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May 26, 2013 4:50 PM   Subscribe

Can fecal transplants save 14,000 lives a year?
posted by Artw (51 comments total) 14 users marked this as a favorite

 
a rather experimental, yet remarkably effective treatment whereby feces from a healthy donor are placed within a C. diff patient’s intestines, either through an enema, colonoscope, or tube inserted through the nose.
You know, rationally I understand that this makes sense and is safe and blah blah blah, but... no. Just... no.
posted by Etrigan at 5:03 PM on May 26, 2013 [2 favorites]


C.diff is fucking awful.
Trying to treat my mom's c.diff is what killed her. I suggested doing this, several times, and was told it wasn't part of their protocol, and generally regarded as untested pseudoscience.
I believe a poop transplant would have spared her the month of shitting herself, being unable to move because she was so full of fluid, and the pain and embarrassment all of that entailed. And she'd be with me today, instead of dead from a brain bleed brought on by round after round of lasix and related drugs.
posted by ApathyGirl at 5:10 PM on May 26, 2013 [47 favorites]


Previously.
posted by Houstonian at 5:22 PM on May 26, 2013


Somewhat related recent Michael Pollan piece in the NYT Magazine.
posted by AwkwardPause at 5:24 PM on May 26, 2013 [2 favorites]


Mary Roach talks about it in her new book Gulp, especially the hoops doctors jump through to have this covered by insurance. It seems like it's a worthwhile procedure, hopefully they can quickly get to the point where it's recognized and covered.
posted by lydhre at 5:35 PM on May 26, 2013 [2 favorites]


Wow, the end of the article is at once hopeful and incredibly sad that people are forced to do this AT HOME rather than under the guidance of medical professionals. Sometimes (often, perhaps) our medical system is completely fucked in how it treats the chronically ill and dying.

Also, I'm reading Gulp by Mary Roach and it's pretty great. Haven't gotten to that part yet though.
posted by OnTheLastCastle at 5:43 PM on May 26, 2013 [1 favorite]


Here's an interesting historical perspective on fecal transplant.
posted by juliapangolin at 5:54 PM on May 26, 2013 [2 favorites]


I first heard of this procedure by a friend who makes medical facial prosthetics for a living. His mentor in college was a gentleman who created Feclone: silicone synthetic poo. This is amusing enough but apparently his initial name for the product was Space Poop.

I love humans so much.
posted by munchingzombie at 5:58 PM on May 26, 2013 [4 favorites]


Further proof that the answer to any question asked by the article headline is inevitably "Ewwwwww!".

(Cultural hangups aside: This is awesome, because: Science. Sometimes I despair that we have to have a special term for "evidence-based medicine" other than simply "medicine".)
posted by sourcequench at 6:03 PM on May 26, 2013


This is awesome. When you think about it, a fecal transplant is not any more gross than than a kidney transplant (that kidney has marinated in someone else's pee!) and far less painfully complex. If I were sick with something this might help, I'd try it in a heartbeat.

Every day people take pregnant mare urine pills and wash their hair with placenta shampoo, and sometimes even eat their own post-natal placentas in smoothies for reasons I forget (anemia or woo or whatnot). What's so different about this? A feces enema sounds disgusting—but NOT more disgusting than hideously painful, explosive diarrhea that destroys your ability to move and eat normally while it slowly kills you.
posted by nicebookrack at 6:11 PM on May 26, 2013 [4 favorites]


Every day people take pregnant mare urine pills

what

wash their hair with placenta shampoo

no

eat their own post-natal placentas in smoothies

plz stahp
posted by elizardbits at 6:17 PM on May 26, 2013 [18 favorites]


We also pay hundreds of dollars for the chance to drink coffee pooped out by civet cats, for no medical benefit! Humans have NO JUSTIFICATION for an "eeewwww" here.
posted by nicebookrack at 6:19 PM on May 26, 2013 [3 favorites]


Better than prenatal placentas.
posted by jason_steakums at 6:20 PM on May 26, 2013 [2 favorites]


I've seen this proposed to patients in two ways, only one of which worked:

"If you're interested, we think you may be a candidate for a new treatment called FRT*"

And,

"If you're interested, we'd like to take someone's poop, mush it up, and give it to you through a tube we insert through your nose into your stomach. Don't worry, you won't taste it"

*fecal replacement therapy
posted by cacofonie at 6:24 PM on May 26, 2013 [2 favorites]


juliapangolin: "Here's an interesting historical perspective on fecal transplant."

