August 25, 2001

Dear Tony

Thanks for sending me the article about genetically engineered human insulin. It is a wonderful example of misinformed paranoia. An article from a reputable medical journal would be infinitely more convincing.

Having practiced medicine for about thirty years before the advent of genetically produced human insulin I can testify that I used to see frequent reactions to both beef and pork insulins - hives, increasing ineffectiveness (larger and larger doses required), local atrophy at the site of injection and others. It is true that insulin has many dangers - whether it is human or animal derived. Animal derived insulin is a foreign protein for humans and as such is very apt to cause immune reactions - which is why genetically produced human insulin is so much better. It is not a foreign protein.

But type I diabetes and, to a lesser extent, type II diabetes is a fatal illness without insulin. Almost all of the dangers, which your article attributes to human insulin, are dangers of diabetes - retinopathy, kidney failure, hypertension, stroke etc. - and they can also occur in type II diabetes even if insulin has never been used. It is true that if too much insulin, human or animal, is given, hypoglycemia may result and may be fatal. If not enough is used the patient develops ketosis. That is one of many reasons why therapy of diabetes is such a difficult and demanding skill.

The Nordisk statement about increased risk of hypoglycemia associated with increased use of human insulin does not state that the risk is greater with human than with animal insulin. I suspect that both the statement from Nordisk and the one from Aventis are incomplete or taken out of context.

Yes, the use of any insulin is associated with increased risk of hypoglycemia - but without it the disease progresses inexorably. There used to be a doctor in Ithaca who was present as a resident in the Toronto Hospital where Banting and Best, who first developed and used insulin, gave the first dose to a girl who was moribund in ketosis. She said it was miraculous to see the girl rapidly regain consciousness.

It is a fact that the world was running out of available animal insulin when the genetic insulin was developed. It is not a plot by the manufacturers to discontinue it. When a better mousetrap comes along, the old ones are discarded.

Part of the paranoia surrounding human insulin probably includes the belief that the adverse effects of human insulin are withheld from the public and medical profession for fear on the part of the manufacturers that their business will suffer. This is a ridiculous idea, if it is believed. Many medicines have been discontinued because dangers have been discovered as they are used. A recent example is Baycol, used for the treatment of elevated blood fats, which was found to have risks, which became apparent after many people used it. The company has withdrawn it from the market. A couple of years ago a drug used for the treatment of type II diabetes and hailed as a great breakthrough, Rezulin, was found to have more toxicity after a year of use than originally thought, and was discontinued. I have absolutely no doubt that after 30 years of human insulin, if it had significant problems it too would have been discontinued.

Many genetically produced substances may have risks, but denouncing human insulin makes me wonder about the validity of many other claims made by opponents of genetically modified substances.

Cordially, John Ferger

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