Thursday, January 17, 2013

The Poop

I admit that sometimes I get pretty excited about weird things, and people look at me funny.  That's cool.  There's no accounting for taste, right?  But when I say that the paper I'm about to describe is FASCINATING, I hope you'll bear with me and perhaps even share my excitement.  Because this paper really is awesome.

A new study published in the New England Journal of Medicine describes the results of human fecal transplants.  Yes, you read that right, fecal transplants.  As in, taking someone's poop and putting it in someone else's intestine.  That kind of fecal transplant.  The LA Times describes it this way:
The remedy was made by combining freshly excreted stool from a healthy donor with a pint of lightly salted water. After stirring and straining, the concoction was delivered through a nasal tube that snaked down to the first section of the small intestine, bypassing any opportunity for patients to taste or smell the solution.
Why in the world would someone do that, you ask?  That's a legitimate question.

Creationist biologist Joe Francis, at the Master's College in California, has long proposed that God created macroorganisms (those you can see) to live in a complex partnership with microorganisms (those you can't see).  Joe thinks that the relationships between macro and micro are essential to the health of both types of organisms, so without the proper balance of relationships, things can go really wrong.  It's all very reflective of the communities that God has created us to live in: family, friends, church, etc.  Ultimately, I think it's also reflective of the Trinity.  (Joe is going to LOVE this paper.)

The problem being addressed in the NEJM study is recurrent intestinal infections by a bacterium called Clostridium difficile.  C. difficile is a hardy little bug that produces toxins in the intestines and causes cramps, fever, and diarrhea.  The elderly are especially vulnerable to infection and in some cases even die because of it.  Standard medical treatment is antibiotic.  Kill those bugs, right?  That's how we've come to think about disease over the past 150 years.  Germs are bad, and they make us sick.  The solution is to kill them.

But what if the problem isn't the infection itself?  What if the problem is that we're infected with the wrong germs?  What if infection is all about an imbalance in an otherwise helpful community of microorganisms that are supposed to ward off bad infections and keep us healthy?  What if there was a way to transplant good microorganisms to sick people?  Good microorganisms that could fight off or help control the bad microorganisms?  Would that be any more effective than the traditional use of antibiotics?

In the NEJM study, 43 patients with C. difficile infections were divided into three groups.  The first group was treated with antibiotics.  The second group was treated with a lavage (flushing out the contents of the intestines) and antibiotics.  The last group was treated with a lavage, a short regimen of antibiotics, and a fecal "infusion" from a healthy donor.  The results were mind blowing.  Less than a third of patients treated with traditional antibiotics were cured (with or without the lavage).  In contrast, 81% of patients receiving a single fecal transplant were cured.  With two fecal transplants, the cure rate rose to 94%.

Joe and I have long wondered if creationist insights might lead to better treatment of disease, but we were both sort of baffled about how to make microbes fight other microbes.  Well, this is how it's done, at least for now.  (Before you complain, I do recognize that this research was not inspired by creationist ideas, but I nevertheless think that this treatment is far more consistent with a benign creation that we are called to care for than treatment with antibiotics that will harm other organisms.)

In the future, researchers will certainly be focusing on what exactly is in the poop soup that provides these amazing restorative benefits. That will help take some of the stigma away from "fecal transplant," and should make the entire process more precise and perhaps even more effective.

See?  Isn't God's creation amazing?  Who would have ever guessed that poop would be good for you?

Van Nood et al. 2013. Duodenal infusion of donor feces for recurrent Clostridium difficile.  NEJM DOI: 10.1056/NEJMoa1205037

Feedback? Email me at toddcharleswood [at] gmail [dot] com.