Low-Hanging Poop

Clostridium difficile causes a potentially serious kind of diarrhea triggered by antibiotic treatments. When the normal bacterial flora of the colon are hammered by a broad-spectrum antibiotic, C. difficile often takes over and causes real trouble.  Mild cases are treated by discontinuing antibiotic therapy, which often works: if not, the doctors try oral metronidazole (Flagyl), then vancomycin , then intravenous metronidazole.  This doesn’t always work, and C. difficile infections kill about 14,000 people a year in the US.

One recent trial shows that fecal bacteriotherapy, more commonly called a stool transplant, works like gangbusters, curing ~94% of patients. The trial was halted because the treatment worked so well that refusing to poopify the control group was clearly unethical.  I read about this, but thought I’d heard about such stool transplants some time ago.  I had.  It was mentioned in The Making of a Surgeon, by William Nolen, published in 1970. Some crazy intern – let us call him Hogan – tried a stool transplant on a woman with a C. difficile infection. He mixed some normal stool with chocolate milk and fed it to the lady.  It made his boss so mad that he was dropped from the program at the end of the year.  It also worked. It was inspired by a article in Annals of Surgery, so this certainly wasn’t the first try.  According to Wiki,  there are more than 150 published reports on stool transplant, going back to 1958.

So what took so damn long?  Here we have a simple, cheap, highly effective treatment for C. difficile infection that has only become officially valid this year. Judging from the H. pylori  story, it may still take years before it is in general use.

Obviously, sheer disgust made it hard for doctors to embrace this treatment.  There’s a lesson here: in the search for low-hanging fruit,  reconsider approaches that are embarrassing, or offensive, or downright disgusting.

Investigate methods were abandoned because people hated them, rather because of solid evidence showing that they didn’t work.

Along those lines, no modern educational reformer utters a single syllable about corporal punishment: doesn’t that make you suspect it’s effective?  I mean, why we aren’t we caning kids anymore?  The Egyptians said that a boy’s ears are in his back: if you do not beat him he will not listen. Maybe they knew a thing or three.

Sometimes, we hate the idea’s authors: the more we hate them, the more likely we are to miss out on their correct insights. Even famous assholes had to be competent in some areas, or they wouldn’t have been able to cause serious trouble.

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63 Responses to Low-Hanging Poop

  1. Sandgroper says:

    You’ve just put me off my chocolate milk.

    I don’t have a problem with belting people, though.

  2. d0jistar says:

    Let’s all keep it clean despite the strong temptation to turn this into a pun thread.

    First of all I’m tempted to say there was minimal push done to approve bacteriotherapy because it’s probably not something that’s patentable and enforceable like a drug product so there’s no vested interest group in pushing it. I mean, apart from doctors who care and dying patients, but, whatever, they wield no clout.

    I also wonder if bacteriological transplants for the stomach or intestine could help those with digestive problems caused by nuking their friendly bacteria with broad spectrum antibiotics. But I’m sure Big Pharma would prefer you to take an expensive pill instead — I mean, another one, in addition to the expensive antibiotic you just took that caused this problem.

  3. Poop enemas seem to work, so no need for chocolate poop milkshakes. More broadly, there is also a “snoot” element: an assumption that a complicated disorder must require a complicated and expensive treatment. Call it the Unjust World Hypothesis. For example, what doctor nowadays would feel useful to recommending low dose aspirin for cancer? It seem too simple. Doctors are uncomfortable doing anything contrary to what they were taught in medical school, so real medicat progress usually takes about 30 years. As to education, payment to teachers in state systems is not on the basis of results. One London private school tried it, and found it very effective. When the poorly paid temporary teaching assistants were offered a bonus for the number of their charges who could achieve specified scholastic targets, attainments improved rapidly.

  4. aisaac says:

    I had an anthropology class once where one of the assignments was to go to the zoo and observe tthe chimps for several hours. The professor said she’d know if we made something up based on what we’d seen on the discovery channel.

    It turns out that chimps spend most of their time shitting in their hands and passing it around and nibbling on it like it was a joint.Maybe that’s a pathological artifact of living in a zoo, or maybe they know something we don’t. They’re certainlynot the only animals to engage in coprophagy. And they didn’t even have c diff.

  5. Garvan says:

    “Along those lines, no modern educational reformer utters a single syllable about corporal punishment: doesn’t that make you suspect it’s effective?”

