It’s not easy being a trail-blazer in medicine. Just ask Dr. Michael B. Edmond, who is professor of Internal Medicine in the Division of Infectious Diseases at Virginia Commonwealth University. Dr. Edmond is also one of the nation’s most enthusiastic supporters of a relatively new technique, fecal microbiota transplantation (FMT), as a treatment for Clostridium difficile, or C. Diff.
Each year, C. Diff infections afflict more than 300,000 people in the United States alone, causing severe diarrhea, abdominal pain, nausea and vomiting. Even though FMT has a 90-percent success rate of curing this potentially deadly infection (C. Diff is linked to an estimated 14,000 deaths annually, according to The Centers for Disease Control and Prevention), until recently it was exceedingly difficult for Dr. Edmond to prescribe this life-saving treatment to his patients.
“There were a number of barriers, and quite a few logistics involved in fecal transplantation,” Dr. Edmond explained.
First, a sick person had to identify a potential donor -- usually, a friend or family member. While this might cause minor embarrassment for some people, in the case of elderly folks -- with their smaller social circle -- finding a donor can prove nearly impossible. Next, potential donors needed to be tested, an out-of-pocket cost of up to $1,500 which is not covered by insurance. Finally, those deemed eligible (anyone who’d recently taken antibiotics, traveled internationally, or is prone to constipation would be rejected), had to produce stool at a specified date and time, whereupon laboratory technicians began the onerous job of homogenizing the fecal material in a blender and filtering it.
Carefully following all these steps before transplantation could occur meant hours of waiting, and unreimbursed time. This is a key consideration, of course, for physicians who work with a form of compensation that’s based upon the volume of patients seen.
“So, I was thrilled, to say the least, when I first learned about OpenBiome,” said Dr. Edmond, who estimates his per patient time for FMT has dropped from three hours, to one. That’s because OpenBiome provides processed, frozen human stool from donors who have been carefully selected and screened for multiple infectious diseases at least twice.
“Really, though, the nicest thing is we can now stock the product, just like anything else. If a patient is ill with C. Diff, I can go to the pharmacy and get a dosage. Once it’s thawed out, it’s ready to go.”
While OpenBiome makes his job faster and easier, Dr. Edmond notes there’s still work to be done -- full FDA approval, for instance, or having more insurance companies to accept it under their coverage -- before fecal transfers gain wider acceptance. In the meant time, he feels it’s his moral responsibility to make FMT available.
“I see patients who are desperate,” Dr. Edmond concluded. “I know the odds are very high that I can cure them with a simple procedure.”