Map of life expectancy at birth from Global Education Project.

Tuesday, August 30, 2016


Clostridium dificile is a bacterium which is an opportunistic pathogen in humans. Specifically, it infects the intestines and causes severe diarrhea, which can be fatal but is always indescribably unpleasant. Much C. dificile is now antibiotic  resistant as well.

For the medical industry, additional bad news is that it is mostly iatrogenic. While community acquisition occurs, the most likely way to get C. dficile disease is to be in the hospital, wherein it lurks, and to receive a massive antibiotic bomb that wipes out our normal intestinal microbia. C. dificile then moves into the abandoned territory.

What to do? How about restore the intestinal microbia. How to do that? Well, don't think about it too hard. What you need is a shit enema. So that's what they are doing, and it works. Adding to the unpleasantness, if you have recurrent infection it works much better to use donor poop than your own, which obviously has not been up to the task. (You may only be able to read the first paragraph.)

I note this not to gross you out, particularly, but because it points as dramatically as possible to our evolving understanding of ourselves not simply as clonal colonies of eukaryotic cells derived from a single zygote, but as ecosystems including not just those, but also a much larger number of prokaryotic organisms. Our eukaryotic genome has co-evolved with the rest of the ecosystem such that it supports beneficial  symbionts that not only are essential to digesting our food but also protect us from unfriendly organisms and quite possibly do other stuff we don't yet understand.

That doesn't mean that the stuff you buy at the GNC that purports to be probiotic will actually do you any good. We're still just beginning to figure this out and  come up with evidence based interventions. But it will become a bigger deal in coming years, I hereby predict.


robin andrea said...

My sister picked up C Diff after an overnight stay at the hospital for a severe migraine, nearly a year ago. She has been dealing with repercussions from that ever since. We have talked about the possibility of a shit enema, but for now she is too squeamish to consider it. Makes me wonder if I would do it, and what I would want to know about the donor. Who donates shit?

Daniel said...

Off topic, but what is your opinion of the health care market place and the trend of insurance companies dropping out? It seems to me the same old same old, i.e. cherry picking by insurance companies in how they pool their risks.

Cervantes said...

Hi Daniel, I think that the lack of competition on the exchanges in some markets is a problem, but so far the ACA is holding up reasonably well. The obvious fix to the problem is the public option, but unless the Dems can take the House and Senate, that isn't likely to happen.

The real fix is single payer but that's even farther out into fantasyland.

Cervantes said...

RA -- I'm not sure you need permission to harvest feces. I expect hospitals have plenty of it from people who have healthy intestines, but need to use a bed pan for other reasons. Hopefully, eventually they'll sort out what specific microbes you need and they can just add those, instead of the whole ecosystem, but for now, that's what they have. You can tell your sister it works very well, anyway.

robin andrea said...

Cervantes-- Holy shit, no permission? Harvested in hospitals? That sounds particularly creepy to me, and I'm not sure why.