#fecal

[jeanlouiecastillo]

[10000thb]

Lurking Seattle’s Time Machine

[deimortiviventi]

My Jabroni Mike art so far this year

[threakyyy]

the dave matthews band chicago river poop incident but it's the splatoon 3 grand festival tour bus

i-

[mzminola]

Jason: I'm just saying that it's messed up you guys just pretended it was a costume change and not a new Robin. I died and you swept it under the rug. Like I didn't matter. Tim: I hear you, but, counter, if Rogues think they can *succeed* at killing a Robin, they're more likely to try. And to try killing other capes, too. It was a protective measure. Jason: They try to kill us all the time anyway. And it's not like it worked, they clearly all know you're the third Robin. How long did it take Joker to figure the switch out, five milliseconds? Tim: Oh no, it took him like...a few hours, maybe a couple days. I was busy I don't know the exact timeline. His face when he thought you were still alive was amazing, though. Jason: What. Tim: As I said, I was busy trying to- Jason: No no no, go back to his face. Tim: Uh...well I landed on the windshield and his eyes nearly bugged out of his head? He just started like. Screaming. "I killed you!" over and over. Just absolutely losing it. Jason: . . . Tim: Like his entire world just ended. Total meltdown. Jason: . . . Tim: I guess he figured it out eventually, or went into denial, but it's not like any of the other Rogues would listen to him after the cops had to fish him out of that sewage tank, it made him a laughingstock, so that bought us more time- Jason: When the cops had to WHAT. Tim: Uh. Jason: *Sewage tank???* Tim: We may have uh. Wound up in a showdown by some of the open tanks. And I may have. Um. Flipped the Joker into one. Jason: . . . Jason: . . . Tim: ...You okay? Jason: The Joker got tossed into a LITERAL VAT OF SHIT and I MISSED IT.

[disease]

NASTY, OCT 2023 | AT THE END OF THE WORLD FECAL MATTER in MATIERES FECALES

[artifacts-and-arthropods]

Palmetto Tortoise Beetle: the larvae of this species produce long, thin strands of feces that are gradually woven together to form protective "fecal shields" around their bodies

During its larval stage, the Palmetto tortoise beetle (Hemisphaerota cyanea) uses its own feces to create a defensive layer known as a "fecal shield" or "fecal thatch."

As this article explains:

Most remarkable, perhaps, is the fecal “thatch” of Hemisphaerota cyanea. In the larva of this beetle, the feces are emitted in strands, which, as they build up over the course of larval life, form a loose assemblage that totally hides the larva from view.

The construction of the "fecal thatch" begins almost immediately after the larva hatches. Each larva begins to feed within minutes of hatching, and the very first fecal strands emerge from its anal turret just a few minutes later. Subsequent strands are then produced in quick succession, and they begin to accumulate around the larva's body; as each strand emerges, it is made to curve around the larva's left or right side depending on whether the anal turret is flexed to the left or right. The direction of the curve usually alternates from one strand to the next, ensuring that a nest-like structure is formed around the larva's body.

As they emerge, the fecal strands are gathered together and then cemented into place with the help of an anatomical feature known as a caudal fork. Once an individual strand has been extruded to its full length, the anal turret is rotated upward until it comes into contact with the caudal fork, and the larva then pinches off the strand while secreting a droplet of "glue," which effectively cements each fecal strand into place against the caudal fork.

It generally takes about 12 hours for the larva to finish building its very own "fecal shield."

As an adult, the Palmetto tortoise beetle has another unusual defense mechanism: its tarsi (i.e. feet) are each lined with 10,000 tiny adhesive bristles, and when the beetle is attacked, it can press its feet flat against the surface of a leaf and secrete an oil that allows it to adhere to that surface with an enormous amount of strength. The adhesive mechanism is strong enough to resist pulling forces that are up to 60 times greater than the beetle's own weight for a full 2 minutes; it can resist even greater forces (up to 230 times greater than the beetle's own weight) for shorter periods of time.