"Eat shit and live!" Brilliant!
posted by notsnot at 6:25 PM on May 26, 2013 [4 favorites]


Every day people take pregnant mare urine pills and wash their hair with placenta shampoo, and sometimes even eat their own post-natal placentas in smoothies for reasons I forget (anemia or woo or whatnot). What's so different about this?

This appears to work, for one.
posted by Etrigan at 6:47 PM on May 26, 2013 [6 favorites]


Dr. Judy Stone did a post on this that mentions some of the science and what we know about its effectiveness. Interestingly enough, we don't have much information on which mode of transplant (thru a tube down thru the nose, thru an enema, etc.) is most effective.
posted by R343L at 6:54 PM on May 26, 2013 [2 favorites]


))<>((

 — because SCIENCE!
posted by scruss at 7:08 PM on May 26, 2013 [18 favorites]


Here's an interview where this topic is discussed.
posted by dobbs at 7:08 PM on May 26, 2013


Previously.
posted by cjorgensen at 7:20 PM on May 26, 2013


I've just started reading Gulp, too, and Roach mentions something relevant:
Humans have taste receptor cells in the gut, the voice box, the upper esophagus, but only the tongue's receptor's report to the brain. "Which is something to be thankful for," says Danielle Reed ... . Otherwise you'd be tasting things like bile and pancreatic enzymes. (Intestinal taste receptors are thought to trigger hormonal responses to molecules, such as salt and sugar, and defensive reactions - vomiting, diarrhea - to dangerous bitter items.)
So people getting the treatment via nasal tube probably don't have any reaction from the taste receptors in the esophagus, because the tube bypasses that area. But if there are taste receptors elsewhere in the GI system, people getting this treatment aren't tasting any more shit than the rest of us. (Well, make that "tasting whatever basic sweet, sour, bitter, salty, and umami components are in shit", rather than the full spectrum of shit flavour, given that we don't have internal olfactory receptors.)
posted by maudlin at 7:52 PM on May 26, 2013


When you think about it, a fecal transplant is not any more gross than than a kidney transplant

I have thought about it, and yes it is more gross.
posted by jeather at 8:45 PM on May 26, 2013 [6 favorites]


C diff is easily bad enough that I'd go for this with no qualms. A friend (young and healthy) got it a couple years ago and it took a huge amount of time and awfulness to sort out. We're talking about an infection that makes shit a key component of your life for (at best) weeks.
posted by wotsac at 9:01 PM on May 26, 2013 [1 favorite]


I have a friend who is a rather well regarded gastroenterologist and he told me, half joking, that hundreds of thousands of lives could likely be saved every year via "shit transplants" and the main barrier is the gross out factor. I forgot about that barroom conversation, which was entertaining if somewhat unbelievable, but this article puts it in perspective.
posted by chaz at 9:37 PM on May 26, 2013 [1 favorite]


Fecal Transplants: A Clinical Trial Confirms How Well They Work
A paper published Wednesday evening in the New England Journal of Medicine may give those patients assistance, and change those doctors’ minds. It represents the first report from a completed randomized trial of fecal transplants, and it finds that the treatment worked much better than the powerful antibiotics that are usually given for C. diff infection — so much better, in fact, that the trial was ended early, because the monitoring board supervising the trial’s execution could not ethically justify withholding the transplants from more patients.
Emphasis mine.

