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Pathfinders: Enema of the People

Something funny is going on with the current craze for faecal transplants. For those not already in the know, this is the decorous practice of shoving someone else’s poo up your behind, an unlikely but ancient stratagem which is delivering an astonishing 90 percent clear-up rate for clostridium difficile and some other potentially fatal infections not treatable by any antibiotic.

Faecal matter transplanting (FMT) definitely seems to be the business, and because there are no issues with immune rejection nor, up to now, any clinical oversight, anybody can do it with a home-made enema, and anybody’s poo will do, provided the donor is fit and healthy.

Clearly the ‘yuk factor’ has been trumped by the statistical ‘Wow factor’ as clinical trials through the last two years have largely confirmed FMT’s efficacy in treating certain bacterial conditions and people have stampeded to get the treatment. In 2012 a group of MIT researchers opened the world’s first stool bank. Oral forms are being investigated for wider pill dissemination. For once, it seems, there’s a cure for something that’s natural, freely available, and out of which the drug companies simply cannot make any money.

But after the first flush of success, worries are now emerging. For one thing, the DIY nature of FMT makes it unregulatable, so there are no controls over who is donating what to whom, or in what circumstances, meaning that far from curing infections FMT might be promoting them. For another, the claims have got wilder. FMT doesn’t just cure c.diff, it cures everything from Parkinson’s to asthma to cancer to MS to mental disorders to obesity, according to unverified reports. Yet counter-signs have emerged. In February this year, a woman with a history of being thin became clinically obese after a FMT procedure in which the donor was obese (http://www.medicalnewstoday.com/articles/289085.php). In a recent New Scientist survey, 15 of 52 responses from practitioners reported ‘unexpected symptoms’ following treatment.

The US and Canada are now imposing regulatory guidelines (New Scientist, 6 June), after ludicrous efforts to have poo classified as a drug for regulatory purposes provoked an outcry. The UK’s National Institute for Health and Care Excellence is following suit. But such measures are unlikely to achieve much, as the nature and seriousness of any ‘side-effects’ remain unknown while the FMT craze continues to run away with itself.

It would be a shame if the current ‘poo-rush’ mentality ultimately ruined the credibility of this useful form of treatment and demoted it to snake-oil status, as happened in the west in the 1920s with bacteriophage therapies. But it’s interesting how people can change their minds so rapidly over such unlikely things. Five years ago, you wouldn’t have put money on this treatment ever becoming acceptable. Social prejudice, you would have thought, would have been too strong.

Considering that people routinely shove other people’s shit into their heads on a daily basis through the news media business, perhaps we shouldn’t be so surprised. Yet people seem alarmingly resistant to changing their ideas when it is in their urgent interest to do so. In a recent study, 2,000 parents were divided into 4 groups and given different leaflets designed to determine whether pro-vaccination campaigns could change their attitudes towards vaccinations. One leaflet focussed on the lack of evidence linking the MMR jab with autism, the second emphasised the dangers of measles, mumps and rubella, the third carried photos of children with the diseases and the fourth was a case study of a child who almost died. A control group were not sent any of the leaflets. What was the outcome? Nothing. No change at all. ‘It’s depressing’, said one of the researchers, ‘we were definitely depressed’ (New Yorker, 16 May 2014).

Other studies show that people’s ingrained biases can be heavily resistant to change even when the facts are known to the subjects, suggesting that people resolve cases of cognitive dissonance by ditching the facts and sticking to their beliefs.

Well, not in the case of poo, apparently. And not if one takes a larger view either. The fact is, if people were as resistant to changing their ideas as some depressed researchers would have us believe, the human race would still be living in caves doing finger-paintings on the walls for amusement. Of course people don’t like being contradicted, or having their precious beliefs scrutinised, picked apart or mocked. Of course they feel threatened, and so of course they’ll resort to irrational defences like ignoring reality. Is the answer to this some sort of self-affirmative mollycoddling, as some researchers think, where you bathe the subject in a warm glow of self-admiration before gently encouraging them to think again about their assumptions? No, it’s not. The answer to people who won’t face reality is to slap them in the face with reality, very hard, and as often as possible.

A case in point arose just last month, when a Nobel laureate who should have known better was excoriated in the press for making jokes about women in the science lab being cry-babies who were always falling in love and, therefore by implication, not being very at science. The professor, no doubt thinking he was making a hilarious joke, was astonished to find himself forced to resign by his university. TV’s wonder boy of physics Brian Cox immediately leapt into the fray to describe the forced resignation as ‘disproportionate’, implying that the remarks while ‘serious’ were effectively a minor peccadillo and not worth making a fuss about.

But was the public reaction disproportionate? Was it a collective failure to appreciate a humorous moment of professional bonhomie? No, it wasn’t. Prejudice and bigotry never use their own names, they always pass themselves off as harmless jokes, trying to sneak under the radar of social disapprobation. That’s why, periodically, some out-of-touch lecturer thinks he can stand up and tell us that women are no good at science and get away with it, even though there’s nothing scientific about this statement and even though the treatment of women in science has historically been and continues to be a disgrace to the discipline.

Ideas like sexism, racism and all the other isms which get in the way of social progress are certainly resistant to change, but change they must, and not by being softly-softly or touchy-feely. The only way to do it is to expose these ideas for the shit they are, and then invite their exponents to shove them somewhere the sun doesn’t shine, preferably with a home enema kit. In the long run, it will certainly be good for them.

PJS