According to this article from the University of Florida:

Each of the greatly enlarged tarsi is equipped with approximately 10,000 adhesive bristles. Each bristle has two terminal pads. When walking, only a few of the bristles touch the leaf surface. However, when attacked by a predator, the beetle puts all or nearly all of the bristles in contact with the surface and secretes oil onto the pads. With the adhesive force created by the oil between the leaf surface and tarsi, the beetle is able to clamp its hemispherical shell down tightly against the leaf and has been demonstrated to withstand pulling forces of approximately 60 times its own weight for up to two minutes. This time period is sufficient to thwart the efforts of predatory ants attempting to pry the beetle from the leaf. 

Palmetto tortoise beetles are native to the southeastern United States, and they're especially common in Florida (which is why they're also known as Florida tortoise beetles).

Sources & More Info:

Proceedings of the National Academy of Sciences: Defensive Use of a Fecal Thatch by a Beetle Larva (Hemisphaerota cyanea)

Earth Touch News Network: By the Power of the Poop-Shield: Beetle Defenses of the Faecal Kind

Cornell Chronicle: Fecal Defense: This Beetle Uses 'Overhead Sewer System' to Ward off (most) Predators, Cornell Biologists Discover

Proceedings of the National Academy of Sciences: Defense by Foot Adhesion in a Beetle (Hemisphaerota cyanea)

University of Florida: Palmetto Tortoise Beetle

Bug Guide: Hemisphaerota cyanea

[cardi-c]

Stinks, feels, and looks identical

24/∞ ghovie gifs

[coolbugs]

Bug of the Day

I was so psyched that I managed to successfully rear this Golden Tortoise Beetle (Charidotella sexpunctata) from a wee larvae with a gross poop hat (fecal shield) to this rad red sports car! And then I realized that I forgot to get baby photos, so you will just have to imagine a flat but spiky larva covered with its own waste. Or Google it :-)

[popsartattic]

Commissions Open

Hey all, my cat is sick and his vet bills have been pretty high so I'm opening up commissions again. I'll draw your OC or favorite character for you! I can do multiple styles, but my main four are a simple cutesy style, a cartoony style, anime style, or a slightly more complex semi-realistic style. Prices for most styles are the same but the cutesy style ones are cheaper because they're quicker and easier to draw. Anyway, here's the pricing-

CUTESY STYLE

HEAD/BUST:

Lineart - $10 Flat Color - $15 Shaded - $22 FULLBODY: Lineart - $18 Flat Color - $28 Shaded -$35

ALL OTHER STYLES

HEAD/ BUST:

Lineart - $18 Flat Color - $25 Basic Shading - $30 Fully Rendered -$40

HALFBODY:

Lineart - $25 Flat Color - $35 Basic Shading - $42 Fully Rendered - $50

FULLBODY: Lineart - $35 Flat Color - $55 Basic Shading - $65 Fully Rendered - $85

EXTRAS

Backgrounds/Props: $5-$50 depending on complexity. Simple gradient backgrounds or very simple patterns are free.

Extra Characters: 2/3 of base commission cost per character

All prices are subject to change and open to negotiation within reason (I'm willing to work with you, so long as you're negotiating in good faith). Prices will not change for an individual commission once a price has been agreed upon, of course. I reserve the right to add an extra charge for designs with excessive detail.

I currently have ten commission slots open.

I look forward to drawing your OCs and/or blorbos!

[talkethtothehandeth]

You say you’re supportive and understand of disabled people but are you supportive of people who have urinary or fecal incontinence? Are you supportive of people’s disabilities when it has to deal with something like a biohazard or something unsanitary?

[2beebebetter]

The downfall of OWONekko has been so insane it doesn’t even feel real like this woman got called out on one bad take she had and immediately started acting like a 4channer 0.00000000001 seconds after it happened

[maracllea]

ᴛʜᴇ ʜᴀʀᴋᴏɴɴᴇɴ ʜᴀʀᴘɪᴇꜱ & ʜᴜɴɢᴇʀ | Dune 2

[sinfullyrosey]

Feral Follies - Part 1

Floyd Leech X GN!Honey Badger!Reader

Warnings: Biting, Violence, Enemies to Lovers (who are still enemies), Hate Fucking, Rough Sex, Dom!Floyd (he tops), Dom!Reader, Eel Slime as Lube (sorry not sorry)

No smut in this part, but will in the next. I haven’t really been posting any big fics as of lately due to school, so wanted to get something out there, even if it’s not any actual smut.

