Anyone who's ever taken a shit before—which is to say, everyone ever—has probably suffered from that form of anxiety when you're about to walk into a meeting or go on a first date and you worry that, midway through, you might have to stop to take a dump. Pooping may be natural, but it's not always welcome. But last week, I was struck by a different kind of performance anxiety: What if I got where I was going and I couldn't poop?
I was on my way to OpenBiome, a facility that pays people for shit, and I was nervous as hell. Will it make me look like less of a man if I can't do the job? I worried. Taylor Swift's "Shake It Off" was playing in the car, which seemed appropriate given the topic at hand.
OpenBiome is America's first "poop bank," which collects stool samples to help treat Clostridium difficile infections. C. diff, as it's often abbreviated, is a bacterium that causes gastrointestinal distress, and it's one of the more common hospital-borne infections: About 500,000 people suffer from it each year, resulting in around 30,000 deaths. For those who are living with it, leaving the house can be a nightmare. One of the most effective methods for treating the infection is through what's called a fecal microbiota transplantation—or, in layman's terms, injecting someone else's turds up your ass.
While that's sort of a crude way of putting it, much of the early experimentation with fecal transplants was done through just such DIY methods, which VICE wrote about a few months ago. While hospitals around the country have developed more medically-sound procedures—either through endoscopy, nasal tube, or capsules—fecal transplants are still a highly specialized treatment, and waiting times for finding a donor can prolong patients' suffering. The reason it can take so long is because the process for securing and treating a healthy specimen is arduous and rife with bureaucratic delays. You can't just use any old piece of shit. You need the primo, uncut, fire turds.
That's where OpenBiome comes in. The nonprofit started out of MIT in 2013 by a group of friends led by Mark Smith, a postdoctoral associate, and James Burgess, who previously worked in the Agricultural Development Program at the Bill & Melinda Gates Foundation. By collecting, treating, and storing a backlog of specimens, they hope to ensure that there is enough poop to go around for everyone who needs it.
The idea came when one of their family members came down with a nasty case of C. difficile infection. "He went in for routine gall bladder surgery and came out with a case he couldn't kick," Burgess told me. "After seven courses of antibiotics, he was really miserable and very sick. He was a young guy in his 20s, and for us—seeing that firsthand, as opposed to just reading about it or thinking about it academically—made us think this was a serious need. This was back before fecal transplants were widely available. He worked in health care, knew about FTP, but he couldn't find a doctor to give him the treatment."
The one in New York, where he lived, had a six-month waiting period. So he treated himself at home with a friend's stool sample and a blender.
"It's a pretty awful experience to go through, if you ask me. Having to go though all that and then in the end you have to stick it up your butt," Burgess said. "I think for us it was pretty eye-opening. Here's this idea we were thinking about, and this could really help a lot of people."
OpenBiome occupies two spaces in an unassuming office in Medford, Massachusetts, near Tufts University, where many of their donors come from. Across the driveway there's a Work Out World and a grim, snow-caked parking garage. In the background a commuter rail hurtles along the tracks toward Boston. Inside, the office looks like any other start-up: Twentysomethings are spread around working on laptops, everyone wears a hoodie, and they all seem really enthusiastic about their work. When I visited, containers full of take-out Indian food were strewn throughout the office, which seemed like the equivalent of a sperm bank having porn on hand (it was actually just lunch). In a conference room nearby, the team was working on getting a last-minute grant proposal done. Everyone was laughing. Almost everyone is Canadian, which may explain why they were so welcoming.
You sort of have to laugh, most of the team members I met told me. This is a serious medical problem they're helping people deal with here, sure, but at the end of the day they still have a refrigerator full of poop. "Even those of us who don't have a science background have lost their filter," said Carolyn Edelstein, director of global partnerships. "Our donors, everyone here is on board with the mission. Sure, at face value it's a funny concept, but at its heart it's making a real difference for people's lives, and I think that changes the tenor of what we do now."
That life-changing poop can't come from just anywhere, though. The donation process, overseen by Zain Kassam, a gastroenterologist and physician of internal medicine, is exceptionally rigorous.
"It's harder than getting into Harvard," Edelstein said, walking me through the 109-item questionnaire potential applicants have to fill out. That comes after an 11-point exam done online, which 55 percent of people don't make it past. Another 65 percent are cut after a clinical interview. All told, only about 4 percent of the people who begin the process ever get to the point of actually donating poop.
