[Link] Low-Hanging Poop

by GLaDOS 1 min read16th Oct 201338 comments


Related: Son of Low Hanging Fruit

Another post on finding low hanging fruit from Gregory Cochran's and Henry Harpending's blog West Hunter.

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.