explains how a treatment becomes reliable, affordable, and widely available.

Asking who gets credit therefore opens a larger question: which parts of medicine does society value enough to remember? When histories include purification, maintenance, nursing, manufacturing, community trust, and distribution, discovery becomes less miraculous but more intelligible. It also becomes possible to see where collective achievement created collective obligations.