Healthy human excrement is becoming a valuable commodity.

OpenBiome, a nonprofit launched by MIT graduate students almost two years ago, is the nation's first stool bank. Its mission is to provide doctors and hospitals with safe fecal material from screened donors for use in the growing number of fecal transplant procedures. Microbiologist Mark Smith, a co-founder, explains in a Boston.com story by Chelsea Rice that the organization is modeled after the Red Cross, to make a medical commodity available in a standardized way.

Fecal transplants-known as fecal microbiota transplants, or FMT, have been found extraordinarily effective in treating patients with Clostridium difficile infections that afflict half a million patients a year with intestinal pain and disabling diarrhea. Most are hospital patients who have been treated with antibiotics that wipe out healthy gut bacteria along with targeted pathogens. With the microbial competition wiped out, C. diff takes over, producing toxins that can cause severe and sometimes fatal illness. With introduction of donated stool into the patient's intestine or colon, healthy bacteria fight the C. diff and the normal microbial gut community can be reestablished. The Mayo Clinic first used FMT to treat a C. diff patient in 2011 and the Cleveland Clinic called FMT one of the top medical innovations of 2013.

In The New Yorker story "The Excrement Experiment," Emily Eakin traces the past and current understanding of fecal microbiota, describes its potential for treating several autoimmune disorders, and reports on recent research suggesting the mysteries of the gut biome may hold keys to many medical conditions, including obesity and mental health issues. Researchers at Washington University in St. Louis found that gut bacteria plays a significant role in obesity in mice. Mice implanted with gut bacteria from a fat human gained weight while those injected with gut bacteria from a thin human stayed slim even when both groups ate the same diet. Research also suggests gut bacteria influences our moods, minds and emotions.

The average human digestive tract hosts at least 100 trillion bacterial, fungal, viral and archaeal organisms that collectively makeup the gut biome. Much of the research focuses on stool, which Eakins explains "remains our best proxy for the brimming universe within." Smith told Eakin part of his inspiration for OpenBiome was a friend who cured his extreme suffering from C. diff by transplanting his room-mate's stool into himself. Transplanting can be done using enemas, colonoscopies or a turkey baster. OpenBiome absorbs the cost of screening donors, whose blood is tested for several diseases, and whose initial stool samples are screened for known harmful pathogens. It is now sending specimens of clinically prepared excrement to dozens of hospitals across the country. Boston.com reports screened doors are paid $40 a day for their contributions. To lighten a gross topic, donors, who are anonymous to recipients, are given code names such as Winnie the Poo, Poop King, and Vladimir Pootin. Note the Boston.com graphic.

Meanwhile, for-profit biotech companies are competing to get stool-based therapies through trials and into the market. Scientists are also designing fecal capsules, which some entrepreneurs call "crapsules," that will be more appealing to patients. And the FDA will have to decide what regulatory measures should be in place. The FDA has viewed medically used stool as a drug. Smith and others hope it will be reclassified as a tissue, which has to meet stringent standards but does not have to go through clinical trials required for FDA drug approval. Read the New Yorker story here.   

 

Healthcare PlexusCalls

Wednesday, December 17, 2014- 1-2 PM ET

Cancer remains a leading cause of death for individuals in the U.S., but has increasingly become a disease patients can survive, thanks to a growing arsenal of effective treatments. For patients today, this arsenal includes cutting-edge surgery, hormone therapy, chemotherapy, radiation therapy, biologics and immune-modulating drugs. Together, this collection of treatments is helping more and more patients to fight, and win, their battle against cancer. Unfortunately, many of these treatments can also lead to side-effects that can disrupt patient's transition back to wellness and, in some cases, threaten their ability to finish their cancer treatment. This tension between treatments that heal and treatments that harm is a major theme in oncology, and is made worse by the fact that in many cases, there are no treatments for these side-effects. Social factors like an aging population, increasing pressure to stay in the workforce and spiraling healthcare costs further underscore the need to help patients, their families, and their providers to manage treatment-related symptoms during and after cancer treatment.

Noah, Sarah and Christine will join the call for a roundtable conversation about the challenges of cancer treatment and what "embracing a complexity perspective" might look like in the everyday care of cancer patients. Please bring your voice and your own experience to this important conversation. Read the guests complete bios.