Worth Reading: Autopsies, fecal transplants, and the marriage economy

A few of the recent pieces I've liked:

Vanessa Veselka at The Atlantic: In the Wake of Protest: One Woman's Attempt to Unionize Amazon

Marshall Allen at ProPublica: Without Autopsies, Hospitals Bury Their Mistakes

Maryn McKenna at Superbug: Fecal Transplants: They Work, the Regulations Don't

Jonathan Cohn at The New Republic: Ron Wyden, Paul Ryan, and the Future of Medicare

Shankar Vedantam at NPR: Marriage Economy: 'I Couldn't Afford to Get Divorced'

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Re: fecal transplants, it seems to me that part of the problem is that each patient treated gets a different treatment. That is, the donor of the feces is chosen based on who is "close" to the recipient, and so each recipient gets a different cocktail of bacteria (and possibly viruses and whatnot). Unless we were to come up with a standard "payload" for these transplants, I don't see how smallish studies can be generally reliable.

By Robert Thille (not verified) on 20 Dec 2011 #permalink

Re: 1: is medical statistics so weak that it can't cope with the donor being an arbitrary healthy person from the same area, probably someone known to the recipient? The statistical analysis should inform the science but not drive it.

I think it sounds great: just reading the headline I'm sure I wasn't the first person to think "that sounds like idiotic woo" but then it became immediately obvious that the aim is purely to re-establish the healthy gut flora using donor material. As I guess it is a fairly safe procedure, surely it doesn't matter if it's non-standardized material?

Cheap, safe and generally effective: sounds a good procedure. There's a lot of room for procedures like that.

There are other non-standardized materials that patients get from donors. For blood, there are donor requirements and screening, and the blood is only given to donors of the same type. I could see fecal donations being screened for the most virulent bacteria that are circulating in a given area.

It would be great to have a large clinical trial of fecal transplants, and that would require the investigators to come up with a standardized intervention (at least in terms of the amount of material and how it's administered) and inclusion criteria for subjects. So far, it seems to have been administered only to people who are desperate because none of the conventional therapies has worked, and it might be hard to get enough participants if such patients are the only ones eligible. This will require someone to make a judgment about whether fecal transplants are more or less risky than a course of, say, high-dose vancomycin, which can have terrible side effects.

The fecal transplant story is interesting if you can get over the ick factor, but I have to dispute that idea that "feces can't be monetized".

Whether it's based in good science or not, probiotics via the other end has already been monetized by the yogurt industry.

It seems to me that fecal transplants are a decent analogy to herbal supplements. It's a relatively crude and uncontrolled approach with no control on or good idea of what you're really getting (good and bad) and in what amounts.

Assuming the concept is scientifically valid, I see the potential for a pharmacognosy approach to beneficial gut flora. A pharmaceutical company could work to identify, culture, and commercially produce mixtures of beneficial bacteria strains for implantation rather than just transplant fecal material of unknown and uncontrolled compositions.

If we could grow new livers in a lab (at a competitive cost), we'd probably be doing that rather than continuing to do transplants.

Scientifically, I question the plausibility of just implanting/transplanting flora into a gut eco-system and expecting the flora to establish themselves and crowd out/ displace the already firmly established flora present. It's not always as simply as buying a cat to control the over-population of mice, and sometimes you end up with a cat problem.