Fecal Grappling


The FDA is such a pain in the ass (pun intended) when approving new treatment modalities.  Fecal transplants may be gross but are a low-cost treatment for a life-threatening infection that could cure up to 90 percent of patients with minimal side effects, often in a few days.  Yet the FDA rules that it doctors could only perform transplants under an FDA-approved research application. This stalemate is going on way too long.  This was the headline, from Fox News, that got me thinking:

FDA grapples with oversight of fecal transplant

So, that is my answer.  Let’s have the members of the FDA go against the researchers in fecal transplants in a grappling match in…..stool.  Kind of like mud wrestling.  Call it fecal grappling.  To the winner goes the spoils, so to speak.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Fecal Grappling

  1. Michael Gorback
    July 2, 2014 at 2:36 pm

    Not to mention the transplants being done for inflammatory bowel disease.

  2. Robert
    July 2, 2014 at 11:24 am

    So from the Fox News article
    The FDA IS CONCERNED this new drug is Sh*t !!!
    Sounds like some bodies been reading overdo$ed America by John Abramson MD
    Maybe the FDA needs to be more like the Federal reserve ?

    • July 3, 2014 at 12:09 am

      “Maybe the FDA needs to be more like the Federal reserve ?” No, the Federal Reserve produces what the FDA is trying to regulate here.

  3. Branden
    July 2, 2014 at 10:54 am

    I agree this is a short term problem and the restrictions are overbearing. Some of the concern is that they are being applied not just to C.diff but other indications where the evidence is less well established. But this will be a short term problem. Defined culture extracts that have shown equivalence to stool transplant without the theoretical infection risk in small studies will soon come to market.

  4. June 30, 2014 at 9:23 am

    Ah, the inglorious poo! If I might, I would like to use the most accurate term possible, in keeping with the tradition in medicine to name things most correctly and succinctly. Please excuse me, Francophiles, in using the sturdy term “shit” from the old Anglo-Saxon language. It was once the workhorse term for fæces, before the Norman Invasion of 1066; let’s set aside history and culture and focus on the problem.
    During the Cambrian Era, and the remarkable evolution of life, the proposition was brought forth of one-way alimentation. Evolutionarily, alimentation predated mentation by many millions of years. Perhaps even before the Cambrian, 558 million years ago, the adaptation of deutorostomy evolved. Voilá! Shit.
    To race forward a bit, we note that the alimentary tract is not sterile. It has a certain flora of prokaryote critters which offer us commensal support. The pediatric literature now asks how the fetus, born of an apparently sterile womb, becomes rapidly populated with the appropriate colonic bacteria. The discussion of the brief transit through the birth canal and crossing the perineum has led to the suggestion that this offers the seed bugs from mom. It may, in fact, be a more complex process than this, giving the newborn a population of safe coliforms to coexist with.
    Our malady in 21st century America is that we have lost our shit, and I will stick with the literal use of the term. We have epidemics of persons harboring bad bugs in their colon. Killing off commensals with antibiotics and suchnot is a common cause of hyperproliferation of a niche species into dominance, one that may not be beneficial as a colonic population.
    As a public health matter, we try to avoid sick shit. The Broad Street Pump study in London was a key study ushering in modern epidemiology. V. choleræ is a notoriously wimpy threat to humans – it must be ingested in such massive amounts to cause cholera, that the water must be turbid with shitbugs – about a hundred million are needed to get a good rolling cholera infection going. Don’t drink cloudy water, and you can avoid the weenie bug V. choleræ.
    I propose that we have overreached in our coprophobia, and have fled from healthy shit. As we saw above, deutorostomes are always around their own shit, and we humans have been dealing with the twin challenges of agriculture and shitting for a long time. Shit is fertilizer – some brilliant cousin discovered this before the dawn of recorded time, the idea landed on him – like Newton perhaps – that shit made crops grow better.
    Our species has been crapping on its crops ever since then. Some of the root crops, like potatos, can carry bacteria not only on the surface, but also internally – without the appearance of damage to the plant. Normal human farming may just be a cycle of recolonization with healthy stool bacteria, from farm to food to fæces.
    Until the Victorian brownophobes came in, and banned shit from our crops, the healthy shit as well as the sick shit. There must have been a Neolithic protocol that only the healthy can shit at the farm.
    But now we have interrupted the cycle, allowing – at best – other mammals and avians to fertilize our crops with their shit, which also has been laden chock-full of antibiotics and other stuff in their feed; and the shit carefully processed to eliminate Coliforms, which are somehow the banner of the enemy.
    Consequently, we have developed this new malady of dyspopulation of the human large intestine with the wrong kind of shit, the shit that kills people. Most people have healthy shit, some have sick shit – we shrug our shoulders and don’t know why. But shit transplants are all the rage, to repopulate the sick colon by tubing in rescue bugs.
    The real solution is laughably simple – allow the chronically ill to try eating normal regular old vegetables that have normal regular old human shit used as fertilizer. I’m sure that a few days floating in a bucket in the backyard would break up the stool but still leave a hearty proportion of miracle dung bugs to do their trick. Grow potatos – grow leeks. Radishes – underground vegetables, whatever. I’m sure that the process of evolution of agriculture selected for the ones with the proper lectins to adhere to healthy bugs, and even internalize them, as potatos do.
    Can you imagine the giant furor this would raise with the FDA and HHS, and every other alphabet agency in Washington? I’m sure that commercial sales of HSG (human shit-grown) vegetables would be scrutinized far in excess of GMO (genetically modified organisms.) There must be laws – felonies! on selling tubers grown in people shit.
    I foresee a hilarious world like Prohibition – speakeasies that allow you to eat a salad made of various vegetables (washed, of course, duh!) made of shitgrown vegetables.
    And perhaps ill persons could have a “dinner party” with healthy guests, who could, out of courtesy, dump in a bucket in the back yard – all hush-hush, of course. Save the sick friends by having a free squat in the bucket!
    That would happen before the bureaucrats would allow it. They won’t give up their turds until we pry their cold dead hands from it. Ick.

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