Some of the things they're screening for are the typical transmissible pathogens you might see when attempting to donate blood, but they also are on the lookout for things like Chrohn's disease or IBS. Anyone on medication for anxiety or depression, or with diabetes or obesity complications, are also screened out.
"If you've done anything at all interesting, chances are you can't be a donor," Edelstein joked.
The reason for that is because each step along the way becomes more and more expensive. The stool has to be sent out for initial testing. After that, additional blood samples have to be taken. They don't want to waste their time and resources on someone who isn't fully committed—shit or get off the pot, you might say. For their troubles, donors receive $40 per poop, with a $50 bonus if they come in five times a week. It costs about $5,000 total to find a donor.
"We want them to come in as much as possible," Burgess told me. "Getting them to come in four times a week instead of three is the difference between us going bankrupt."
"Shit is literally gold for you," I joked.
"It's valuable stuff! A couple times we've run out, and demand is growing fast from hospitals. That's bad news if people are having their treatment get deferred. For us, it's important."
So how does it actually work? "Research has shown that if you take a sample of stool from a healthy person and transplant into the bowels of a patient, the bacteria in the healthy stool will repopulate their healthy microfloras," Edelstein explained. "Basically, the bacteria from the donor stool will out-compete the infection. The bacteria can't compete against this surge of healthy bacteria."
In sometimes as little as a day or two, patients who have been sick for months will find themselves feeling relieved.
At OpenBiome, there are about 16 active donors at the moment. They've processed about 2,300 treatments since they've started, sending them out to a clinical network of 185 hospitals in 28 states and five countries. The poop market is a burgeoning one, it turns out.
But they've come to find out that not everyone poops the same way. Some are morning poopers, some are night poopers. They've also begun gathering data for research on the types of poops people contribute. To date, 581 grams is the biggest load they've received. "I think 100 grams is about the size of an apple," Edelstein said. "That's like six apples with a poop, to give you a pretty good picture of it."
Thank you for that.
A bigger sample isn't necessary, but it does allow them to be more efficient when preparing a treatment. The record-setting donor was pretty nonchalant when he dropped it off, she said. Just another day at the poop office.
"Ever since I can remember I've loved to poop, and often dreamt, like most young girls do, of making money from my excrement."
Downstairs in the lab, the stools are processed inside of a bio safety cabinet with an airflow curtain, which prevents contamination in either direction. Prior to that it's mixed with a saline solution, and run through a machine whose technical name is probably not a poop smasher, but does basically just that.
"It comes out looking like a chocolate milkshake consistency," Burgess said. It's processed in a plastic bag with a sort of strainer, that draws out the useable liquid and leaves behind corn, and other undigested leftovers. Then it's separated into bottles which are kept in a -80C fridge for months, where they wait for donors to pass a second round of screening. If all goes well, it's packed up in boxes filled with dry ice, and shipped out for use around the country. OpenBiome also in the process of perfecting a capsule-delivery system, which, common sense to the contrary, is a considerably more pleasant way to ingest poop than having it blasted up your butt.
Burgess gives me the impression that it's all pretty straightforward. "The complexity comes in when dealing with donors, trying to find healthy people, and keep on top of their health. Anyone can blend poop—we didn't invent that. The hard part is finding good donors and getting all the poop you can from them."
After some recent attention in the press, potential donors are practically banging on the door to be considered. "Our email is blowing up right now from people all over the country," said Daniel Martin, another team member. "People are like, 'Hey, I got some poop, can I get money?'" One email in particular is a favorite among the staff: "Ever since I can remember I've loved to poop, and often dreamt, like most young girls do, of making money from my excrement," it read.
I've always loved to poop, too. And I do a pretty good job of it. Am I one of the top poopers in the Boston area? Maybe, but that's not for me to decide. The team provided me with a setup to go try it out for myself, for journalism's sake, to see what it's like when other donors come in. But after learning they weren't actually going to be able to use my donation for science, I sort of lost my poop boner.
Nonetheless, I set up the poop works on the rim of the toilet, hoping for inspiration. Then I sat there and thought about it. The idea that something that I do every day and take for granted had the potential to save someone's life made the occasion too fraught to confront.
"I couldn't do it," I said on the way out with an empty bowl. That's OK, they told me, it happens to a lot of people on their first time. But I think they were maybe just trying to make me feel better.
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