Fecal Transplants: The FDA Steps In
posted by the man of twists and turns at 9:58 PM on May 26, 2013 [7 favorites]


Lives saved, sure, but I’d do this in a second if I thought it would help out with the fairly mild indigestion problems I’ve had. Some people here have probably changed diapers. Seriously, how is that in any possible way less gross?
posted by bongo_x at 9:59 PM on May 26, 2013 [4 favorites]


This is a job for daytime TV! Seriously, you want to normalize this, get a beloved daytime talk show host to give a tearful accounting of how much it helped them. It's like the one thing schlocky daytime tv is good for, getting middle America acclimatized to new concepts.
posted by jason_steakums at 10:02 PM on May 26, 2013 [7 favorites]


It's amazing how culture affects medicine and vice versa. A few hundred years ago people thought blood transfusions were gross too. I really doubt we'll ever treat crap with the same "fluid of life!" respect that blood warrants (imagine fecal donation banks—actually, don't imagine it). But I bet the squeamishness over fecal transplants will be One of Those Things that doctors a few hundred years from now shake their heads in regret over the lack of information in these rough old days.

But in that vein (no pun intended), like with blood transfusions, we'll see more unintended results as we perform more of them. Maybe the potential lives to be saved by fecal transplants are more pressing than figuring out exactly how they work first; maybe we're going to find out the hard way the nasty intestinal equivalents of "wrong blood type / clotting factor in transfusion."
posted by nicebookrack at 10:02 PM on May 26, 2013


Oh god, imagine the furor when daytime TV announces its discovery of special fat-burning fecal transplants. "Revive your gut! Supercharge your metabolism!"
posted by nicebookrack at 10:07 PM on May 26, 2013 [3 favorites]


Yeah, The Doctors will be more unbearable than usual when they get fecal transplant fever. But! It gets a lot of eyes and still helps to normalize it.
posted by jason_steakums at 10:13 PM on May 26, 2013


With the recent evidence of bacteriophages in mucus affecting immune response, I wonder if snot transplants are next.
posted by BrotherCaine at 10:42 PM on May 26, 2013 [6 favorites]


Mary Roach talks about it in her new book Gulp, especially the hoops doctors jump through to have this covered by insurance. It seems like it's a worthwhile procedure, hopefully they can quickly get to the point where it's recognized and covered.

For some hospitals, it is also a matter of getting a protocol developed for their infrastructure to handle, prepare and administer donor material in a safe and timely manner.

I very recently helped out someone with a C. difficile infection — last week, as it happens. I had to give a stool sample up front to test for parasites, and a blood test for other infectious agents (HIV and flavors of hepatitis, I think).

Once I qualified as a donor, the last bit of it was only as difficult as giving a stool sample fresh enough to be administered after a scheduled colonoscopy — basically within four hours, on ice. There was no tube down my gut and none down the patient, either (to my knowledge).

I suspect most people will get over the gross factor once all the expensive, ridiculously strong, and last-resort antibiotics we use for C. diff are either no longer covered by insurance — or, more likely, simply do not work as the bacteria that people get infected with become entirely resistant to vancomycin.

Once you're shitting out your guts day after day and shaking from the dehydration and cramps, while paying $500 for a course of antibiotics that don't often clear up the infection — or if you ever get to know someone who goes through this — you'll probably get over the gross factor pretty quickly and sign up to either give this a try or offer to help someone out who needs it.

If your insurance doesn't cover it and your hospital wants to learn how to set up fecal transplants, ask them to cover it. The hospital that treated my friend had only done perhaps between fifteen or twenty procedures. They covered my friend's care and the bills for my lab work.
posted by Blazecock Pileon at 11:28 PM on May 26, 2013 [14 favorites]



With the recent evidence of bacteriophages in mucus affecting immune response, I wonder if snot transplants are next.


My toddlers have been giving me those regularly for years now by sneezing straight into my face, to no apparent gain!
posted by Harald74 at 11:34 PM on May 26, 2013 [3 favorites]


The cat sneezed up my nose the other night. Have not developed cat like reflexes or night vision as a result.
posted by Artw at 11:38 PM on May 26, 2013 [10 favorites]


We exist mainly to provide a habitat for gut bacteria. We are 100x more bacterial than cellular.

