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tv   Book TV  CSPAN  February 13, 2011 5:00pm-6:00pm EST

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patients to be able to use. there were other companies that developed of the devices can and then there was the visual comparison to bearing kim's trips to the files. but if you just look at the cook, your -- at that time he needed not only strips, but they control solution, atolls, wash bottles. it took more than a few seconds, up to a minute or so, to be able to -- for the steps to be able to be developed. it ..
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>> basically to put a drop of blood, it had dual pads. you compared to the pad to the chart on the vile. if it didn't match the chart, you have to interpret. you had a range. you didn't have an extraordinarily accurate and precise method for blood sugar. this is the picture of the first meter. the ains meter. this was not met for patients to go out on their own and buy and keep. this was an development from the 1980s. so the area moved very, very quickly. it became commercially viable and very, very successful. seven inches in length approximately. this is another generation. ames meter. the meters got smaller, more
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refined. this is the original dexter sticks. you can see the pads. they were large. they had to be completely covered with blood and incubated and washed off and you could compare the strip with the color chart on the vile or ultimately the same strip could be insert into a meter. reflecting on the meter. the meter got smaller. the accucheck meter was popular. still is. different sizes. i brought some samples of the different meter that is are currently in use. for people that want to use strips, the one that two meter. you have had a ten-test disk. this is a way of measuring
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hemogloben at home now. this is a recent model. it's a brilliant tour. i'm not a salesperson. but it's the contour asb. it works, you insert the strip and the meter retains the levels. and the meter and values can be downloaded to the computer and create files and send to the physicians. this is all in the span from the 1980s to where we are today. i think these are -- this is also a booming technology. these were the original lancets. how do they draw through the blood? this is the guillotine. this is the original model. it was very -- if you look at the size of the needle, it was extraordinarily painful. patiently actually hated this, the fingers were callused and black and blue. this is a refined version of the same thing. it allowed the platform to be
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removed and put in different platforms depending on the size of the penetration of the needle and this is where we are today in terms of different devices, lancets, different size needles, 33 gauge needles and all sorts of different devices that house the needles. this is actually -- although it looks simple, it is not simple to develop. i think the patients really today can do finger sticks. i don't think everybody necessarily loves doing it, but it's a close to pain free as i guess is possible. kind of in parallel development with the meters is the development of the insulin pumps. so just to refresh our memories, basically, and to mimic the way the pancreas normally functions
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is quite different. with insulin injections, which mimic the basic mode, to product the production of glucose, the long acting are meant to cover that aspect which is done very, very in many times very poorly to very approximate process. and then the bowlless insulin, the short acting to cover the requirement for insulin. so this is a very simple scheme. but this is paceically the -- basically the bottom line or the basis of the development for insulin pump therapy. it was found that insulin pump therapy, you can more easily mimic the natural function of the pancreas. and to this day, you with achieve the insulin levels much more predictable, the long acting insulin.
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certainly in many cases. in 1979, this was one the classic articles that appeared in the "new england journal." worked on at yale, and groups that were developed and insulinned in pump development at the same time. the group in the uk that published pretty much in the same time frame. but you can kind of see it's very hard to see from the slide. you can see that individuals were under conventional doze, on the pump, and then back. sorry. and then back -- when the publicist continued, they regained their previous abnormal glucose patterns. so the insulin pump therapy was really very important in terms of being able to demonstrate is that you can actually put patients on the mechanical device and mimic much more closely what the pancreas does. even though the insulin pump,
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it's not quite perfect. aside from measuring glucose, it's important to look at other markers. we use glucose as the diabetes control, but this is kind of the surface issue. chemicals, hormonals accompaniments. including abnormalities in this article which today is more commonly referred to as igf1. that had to do with the ability to regulate growth. children that had poor -- that had poorly controlled diabetes didn't grow properly. when their blood sugars were better controlled, the -- as a result of that, the growth hormone levels were sue pressed and igf1 levels became elevated and the children really grew. this was one of the papers that was published in the "new england journal" in 1981 that talked about this. there were many other publications that talked about the physiology and the importance of maintaining