    No doubt it is effective, when it is deserved, and administered by calm, emotionally stable, professionals. But that is not how I remember corporal punishment at school. I never minded getting in queue to recite my tables where the punishment for a wrong answer was administered by a leather strap. But I did mind it when teachers lost their tempers.

    Garvan

  6. rightsaidfred says:

    that is not how I remember corporal punishment at school

    In part here is the nature of modern bureaucracy: if something worked somewhere once, then it must be tried everywhere all the time. So the bureaucratic sadist in a school setting is caning everyone constantly until moral improves, and such a person would no doubt prescribe “chocolate” milk for every meal for everyone. We recoil at the specter of overuse.

    • peppermint says:

      You know they’re not going to use corporal punishment in a disproportionate manner against the identifiable demographic groups which are disproportionately causing trouble. This is already a scandal with mere suspension as punishment.

      I’d like to see them write down as policy exactly how hard you get beaten for hatespeech versus theft, or what quota of one group you must punish to be able to punish another.

  7. dearieme says:

    “solid evidence”: oh dear, the standard of jokes around here …..

  8. IC says:

    Shit and stick are good for you.

  9. IC says:

    Pain associated with stronger memorization: good for education. It is natural for animals to memorize traumatic event to survive.

    Clostridium difficile infection is mostly a complication of broad spectrum antibiotic. Yes, wipe out good germs to make room for bad germs. The answer is obvious.

  10. Anonymous says:

    If you were suffering from refractory C-Diff you would welcome a fecal transplant. I recently learned about fecal transplants because a friend’s 17 year old son was facing a colonoscopy as a result of C-Diff gone haywire. A physician at UNC Chapel Hill performed the fecal transplant which did the trick. They are also doing them at mayo.
    The FDA and Big Pharma lobbying groups can not stop stories of successful DIY FTs from getting out. Obviously no one can stop you and if you are sick they aren’t that disgusting…give me a break. Thank God for the internet.

  11. anneallen says:

    NPR did a piece on fecal transplants a few months back. The cat is out of the bag. If you search the web you will find reports of successful DIY fecal transplants that people have preformed on themselves when they could not find a willing physician. Some of the report miracle like cures – and the procedure is simple.
    If you suffer from refractory C-Diff you will welcome a fecal transplant.
    My friend’s son was fortunate to undergo a fecal transplant at UNC Chapel Hill hospital. His gastroenterologist has been involved in FT studies which show incredible success rates. He said they are now doing them at MAYO. The FDA and Big Pharma lobbyists can’t stop the good news from spreading…thank God for the internet.

    • I work at a hospital, and those who have shared that experience know that there are always numerous encouraging medical facts and posters in the restrooms. Fecal transplants for c-diff are mentioned on the newer posters. The blender that is the side-illustration is a bit unnerving, however.

  12. Greg Pandatshang says:

    We don’t cane children (as much) any more because it is sadistic and produces children and adults with neuroses. I think people beat children a lot in the post-agricultural/pre-modern era because having neurotic adults was less bad than having adults who were not tamed to fit into the incredibly strict social hierarchies that prevailed at that time.

    That said, I’m less concerned in principle about corporal punishment in a classroom setting, because the emotional bond that’s being abused isn’t as serious as the parent-child relationship; a public, rather than private, setting. Even better if corporal punishment is administered by a vice-principal or other disciplinary specialist rather than by the teacher (this dovetails with a point Steve Sailer often makes – and you wonder how everybody else avoids noticing it – that school discipline should be handled by specialists who are good at it, and teachers should be people who are good at teaching rather than good at discipline). I say “less concerned in principal” because, like Garvan, I’m doubtful that corporal punishment would be executed well by the average bureaucratic school system; it could easily and quickly devolve into blatant sadism.

    I have no problem with using corporal punishment on adults if it works to control crime. Corporal punishment strikes me as a much more civilised approach to social control than prison, which is usually a bad idea and at worst is a Salò-esque horror story. The social norm that corporal punishment is sometimes okay for children but never okay for adults seems pretty messed up to me.

    • Magus Janus says:

      do you have any solid empirical evidence on the so-called neuroses caused by corporal punishment?

    • IC says:

      Psychopaths are immune to corporal punishment as decribed by researchers. Basically psychopaths display no sense of fear due to impaired amygdala in research finding. No surprise that criminals have higher percentage of psychopaths than general population.