Also, it’s a chance for me to try something different by asking ya’ll whether or not I should give Reader male or female genitalia for part 2 of this fic. Originally, I was just going to have the scene play out and not specify anything, but I got stuck writing it and now am considering giving ‘em female bits just to make things easier on me. Or should I stick to my original plan and leave it up in the air? I’ll be able to be more descriptive with an actual set of naughty bits.

I’ll try not to use any pronouns regardless of the final outcome though.

Your relationship with the infamous Floyd Leech is rather… complicated to say the least. The two of you didn’t have the best foot forward when meeting and this had undoubtedly caused a sort of heated rivalry between you and the Leech brother.

It had been during lunch, while you were walking over to your dormmates’ table, food in hand, when you noticed a tall, Octavinelle student looming over your friend. Said friend was cowering from the looming figure, while a few of your dormmates bristled and snarled at the stranger but didn’t move to defend the quivering beastman.

This didn’t sit well with you, so you hurried over to the table and put your tray down, before climbing onto the table to gain some leverage. This got the attention of everyone at the table, including your friend and the stranger, and before the tall asshole could say anything, you promptly bit into his shoulder without any warning, just like how you were taught back home.

All hell broke loose after that, students were panicking and hollering as the scene unfolded before them. The student, who you currently were latched onto, didn’t take too kindly to your actions and retaliated in turn. He growled and grabbed at you, attempting to pry you off, swearing at you as he did so.

You responded by biting down harder, drawing a few more droplets of blood.

The next of what happened was a bit of a blur as you had been rather blinded by your initial fury during the whole ordeal. You remember the student trying to bite you back but being unable to reach your shoulder or neck properly. He settled for simply clawing and punching at you, and at some point, began wrestling your still latched on form to the ground.

He was on top of you, trying to smother you under his weight by the time faculty arrived. A few other students also from his dorm arrived, attempting to break you two apart without getting caught in the crossfire themselves. There was even one of them who looked oddly like the jerk you were mentally maiming, though he kept his distance and tried to defuse the situation with words aimed at his lookalike.

Eventually staff was able to pull you off him and separate the two of you before matters really got out of hand. It was a wonder how neither of you got expelled, but from the looks the headmaster gave, it appeared this wasn’t the first time this sort of occurrence happened involving the said Octavinelle student.

Crowley left you off with a warning and said that since it was only you and the other who got injured and there was no property damage, you only had to help clean the cafeteria for two weeks.

Whatever, at least that jerkwad got what was coming to him, so it was worth the punishment.

Since that day, the student you now knew as Floyd, had taken to referring to you as “Barracuda” in reference to your feisty nature and stubborn, yet powerful bite. You didn’t much care for such nickname, especially after learning that the name was slightly derogatory on his part, a way to belittle and distant you from him.

No matter, you took to referring to him as “Kinyesi” in return, an obviously derogatory term of your own. He didn’t catch on until much later when one of Savanaclaw’s students told him what the term directly translated to.

Though your relationship didn’t stop at just name calling, oh no no, it spread into verbal and physical confrontations as well. That first fight in the cafeteria certainly wasn’t your last. You and Floyd had gotten into plenty of other fights over the past few months, usually taking place outside of class, away from the other students and staff. Rarely did you two ever get in a brawl where you could get caught and sent to the headmaster again.

And yet, the bruises and scars still painted a very vivid picture to anyone who saw them to what has been occurring between the two of you since that first fight. Your arms, face, and torso were littered with healed scratch marks and bitemarks. The same was for Floyd, accept he was the only one with a deep bitemark scar on his shoulder. The mereel still hadn’t managed to pay you back for that one.

That is, until today.

Floyd managed to get the upper hand by ambushing you while you were alone in one of the infrequently used hallways on campus. He snuck up behind you and unsuspectingly picked up your smaller frame by your underarms and slammed your back against the wall.

Your bag clattered to the floor in the process and your head spun from the impact. Once you gathered your bearings, you glared up at that stupidly, toothy grin of his.

“Hehe, hi little Barracuda.~”

You huffed, baring your fangs, ears flattened backwards in a warning to back off. Floyd was unfazed by the threat, more so amused.

“Fuck off, Kinyesi.”

His grin faltered at that, but as quickly as it fell, it curled back up, wider, and more sinister. Before you could even think to react, the eel sprung forward and clamped his jaw right into your shoulder, sinking his sharp teeth into your flesh.