Mark my words, within the next decade we are going to learn that a majority of our modern health problems are directly attributable to damage done to our gut biome.

Ingesting preservatives, antibiotics, hormones, modified ingredients, and abnormal quantities of processed junk adversely alters the biome, leading to leaky guts, stress hormones, bacteria population imbalances, and countless other effects that harm the rest of the human organism.

Happy gut bacteria are the keystone to good health.
posted by five fresh fish at 1:02 AM on May 27, 2013 [4 favorites]


Every day people take pregnant mare urine pills and wash their hair with placenta shampoo, and sometimes even eat their own post-natal placentas in smoothies for reasons I forget (anemia or woo or whatnot). What's so different about this?

This appears to work, for one.
posted by Etrigan


No comment on placenta products (which are probably woo), but pregnant mares' urine works just fine. It's sort of an awful industry, and HRT is potentially a bad idea anyway, but it has been in use for something like 70 years, by many, many people. So I'm pretty much on board with the not seeing a reason for being grossed out crowd.
posted by po at 1:42 AM on May 27, 2013 [2 favorites]


Oh god, imagine the furor when daytime TV announces its discovery of special fat-burning fecal transplants. "Revive your gut! Supercharge your metabolism!"

That's actually very plausible though, right? In otherwise identical groups of mice fed high-calorie diets, changing the gut microflora (a course of antibiotics followed by fecal transplant) controls whether or not they become obese. There's a lot of biomed stuff that doesn't transfer from mice to humans, but we know that bacteria in humans' guts help to digest our food with varying degrees of efficiency, and that if you study humans' microbiomes there are certain strains associated with obesity. That's not iron-clad, as there's the obvious problem of establishing causation. But it's very suggestive.

Mark my words, within the next decade we are going to learn that a majority of our modern health problems are directly attributable to damage done to our gut biome.

Undoubtedly. And network / population effects generally (thinking about populations of pathogenic organisms, white blood cells, tumour cells, etc), as our ability to model them improves.

It's fun to think about advances in our understanding of medicine in terms of the prevalent technologies of the time: the Greeks had four elements and imbalances in the four humours of the body, at one point in Europe we had a strong church and the idea of disease being divine punishment or malign influence, as we started to learn chemistry we understood that disease was spread by malodorous gasses, later we had the body invaded by individual species causing parts of the machine to malfunction, and now we're on a website discussing the body as a complex, multiply interacting network. Not a very deep idea, or one that probably withstands much scrutiny, but I'm quietly amused by the symmetry and curious how the next technical revolution will shape our mental models of ourselves.
posted by metaBugs at 2:40 AM on May 27, 2013 [11 favorites]


We also pay hundreds of dollars for the chance to drink coffee pooped out by civet cats, for no medical benefit!

What you mean "we", kemosabe?
posted by Thorzdad at 4:03 AM on May 27, 2013 [1 favorite]


I think it's gross, not that it's ineffective or a bad idea, and I'm fairly sure that if it came to it, I'd give or receive the transplant.

Still gross.
posted by jeather at 5:44 AM on May 27, 2013 [2 favorites]


Related from the New York Times Magazine. If this was available to improve my metabolism and help me lose weight, I'd do it. But keep that stuff out of my nose.
posted by koucha at 7:33 AM on May 27, 2013


^ So I googled Felcone.

SiliClone Studio is the sole manufacturer of Feclone™ simulated fecal material used worldwide for industrial testing of wipes, diapers, etc. ...

Good. We have placebos. It's a start.
posted by de at 7:49 AM on May 27, 2013


It's gross because it's shit, which we have excellent reasons to have deep revulsion for. Urine is functionally sterile, but feces are full of bacteria that can make you very sick. Reading all of this made me want to wash my hands and clean my keyboard, and I'm not particularly germ-phobic. But, sure, there are many gross things in medicine, and we still do them. Getting a cornea from a dead person, estrogen (unless it's synthetic, it's from pregnant horse urine).