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regular blood sugar, looking at issues of type control, complications is really an outgrowth of our understanding of the importance of the physiology of diabetes and it's complications. this is me just a couple of years ago actually. no. but this was the original pump. it was the autosyringe pump. this is a device developed at yale university. actually as a agent for children with certain hemological disorders. you as i -- as i mentioned, you can't make something for personal use. keeping your eyes open for applications of things that are already in the public domain, this is actually kind of marvelous, you know, almost an intuitive idea. so the pediatric
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endocrinenologist at yale used to device for insulin. i'll show you a picture. this is one the current models -- well, not the current. but half of the size. exposed buttons, the whole pump was exopods, there's no cover to this thing. the knobs were not programmed according to insulin units. so you had to figure out the algorithm of translating what the pumps could provide into adequate amounts. the initial group had to be relatively intelligence, relatively insightful so they couldn't make mistakes. they didn't have the ability to really adjust the basil rate this is with model either. another view of the same thing. this is the second generation
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autosyringe pump. you can see the refinement in the technology. it had a case over it. still fairly large. the as6 pump. so it's also interesting to read the fine prints in some of these ads. clearly this was a refinement. the first model could fit in the patients pocket or worn almost unnoticed. you can see how you -- you kind of wonder how credible, you know, those statements were. rechargeable batteries, rates very variable and so on. you can see almost two current pumps, although they are not current, but pretty much the same size as our current generation. matching the same size of this pump. further refinements. and this is really kind of the history of the insulin pumps, at least through the 1980s. so where are we today?
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again, clearly not meant to read the fine print. but you have a variety of pumps, a number of companies that are involved in the manufacturing process. the pumps have a tremendous versatility. i don't know whether they are circulating with that. you can program insulin rates. the initial pump could only give about one unit of insulin an hour. that was about the maximum. you could only change it by one unit. the current pumps you can adjust down to 1/4 of a unit. you can refine based on the patients needs. other pictures of the same thing. some are water proof. this is the way some patients sometimes on their belts. often under the clothing. and it infuses insulin through
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the catheter and into the skin. this is what's called a patch pump. this is a pump that is worn by people that don't want to be hooked up to a catheter. this is literally put on the skin. it's disposable. it's worn for about 72 hours. insulin is inserted into the underside of the pump and applied to the skin. when the pump is activated, there's a small needle that coming off of the base and that infuses insulin. it's fairly large. it's a first generation. it works extremely well. there are many individuals that use this -- the omnipod pump. it requires the use of a handheld device program to pump. if the individual forgets the device at home and they just have this, they are out of luck. be that as a may. there are different types of infusion sets. and then we get to censors. this is fairly recent in the
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last several years, three companies that make censors. but the basic concept is that you have to -- you have a sensor that transmits. these are glucose levels from the fluid, and the levels are sent to the pump. and the measurements are done every three to four minutes. there are alarm systems now on pumps that are warning individuals of the blood sugars running too high, too low. trend alarm. it doesn't help individuals when the blood sugar goes off and 30. if it starts to approach the low value. the alarm is triggered and there's a vibration mode as well. this technology has evolved and will continue to evolve quite rapidly. this transmitter of the glucose
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level. what is very good for the physician to download the information and to be able to interpret, analyze, and then make suggestions in the terms of the changes in the different insulin algorithms. this is exactly the way it looks when you download the dex com center. you see the dots. purple triangles are finger sticks. this is done over the several days. this is a color. you can see the overnight period, which for many patients is a black box. you can see one individual. although if the patient were to check the blood sugar at 8:00 or 9:00 in the morning, it could be quasi reasonable, but it would miss virtually the whole night of running high. they had high hemoglobin and you can't figure out why they are not doing better.