Your eyes widened and a sharp hiss fell past your lips. On instinct you struggled in his grip, but was unable to free yourself, let alone gain proper leverage given your dangling position. He managed to draw some blood, much like how your own bite did to him.

Your kicking and clawing did nothing to remove the eel’s maw from your shoulder, so you were left with raging insults thrown his way as you cursed him out. The bastard was unfazed by your violent attempts and only responded by gnawing at the injury, causing more jolts of pain to shoot out along your shoulder and neck area.

But as quickly as he sunk his teeth into you, Floyd soon released himself from you and pulled away to now face you once more. He had that same annoying grin on his face, this time painted in the scarlet red of your own blood.

He licked his lips.

“Now we’re even!”

He said it so nonchalantly, like a child who just hit the kid who hit them first in retaliation. He was trivializing such a brutal display like it was nothing. You couldn’t help but growl up at him, even after he placed you back down on the ground, still grinning down at you.

Your hand raised to inspect the damage. You winced at the sharp sting and hot feeling of the small amount of blood now clotting on your shoulder. Surprisingly, it wasn’t too bad, nothing compared to the nasty bite you initially gave him, anyways.

You narrowed your eyes suspiciously. Why didn’t he cause more damage? Try to maul you or rip a chunk of your flesh out? He had the perfect opportunity and just, squandered it?!

“The fuck you mean, “We’re even?” You just bit my shoulder, unprompted, asshole!”

He merely shrugged as if it was obvious.

“You bit me unprompted and left a mark, so it’s only fair I do the same to you little Baracuda!~”

Your tail swayed in irritation at his response. He wasn’t entirely wrong in what he said, but you technically attacked him to defend your friend. He attacked you because he’s a psychotic, violent jerk! Yours wasn’t unprompted, but his sure as hell was!

“And now we match!”

Ears perked at the statement, and you could only look at him in complete bewilderment at what he just said. His sadistic grin had turned to one of playfulness and contentment, almost sounding, friendly in a way. Not a hint of mockery or threat could be heard in his tone. He sounded genuinely happy at what he had just proclaimed to you, as if he hadn’t just bit into your flesh like a predator starved.

“You are some next level batshit, Kinyesi.”

Weeks had gone by since that day, with little change between you and Floyd Leech. Well, on your part at least. You still hated the twin, and the two of you still had your weekly brawls that usually ended in either a draw or you, somehow, coming out on top. You still hated his guts and he still found joy in annoying you.

But recently the fights had somehow… shifted.

They were still violent and full of loathing, but it felt as if the atmosphere surrounding you two had a new air to it. Like the heat was no longer just about the animosity shared between you and him. As if something else, something new and unknown, was present whenever either of you landed a particularly harsh bite to the other.

The bites had become less painful, less about causing damage and more aimed towards a direction you couldn’t quite pinpoint. It was a foreign and strange feeling that built up in the pit of your stomach and festered there, growing hotter and hotter the more you fought.

The foundation of your and Floyd’s relationship had changed at some point and neither have properly acted on it, let alone, realized the shift.

You and the Leech brother found yourselves once again duking it out in an isolated spot on campus, away from the prying eyes of the other students and staff. Floyd had provoked you like he always did and before thinking things through, you had already tackled him to the ground, growling and spitting insults with every attack you threw his way.

In turn, he threw some of his own punches right back at you and had even managed to get you in a choke hold twice before you clawed your way back out again. Both of you were already gaining some new claw marks and bruises. Floyd was loving every second of it and acting as if you were merely play-wrestling, despite your expression saying otherwise.

He had managed to pin you to the ground once more, putting all his weight on you and holding your hands down so you couldn’t use them. You were spitting and hissing at him, trying to wiggle your hands free and bucking your hips to try and push him off of you, but to no avail.

Floyd was unfazed by your efforts and was sending a slew of mocking taunts and insults right back. His red-stained, pearly whites flashing in warning, possibly about to sink into your skin for the hundredth time. You growled, baring yours right back as if to say, “Try me, bitch.”

Your efforts to remove him caused you to feel something you hadn’t felt before. Something that was not just his flat pelvic area… Something sharper… pointier…

You suddenly froze, body on high alert and aware of something hard poking at your lower region. You sniffed at the air, picking up a distinct scent. You slowly, forcefully pulled your gaze away from his face and down towards his lower half to spot a noticeable tent peeking out from his pants. Your eyes widened and breath hitched.