    • feministx says:

      Yes, fecal transplants and corporal punishment are not similar because though some few doctors and homeopathic practitioners may have come upon fecal transplants’ effectiveness, it was basically a secret to humans until recently. All societies are familiar with the nature of corporal punishment. We have all used it for thousands of years and only stopped recently because we decided it was cruel and unfair.

      I agree. Corporal punishment is cruel and heavily prone to misuse. People that work in schools are not infallible. Often they become bullying themselves and pick targets based on their own biases. No young person deserves to be assaulted because someone has it out for them.

      Have you ever had a bad boss? How about one of those female bosses that became passive aggressive and slightly abusive if your timecards didn’t get done on time or some other such beaurocratic crap? Would you like it if they had the authority to hit you just because they had some level of authority over you?

      Some ideas are unpopular because our society rightly rejected them as it advanced past the enlightenment and through a democratic civil society. We do not need to be relativists and waste time giving serious consideration to societal policies that seem morally repugnant. That is not at all the same thing as making sure to consider all possible ideas for scientific and technological merit.

      • Toddy Cat says:

        Admittedly, FemX, corporal punishment can be cruel, and is prone to misuse, but so is any form of punishment, and there is nothing to say that we have it right now. Personally, I would rather be smacked occasionally than emasculated, drugged, and suspended from school for making “bang-bang” noises with my finger. I’m old enough to remember corporal punishment in schools, so I’m not just talking, here. Modern people seem overly horrified by any sort of physical violence, and not horrified enough by the nightmare of being caught up in the toils of an eternal, seemingly omnipotent bureaucracy. The old regime of school discipline was certainly not perfect, but what we have today seems a lot worse. Individuals can certainly be cruel, but they are nothing compared to “Due process”.

      • feministx says:

        “The old regime of school discipline was certainly not perfect, but what we have today seems a lot worse. Individuals can certainly be cruel, but they are nothing compared to “Due process”.”

        I don’t understand how due process can be worse than relying on the tempers of individuals. One of the premises of western civilization is that justice is not served by granting authorities the right to hand out punishment as they choose.

  13. Douglas Knight says:

    Education reformers don’t spend any time condemning corporal punishment because they aren’t aware that it’s still common in American schools. If you could convince them of that, you could probably get a grant to study its correlates with performance. But that’s a big if.

  14. Dahlia says:

    It will be interesting to see what all it can cure. Sufferers of Crohn’s are reporting that it helps them a lot. It seems like it would help anything gastrointestinal. Parkinson’s is the latest I’ve heard it helps; I had some vague idea that it was just a neural disorder.

    Yeah, the ick factor. Also, there’s asking someone for a “donation”. I’ve offered to help the family members on my mom’s side more than once by offering one of my kids (and I’ve got this idea that the skinnier and healthier, the better), but no takers thus far. I nearly lost my mom to colon cancer when she was 52; my aunt isn’t even 60 and she’s not long for this world; any my uncle died from Crohn’s earlier this year at 61 or 62.

  15. ironrailsironweights says:

    Looks like the actresses in 2 Girls 1 Cup never have to worry about Clostridium difficile.

    Peter

  16. Pingback: Another Map of the American Nations: School Corporal Punishment | JayMan's Blog

  17. JayMan says:

    On the school corporal punishment thing, there is a predictable regional breakdown in the country:

    Another Map of the American Nations: School Corporal Punishment | JayMan’s Blog

    I suspect how useful it is varies according to where you are; or more specifically, whom you have in your schools. A bunch of wild Southern Whites or people of color, and you might need to use it. Rural Minnesota, not so much…

  18. melendwyr says:

    It’s not difficult to work out the blind spots in the human capacity for evaluation. What’s significantly harder is applying that reasoning to your own beliefs and thinking habits. The very hardest part is recognizing and accepting that everyone has these blindspots, even ourselves. I doubt anyone really ever completes that stage. There are always new forms and new approaches for us to camoflauge our delusions from ourselves.

    When people are not motivated to investigate, they’re likely to miss things. When they are motivated to not investigate, they’re likely to miss things. The absence of motivation, or the presence of contrary motivation, can take almost unlimited forms in theory, but in practice it’s fairly straightforwardly related to the various features of a situation.

    Unfortunately, when we can find low-hanging fruit that hasn’t been picked, it usually turns out that there are powerful forces keeping it that way. Not usually an actual conspiracy, but the masses prejudices and desires of many people.

