Jan 22, 2013

Poop the Magic Gut Cure

Okay, no puns. No polite, squeamish euphemisms. This is big news.

A team in the Netherlands has shown that fecal transplants are wildly effective in curing intestinal infections. Fecal transplants! That's the taking of a healthy person's stool and putting it into your gut.

The technique was so effective that the trial was actually stopped. Why? It was considered unethical to continue while withholding the wonderfully-effective fecal transplants from the other control groups.

The way it works is that the healthy bacteria in the stool transplant essentially repopulate the flora in the barren ecosystem of the sick person. Though there has been talk of this method for a long time, (occasional papers on it, doctors practicing it here and there), this study represents the first randomized trial comparing transplants to antibiotics. The results were pretty astounding. 43 patients. All of them have a vicious intestinal infection called Clostridium difficile. 17 got the fecal transplants. 13 got an antibiotic (vancomycin). 13 got the antibiotic plus an enema (to deep clean the colon). One of the fecal transplant patients had to drop out for unrelated reasons, and from there, 15 of the 16 were completely cured. Of the folks on antibiotics, only 7 of 26 were cured.

There's been a lot written about this in the last few days, but I found Maryn McKenna's article at WIRED to be the most thorough. She had written about this treatment a year ago and received overwhelming interest from patients -- those suffering from intestinal infections and desperate for a cure -- and almost complete radio silence from doctors. Her read is that the main barrier to the treatment being widely available is reluctance from doctors: "physicians’ own distrust of the procedure, or distaste for it."

It's true, the nuts and bolts of fecal transplant are pretty grody. Since doctors don't know exactly which bits of the healthy stool are necessary for the transplant to fight off the bacterial infection, they have to transplant it basically as-is. Stool is taken from a healthy person (and screened to make sure there are no parasites or infectious organisms). It's put in a blender. It is mixed with salt water. It is then pumped into the gut via enema or nose. Yes, nose -- a tube full of stool is fed in through the nose and down the throat, past the stomach and into the intestines.

The hope is that, over time, it will be possible to isolate the helpful bacteria from the healthy stool, and come up with an easier (and less stomach-churning) way of getting it into patients. But for now the stool needs to stay intact. So, poop in a blender it is.

So, here is my question for you. Couldn't we come up with a better sounding name than "fecal transplant?" A Canadian group came up with the term "RePOOPulate." Cute, but I'm still not feeling it. Couldn't we come up with something more soothing-sounding? Something that would sound reassuringly potent and healthy if you had a painful infection? Something you could brag about to your coworkers on your way to the doctor's office?

Please post your ideas below! And heck, if we get some good ones, I will gladly send them over to the good folks in South Holland who conducted this trial. Onward folks, poop to the people!


To get your brain whirring, remember -- the way this works is that the sick person's intestine gets repopulated with lots of nice healthy flora (bacteria) from the transplant. So maybe something about fertilizer?

 

Avoid marketing mistakes from times past. Turns out this treatment has been around a long time. A really long time. The Chinese were doing it as far back as the 4th century (according to this New York Times article); they'd give it to people by mouth. But they apparently called it (again, according to the New York Times)... "yellow soup."

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