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Fecal Transplants: Gut Feelings for Medical Tourism Patients

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Fecal matter isn't just a load of crap to medical tourism patients willing to travel to the Northwest corner of the United States from as far away as Sweden and Spain.

Some of these international patients might rationalize that it was more of a gut feeling which subjected them to a procedure that placed donated poop in their colons to cure nasty bowel infections. To these medical tourism patients, a fecal transplant was anything, but a pain in the behind. It actually saved their lives.

The medical speciality is known as a fecal transplant, and there are few medical practitioners who can perform the unusual procedure, which has made Portland, Ore., a destination hub for patients outside the United States seeking advanced naturopathic treatments.

Mark Davis, a physician at the Center for Natural Medicine, says there are only a handful of practitioners around the globe who perform fecal transplants. These doctors, however, limit the therapy to one specific form of colitis even though there is a growing body of evidence that fecal transplants can help treat other gastrointestinal diseases.

In many cases, the therapy uses diluted stool from a healthy person to repopulate bacteria in the gut of a patient who is ill, typically after antibiotics have killed off microbes that can no longer re-establish their necessary balance. Stool is administered by an enema or a tube through the nose.

Eclectic Approach

Naturopaths are willing to take this more eclectic approach to treatments whereas other physicians might be reluctant to deviate from established standards of care.

Davis has treated about 10 international patients so far, and he has local stool donors ready when foreign visitors arrive. The treatments take about 10 days. Most patients receive one stool injection a day. Each injection introduces trillions of bacteria into the patient's gut.

Experience dictates that when patient needs are not being met, people who desire medical help are more than willing to travel great distances to find innovative procedures and treatments no matter what they may be — that are critical to their livelihoods, said Jonathan Edelheit, CEO of the Medical Tourism Association. Healthcare is no longer limited by boundaries, but rather determined by when and where medical procedures and treatments are available.

The Food and Drug Administration, which is in the process of reviewing treatments, wants to begin requiring doctors and clinics — like the Center for Natural Medicine — that perform fecal transplants to apply for investigational new drug applications  known as INDs in order to continue their work.

Regulatory Prescription

Federal officials hope to boost regulatory clarity about the procedures, which for now, doctors say could bring poop transplants to a standstill. That means more patients willing to go to any lengths to get a desperately needed transplant where doctors haven't already shut their doors.

Fecal transplants and other naturopathic therapies have turned more than a few heads in the medical tourism community, where international patients typically visit the United States for cutting edge care — like cancer treatment — that isn't available in their home countries.

We are the only place on the whole planet that both treats patients with naturopathic cardiology and trains doctors from the same location, Martin Milner, who practices naturopathic cardiology, told the Portland Tribune.

During the course of his 30-year practice in Portland, Milner estimates he has treated 50 or 60 international patients at the Center for Natural Medicine from countries that include Pakistan, Japan and South Africa. He says those countries have long traditions of naturopathy, but none of the practitioners have the breadth of conventional medical training that students at the local National College of Natural Medicine receive.

Licensed naturopaths in Oregon are able to prescribe drugs and natural medicines unavailable in most other countries. Milner says in other countries, naturopaths tend to focus exclusively on herbal medicine and nutrition. Even his patients who come from Germany, which has a long history of natural therapy use, are unable to get about half the therapies he prescribes.

Milner invented a slow-release natural compound thyroid hormone replacement medication. International patients who read about him or his therapies are told a first appointment has to be face-to-face. Subsequent discussions can take place via Skype.

Milner expects the attraction for international patients will only increase once the National College of Natural Medicine establishes a proposed partnership with the Center for Natural Medicine. That effort, which would provide students at the naturopathic college expanded clinical and research training opportunities, should create a global market identity for naturopathy in Portland.

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