From the Wired article
The investigators planned to enroll 120 patients, with the goal of judging them cured if they made it to 10 weeks from the beginning of any of the treatments without relapsing. In the end, they stopped the trial after 43 patients had been enrolled over 28 months — 17 for the transplants and 13 for either of the antibiotic-treatment arms — because the transplant patients were doing so much better.


There's some prestige and maybe an award, but probably no patent for the team that develops the protocol for this treatment. The NIH should be offering lots of funding for trials. And that's the problem. It's going to be grant-dependent, and especially with this Congress, grants aren't flowing (I don't know how much the sequester has hit medical research, would love a cite). With no likelihood of a new drug or device to be patented, corporate research has no reason to exist. This is such a great example of what's wrong with how we do health care in the US.

jason_steakums, I happen to have the Today show on while I read this, and you are so, so right. If there's a Kickstarter campaign to give Matt Lauer a transplant, I am so in.

Blazecock Pileon, way to go, and another example of what's wrong with our Westernized health care approach. I'd call this an example of integrative medicine, and, as with drugs and devices, if there's no corporate push to fund presentations at a lush conference, or ads on tv and in magazines - for doctors and patients - it will take a lot longer for this to get adopted.
posted by theora55 at 8:07 AM on May 27, 2013 [1 favorite]


AwkwardPause: "Somewhat related recent Michael Pollan piece in the NYT Magazine."

Seconding the reading of this article (the same one that koucha just linked to.) Highly relevant to this conversation. I was kind of surprised it didn't get an FPP of its own when it came out.
posted by gingerbeer at 10:05 AM on May 27, 2013


I was kind of surprised it didn't get an FPP of its own when it came out.

If not you, who?
posted by the man of twists and turns at 2:16 PM on May 27, 2013


SiliClone Studio is the sole manufacturer of Feclone™ simulated fecal material used worldwide for industrial testing of wipes, diapers, etc. ...

Yes indeed, I'm waiting for the drug companies to patent shit and sell it for big big buck$. Why use disgusting home processed free crap when you can use the new, improved, tasteless, rose-smelling costly Wonder Poo?

C diff or a transplant? No choice there for me.

However, having had a nasal-gastric tube and watching the green slime oozing into the bucket, I can tell you if I had to do a transplant by tube, then please knock me out while you do it. You can knock me out if you do it rectally--I just don't want to participate while conscious. Better yet, don't tell me how you're going to do it, just knock me out and go for it.

Either way, brush my teeth before I come around, please.
posted by BlueHorse at 4:35 PM on May 27, 2013 [2 favorites]


IF IT SAVED MY LIFE...
posted by QueerAngel28 at 5:18 PM on May 27, 2013


I am so tempted to go on a health kick diet, and then sell my shit on the intertubes as a DIY cure-all.

Even better, flog it as a homeopathic medicine. Cuts the liability risk.
posted by five fresh fish at 7:00 PM on May 27, 2013


This topic has popped up in my life four or five times this weekend. First Smithsonian, then several discussions at a barbecue (awkward), now here. I recognize this probably means someone's research outlet has a great PR arm, but it makes me fear that the universe is trying to mentally prepare me for one of these.
posted by rednikki at 9:32 PM on May 27, 2013 [1 favorite]


Great illustration of why free markets are lousy at efficiently providing health care. There is simply not enough money in the procedure to get a company to pay for the rigorous studies to test its effectiveness. No intellectual property means profits too small to interest investors. It's why we need government involved in health care from basic research, to initial testing, to translational studies, to FDA approval. The NEJM study (funded by the Dutch government) is a great start, but someone needs to fund carrying the ball through FDA approval.
posted by Mental Wimp at 11:20 PM on May 27, 2013


imagine fecal donation banks

I want this to happen just so they can hand out stickers: "I GAVE A SHIT."
posted by Strange Interlude at 7:25 AM on May 28, 2013 [7 favorites]


imagine fecal donation banks ...

... it's easy if you try
posted by maudlin at 8:13 AM on May 28, 2013


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