  19. a very knowing American says:

    Along these lines, let me suggest a treatment for couples with fertility problems due to the husband’s low sperm count:

    It is plausible (not certain) that human males vary their sperm production in response to indicators of sperm competition. So the experiment would be for the husband to watch his wife having enthusiastic sex with somebody else — the somebody else would use a condom obviously — after which the husband would take over. This might solve the sperm count problem, although I can see that there might be undesirable emotional repercussions.

    Any volunteers, for any of the three roles?

    • peppermint says:

      okay, but sperm production takes a while. so wait a day or two.

    • Greying Wanderer says:

      You might not need to do it for real – just picture it, and if you didn’t like to picture a man the response might trigger if you pictured a woman instead even if that made no sense from a fertility angle. Free viagra / fertility treatment if it worked.

  20. SMERSH says:

    http://www.myfoxny.com/Story/23600644/pills-made-from-poop-cure-serious-gut-infections

    Somebody created a pill with the bacteria only, none of the feces.

    Certainly seems like something that could have been done (and monetized) earlier than it was.

  21. mindfuldrone says:

    It turns out that cesarian sections can deny the child the mothers bacteria–with consequently similar problems.

    • Greying Wanderer says:

      Anyone ever studied the percentage of gay caesarians?

    • sfer says:

      Some doctors swab the c-section baby with the mom’s vaginal secretions right after they are born. Good idea to get your doctor to do this if your kid is being delivered with a c-section. Otherwise the kid will be colonized with bacteria from peoples skin.

      • anonymous says:

        “…Some doctors swab the c-section baby with the mom’s vaginal secretions right after they are born…”

        Sooo….. if the appropriate beneficial bacteria can be obtained by vaginal secretions, why bother inflicting stool-ingestion protocols on c-diff patients? Direct oral consumption of vaginal secretions is far more enjoyable, and there will be no shortage of willing female donors…

  22. j mct says:

    I’m not sure if pure disgust might not stop someone doing a fecal transplant but one might want to consider what might happen if it didn’t turn out to work, or it had some bad side effects. Jay Leno would be telling a ‘what were they thinking’ or ‘what kind of guy do you have to be to think this is a good idea’ jokes on the tonight show specifically about you. One could very well look like, well you know what. The possibility of being a major laughingstock might have been a deterrent.

    Per corporal punishment, though doing it might make some a bit squeamish, I think the rub lies in quotes about what sort of kids the educators were using it on were talking about, as in boys. The present day American school is not designed to teach boys, it is designed to teach girls. If a boy can and does learn in the school, as many of them do, the teachers will not go out of their way to stop them, which is kind of nice I guess, but coming up with an optimal learning environment for boys isn’t something anyone in education is even remotely interested in.

    I do not know this from personal experience, but from all my older relatives’ tales about catholic school in NYC from the 40’s and 50’s, nuns used rulers to cure ADD, maybe a yardstick for the tough cases, and had close to a 100% success rate. We don’t that anymore, we dope them up instead with psyche altering drugs like Adderall, because we’re more humane.

    • Don’t think we cured them. The better-controlled boys sitting next to those whapped may have had some spillover benefit. It may have been a superior intervention. But we need numbers, not anecdote and reverie.

    • Greying Wanderer says:

      “about catholic school in NYC from the 40′s and 50′s, nuns used rulers to cure ADD”

      I think there’s a lot of truth in that. Personally i couldn’t sit still indoors until i was about 42.

      It’s often abused of course so in my ideal world there’d be special schools for boys like that instead where you’re oudoors all the time and they teach you how to weld a cannon out of scrap metal like that redneck science TV show.

      • Greying Wanderer says:

        nb Ths wouldn’t necessarily mean a non-academic education eventually. The ideal (imo) would be you’d keep them in school long enough to learn how to read and add up then send them to the outdoors build your own hovercraft school (with air cannon that fired 2 by 4s so they could have battles on the lake) until they were around 15-16, then draft them into the technical branches of the military until they were around 24-26 or so and starting to calm down and then they’d go back to school and come out with an engineering degree in their early to mid 30s.

        I think that process would create world class engineers.

  23. j3morecharacters says:

    Fecal transplants: My daughters were doing it all the time in the kindergarten. They ate soil too.
    Canning: Victorian schools were into it, producing generations of Englishmen with a taste for corporal punishment.

