Robert Hyde Sr. was first diagnosed with Clostridium Difficile, called C. diff, in 2013. He fought the infection, caused by a drug-resistant bacterium, for four years, vomiting almost every time he ate and suffering from debilitating diarrhea.
“This is a disease that I never even heard of, and yet I’m so sick. The doctor, before the stool test came back, told me that if something didn’t happen I was going to die,” said Hyde, age 77.
The spores are highly contagious and can live on surfaces for months. Robert and Nadine, his wife, used separate bathrooms and cleaned areas of their home each day with hospital-grade bleach wipes.
Hyde said this includes “bathrooms, door knobs, toilet seats, light switches, everything. And I am so afraid she is going to get it. I’m going to kill my own wife.”
The Centers for Disease Control and Prevention calls C. diff an “urgent threat to the United States.” The bacterium is estimated to cause half-a-million infections each year, killing tens of thousands of people within the first 30 days of diagnosis. The infection is more deadly than HIV/AIDS.
Doctors prescribed antibiotics for Hyde but the infection kept returning, mutating with each relapse and growing more resilient each time. The cost of Vancomycin, a standard antibiotic therapy for C. diff, was not covered by insurance, making their out-of-pocket costs $400 for a 2-week supply.
“We felt it was better to take care of burial matters because we thought Bob had little time to live,” Nadine said.
But then doctors suggested another treatment option. It’s called Fecal Microbiota Transplantation, or FMT.
Historical records show a similar practice was used as early as the 4th century by an alchemist named Ge Hong, who used “yellow soup” to treat patients with intestinal conditions.
Through an endoscopic procedure, human stool from a healthy donor is inserted into the colon of the sick patient. Transplants can also be done through an enema, or even given in a capsule form that is triple coated then swallowed. The healthy bacteria colonizes the colon, eventually killing the persistent infection.
Dr. Michael Lajin, Gastroenterologist and Intervention Endoscopist at Sharp Grossmont Hospital, said FMT has a 90% success rate for curing persistent C. diff infections.
“Fecal transplantation for treatment of C. diff can be life-saving, especially in people who have severe illness, severe colitis, and it can save them from death. It can save them from surgery where the whole colon has to be removed," Lajin said.
Dr. Fadi Haddad is an infectious disease specialist, also at Sharp Grossmont Hospital. He likens C. diff to weeds growing on a lawn.
“You can opt to kill the weed by giving it an antibiotic or by getting rid of the whole lawn and putting in a new lawn. And that’s what we’re doing,” Haddad said. “Rather than using a drug to target the bad bacteria, we can use bacteria to fight bacteria.”
But the use of FMT has been greatly limited.
In 2013, the Food and Drug Administration issued strict regulations on the use of fecal matter. Fecal matter, as it’s used in FMT, is defined as a drug under the FDA Glossary of Terms because it is used to treat and prevent disease.
The use of FMT first required an Investigational New Drug (IND) application to be used in FDA-approved clinical trials. But several months later, the FDA announced they would provide “enforcement discretion” in the case of C. diff patients not responding to standard therapy.
FMT could be used to treat C. diff without the restriction of an IND, with certain usage conditions. For Robert Hyde, this meant his insurance would cover the cost and the hospital would perform the procedure.
“When I had the fecal transplant in the hospital my bill was zero,“ Robert said.
Fighting the limits on FMT
Today the use of FMT remains controversial, especially among people who believe it should be used more broadly for conditions other than C. diff.
Joel Sprechman runs an intestinal health community resource called “One Great Gut” in San Diego. However, because he suffers from Inflammatory Bowel Disease, and not C. diff, he couldn’t get the fecal transplant in the United States that he believed would be beneficial.
“I love my country, but if I can’t get the treatment I need here, I have to go elsewhere,” Sprechman said.
He traveled to Australia where he received a series of 10 transplants, costing him more than $13,000, on top of travel expenses. He said he has never experienced such potent medicine so quickly. But the financial burden was too great to continue therapy. His condition worsened, at one point his weight dropped to 115 lbs. He said he imagined suicide.
“I’ve had many stool tests, just to see what’s going on to check it out. And every time I hope that I have C. diff because then I can get it paid for. I can get the fecal transplant, which can be very helpful. Fortunately, or unfortunately, I’ve never had C. diff,” he said.
