[Reprint] Stool Pigeon
Better or Worse than ‘Dung Dash’?
Quick Note from Summer 2025
I spent a couple of mornings last week chaperoning field trips for the Newcomers School, which is an unusual model where refugees and other immigrants spend one year together getting acclimated and practicing their English before going on to their regular neighborhood schools. Tuesday we went to the History Museum, which has a project on Greensboro’s longstanding tradition of hospitality to new arrivals. Thursday was the High Point children’s museum.
We were outside in the homestead park for much of Tuesday. The single biggest reaction I saw from the kids was the storm of giggles when they were presented with a chamber pot. People forget that even outhouses were not common here until the Rockefellers decided that hookworm was holding back the Southern economy.
The culprit behind “the germ of laziness,” as the South’s affliction was sometimes called, was Necator americanus —the American murderer. Better known today as the hookworm, millions of those bloodsucking parasites lived, fed, multiplied, and died within the guts of up to 40% of populations stretching from southeastern Texas to West Virginia. Hookworms stymied development throughout the region and bred stereotypes about lazy, moronic Southerners.
Shitting outside (what the NIH calls ‘open defecation’) was still a big problem in rural India when I was there in 2018. According to this article, the issue is one of social engineering more than infrastructure.
Perhaps the most important barrier to the adoption of affordable latrines in rural India is the unique history of untouchability and its continuing practice. Affordable latrines, such as those recommended by the World Health Organization (who) and subsidised by the Indian government, have pits that need to be emptied manually. Rural people equate manual pit emptying with scavenging and other degrading forms of labour traditionally done by Dalits. Because of this, non-Dalits refuse to empty their own latrine pits. Dalits, who were traditionally compelled by violence and poverty to do similar work, increasingly seek alternatives to the kinds of physically and ritually dirty jobs that have been used, for generations, to justify their oppression, exclusion, and humiliation.
Dalits used to be called untouchables. We don’t use that term here, but according to public radio, American Hindus still maintain those prejudices. I have no personal experience with that, but I have had people tell me they were Brahmin as though they expected me to be impressed.
This week starts the stem cell adventure, kicked off this morning by a Public Day.
I’ll let you know how that goes.
Original Post from Feb 2021
It is technically legal to send fecal material through the mail, as long as it is for medical purposes, and not for revenge or bio-terrorism. However, last week my GP’s office told me to just bring them my sample, as they had been “having trouble with the mail.” They didn’t specify what that trouble was, but I suspect it was a freshness issue. Samples over ten days old are no good, apparently.
So, entrepreneur that I am, I started thinking about dedicated fecal delivery services. We have them for transplanted organs already, and I don’t just mean Kid Flash in that one episode of Young Justice.
As we learn more about the microbiome, it’s becoming clear that fecal transplants are both medically useful and potentially profitable. There’s a recent movie about the beginnings of the industry.
Imagine a worldwide network of donation centers like we have for blood. A Brown Cross, if you will. Or in Islamic nations, a Brown Crescent. I won’t traumatize you with homemade depictions of their hypothetical logos. I will say that this is not a crazy idea, because the proof of concept already exists in Boston.
My own sample was just being screened for colon cancer. I turned 50 this year, so I’m now in a higher risk stratum, regardless of family history. Having grown up on a dairy farm, shoveling literally tons of animal shit over the course of my childhood, I’m a whole lot more comfortable sampling mine with a little grooved stick (the government of Hong Kong provides detailed directions) than I am with a colonoscopy.
This is not simply robotic homophobia on my part. I have actual reasons.
Anesthesia is not without risk
I’m not going into any detail on this, because I feel like the concern is already out there, as in this older [paywalled] article from Scientific American, as are the best practices for patients in dealing with the risks.
https://www.webmd.com/a-to-z-guides/anesthesia-risks-what-patients-should-know
I instead want to focus on something not a whole lot of people are thinking about publicly.
Endoscopes are really hard to clean
More controversially, almost 30 years ago, an EPA scientist named David Lewis published some papers about disease transmission through dental equipment. Then he moved on to do similar experiments with endoscopes. These papers did not make him any friends in the industries he was criticizing, as you might guess from all the comments on his 1993 dental paper in the Lancet, at a time before open peer review was common. However, it was his later work on using under-treated sewage as agricultural fertilizer that got him forced into early retirement.
He wrote a whistleblower memoir, which I reviewed in a previous blog.1 After reading my review he contacted me, and we struck up enough of a conversation over e-mail that he drove up from Georgia to visit one of my Governor’s School classes. As late as 2016, he was still publicly urging caution in choosing your endoscope facility, in this opinion piece in the Oconee Enterprise:
I visited the endoscopy clinic and asked two important questions: “Who manufactures your endoscopes; and do you sterilize them with peracetic acid?” Routine flushing with peracetic acid helps remove traces of patient material that escape cleaning. His answer, “Olympus and no,” was not what I had hoped to hear.
A recent review strongly states that any disease transmission is a one-off mistake, not a systemic problem (emphasis mine).
Historically, the risk of viral transmission related to endoscopy has been rare to nonexistent. Previous reports of hepatitis C transmission were due to nonadherence to aseptic techniques in drug administration, lapses in reprocessing protocols, and failure to adequately disinfect reusable biopsy forceps. Multicenter prospective studies of endoscopic procedures on hepatitis C carriers or hepatitis B seropositive patients did not demonstrate post-procedural transmission following appropriate disinfections protocols. To date, there have been no reported cases of endoscope-associated SARS-COV-2 transmission.
That may or may not be true. The length and complication of the disinfection procedure, expressed as the flow chart in Figure 1 of that review paper, does not increase my confidence. Neither does the lawsuit settlement Dr. Lewis mentions in his editorial.
When it comes right down to it, I personally care much less about my ability to sue someone for malpractice than I do about not catching something nasty in the first place. The fact that the medical community is still arguing about endoscopy means that I don’t want one unless it is absolutely necessary. Having other options makes it un-necessary, in my opinion.
Other Options
There are three different fecal-testing kits, which rely on different technologies. None of them is quite as sensitive as endoscopy, which is (as mentioned before) simultaneously a test and a treatment, because if they find a polyp they can just snip it out at the same time. However, endoscopy is surgery, and a small risk of anesthesia complications, or of poking a hole in your intestine, or catching a virus, is larger than zero risk. The fecal testing kits have essentially zero risk. You can do one every year, as opposed to getting ‘scoped once every ten years.
Plus, they’re cheap. If you are one of the millions of Americans without medical insurance, they may be your only realistic option.
But back to my original market-research question. If you had to choose a fecal delivery service … ?
Dr. Lewis’s short profile at the National Whistleblowers Center, which offers legal support, policy advocacy, and public education about this essential but unpleasant function for the body politic.
https://www.whistleblowers.org/whistleblowers/dr-david-lewis/