Thursday, January 3, 2013

Poo-Poo Platter

This article was, for some odd reason, the front page story in today's Plain Dealer.  (Slow post-holiday news day?)  Two gastroenterologists from New England are working on a randomized controlled trial comparing the efficacy of fecal transplantation vs placebo in cases of refractory, recurrent clostridium difficile (c. diff) colitis.  What exactly is "fecal transplantation" you ask? 

Just what you what might expect, alas:
Transplants can be performed in a number of ways. Most often, doctors use a colonoscopy-like procedure, sedating a patient and depositing liquified, donated stool through a tube in the rectum. But sometimes they use a nasogastric tube, that goes through the nose, down the throat and into the gut. Other times, the stool is administered as an enema.

The idea is that by "seeding" the colon with native bacterial flora, biological competition will help crowd out the pathologic c diff that proliferate after treatment with antibiotics for an unrelated illness. The idea itself actually demonstrates fairly original, out of the box thinking.  But there are several aspects of this that require further deconstruction.

To wit: let us focus on the phrase "donated stool" from the linked article.  I can only assume that this implies that the authors of the study foresee a future where every city will have a shit dispensary where poor college students can go to make a quick 25 bucks, a la the plasma and semen collection depots I recall from undergrad days at Ohio State.  Instead of homely little rooms with a hard bed and a stack of vintage Playboys from the 70's on the night stand, one would be directed to a deluxe-suite bathroom stall equipped with a veritable wet bar of defecatory agents on a side shelf (Miralax, Milk of Mag, fermented prune juice shots etc), padded seats, quadruple-ply toilet paper with Baroque era stitched patterns, and a diverse selection of daily newspapers arrayed on those bamboo pole thingies libraries and chain bookstores use to dissuade you from stealing the Metro section.  All toilets would then empty into a common estuary.  Giant vats of temperature-controlled fecal stews.  Perhaps dispensed to participating hospitals and clinics in discrete little two liter cartridges with easy-pour nozzles.   

Furthermore, like any treatment, one must assume that a discussion will take place between physician and patient prior to administration.  This discussion could take any number of iterations.  Something along the lines of:

Dr: Sir, I am having a hard time curing you of your c diff colitis.  You have failed all medical therapies. 
Patient: Yes.  I am profoundly disturbed by that fact
Dr:  I propose that we snake a long silastic tube through your nose down into your stomach.  And then, via said tube, we will infuse a liter of human excrement (not your own, mind you) down into your stomach.  You will have a hearty selection of Pixar movies at your disposal to distract your consciousness from the  reality that Port-a-Potty offal will be flowing steadily into your gut.
Patient:  That sounds fabulous.  Do you have Wall-E?

I'm sure some as yet to be determined euphemism (natural bacterial replacement therapy, NBART) will arise to divert attention away from the idea of "river of shit, not my own."

I hope the RCT demonstrates superior efficacy.  I literally cannot wait to write my first order in a real live medical chart---- "300cc shit, per OG, q6 hrs over 20 minutes each.  Flush thoroughly after infusion."

1 comment:

Anonymous said...

I believe that the method most commonly used for fecal transplantation is simply an enema.

You're not trying to get the patient to DIGEST the feces. You're just trying to colonize the colon with it.

Ergo, the back route makes more sense.