A grainy ten-year-old video shows Dr. Mark Davis examining an elderly patient, complaining of stomach problems, in his Maryland practice. Before the FDA issued the new guidelines, Davis, a naturopathic doctor, used FMT for people with chronic intestinal conditions, including inflammatory bowel disease and irritable bowel syndrome.
He said he is no longer able to prepare or administer it for those patients, even though he said FMT is safer than any drugs and more effective.
In early 2018, he traveled to Baja California where he consulted at a retreat that offers medically supervised fecal transplants for patients who could not legally get them in the U.S.
“The people that go to these retreats are people who feel like they don’t have any other option, they are people who feel like they have tried everything in conventional medicine, and often people who feel like they have tried everything in alternative medicine,” Davis said.
At his practice in Maryland, the IBD Specialty Center, Davis said patients who could not afford retreats plead with him for help, in spite of FDA rules.
“I have had people try and bribe me, or say can we skirt the law somehow. I don’t love the law but I follow it,” Davis said.
He said there is something he can legally do to help patients who aren’t candidates for FMT in the United States and who can’t afford the high cost of an FMT retreat abroad.
“I say, ‘Hey look, is there somebody in your friend or family community who is healthy and we can screen to make sure they are really healthy, and who you can ask that weird question: Can I use your poop as medicine?.’ Then you can do it at home,” he said.
He provides a health questionnaire and writes laboratory orders to screen donors for illness. Once donors are cleared, patients can self-administer the transplant by following a step-by-step guide he supplies that teaches patients how to prepare the stool as an enema at home. He said “it’s not really harder than following most kitchen recipes at home.”
But some conventional clinicians argue this is not a safe option. Dr. Michael Lajin said rigorous trials are in place for good reason.
“I don’t think it’s a good idea to do it outside what’s approved by the FDA,” Lajin said.
“We have to go through vigorous and rigorous screening. So there are certain labs that screen the donors and they go through detailed history and they go through blood test and fecal test and less than 5% of donors are accepted.”
Other doctors argue there is not enough evidence that FMT is safe to use for any condition, except what is currently approved by federal standards. Dr. Fadi Haddad said using the treatment outside of classical textbook application could result in unintended consequences.
“We don’t have to rush to a conclusion by just saying that FMT works in every condition. We have to take our time and get the right studies, the right research, the right donors, the right bacteria, and make the right conclusions,” Haddad said.
Internationally, dozens of FMT clinical trials are being conducted for conditions that range from pancreatitis to anxiety. However, it could be years before FMT is approved in the U.S. for these and other conditions.
Mark Davis said FMT is in a state of limbo as it is classified as a drug but can never be licensed as such because the FDA requires every drug to be identical from one dose to the next.
“FMT is not that and it will never be that,” he said, “so they defined it as a drug but a drug that could never be approved.”
Davis said one solution, suggested by other clinicians, would be to reclassify it as a tissue, like blood or bone marrow — something that treats and prevents disease but is never the same in every batch. But, he said, since the product is not composed of human cells, but rather bacterial cells, it couldn’t be defined as tissue by the FDA.
“What I would like the FDA to do is to say, ‘You know what? FMT is not a drug, it’s something else’,” Davis said. “And we should classify it as its own unique thing and give clinicians some more latitude to be able to treat patients with a variety of conditions.”
