When I was cutting my teeth in the pharmaceutical industry, I worked a lot in Infectious Disease. It was a great therapeutic area to be in — working on antibacterials had a real “Us vs. Them” dynamic that you could embrace, as opposed to working in oncology, which has a “you vs. screwed-up you” downer embedded in it.
So, as I was scanning the science headlines the other day, I did a doubletake when I saw “Clinical Trial Shows How Well Fecal Transplants Work”.
I’m sorry. Say again?
As it turns out, this is not a headline from The Onion, but one sourced from no less than a recent New England Journal of Medicine article and commentary about a clinical trial designed to test how well fecal microbiota transplantation (FMT) compared to the last-ditch antibiotic vancomycin when treating patients with relapsing pseudomembranous colitis due to Clostridium difficile infection — a condition that leads to chronic fever and diarrhea and can be life-threatening. The idea of FMT is to replace the colon’s “ecosystem” with healthy — errr — matter, which will then fight off the infection.
And as it turns out, FMT is pretty darn effective. More so than vancomycin (or vancomycin and colonic lavage, which is part of the FMT procedure). In fact, FMT was so successful that the monitoring board shut the trial down early because it began to seem unethical to randomize patients to the non-FMT arms of the study.
Interestingly, FMT has been known since the 1950s, but hasn’t ever really caught on as a treatment paradigm. Why? Well, mostly because it’s gross. I mean, I know we do transplantations and transfusions all the time, but can you imagine the conversation when this procedure was first proposed? In it the — err — donor sample is screened for unwanted parasites, diluted, strained, and given by a tube that snaked up through the nose and down through the stomach to the start of the intestine.
So, kudos for the team for not sticking their noses up (though maybe holding them) at an idea that while it has a fairly high ick-factor, may end up helping thousands of people.