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using the sensor is helping for the blind spots for the individuals. very, very helpful. this shows the same thing, it integrates the different days together. you it see the overnight period is high and coming down higher during the day. that's not the appropriate time to spend and go into considerable detail. this is the pure link system. they had download their devices at home on to the computer. and then if the physician has access to their password, you can actually download the information there. the critical data at home or in the office without the patient actually being there. you can send the patient an e-mail, call them, or whatever else. these are the reports that we get. it's exactly the way he looks. so if you see a patient every two or three months, you can do work with patients in between. so you are not wasting a lot of time to find out the hemoglobin is basically saying the same. it's large, covered by
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insurance, and although certain elements still in the infancy, i think the basic preface is quite extraordinary. this is an office space sensor for patients that don't want to wear at home. they wear them for three days. downloaded in the office and with the softer package, you can -- you can analyze the data over three day process and then give patients feedback. this is another way to look for blind spots in the individuals that don't want to wear sensor all the time. can't afford to have a sensor and so on. this particular individual, although there's -- it was clearly always the type i diabetes. you can see the basic trend here is actually not too bad. the augmented pump. this is the publication from earlier this year. this is a combination of the sensor and -- excuse me, the sensor and the pump therapy. and this basically showed that
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if you combine the two, you can achieve more than if you just -- if you don't use sensor technology. this is basically one way of demonstrating or proving that sensor technology, besides being the commercially viable platform was -- is also kinkily -- clinically useful. this is also the sensor. they wear the pump through the insulin and the sensor. it puts more burden, restrain, more sense on the patient and the medical system. it provides a tremendous amount of opportunity to really improve and fine tune the control. the patient holding the device, this important is transmitted to the same pump that infuses insulin through the catheter. the kind of the holy grail as it were short of any revolutionary developments in terms of either eye cell or pancreatic transplant is the system of the
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artificial pancreas. the jdfr has a huge investment in this area. there are a couple of study groups, one in virginia and one in the uk that's published on this and has presented data over the last several years. and it's a fair -- it basically links all three systems. it involves use of the sensor, the computerized algorithm. the computerized algorithm which is much more efficient and powerful than any human mind can be and provide the insulin adjustments to the pump. so this is all now in a fairly early stage development. this is actually what this looks like in the clinical setting. the data looks extremely promising. and the rate -- the risk of hype glioseem ya is much less than the kind of individuals that make the decision of changing the rates of the insulin.
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if this is accurate, they predict in five or ten years, it will be miniaturized. this is what people have been looking for many, many years. this is only to suggest the infusion of insulin ultimately may not be enough. one the defects also is inadequate si of another pancreatic protein. some people feel you need to compensate for the inadequacy not only in insulin, but to be able to regulate blood sugar levels more accurately and reduce the risk of hyperglycemia. this is a platform that was discontinued by pfizer a couple of years ago. it's very large, cumbersome, very expensive, and to use
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insulin pellets. just never took off. for a variety of seasons. one just simply the size alone was prohibitive. also there was a long term concern about the changes in tissue and so on. this was never really taken off. insulin by injection is still the gold standard. and until something -- there's a better way of administering insulin that's effective and safe, is remains the gold standard for the treatment of type i diabetes. there's another one that had the application for the fda. this is the mankind, it's much smaller. i don't know that there's enough data yet about some of the pulmonary use. inhaled insulin is only to mimic the short acting insulin. they still need to take long acting insulin by injection. that's where i end. thank you for your attention. [applause]
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[applause] >> thank you, michael for the tour in insulin types delivery and monitoring systems. i'd be happy to introduce ross and make a few comments. then we are open for questions. >> ann, thank you for having me. i promise we'll quit exactly at 7:30. guillotine. my job is to help you read between the lines. first of all, i want to congratulation michael. it was a fun cover of therapy and also mr. ainsberg who recovered the history. i'm going to go through both of these to read between the lines. let me start, and i'm going to spend much more time with mr. ainsberg. learns about diabetes, whereas the history has picked up. we need to do what we can.
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let me start with michael. and it's a truism. you saw how many approaches there are at the diabetes now. that tells you none of them are very good. i used to have an equation which i created as a joke and i couldn't find the equation for the occasion. let me tell you that if it's one therapy. past two. two, less than half as good. by the time you get more than two, it's really in trouble. there are so many approaches. it also reflects that insulin was one the treatments. you have to understand the whole bunch of diseases discovered where it was a deficiency. vitamin deficiency, rickets, each time you gave them back and it was all better.
