More germ warfare, this time about fecal microbiota transplants
Despite their mind-boggling track record, fecal transplants as effective treatments for intestinal disorders (and possibly those elsewhere in the body) have encountered PR problems–what Loom blogger Carl Zimmer calls the yuck factor.
That’s doubtless chiefly because of what they are, literal shit. After a century and a half of sanitation inculcation, it’s hard to get the mind around the idea that the microbes they contain are life-giving. At Pacific Standard, Bryn Nelson recounts a tidy theory that once upon a time, in agricultural societies, feces were looked upon with favor as fertilizer. But when we moved to cities, close quarters, the appalling state of the streets, and and disease transmission (cholera in particular) turned friendly fertilizer feces into something dangerous and disgusting.
The implication is that the yuck factor is not an inborn and inevitable human reaction to our own excrement, but a historical development born of demographic changes. Be that as it may, the yuck factor is surely the reason that the adoption of therapeutic fecal transplants–which, Nelson tells us, originated in China more than 1500 years ago and were experimented with successfully in the US in the 1950s but then vanished–has been so slow.
Now comes a development that could help change that: frozen feces in pill form. A smallish experimental study at Massachusetts General Hospital has shown that the frozen feces pills are as effective as the predominant forms of feces administration: enemas and nasogastric feeding tubes. Both are embarrassing and–especially the tube method–painful.
Also, as Nancy Shute points out at Shots, with the tube method there’s the possibility of inhaling feces. That’s not just yuck or even gross, it’s potentially dangerous. Excrement makes good fertilizer and is full of microbes that are essential for good health and even life. But there are bad bugs in there too.
The researchers have now tried frozen feces on some 40 patients with infections from Clostridium difficile, the antibiotic-resistant, debilitating, potentially fatal cause of massive diarrhea. It often follows antibiotic treatment for some other infection that kills the target bug but also the normal resident microbes that usually keep C. diff from getting the upper hand.
The cure rate in this treatment was 90%, similar to other C. diff fecal transplant tales. These terrific results were reported at a meeting only last Saturday, but the Journal of the American Medical Association had snapped up the paper and published it (open access) the same day, to the researchers’ delight. “I’ve been a microbiology researcher for 25 years, and this is the biggest thing we’ve done,” lab head and senior author Elizabeth Hohman told Shute.
The researchers are making the frozen pills available “to qualified patients” without formal clinical trials, according to the New York Times. I don’t know who they regard as a qualified patient, but I’m betting there’s a stampede of desperate people toward Mass General.
Regulatory agencies will doubtless have something to say about that. But they’re going to have to move fast. The approaches to fecal transplants are changing all the time, and the demand for this near-miraculous cure is unstoppable. Alexander Gaffney points out at Regulatory Focus that the Food and Drug Administration is already in a quandary over how to deal with fecal transplants. FDA issued something close to a cease-and-desist order in the spring of 2013 and ended up in deep shit.
From freezing feces to freezing eggs
Apple and Facebook probably thought they’d be seen as deserving a lot of, um, brownie points when they offered women employees an unlooked-for reproductive benefit: up to $20,000 to freeze their eggs.
Some women probably do like the idea of a company assist with postponing childbearing. They might change their minds if they read up on the risks of egg recovery and the disappointments of in vitro fertilization and other forms of assisted reproduction.
There are several reasons why offering women a chunk of money as enticement to delay childbearing in order to continue working (because that is what this “benefit” is) is a rotten idea. Canadian bioethicist Françoise Baylis lists 7 of them at the Impact Ethics blog.
The most potent argument against putting off children is that pregnancy and childbirth become increasingly iffy with time. For one thing, a woman’s eggs are present at her birth, and they age right along with her. As Ricki Lewis, my colleague here at the PLOS Blog Network, points out at her blog DNA Science, the eggs of a female fetus start developing when a pregnancy is about 5 months along. So a pregnant woman is carrying not only her own potential children, but her grandchildren too.
The most common abnormality among the children of older women is an extra chromosome, as is the case in Down syndrome. Lewis says that the specific reason older women are more likely to generate eggs with extra or missing chromosomes is not known. But the statistical fact is that for a woman in her 20s, the risk of a fetus with an extra chromosome is about 3%. For a woman in her 40s, though, the risk increases tenfold, to more than 30%.
I suppose the companies might argue that’s exactly the reason to undergo egg freezing when you’re younger, and here’s $20,000 to help you do it. But, Lewis argues,”Facebook and Apple are attempting to pay female employees to undergo a very risky procedure with not-well-understood consequences, when we don’t even know the mechanism behind the maternal age effect.”
Speaking of eggs, easter eggs in scientific papers.
HT to science writer and sleep expert Lynne Lamberg, who sent along this amusing tale of risqué acronyms in scientific papers. I suspect distribution may be a bit limited, however, since to get the the jokes you not only have to be pretty good at French, you have to be pretty good at idiomatic French expressions of the naughty kind.
But that item triggered my hunting instinct. Recalling that software engineers have named the jokey items they bury in their programs “easter eggs,” and that the term has now migrated to jokes hidden in computer games, on YouTube, and divers elsewhere, I searched “easter eggs in scientific papers”.
Lo and behold. A treasure trove devoted to bringing public attention to little inside science jokes, and named exactly my search string. I wasn’t really surprised. You can find anything on the Internet. Be warned, though, that many are (like the French one) examples of inside baseball.
Easter Eggs in Scientific Papers is up-to-date with an example from the new chemistry Nobel winner, Stanford’s William Moerner, who has worked on microscopy of single molecules. He writes of a guacamole, which he says is the inverse of a mole.
To get that chemical joke, you have to know that a mole is a quantity of something that contains 6.02×1023 particles, and 6.02×1023 is known as Avogadro’s Number. (A mole, About Education explains, is simply shorthand for A Very Large Number.) According to Moerner, guacamole is, of course, one single molecule [that is, 1/(Avocado's Number) of moles.]
As I said, inside baseball.
But the author of Easter Eggs in Scientific Papers, an anonymous self-described computational biologist, is nothing if not thorough. He has traced the origin of Avocado’s Number back to 1988, to another Nobel Laureate, the beloved molecular biologist Sydney Brenner. Brenner defines it differently. A guacamole does indeed depend on Avocado’s Number, but Avocado’s Number can be anything you want it to be, Brenner says. “So a guacamole is I don’t know how many numbers.”
Here’s another science easter egg, from the same archivist on a different blog. Still inside baseball of a kind, but intelligible at least to anyone familiar with the academic world. From a scientific paper: “Order of authorship was determined by proximity to tenure decisions.”