This is in fact not new at all. It lives inside each one of us. KPBS reporter Maia Tribble see tells us how doctors are using human feces to save lives. >> So awesome, I am so happy to be here. >> It's not the typical sentiment when visiting hospital. >> But for Robert and Nadine height, it is for good reason. >> They are visiting the medical team, who helped save Robert's life from crippling bacterial infection. >> This is where I spend all my time, it is like my home. I vomited every time I ate. I had within seconds after I would put food down, within seconds I would have to go diarrhea. This is a disease that I never even heard of. >> But yet I am so sick. >> It's called Clostridium difficile or C. diff. The spores are so contagious, they can live on surfaces for months. And can easily be spread from person-to-person. >> We couldn't have relations, we could kiss, we could do anything. >> No social life. No social life. I couldn't have friends. >> The cost of antibiotics rising with each new relapse. One medication called vancomycin costs $400 for only two weeks apply. >> And they keep giving it to you dose after dose after dose. >> Robert is dying. Potentially one of tens of thousands of Americans who die of C. diff each year. Dr. pod here.is a special set the hospital. >> Before we use to cut the colon, surgically and treated that way in cases of C. diff. FM T stands for fecal microbiota transportation. Human stool from a healthy donor is transplanted into the colon of a sick patient. >> You have good bacteria, and if you can give it to me, it can help me. It's like spreading seed on it bank. >> By using our own good bacteria rather than using a drug to target the bad bacteria, we can use the bacteria to fight bacteria. >> Dr. Michael machine also from [ Indiscernible ] a proper to translate. >> This is an actual powerful tool that has more than 10 a 90% chance of curing the disease. From Sharp Grossmont Hospital. >> After 15 minutes I noticed a difference. >> I said the burning is gone. And the nausea is gone. >> So 15 minutes. >> Was all it took. >> In 2013 the FDA issued strict new guidelines on FM T, human stool when used prevent or treat disease, is defined as a drug and can only be used as medicine and FDA approved trials. A compassionate exception was made for C. diff patients not responding to spend standard therapy because of its effectiveness. With the update calls enforcement discretion, gave Robert his life back. >> In two days I have a normal bowel movement. >> Was people would say no that is a big deal, but when you have diarrhea for four years, it is a big deal. >> To be normal again. >> And I can eat anything now. >> But what if FNT can be used more broadly for conditions other than C. diff? >> Most of my [ NULL ] up here. >> Joel [ Indiscernible ] and others believe that FNT can help their condition. >> I want to support them here in San Diego. And they are hurting. Their loss, they are confused. They don't know what to do next. >> We will meet him tomorrow and find out the links that he and others will go to get a fecal transplant. >> Maya Trabulsi, Trent KPBS news.
Yesterday, KPBS reporter told us about how fecal transplants are saving lives, we hear why some argue strict regulations on the medical use of this matter may be limiting access to health. >> Reporter: A fecal transplantation, FNT, saved Robert Hyde's life. >> I had prayed that God would open up an avenue for me to talk about this. >> Reporter: He battled a drug-resistant infection, for years, costing thousands of dollars, but the fecal transplant, that was a different story. >> When I had the fecal transplant in the hospital, my bill was zero. >> Reporter: But what if you got something else that may respond to a fecal transplant? But I was diagnosed with inflammatory bowel disease. >> Reporter: A community resource called one great gut, and San Diego. Because he suffers from inflammatory bowel disease, and not CDIF, he couldn't get the transplant he wanted. >> I love my country, but if I can't get the treatment I need here, I have to go elsewhere. >> Reporter: He went to Australia to get a series of 10 transplants. >> I have never experienced such potent medicine so quickly. >> Reporter: The financial burden was too great to continue therapy. >> In excess of $13,000. >> Reporter: His condition worsened, he dropped to 115, and he imagined suicide. >> I have had many still test to see what is going on, and every time I hope that I have CDIF, because they can be paid for, I can get the transplant. >> Reporter: Fecal matter is resident -- regulated as a drug In the name of safety. >> We don't want to use something and figure out later that it has risks, we have a very respected agency, the FDA. >> Reporter: Considers the use of FNT to be experimental, and generally bands its use, a set of trials, but it does allow it in the case of CDIF discretion, enforcement discretion. >> I get to say yes, I can use this. >> Reporter: A doctor, who specializes in fecal transplantation, he believes its use needs to be brought in. >> It is a lot safer than any of the drugs, and more effective. That is the bottom line. >> Reporter: Doctor Davis says that before the restrictions took effect, he used it for patients with several chronic intestinal conditions, in San Diego for my interview on his way back from Baja, California, where he consulted that offered medically supervised treatment for those who couldn't get it here, the patient cost, $15,000 for a two week stay. >> The people who go to these retreats are people who feel like they don't have any other options, they feel like they have tried everything, conventional medicine, and often people who have tried everything and alternative medicine. >> At his practice in Maryland, patients who can't afford retreats still plead with them for help, in spite of FDA rules. >> I've had people try to bribe me, or say can we skirt the law somehow, but I don't love the law, but I follow it. >> Reporter: There is something he can legally do to help. >> You can do it at home, we can screen a donor, you can collect and process it, and administrate, it is not harder than following most kitchen recipes. >> Reporter: Right now, there isn't enough evidence to support the use of FNT for conditions other than that. >> We need to take time, the right studies, research, the donors, the right bacteria, and conclude the right conclusions. >> Reporter: But it could be years before it is used for other things. They feel like they are running low on options. >> People are going to do it at home, unsupervised, highly risky, putting themselves and their family at risk, all because of these silly rules and regulations. >> Reporter: KPBS news.