“Is… is that..?”

Oh Great Sevens, he was popping a boner in the middle of your fight.

A heated flush took over your face, removing the redness from your anger and replacing it with embarrassment. Your eyes widened up at him in disbelief and disgust. His eccentric expression hadn’t changed, lips curling up wider in excitement.

“Oh, my fucking-ARE YOU TURNED ON BY THIS?!?!”

The mereel let out an uncharacteristic trill sound you hadn’t heard before and got closer to your face.

“Maybe.~”

Maybe your ass. His dick was harder than those weak attempt at cookies Kalim made for that one celebration a few weeks back. You huffed hot air into his sleazy face and hissed.

“Neee, I’m bored of our usual game, Barracuda, let’s play something more fun!~”

He proceeded to emphasize his point with a quick thrust of his clothed dick against your crotch. The contact sent a sharp jolt of heat to your lower stomach, and you bit your lip to keep any sound down.

“What are you-” You were interrupted when you took a sharp inhale at the pleasant feeling building in your nether regions.

“I’ve noticed a change in our little game, Barracuda. I’ve notices that you smell different whenever we wrestle, different than your usual smell. Your scent is more… inviting.~”

A blush rose to your cheeks. So, it wasn’t just you who’s noticed, huh? Something was different that even the eel jerk had taken notice and decided to act upon it by grinding his hips down onto you. And you’d be lying if you said this shift wasn’t in the least bit welcomed. You were still trying to wrap your mind around these newfound feelings, but his blunt advances in the matter were aiding to convince you easier.

But did you really want this, truly? With him of all people? The big bad eel of Octavinelle Dorm? The giant thorn in your side for the past month or so? The guy who got your heart racing and blood boiling in a mix of frustration and odd attraction. The one who currently was on top of you, still pinning your smaller body to the ground and grinning down at you in that charmingly condescending way.

The guy you so desperately wanted to kiss and let rail you right about now.

. . .

Ah, fuck it.

You threw all doubt to the wind and proceeded to aggressively mash your mouth against his, teeth clattering together and lips sloppily molding together in a mess of heated aggression and hormones. The eel was taken aback at first, but slowly grinned into the kiss before returning it with just as much vigor.

You moaned into the kiss, pushing your hips up to meet his own grinding thrusts. Heat started to pool inside you and spread throughout your body as Floyd let go of your hands to instead roam free and grope around your sides and butt. With your own free hands, you quickly wrapped them around his head and neck to pull him closer, deepening the kiss.

When he tried to pull away from your kiss, possibly to say something stupid or make some quip at how desperate you were being, you growled lowly before harshly biting his bottom lip. The sharp nip drew blood and got a disgruntled groan out of the taller male. His bicolored eyes leered down at you, taking it as a challenge and trying to bite into your tongue, albeit unsuccessfully. Instead, you bit his tongue, much gentler in comparison to the one you did on his lip.

His attempts made you pull away, a string of reddish-pink saliva connecting you two before breaking off. You licked the copper liquid from your lips, grinning up at him while he snarled down at you in return.

“What’s wrong, Floydy-boy, badger got your tongue?” You teased, tail wagging beneath you.

The eel huffed, but matched your smirk, lips pulling back to reveal more and more of his razor-sharp teeth in a show of challenge. A challenge you were willing to accept with just as much vigor, if not more so.

“No, but you’re about to have an eel have yours, Barracuda.”

[mostlysignssomeportents]

Monopolizing turds

Update 31 May 2023: an earlier edition of this article identified the price of Rebyota as $20,000; this was the rumored price prior to Rebyota’s release in December  2022, when Stephen Skolnick wrote the article I referenced. When Rebyota was actually released in 2023, the average wholesale price (AWP) was $10,800. Thanks to Benjamin Jolley for catching this error, and to Stephen Skolnick for getting to the bottom of it.