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insulin, we had the same allusion that it was all better. it took a long time, i'm going to guess it took almost 30 years to come to recognition, and they lost vision, kidney failure, strokes, and all kinds of other problems. so the problem really is that giving insulin doesn't do what the beta cell can do. it can measure glucose, give the glucose exactly the right ways. what you saw was dr. bergen presented brilliantly, the numerous number of ways we've improved the way to do it, but we are still far from mimicking what the beta cell can do. the fact they are being invested in, represents the fact we aren't doing as well as we can. that for the medical student, the lesson is, diabetes, i think that we pointed, i remember we
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were trying to shine when we were talking about how you can do, when you know diabetes, you know all of medicine. turns out that diabetes is one the area where the really good doctor makes the difference, and the really cooperative patient really makes the difference. it's one the areas where the art of medicine is still alive because the science has really not been able to keep up. so here we are, 90 years after the development of insulin. it's still clear that we have not been able to replace what the body has lost and that the attempts we're doing while increasingly sophisticated and better and better, still fall short. that means that doctor and practice has to work with the patient to really get the job done as best as they can. but at the same time, the researchers have to do a lot better and come up with a better way with. let me turn to michael's -- away from michael's talk and go to arthur's talk for a minute. and, in fact, i'll save that for
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the last ten minutes, probably. we'll talk about the noble prize and we're going to vote on the noble prize again. and now the other thing is i -- when i started -- when i heard about the book "breakthrough" i said who are these crazy guys writing that story again. michael bliss, who you saw, really did a spectacular job writing the book called "the discovery of insulin." it's a masterpiece. it won all of the awards. when i picked up the book, arthur, i came in with a severe prejudices. the arrogance that these people could do it. i enjoyed every minute of the book. and i recognized. he started nine runs behind, i'm sorry, the football season. he started six touchdowns behind.
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you if a beautiful job. mark was a well known literary critic. he gave a class all of the seniors, or 400 of us, he spoke in such a personal way you felt you were in private conversation. he gave a course called the narrative art. how do you tell the story? i remember now exactly what he said. these guys who write who done its and they hold all of the information and let it out. that's no art. that's bologna. the art is taking the story that everybody knows. you start the odyssey. you know that ulysses is going to get home. you know that penelope is going to be faithful. same with the biblical stories. you know that joseph isn't going to be killed. you know the story. i had to thank you and we must remember to join things.
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you did a brilliant job retelling the story. i sat there like a little boy that's ever heard it for the first time. i read it every summer with the students. hats off, as i say, you started way behind. okay. now -- let me stop now and take questions from the audience. then i'll come back and read between the lines with you on any of the issues that we would like to do. >> all three of you come on up. yeah. let's have some questions. anybody? you've heard all of the stuff about the people and the science. anybody, students, of all ages, yes? >> i think one the most remarkables things about the story is the discovery of insulin how quickly it went to the lab to the marketplace. two years.
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obviously, nowadays it takes longer, excuse me, because we have so many regulations in place to safeguard the patients. there were no regulations. it worked out well. we have debates. cancer drugs that seem promises. should they be able to skip ahead and go to market? there's the ethical questions, the patients are at risk if you step skips, if it's a good drug, it's doing to save lives. how do you think about that question today? >> very good, difficult question. >> okay. i'll try to give a short answer. i'm going to defend the fda and the rules. they have to steer a very, very narrow course. the number of miracle drugs are few. most the advances that we are seeing today are made in the publicity in the drug. they tickle the molecule and try
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to convince us it's worth the number of price. even though there are a lot of distracters and a lot of issues. we will tell you the fda is the best regulatory drug group in the world that has faults. it's like democracy. it's not all that good, but there's nothing better. and you need to sit down with all of the disasters that have occurred, i think the disaster that europe experienced, you remember when the kids were born, the united states escaped it, and, in fact, that was the landmark that allowed that congress then allowed the fda to increase it's power. i think we are doing the very tricky balance. and one that even the fact that in some of the areas like cancer and aids, they have accelerated pathways where the risks benefits have been changed to meet the attitudes and things that you were worried about. >> perhaps i can add a comment. there's a way of using medication before the approved
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use. if you have a life threatening illness and there's nothing else around that is available or has nothing else that effective, there's a way of accessing medication in a relative short time frame that cuts through the regulatory process. that's relatively open thoughtic. i think in the situation back in 1922 or 1923, if insulin, if there was no other medication that worked, and insulin was available without going through a whole clinical trial, which really wasn't available at that time either, as we know that clinical research became much more developed after the second world war in this country. basically compassion use available today for individuals that require -- have life threatening illnesses. >> i think you can address this. what's surprising is that regulatory -- the ability of doctors to do whatever they want on a patient without irbs, without anything, is relative recent.