  24. Toad says:

    Coproral punishment?

  25. Mike Johnson says:

    Fecal transplants can cure specific, life-threatening infections. Can they also treat chronic GI conditions? I’m assuming so. Can they also help chronic conditions in general? Maybe. Gut flora seems to have some pretty serious reach.

    And somewhat off-topic, the NYT has a pretty good post about chimerism. http://www.nytimes.com/2013/09/17/science/dna-double-take.html
    Soft evidence for the ‘vanishing twin’ hypothesis of homosexuality, perhaps.

  26. feministx says:

    “Along those lines, no modern educational reformer utters a single syllable about corporal punishment: doesn’t that make you suspect it’s effective? I mean, why we aren’t we caning kids anymore? The Egyptians said that a boy’s ears are in his back: if you do not beat him he will not listen. Maybe they knew a thing or three.”

    In Egypt and areas that surround it, they also believe that beating your wife is an effective way of keeping her obedient.

    “Sometimes, we hate the idea’s authors: the more we hate them, the more likely we are to miss out on their correct insights”

    In the muslim world, their insight about the efficacy of beating your wife might well be accurate. Beating her really might make her more obedient than she would be if there were no threat of violence.

    And so? How long should we dwell on whether their insight is correct or not?

    • Greying Wanderer says:

      @feminsitsx
      Replying to a post in a previous thread

      “GW, I am replaying the scenario with the police actually responding and taking the fellow to jail. This is what I wished happened.”

      Good plan, also worth remembering that public space is no-one’s specific terriotory whereas private space is so in a situation like that if you go into a preferably expensive store and stand right by the manager they’re guaranteed to do something as it’s their terriotory and if the cops have a specific location like a store they’re more likely to come.

    • Sandgroper says:


      Obviously a young inexperienced girl – she should have just cracked him a couple of real good ones, and then taken off before some busybody called the cops.

      • Greying Wanderer says:

        You have to take average physical size into account though. My wife has hit me 100s of times while on her period and it just bounces off. If i’d hit her the same number of times with the same intensity she’d be long-dead.

        Also worth noting that as soon as one person stepped up a cluster formed almost right away.

    • The fourth doorman of the apocalypse says:

      Perhaps it is worth noting that a mother who has sons and daughters in that environment would, rationally, want her sons to beat their several wives and her daughters to find enlightened husbands who do not beat their wives.

      • The fourth doorman of the apocalypse says:

        Actually, I revise my comment. Mothers probably want their daughters to find husbands who beat their wives just like all the other men who contributed genes to them.

        This is because culture is strongly dependent on genes and genes adapt to local culture. Any change in the culture puts those holding genes well adapted to that culture at risk of not being passed on to the future.

        You seem to be able to string words together but the ability to think seems lacking.

      • feministx says:

        “You seem to be able to string words together but the ability to think seems lacking.”

        That’s your response to me asking you “why”

        Dude, you’re the one who made a statement and subsequently retracted it upon being questioned. How exactly am I lacking in the ability to think by questioning a statement that you yourself thought was inaccurate?

  27. albatross says:

    feministx: I imagine beating people when they disobey you is a pretty good strategy for getting them to so what you say all around. There are some obvious downsides (you have to sleep sometime. sullen compliance to avoid punishment may not be quite what you wanted, someday your kid will be bigger and stronger than you and have a score to settle), but it surely works.

    • feministx says:

      I agree. It probably works, at least for the short term, but it may cause longstanding mental issues.

      • neilfutureboy says:

        As the example of nuns using rulers on recalcitrant teenage boys shows once you have canalized thought process early they stay that way. Military discipline works on the same process.

        I understand that some women actually enjoy being spanked. This does sound very much like the effect of 10s of thousands of years of genetic pressure. Does anybody know if bonbono ladies have the same predeliction.

  28. Greying Wanderer says:

    off-topic but related to a previous post about food storage (been reading tacitus again)

    http://www.ourcivilisation.com/smartboard/shop/tacitusc/germany/chap1.htm

    “They have also the habit of hollowing out caves underground and heaping masses of refuse on the top. In these they can escape the winter’s cold and store their produce. In such shelters they take the edge off the bitter frosts;”

  29. Jim says:

    feministx – Stalin used this strategy. It didn’t seem to cause him any mental issues at all.

  30. agnostic says:

    All we are saying, is Give Poop a Chance.

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