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.