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i mean there was no oversight between 1947 even. some the experiments that went on by doctors and patients trying to develop the vaccine by injecting cancer cells. there's a litany of things that really crossed over boundaries. we know at tusky, there were a lot of developments. >> let me confess, i was a physician that lived in the wide west. there were no rules. you look back and each of the rules that came in, it was because there was some tragedy or terrible event that occurred that caused the rules to be changed. let me call on my buddies, one the great in medicine and laboratories. again, between the lines. he says when the nuremberg trials, the nazis trials, right after world war ii. the doctors that did the
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terrible experiments in the concentration camps, the american camps came to witness. did we do anything like that in the united states? the americans say, of course, we do not. but, in fact, if we look at the tuskegee trial and the experiments in guatemala, you see "the new york times" where the tuskegee trial was a trial where a large number of patients went untreated. my people, you know, i -- but then was even worse, it turns out they were experimenting with penicillin to see if it could prevent syphillis and we're giving syphillis to the prisoners and bringing prostitutes. it made nuremberg, it was clear the things were the same, similar kinds of things. the reason that i raise it is not to defend the nazi criminals by any means. but, in fact, rules are absolutely required because when left to our own, we physicians
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haven't been very good about it. >> another question. >> i have a question for the author. elizabeth hughes, you know, you mentioned as soon as she started receiving treatment, she wanted to be out of the spotlight and move on. as far as writing the book and doing research, did you work with the hughes family? what was their perspective? were they in favor, or did you have to work with them? >> very good question. we made a decision when we began researching and writing the book we would not talk to anyone in the hughes family. we would not talk to any of the descendants of any the discoverers. we wanted to work with just the artifacts that were available to us. we didn't want to unfortunately get spin from people 75 or 80 or 90 years after the event. that's a decision that we made. the question that comes up quite a bit is, you know, why did
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elizabeth turn and back on toronto and never really discuss her condition throughout her life. we think there are several reasons for that. first of all, during the time, 1920, people didn't like to discuss very severe illnesses within a family. they were very concerned about marriage, and you were very concerned that your future, the opportunity for marriage would be diminished if people knew that it had a very serious illness. we think that's one factor. the second factor is there was an element of guilt. elizabeth hughes knew that she received insulin and the other child and children did not. i think that's part of it. finally in 1922, if you could just imagine front page story, daughter of the secretary of state, he was the most famous man in america, she was all of the sudden the most famous women in america at 15 years old. she was a private person. and she had her moment of fame.
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and i think she really wanted to lead a very private life. i didn't discuss tonight, she had an extraordinary life. she was a trustee of a college, she founded a university in michigan, she was a pillar of her community. and she was the founder of the united states supreme court historical society with warren berger in 1974. and she did it on her own, and she did not want to be known as the insulin girl. years later, after -- when people approached elizabeth hughes and asked her, excuse me, weren't you the sick child? she said, no, you must be talking about my sister who died. so that's the way she deflected it. you have to read -- you really have to read my book to read the whole story on the hughes family. please. >> so this activity, first of
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all, thank you to all of my speakers so much. i appreciate everybody's being here. do you want to say a couple more things? >> yes. go ahead. >> let me start by saying in my enthusiasm about the point that i made about how bad we in america has been. there's no question the nazi doctors through the outbreak, were some of the most reprehensible physicians in history. i want to point out the violations done by american physicians and japanese physicians, and physicians elsewhere, broke those same kinds of rules and laws. so i don't want to be misquoted in trying to equate them. i wanted to point out the rules were absolutely necessary, because in the absence of rules, even the united states public health with hypocrites and others violated the rules in extraordinary ways. what i'd like to do now, is there any more questions?
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i'd like to turn to the noble prize in 1923. let's give it again. okay. how many of you think that banting deserved the noble prize? okay. how many you think that best deserved the noble prize? okay. how many think that the mccloud deserved the noble prize? okay. you guys are really -- you fell right into my trap. [laughter] >> okay. and how many of you think that collar deserved the noble prize? you do. a few. okay. good. good. how many think there's something else, clues? how many think that includes deserved the noble prize? quite a few guys. good. is there anybody missing? anybody that we didn't include in the candidate list?
