I’ve always been amazed at the things and activities around which commons have been unexpectedly developed – noncommercial theater, humanitarian rescue maps, specialized scientific microscopes. Little did I suspect that I would encounter a commons based on....human excrement. Even more surprising is that this valiant little commons, dedicated to using the human biome to benefit everyone, may soon be enclosed by Big Pharma. Yes, there is big money in turning our shit into branded, proprietary product.
First, a little background (from an excellent NYT article on the topic). OpenBiome is a Cambridge, Massachusetts stool bank that provides people with bottles of a “mud-colored slurry” used in fecal transplants. In recent years, physicians have made the amazing discovery that transferring the microbiota of healthy donors into the guts of people with certain illnesses can rescue them from death’s door and cure them. OpenBiome assists in this process by collecting stool donations from the public, processing them in safe and reliable ways, and making them available to patients and doctors for F.M.T., or fecal microbiota transplantation.
Tens of thousands of people suffer from the bacterial infection Clostridiodes difficile, or C. diff, for example. Fecal transplants have proven to be effective in 80% of these patients. Some feel much better within hours. Working as a nonprofit, OpenBiome helps such people by producing between 900 and 1,000 fecal transplant treatments each month, for about $800 apiece.
But now many pharmaceutical companies see fecal transplants as the Next Big Thing: a new way to deliver their drugs to treat diabetes, cancer, obesity, autism ulcerative colitis, and Alzheimer’s and Parkinson’s diseases. As the Times put it, “Human feces, it turns out, are a potential gold mine, for both medical researchers and drug makers.”
Based on the huge success of fecal transplants for C. diff, drug companies would love to extend and control this drug-delivery system for other diseases. Naturally, this would mean pharmaceutical companies destroying the fecal transplant commons and creating a new market order that they could dominate.
Ah, but how to achieve this goal? Answer: Through the strategic use of government regulation.
If the Food and Drug Administration can be persuaded to classify fecal transplants as a “drug” (rather than as organs, tissues, or blood, or some entirely new category), then FDA regulations would greatly favor drug companies and markets as the way to provide fecal transplants. The US Government would in effect create a regulated market for feces, to the exclusion of other potentially reliable, safe, and affordable options, such as commons.
Naturally, policymakers are not likely to regard a fecal commons of the sort facilitated by OpenBiome as the preferred option. Pharmaceutical companies don’t like that kind of competition, and Big Pharma calls the shots in Washington. In the name of rigorous health and safety, federal regulation is likely to be invoked by industry as the most effective way to invent a new market for itself. This would eclipse OpenBiome and preempt the idea of a viable fecal commons.
The drug industry would surely find this option attractive because it is currently having trouble getting patients to participate in clinical trials for fecal transplants – a necessary step for getting FDA approval. Sidelining OpenBiome could only help. The FDA has already stepped up its oversight of OpenBiome, which has caused its prices for fecal treatments to double to $1,600. It doesn’t take much imagination to see how prices would soar much higher -- and OpenBiome would suffer -- if Big Pharma truly got its claws into this market, selling our own excrement back to us as branded product.
In short, we may be about to witness an historic moment -- the market enclosure of human excrement as a medical treatment. Or as one gastroenterologist put it, the rise of the “poop drug cartel."
Such enclosures are a familiar pattern of capitalism. To meet an important need, commoners demonstrate the feasibility of an innovation through their hard work and mutual aid. Then for-profit businesses swoop in to monetize, privatize, and marketize everything. Commoners lose control of what is theirs, pay more for what they used to get for free or inexpensively, and suffer under the extractive terms of a market order, with the blessings of industry-friendly regulation.
Another path is feasible, but will the FDA make it illegal?