It’s been ten years — to the day! — since I first started writing about the bizarre, amazing world of turd transplants, in which a sick person receives a microbiotic infusion in the form of some processed poop from a healthy person:

https://web.archive.org/web/20130608030455/http://blogs.plos.org/publichealth/2013/05/29/why-diy-fecal-transplants-are-a-thing-and-the-fda-is-only-part-of-the-reason/

Gut biomes are one of those understudied, poorly understood medical areas that are both very promising and also full of sketchy medical claims from “supplement” companies, influencers, quacks and grifters. But in the decade since I first started tracking turd transplants (formally called “Fecal Microbiota Transplants” or FMTs), a growing body of sound science has emerged on the subject.

One thing that’s increasingly undeniable is that the composition of your microbial nation is related in significant ways to both your physical and mental health. What’s more, as antibiotic resistant “super bugs” proliferate, FMTs are becoming increasingly central to treating dangerous gut infections that otherwise stand a high chance of killing you.

“Eat Shit and Prosper” is Stephen Skolnick’s delightfully named newsletter about poop and health science. Skolnick is a physicist by training, but has a long history of collaboration with Openbiome, a nonprofit that coordinates between doctors, patients and donors to provide safe FMTs:

https://stephenskolnick.substack.com/

In an edition of Eat Shit from last December, Skolnick recounts the amazing history and dismaying future of FMTs. In 2013, the FDA announced it would regulate FMTs as “Investigational New Drugs,” which could only be administered as part of a registered clinical trial:

https://stephenskolnick.substack.com/p/a-monopoly-on-poop

At that point, FMTs were already in widespread use by docs to treat otherwise untreatable cases of Clostridioides difficile (C. diff), an antibiotic resistant bacterial infection that literally makes you shit yourself to death. These doctors were in no position to run registered clinical trials, which meant that they would have to stop using the most effective therapy they had for a potentially lethal infection.

Doctors and patients kicked up a fuss, and the FDA walked back its guidance, announcing that it would exercise “discretion” in enforcing its Investigational New Drug rule, giving a pass to docs who were treating C. diff with FMTs:

https://www.federalregister.gov/documents/2013/07/18/2013-17223/guidance-for-industry-enforcement-policy-regarding-investigational-new-drug-requirements-for-use-of

That’s where things have stood for the past decade or so. The “discretion” rule means that patients could still get FMTs, but their insurance wouldn’t cover it. But even if you had cash to pay for an FMT, your doc probably wouldn’t administer it for anything except a C. diff infection, despite the promising signs that FMT can help treat other conditions, and despite the generally safe nature of FMTs.

If your doc did give you an FMT, chances are good that they sourced their poop from Openbiome. Openbiome recruits very healthy people, gets them to poop in a bag, then processes the poop — removing nonbacterial solids, testing it for pathogens, freezing it, portioning it, and sending it to docs. All this is done at cost, and it’s not cheap: $1–2k/treatment, mostly due to cold-chain logistics (the poop is shipped at -80C).

Despite the cost, and despite the limitations on treatment, the Openbiome method has proved very reliable. Indeed, FMTs as a whole are pretty darned safe, with the most common side-effects being transient gas and bloating. In the past decade, there’ve been a total of six “adverse effects” associated with Openbiome’s 5,000+ procedures, all in severely immunocompromised people, and none conclusively linked to the treatment:

https://www.sciencedirect.com/science/article/pii/S0016508522003511/pdf

A decade into this system, the FDA has taken the next step forward — only it’s actually a step backwards.

During this intervening decade, a pharma company called Ferring has conducted clinical trials on FMTs and received approval for an FMT product called Rebyota. The process for making Rebyota is effectively identical to the process used by Openbiome: collect poop, remove solids, test for pathogens, add glycerol, freeze and ship.

The main difference between Rebyota and Openbiome’s poop is price. While Openbiome charges $1–2k per treatment, Rebyota charges $10,800

That’s some expensive shit!

Fine. Getting Rebyota through clinical trials means that insurers might start covering it, and perhaps some patients will prefer brand-name poop to open-source poop. But as part of the FDA’s approval of Rebyota, the agency also rescinded its “discretionary enforcement” guidance, making it illegal for docs to source their poop from Openbiome:

https://www.fda.gov/regulatory-information/search-fda-guidance-documents/enforcement-policy-regarding-investigational-new-drug-requirements-use-fecal-microbiota

For Ferring, this is a monopoly on shit, one that lets them charge patients $10.8k for poop that costs $1–2k to process. The FDA does not claim that this is being done in the name of safety. Instead, an FDA official told Skonick that the goal was to “incentivize innovation without creating an access crisis.”