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okay. that's what i'm going to talk about. when i think about the noble prize, who are without which wouldn't have it happened? now what will banting bring to the table? he brought to the table a certain amount of craziness. okay? he thought that god had spoken to him and gave him a secret. in retrospect, that secret was nothing but a tallisman. it was not a big deal. when you pied up the pancreas in lily's freezer. they didn't get the call -- calves, they just took the pancreas, chopped it up. when somebody in the a lab, banting he's a medical official. no experience. can he walk into the lab and
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make up the protocols. i remember i came into the lab at the beginning of the summer they went to europe because their first trip to europe they were invited each of them with their families to go to europe. and my friend and i started to work. we actually got some reasonable results. but we used all of the protocols, instruments, equipment, ideas that they gave us. so that everything that banting did was based on his coming to one -- there were only two or three labs in the world that he could have gone to and been able to do what he did. because mccloud was, in fact, totally encyclopedic on the entire literature. the season that mccloud didn't work, he knew that more than a dozen people had tried to isolate it. the name insulin was named by mr. schaefer in 1907. in the 1905 lecture where they named hormones hormones for the
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first time, he was arguing whether or not how much the pancreas did. so why did 12 or 15 other people work so hard, and you pointed out, you last few claims remained i had. no, i had it. no this guy had it. so a dozen guys who had discovered it before. how did they discover it? what do you they mean they discovered it? what were they searching for? somebody had to discover it before. who's missing? oscar mincofsky. sorry. i have to stay in the middle. oscar discovered insulin. okay. he and von mary in the 1880s very trying to figure out what does the pancreas do. immediately, i just did it for the fun to help out my body. it was oscar's idea. it was oscar that discovered the pancreas was removed and well
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trained he was urinating. he discovered he was urinating glucose. he tuck it had back into the kidney and made a pancreatic transplant. it was his discovery that launched. he discovered insulin existed, some hormonelike material that went into the blood to control glucose. it then set out of the race where everybody started the search for how to do it. lab after lab, had reasonable results and could never quite get it. okay. they kind of had it. they kind of had it. they couldn't quite get it. as you saw, in fact, the banting and best starts at the beginning. they had a lot of trouble routeing for the experiments. if you take out the original notebooks, you couldn't report anything. if you look at the original papers, you wouldn't report them. okay. so they did report them. but they were really very as
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almost as unpredetectivable -- unpredictable as the other one that is had come out. in fact, we were joking about it, arthur and i, when they went to new haven to announce it, they couldn't make the insulin. they were announcing it, but couldn't do it. then there was a big announcement in washington, and the ground swell and the applause at that moment and they couldn't make it. okay. so they were very, very different. it was really again a rickety system. the thing finally got done because the university of toronto got behind it because lily got behind it and they got the message to work. one the things when you public a paper, you promising that it is reducible. five days out of seven you can get the experiment to work. there are hundreds of discoveries made where you kind of have it but you don't have it and you can't report it and you
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doesn't get settled. so, in fact, mccloud clearly deserves the noble prize. it wouldn't have happened if the crazy guy banting who came with the talisman, and not a real indication, but mccloud had all of the facilities, protocols, and all of things that you actually used to do it. but i mean oscar was alive at the time. he was a professor in germany who was the first one to give insulin in germany. probably in those days they used to give the noble prize very quickly. they wanted a very current discoveries. and kroge who you saw came to get his wife treated. he had won the noble prize himself, and he was on the noble committee. the prize was given very quickly. had they done the kind of studious study and the prize been given ten or 15 years later, or 10, because oscar died
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in the 1920s, they would have ginn him -- given him the prize. they realized the study that led to the discovery. banting and mccloud really isolated a purified insulin, but didn't discover it. okay. charlie bess, he was the only one that i met. charles bess, i was an autograph book of his. reprints and so on. he was a wonderful guy. he was a medical student. had the coin toss gone the other way, noble was the other guy, he probably would have replaced. if i would have been lucky enough to be a medical student, i would have lucky enough to be on it as well. i think mccloud and banting deserved the prize. too bad they left out oscar. that was the one that probably should have gotten it.
