August 9, 2019, by Brigitte Nerlich
Poo and puns: Recent representations of faecal microbiota transplants in English language news media
Bacteria, germs, poo…these are words that normally don’t evoke images of health and happiness. The relationship between humans and bacteria is often understood as a combative one. Bacteria are an enemy that must be fought and we have been fighting them for many years. We have been fighting them in the toilets, we have been fighting them in the kitchens and we have been fighting them in hospitals. All the while bacteria have been mounting a resistance to the weaponry – such as antibiotics – we use to fight them. And so, the fight goes on.
This is still a dominant picture of bacteria. But things are changing. Bacteria have had an image make-over since the advent of probiotics and ‘good bacteria’. This more positive view has grown alongside the development of the new research field of microbiomics, which studies all the microorganisms of a given community (a ‘microbiota’) together. But of course, there are still ‘bad bacteria’ around. One of them is Clostridium difficile (or C. diff for short). This bacterium can infect the bowel and lead to serious diarrhoea. It especially affects people (mainly the elderly) who have been treated with antibiotics in hospital settings.
Here is where ‘poo’ comes in, or rather faecal microbiota transplants (FMT). This is the process of transferring stool from a healthy donor, who has a healthy gut microbiome containing good bacteria, to a recipient with a dysfunctional intestinal flora (containing bad bacteria), in order to repopulate their gut microbiome.
FMT has been used in one form or another for a long time, but has only recently made its appearance in official health care settings, especially in the treatment of otherwise intractable cases of C. diff.
Clinicians and scientists are starting to talk about FMT to journalists; journalists and science writers are picking up these stories and patients too are relating their experiences to the media. For our research, we wanted to find out more about this, get a feeling for what conversations people are having about FMT and whether this is changing the ways in which we understand the relationship between humans and bacteria.
To do this, we investigated how English-language newspapers represented FMT between 2003, when the phrase first appeared in English-language news, and 2017. From what we can ascertain, both science and the media began to follow the FMT story more closely from 2013 onwards.
In order to generate a data set of news articles on FMT, we searched for ‘fa(e)cal microbial’, ‘microbiota transplant’ and ‘stool transplant’ on the Nexis® UK news database. ‘Fa(e)cal transplant’ generated an amount suitable for qualitative analysis: 1609 articles – 1547 with duplicates removed. We then focused on ‘newspapers only’, which meant excluding trade publications, websites, magazines etc. This left 612 articles and after duplicates were removed, the remaining overall data consisted of 504 articles [December 24, 2017 search].
We studied these articles using qualitative thematic analysis, paying particular attention to certain forms of language; namely puns, wordplay, metaphor and argument structure, salient topics and events, key actors, and emerging patterns within the data, which clustered especially around the three aspects of FMT: faeces, bacteria/microbes and transplants/donation. We also examined broader themes associated with health and the gut microbiome, in order to uncover emerging social representations.
Our findings show that print media focused in particular on creating novel, mainly hopeful, social representations of faeces through wordplay and punning, side-lining issues of risk and fear. There was, of course, also hype, and future research should pay attention to evolving ‘GutHype’. In our media sample we saw controversy emerging around FMT and obesity. For example, one headline proclaimed “Bowel hope turns to crap” (Sydney MX, Australia, 06/02/2015). Autism featured as one of many hyped-up diseases that FMT is supposed to cure. One article asked “Are gut microbes really a panacea, or just overhyped?” (The Guardian, 2017), and another, in The Globe and Mail, talked about “Poo and woo woo” in a “post-truth” world.
The ‘gut reaction’ to the process of FMT is likely to be one of disgust. Throughout our corpus, this gut reaction was highlighted but also counteracted through various rhetorical strategies, namely punning, strategic use of numbers/science, contrastive storytelling, and the use of ‘but’. For example, a seminal 2013 study on FMT which triggered media attention was reported in Scientific American under the title “The S••t hits the fan!!”. The work of an FMT pioneer Australian doctor, Thomas Borody, attracted a lot of attention and reporters pointed out that his scientific papers include “such titles as Flora Power and Toying with Human Motions. But he is also deadly serious”. Another example of what we call the ‘but strategy’ is the: “The procedure is, of course, messy and odoriferous, but it’s also simplicity itself.”
We also identified changing metaphorical framings of microbes and bacteria from ‘enemies’ to ‘friends’ (“microbial miracle workers”). Additionally, readers are familiarised with FMT through the depiction of the process as being both mundane (“you can now liquidise your partner’s poo in a blender and insert it into your body at home”) and highly medicalised (“pills you pop in the mouth and swallow”).
We argue that emerging media representations have the potential to background the yuck factor and shape more positive social representations of FMT, paving the way for FMT to become a more socially acceptable procedure. Future research can build on this baseline study in order to study how social representations circulate in the wider media and public sphere, online as well as offline, and how they may change over time and differ between countries, as research into FMT progresses.
Hodgetts T, Grenyer R, Greenhough B, McLeod C, Dwyer A et al. The Microbiome and its Publics. EMBO Reports 2018;19:e45786.
McLeod C, Nerlich B, Jaspal R. Fecal microbiota transplants: Emerging social representations in the English-language print media. New Genetics and Society 2019; 38/3, 331-351.
Nerlich B, Koteyko N. Balancing food risks and food benefits: the coverage of probiotics in the UK national press. Sociological research online 2008;13:1–14.
Dr McLeod presented her data at the Microbiology Society Focused Meeting Anaerobe 2019: Changing perceptions of anaerobic bacteria; from pathogen to the normal microbiota and back