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Tuesday, 19 February 2013
Sometimes Rationality Must Overcome Revulsion Bookmark and Share
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­­­During my childhood, medicine always tasted disgusting and I suspected that adults made it so deliberately to spite children. They could have made it delicious had they wanted to.

Disgusting ingredients have been used in supposedly therapeutic concoctions down the ages. They had three qualities: vileness, rarity, and expense. These strongly promoted the placebo effect, for who would not claim to feel better if continuing to swallow camel’s goat’s bile were the alternative? A little bit of what revolts you does you good, that is the theory.

Now at least when we resort to disgusting means, they are scientifically reasonable. I worked for a time for a surgeon in a country where antibiotics were not easily available, who wanted to test honey as an antiseptic dressing for open wounds (bacteria do not grow in honey). I cannot remember the results from the bacteriological point of view, but I recall that the aesthetic results were not pleasing.

I have also seen the use of maggots for wound cleaning. The therapy is effective, but it is difficult not to be repelled by it, especially if (as I have) you have actually suffered a parasitic skin infection by maggots.

However, my disgust at honey and maggots paled by comparison with what I felt upon reading the title of a paper in a recent edition of the New England Journal of Medicine, “Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile.” The excrement of various creatures was long an ingredient of supposed remedies in the days when nothing really worked, but I had fondly supposed that medicine had passes what Freud, in another context, would have called the anal stage.

Clostridium difficile is a life-threatening bowel infection that old people in particular are liable to contract when in hospital (indeed, the rate of such hospital-acquired infection is one indication of the general state of hygiene of hospitals). The infection gives rise to dangerous diarrhea and can be very difficult to treat. The usual method is therapy with an antibiotic, vancomycin, together (sometimes) with bowel washout; but in a sixth to a quarter of cases there is a recurrence. In addition, vancomycin is a drug with serious side-effects.

The authors, from Holland, divided patients with recurrent Clostridia into three groups: those who received vancomycin for fourteen days, those who received it for fourteen days plus bowel washout, and those who received vancomycin for four days and then a duodenal infusion of a solution of donor feces, the donors of the latter having first been screened for various communicable diseases of course.

Originally the authors had expected to enroll 40 patients in each group to show a difference between them, but as the trial progressed the results were so clear-cut (as is rarely the case in such trials) that it became unethical to continue. The cure rate of those given the infusion of feces 81 percent, or 94 percent on repeat treatment; in the other groups it was 31 percent in the vancomycin alone group and 23 percent with vancomycin plus bowel washout. Furthermore, 83 percent of the patients who did not respond to antibiotics were cured by infusion of feces.

Recolonization of the bowel by normal bacteria, then, is better than antibiotic therapy alone. Here is a case in which rationality must overcome revulsion. My admiration is great for the person who first thought of such a therapy: imagination leapt over prejudice. If it had been up to me, I should have waited passively until the pharmaceutical industry developed a more effective antibiotic than vancomycin. With this method, however, the raw material is abundant and cheap and not, I presume, under patent.

First published in PJ Media.

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Posted on 02/19/2013 9:16 AM by Theodore Dalrymple
Comments
19 Feb 2013
del

Not <i>directed</i> at anyone associated with NER...does anyone know , or can construct, a verbal imperative form of "coprophagy"?

(coprophagous grin)



20 Feb 2013
Send an emailSue R

'Eat shit' ?



20 Feb 2013
del

 Sue R.,

Well, yeah, but I am looking for a word forged from the Greek roots...



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