Fecal Matters

Most teenage boys make money the old-fashioned way. They mow lawns, wash cars or flip burgers.

But one 13-year-old in Portland is the envy of his friends for the way he makes his money. He gets $50 for donating his feces.

The boy (who, for reasons that will soon become obvious, asked not to be named) is part of a burgeoning business in fecal transplantation: a medical procedure in which—and here's where you might want to put down that doughnut—donors' poo is injected into a patient's body.

In Portland, fecal microbial transplantation is being promoted by a naturopath for a wide range of maladies. The treatment isn't approved by the U.S. Food and Drug Administration.

But the procedure—used in experiments since the 1950s—is getting approving articles in medical journals and increased use in mainstream hospitals, such as the Mayo Clinic in Phoenix, as a procedure to treat a very specific intestinal ailment.

Bacteria from another person's feces are delivered into the patient's digestive system—usually through an enema—to fight Clostridium difficile, nasty bacteria that can rage in the digestive system and cause severe diarrhea and other unpleasantness.

Natural defenses usually fight off C. diff, which can get out of control if antibiotics inadvertently kill the body's good bacteria. A different, stronger antibiotic often works. If that fails, some doctors are turning to fecal microbial transplants, letting someone else's good bacteria go in and kill the bad.

There are about 500,000 cases of C. diff each year, and only a small number get the treatment. Anecdotal reports in journals give fecal microbial transplantation a 90-percent success rate in fighting it.

"I thought it was icky at first," says Dr. Christina M. Surawicz of the University of Washington School of Medicine, who first did the procedure in 2006. "But the results were dramatic."

Doctors and naturopaths can use the procedure without FDA approval (it doesn't involve drugs or tissue).

"Certainly, this treatment isn't ready for prime time," Dr. Colleen Kelly of the Alpert Medical School at Brown University tells WW in an email, "but there are a number of doctors who are interested in studying this further."

Portland naturopath Mark G. Davis, who opened the Bright Medicine Clinic four months ago, is using fecal microbial transplantation for other health problems, including autoimmune disease, eczema, asthma, multiple sclerosis and depression. 

"What makes me unique," Davis says, "is that I'm doing it for other ailments."

Retreats at his North Portland clinic range from one to 10 days. The five-day "colon health retreat" runs $4,000.

Davis needs "clean" excrement from a donor who hasn't taken antibiotics or been sick recently. He dilutes the sample in saline, filters the slurry and injects the liquid into the patient via enema.

Davis says he was "self-taught" after watching the procedure as a student at Portland's National College of Natural Medicine. (Davis graduated in 2011 and got his state naturopathy license fast fall.)

Surawicz and other physicians warn about the risks of fecal microbial transplantation (infection, for one) to treat other ailments when there is no meaningful evidence it works.

Davis disagrees, saying the procedure—like colonics or gluten-free diets—detoxifies the body and improves mood.

As for performing an unregulated procedure as unproven therapy, Davis says, "The FDA hasn't said not to."

The 13-year-old, who donates to Davis' clinic, says he was selected because of his good diet, and because his parents never allowed him to take antibiotics.

"I didn't believe it at first," he says. "But it's a really, really easy job."

(His parents confirmed for WW that they approve of his $50-a-pop job as a feces donor, now in his third week.)

He excretes his specimen into a plastic receptacle, and then must scrape out the sample ("it needs to be a medium-sized poo") before transferring the stool into a Tupperware container. He adds a cup of water and seals it for the clinic to pick up.

“I was sort of surprised you have to scoop out the poo and wash the container,” he says. “That’s the downside of the job.” 

Nor did he expect that, when the clinic calls, he would have to donate on demand.

"I feel a little pressure," he says. "One time when I couldn't go, the doctor had to find another donor."

When he's not working, the 13-year-old, who lives in Irvington, plays basketball and tennis.

He estimates he has made $500 so far with his donations, but isn't sure how much longer he wants to continue the work.

"I raked leaves and baby-sat before. This is a lot easier," he says. "I would probably like it to go on for a couple of more years—but I'd like to have a break every now and then.”  

WWeek 2015