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Sunday, July 25, 2021

Myths and Misconceptions about Health: Fecal Transplant – That Stuff In The Toilet Can Be Medicine?

The focus of this column will be on ideas or beliefs about health that people generally follow and/or teach to others. My aim is to debunk these myths, but the intention is not to make individuals feel silly for believing them. Instead, the goal is to provoke some critical thought and understanding about where and why these beliefs may have emerged. Overall, I hope that readers will receive a new outlook on whatever health practice or topic is being discussed. I also hope that the column will encourage them to question what is commonly accepted as orthodox in health.

Wait you put what where?

Typically at the sight of any sort of feces, humans naturally tend to steer way. Excretion does not have a pleasant smell nor does it have an appearance worthy of a gaze. If you see animal feces on the ground, you will more than likely move away and maybe even add in a gagging sound. However, there is something about human waste that makes people cringe at the very thought of seeing it anywhere other than in the toilet. Therefore, it is not surprising that making use of human excretion is taboo in Western culture. Waste is usually associated with disease and uncleanliness, so to imagine that it may have a positive medicinal effect is unthinkable. This common conception of human excretion is put to a challenge by fecal transplant or more officially called fecal microbiota transplant (FMT). This novel treatment requires placing the stool of a healthy person into the colon of a sick person. Most notably, the individuals who undergo this transplant have Crohn’s disease, an autoimmune disorder that reportedly does not have a cure and whose activity is still being understood. It has also been proven to work in treating a bacterial infection called Clostridium difficile or C. difficile, which has symptoms similar to Crohn’s disease.

Poo is really medicine?

FMT has had incredible results and in many cases people recover within hours. In 2013, a trial comparing the effectiveness of FMT to vancomycin, an antibiotic drug that fights bacterial infections ended early because it was concluded unethical since less than a third of the patients treated with vancomycin recovered whereas 94 percent of those treated with FMT recovered. There is a new organization called Openbiome and it is the world’s first stool bank. Essentially what they do is recruit donors, and these donors are then put through intensive clinical tests and a strict screening process. Less than 20 percent of the recruits actually pass the blood and stool tests. They then process the stool, freeze it, track it and then ship it to hospitals across the country. It is a very careful, nonrandom process, and it is also relatively inexpensive in comparison to the prices implemented by pharmaceutical companies selling drugs for C. difficile. Not only is FMT exceptionally effective, with almost all treatments being successful, but it is also really cheap.

Big Pharma and the FDA

Despite FMT’s effectiveness, doctors are not allowed to perform the procedure without special licensing.The reason being that FMT has not undergone clinical trials, and is thus interpreted as an unfair advantage to the drug companies. These companies have to invest large amounts of money and time into clinical trials in order to get their drug approved by the FDA. FMT, however, has not had to undergo this process, which has stirred up some controversy with the Openbiome organization because they are endorsing this treatment, especially considering that they are now processing stool capsules. Therefore, drug companies will likely want FMT to go through the FDA because the cost is so low and effective, that it will obviously outcompete their products. Unfortunately, regulatory agencies’ decision to require a special licensure to perform FMT has prolonged and made it difficult to access treatment. Sufferers cannot always find doctors to perform their procedure or maybe they cannot afford the drug prices, so they choose to perform FMT at home. This is incredibly risky, so that is why organizations like Openbiome are created to make fecal transplant easily accessible. However, if they have to undergo FDA approval, then this easy access might be hindered. Their prices will likely go up and at-home procedures may persist.

Give A Sh!t Campaign

It is odd to imagine that you can be incredibly ill and have a reliable, effective treatment, but you might not receive it because of the stigma surrounding fecal medicine or because of the legal controversy debating whether poo should or should not go through clinical trials. This treatment, like any other medicine, is intended to help people recover from illness. Although, excretion may be offsetting to most, it is still a powerful medicine and it would be great if more people would be more open to it. Openbiome has a “Give A Sh!t Campaign” to help raise money for lab equipment and an expansion of their organization to make the treatment more accessible.

Tiffany Marquez can be reached at tmmarquez@ucdavis.edu.

Graphic by Jennifer Wu.

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