That is, the FDA changed its guidance and put nonprofit stool banks out of business because it wants to incentivize pharma companies to perform expensive clinical trials, and it believes that these companies won’t pay for trials if they have to compete with the likes of Openbiome, which would make it impossible to charge 900% markups on poop.

Trials are important! Evidence-based medicine is important! But Ferring’s clinical trials didn’t tell us anything we didn’t already know. FMTs were already the best therapy we had for C. diff. Testing Rebyota against a placebo didn’t tell us anything new — unlike testing Rebyota against the existing therapies, e.g. product from open stool banks.

Such a trial might have given rise to a very different regulatory outcome, because the cure rate reported by Rebyota is much lower than the cure rate from Openbiome’s own interventions:

https://link.springer.com/article/10.1007/s40265-022-01797-x

That is, using the $1k poop from Openbiome seems to be much more effective than using the $10.8k poop from Ferring. But Openbiome, a nonprofit, hasn’t been able to perform the kind of rigorous — and expensive — clinical trial that Ferring funded.

This points to a significant problem with the FDA’s model. The agency wants good clinical data for the medicines it regulates, as it should, It presumes that the only way to get that data is through granting commercial exclusivity to a for-profit, which ends up costing patients vast sums, and locking many patients out altogether.

This creates all kinds of new dangers. 150,000 people/year in the US contract Recurrent Clostridium difficile Infection (RCdI). FMT increases the cure rate by 20% relative to antibiotics alone. That means that if everyone with RCdI gets a poop transplant, 30,000 extra people will get better. That’s a big number!

For well insured people, Rebyota probably represents a cash-savings — if your insurance covers the $10,800 procedure, you might pay $500 out of pocket, which is far less than the $1–2K you’d pay to get an Openbiome poop transplant. But if you’re uninsured or underinsured, the FDA’s new enforcement rules mean that you’re now on the hook for $10,800.

The FDA did carve out a loophole: if your doc or their hospital are willing to prepare the poop transplant themselves, they can administer that. On the one hand, preparing a poop transplant isn’t that hard — some people do them at home, on their own:

https://web.archive.org/web/20211015060558/https://thepowerofpoop.com/epatients/fecal-transplant-instructions/

But on the other hand, there’s been exactly one death conclusively linked to FMT, and it was from one of these hospital-prepared transplants (the patient had just had a marrow transplant for cancer that wiped out their immune system, and the donor had a novel pathogen that the hospital failed to test for).

So the FDA has created a situation where, if you can’t afford a $10,800 proprietary formulation, your only option is to convince your doc or hospital to prepare their own poop transplant, which will cost less than the $10.8k for Rebyota, but more than the $1–2k from Openbiome, which has all kinds of economies of scale. And if you do manage it, you’ll be getting a procedure that has a much worse safety track-record than the Openbiome process that the FDA just killed.

The FDA has an important role to play here, but as with so many policy questions, how the FDA plays that role depends on things that are far upstream from the agency and its decisions. The choice to fund medical trials through the promise of exclusivity — and with it, extremely high margins — puts the FDA in the position of choosing winners in the marketplace: Ferring wins, Openbiome loses.

Ironically, this is the thing that exclusivity is supposed to prevent. By using profit to incentivize medical research, the FDA is supposed to be recruiting the Invisible Hand as its partner in regulation. But exclusivity is incompatible with the idea of medicine as a public good. The tens (hundreds) of millions that Americans will pay for $10.8k poop transplants from Ferring will add up to far more than it would cost to underwrite clinical trials for an open process like Openbiome’s.

The result: both Americans’ wallets and Americans’ guts suffer.

Catch me on tour with Red Team Blues in Hay-on-Wye, Oxford, Manchester, Nottingham, London, and Berlin!

If you’d like an essay-formatted version of this post to read or share, here’s a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/05/29/oh-shit/#rebyota

[Image ID: A poop emoji wearing a top hat and a monocle, posed against a backdrop of e coli bacteria seen through a high-resolution microscope.]

[declaweddisabledpurebred]

Boscoe [Original Post]

American Curl (age and status not listed)

Boscoe is fecal incontinent due to a tail pull injury.

Available In: Murfreesboro, Tennessee (United States) [Roscoe Rescues]

Posted on June 4th 2024