Why Poop Transplants Could Be the Key to Saving Thousands of Lives
Look down in the toilet. What you're flushing away is only partly what you think it is. Besides undigested food and bodily wastes, bacteria make up more than half of a typical turd. And those happy little germs are, in the right circumstances, a life-saving elixir. Poop, it seems, can be medicine.
Bacteria and their microscopic friends are a major part of your life, whether you realize it or not. Trillions of the little dudes live in your intestines, eating and becoming your poop, and plenty more live on your skin, in your mouth, and pretty much everywhere on your body. But that's not gross, it's wonderful! Those little buddies adjust your skin chemistry, help digest your food, and take up space so that bad germs can't move in. They're so valuable that your immune system actually encourages them to thrive.
All this is fairly new science. We're learning more about these friendly bacteria -- the "microbiome" -- every day. And just a few years ago, doctors began exploring the idea that one person's waste could be another's treasure. That's right: poop transplants are already happening, and could become standard practice in the near future.
Poop cures a killer infection better than medicine
The dreaded C. diff infection that kills 15,000 people each year often begins when antibiotics kill off a person's microbiome, kind of like clear-cutting a rainforest. Normally the species trickle back in, eventually establishing an ecosystem sort of like the original. But every now and then, the recolonizing goes awry. One species, Clostridium difficile, takes over, and the ecosystem can’t re-form.
The traditional treatment is more and stronger antibiotics. But C. diff is often resistant to those, so it just keeps on growing. Only about a quarter of patients can be cured this way; the rest end up in the same painful, diarrhea-ridden, life-threatening situation 10 weeks later.
Here’s where poop comes in. Taken from a healthy person, a turd is a microbiome starter kit. It contains a sampling of what was in that person’s intestines, so that means thousands of species that all work well together. A doctor can take that healthy stool and blenderize it so it looks like a chocolate milkshake, and now I’ve ruined chocolate milkshakes for you forever. Sorry about that. The slurry is then squirted into the digestive tract, often via colonoscopy, but sometimes by enema or even through a tube that goes from the patient’s nose to their stomach, bypassing the taste buds. Remember our 26% cure rate with drugs? The poop milkshake cures 90% of the people who try it. That’s the power of a healthy microbiome.
There are stool banks -- like blood banks -- where you can donate your dump
In the early days of fecal transplants, every treatment had to be harvested fresh from a healthy donor. Many are still done that way, but it’s a pain in the butt (more metaphorical than literal). Think about who, in your circle of family and close friends, you'd be comfortable asking for a stool donation. It's a small number, right? To complicate matters, a lot of people harbor bad bacteria or parasites that are no biggie in a healthy person, but would be a terrible idea to squirt into the gut of someone who's already very sick.
So your potential donor has to be tested for all kinds of diseases, and your doctor has to have a strong stomach and a blender at the ready. That's why a handful of organizations have sprung up to supply poop from pre-screened donors.
One of those is OpenBiome, a nonprofit stool bank that pays $40 a poop to a very select crowd of healthy, generous people. Donors have to make their delivery to the Boston-based office within an hour of, you know, making the delivery. But to get to the point where they’re given the coveted blue sample buckets to take home, donors have to pass a 179-question interview, a 30-item blood test, and commit to donating several times a week for two months. Only about 3% of interested donors make the cut, according to Sasha Lieberman, a spokesperson for OpenBiome. Even then, only the finest poops are selected: too hard or too sloppy, and they'll be denied.
After all that, the company is ready to process your poop into a $385 milkshake or a $535 batch of pills, which it sells to doctors. That price, which Lieberman says only covers costs, is similar to the $400 or so for a course of vancomycin -- except that the poop is far more likely to work.
The medicinal potential of poop
So far, C. diff infections are the only condition that fecal transplants are definitely known to cure. Other conditions -- like irritable bowel syndrome, ulcerative colitis, and even obesity -- are on the maybe list, but "those are more complicated diseases in terms of what causes them," says gastroenterologist and fecal transplant specialist Colleen Kelly. Clinical trials for those conditions and more are underway, but Dr. Kelly considers such treatments "not ready for prime time."
There's a legal side, too. The Food and Drug Administration ruled in 2013 that poop is a drug when it’s used to treat diseases. Specifically, it's an unapproved drug. The FDA said it would turn a blind eye to C. diff treatment, since it would be unethical to withhold such an effective cure. Those other disease treatments are still verboten, unless you're enrolled in a clinical trial.
Even if fecal transplants do get approved as a treatment, other legal problems might pop up. Dr. Kelly notes that the first company to make a formal application for drug approval could end up with exclusive rights to the nation’s poop -- leaving other folks shit out of luck.
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Beth Skwarecki is a freelance health and science writer who is suddenly craving a chocolate milkshake. Follow her on Twitter at @bethskw.