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what should i do with my premise two -- precious two minutes? i think you pointed out rightly by the way the canadian nationals, a lot of things decided how much credit? he was a war hero, farm boy, david and goliath story. we all like the story. anybody that worked in the lab, we will tell you that story never held water for us. people just don't -- unless they are real geniuses. i don't think that mccloud, banting was that territory. i think there really was a collaboration of banting coming to a special lab that would really do it. okay. let me ask you a question. why do you think? you interpreted a finding differently than i will. the first paper was published by
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banting and bess. mccloud's name was not on it. why was mccloud's name not on it? your interpretation as you said, he assigned the achievement to them. i was going to put it a different way. those of you who were scientists would recognize it. when something really goes bad, the big guy takes the hit. okay? to the credit that's shared when it was the big guy. so mccloud in good sense has looked -- these results are rickety. i'm going to put my name on it. not because they didn't contribute. if things go bad, nothing will happen. for me, that'll be my career. it'll really go down. as i think about all of the disasters that happened to people in the medical university in my time, almost all of the time, there's a big guy that took the history. mccloud was wisely holding back. he wasn't sure enough they did do it. it was not reproducible.
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that's why he kept his name off. not because he didn't really make a major contribution. let me just close by saying that you are going to spend a lot of time learning how to take care of diabetes. it's a very important thing for you to learn how to do. and it used to be the olden days that most did a good job. but increasingly, the doctors have gotten more callus and negligent. i'm asking you as physicians in training to really take the dice care -- take the diabetes care seriously. it's one the few in medicine, how good the doctor is really makes the difference. now just in terms of knowing what to do, how to communicate, motivate, and go through all of the hard work of getting the control to do better. so michael, you got them started. but getting the job for the next four years to make sure they get without grounding it and you share responsibility.
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so i'll know how to pick on both of you. [laughter] >> and again, arthur, could you give my congratulations to celia and the both of you. i enjoyed this book. it made her cry, it made me cry, you made me stay uplated that i wanted. i meant to quit, but i got stucked in. we are standing here. i want everybody to see the most famous metal award in diabetes is the banting metal. we're standing with a metal winner, 1982. so that deserves a hand alone. [applause] [applause] somewhere and that was arthur
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ainsberg on booktv. for many visit breakthroughthebook.com. >> peter, i'd like to congratulation you on a terrific book. this is the third one. i think you have established yourself of the preeminent historian of the movement. i think this book shows why. because it's con size, it's white, it's fair, it's passionate. i think it's really the best summary of what's happened since 9/11. let me start by asking all of you a very basic and yet hard to answer question. which is what should we be calling the conflict about which you write? the subtitle says the enduring conflict, but what do we call it? >> max, first of all, thank you for those comments. i'm very happy that you -- i mean especially really well qualified author like yourself as read the book and we're
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having this discussion. what should we call it is an interesting question. i think there's an linguistic problem about the conflict. as i say in the book, president obama had a pretty interesting question when he came into office. which was how to define the war formerly called the war on terror. i think the liberal side of the democratic party and a lot of the europeans would have liked to redefine it. i think that would have naive on multiple levels. al qaeda has been in war since 1998. certainly when they blew up our embassies. they have decided war on us. they have done warlike things. for us to present it's not a war, would be wrong. george w. bush by framing it which he did nine days after 9/11 is a problem. al qaeda is a serious problem. it's not nazism or communism. i don't think we have the language to explain it exactly. because it is a form of warfare.
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the nearest term because of the terms of the american historical times is the war against the pirates in the late 18th century. which is certainly a war, it wasn't a interstate war. and it wasn't, you know, going to destroy the republic. >> former governor of virginia, george allen. former senator from virginia, george allen. what can washington learn from sports? >> it can learn a great deal. i learned a lot growing up on the sidelines in the training camps and playing sports myself. probably the most overarching thing, when sports the race, religion, ethnicity doesn't matter. can you help the team win? not guaranteed equal results, but equal opportunity. which is what our country was
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built on. you would never see the way that washington operates, redistributors from the winners to those who are not winners. if we are up to washington, they take one the steelers six super bowl trophies. the poor detroit lions. they've never made it o super bowl. let's give them a trophy. no you have to earn it in sports. there's accountability. and personal responsibility. there's measurements. you know who's winning and losing. and there's also in sports a competitiveness that you are always looking how you can improve yourself and how you can make your team better. and for team america, we need to be looking at what are economic policies, tax policies, energy, education policies, which are mostly state, not federal, but what can we do to make sure that everyone in america has that opportunity to compete and succeed. i have a chapter in the book that you never punt on first downs. well, we've been punting as a country on first downs since the
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1970s. most sports teams love to say we are number one. we are number one. well, america actually is number one when it comes to energy resources, thanks to our plentiful coal, as well as gas and oil. the leaders in washington looking at these resources as a curse. any other country would consider them a blessing. so we need to unlease our resources and the resources of our creative people rather than continue to get jerked around by hostile dictators and cartels. >> is the competition getting fiercer between team republican and team democrat? >> it sure has been. the fans decide, the people. the fans get to vote. depending on the office every two years, four years, or six years. and the fans were not happy with what's going on in washington. who in the heck has been cheering about anything coming out of washington for the last several years.
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other than strasburg who is a pitcher with the nationals baseball team, there hasn't been much to cheer about. people love their high school, college, pro teams. the people said that we want to change. they see that what's going on in washington by any measurement whether it's debt or whether it's the lack of jobs, washington washington -- the policies in washington, whether it's bailouts under president bush or the health care monstrosity, or stimulus spending. none of that is working. so the voters, the people, the fans, the ticketholders, so to speak within the owners of the government say that we want to change. they made that change in the lexes. now those who have been elected, the number one thing they need to do, keep their promises. keep their promises they made to the people and that will at least start getting our country back in the right direction. >> do you miss being in the arena? >> i do from time to time.
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susan and i have been very active in bob mcdonald's governor race last year, and helping in southwest virginia to scott at the beach and rob better on the south side, and keith in the northern virginia, and so we are involved. and there's many people who have encouraged me to get back into it. and we'll consider that. but right now, i'm trying to use this back to try to find a fresh or unique way of sharing people ideas that make good sense that they understand that will make sure that team america is in a better position to be ascending so that everyone has an opportunity to achieve their american dream. >> the afterword by former congressman j.w. watts, forward is by l.a. rams, deecan jones. >> yes.
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mr. jones played with the rams. my sister named his child after him. he's my older daughters favorite speaker. there's a lot of stories in there. ronald reagan who is the one that actually got me interested in politics, because as governor, he would come to the l.a. rams football practice. now here's a politician that knows who's important. then he asked me to be chairman of young virginians for reagan in 1976 when i was at uva. that's what got me involved in politics. because ronald reagan became governor the same year we moved out to california. there's a lot of stories in there. baseball, football, hockey, or even a nascar fan. >> george allen "what washington can learn from the world of sports." book tv covered a previous
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event. go to booktv.org, and you can watch the full event in it's entirety. >> every weekend booktv brings you 48 hours of history, biography, and public affairs. here's a portion of one of our programs. >> hi, who do you think would be the best choice for our next republican candidate for president? [laughter] >> with a real chance to win and even though i think john mccain is a good american, would make the best candidate? >> i -- i really -- you know, i have this thing on my show called the duck of the day. i know my producers are rolling on c-span. they are going to get me with the duck of the day. i don't know who the best person is right now. here's my answer. i'm not worried about that yet. i know everyone wants the next, you know, the next reagan to
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walk in the room, the next figure who's going to lead us out of the darkness. i'm not worried about it. i truly believe, and i've been in how many cities, 15 cities now and just a little over a week and a half. i am thrilled about what i am seeing from the ground. it's going to happen the way it's supposed to happen. i have great faith, i have this cross on, everybody knows that i wear. i have great faith. [applause] [applause] >> that, you know, we're not an accident. this country. this whole thing didn't happen because of some series of coincidences that we had the brilliant men that came together at constitutional convention and, you know, did this magic. it's not magic. we have a destiny to fulfill. and i believe, again, if the citizens are engaged, and it means more than going to
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speeches, i mean i'm glad that you all game, believe me. it would have embarrassing if it were just raymond and randy here and a few other people. i'm excited you are here. but what you do when you leave here is what matters. what i'm saying to you, it's happening. people are organizing in ways they haven't. let me say mr. president, i'm high fiving you on the community organizing thing. because we're doing it now. [applause] >> to watch the program in it's entirety, go to booktv.org, simply type the title or the author's name and click search. :

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