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  1. Vaginal Microbiota Transplantation: The Next Frontier.Kevin DeLong, Fareeha Zulfiqar, Diane E. Hoffmann, Anita J. Tarzian & Laura M. Ensign - 2019 - Journal of Law, Medicine and Ethics 47 (4):555-567.
    The success of fecal microbiota transplantation as a treatment for Clostrioides difficile infection has stirred excitement about the potential for microbiota transplantation as a therapy for a wide range of diseases and conditions. In this article, we discuss vaginal microbiota transplantation as “the next frontier” in microbiota transplantation and identify the medical, regulatory, and ethical challenges related to this nascent field. We further discuss what we anticipate will be the first context for testing VMT in clinical trials, prevention of the (...)
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  • Introduction: The Promise and Challenges of Microbiome-Based Therapies.Diane E. Hoffmann - 2019 - Journal of Law, Medicine and Ethics 47 (4):476-481.
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  • Bacterial Baptism: Scientific, Medical, and Regulatory Issues Raised by Vaginal Seeding of C-Section-Born Babies.Noel T. Mueller, Suchitra K. Hourigan, Diane E. Hoffmann, Lauren Levy, Erik C. von Rosenvinge, Betty Chou & Maria-Gloria Dominguez-Bello - 2019 - Journal of Law, Medicine and Ethics 47 (4):568-578.
    Several lines of evidence suggest that children born via Cesarean section are at greater risk for adverse health outcomes including allergies, asthma and obesity. Vaginal seeding is a medical procedure in which infants born by C-section are swabbed immediately after birth with vaginal secretions from the mother. This procedure has been proposed as a way to transfer the mother's vaginal microbiome to the child, thereby restoring the natural exposure that occurs during vaginal birth that is interrupted in the case of (...)
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  • FMT and Microbial Medical Products: Generating High-Quality Evidence through Good Governance.Pilar N. Ossorio & Yao Zhou - 2019 - Journal of Law, Medicine and Ethics 47 (4):505-523.
    This article argues that current data for the safety and efficacy of fecal microbiota transplants as a treatment for any indication, including recurrent Clostridioides difficile infection, is low-quality. It develops a governance proposal that encourages production of high-quality evidence by incentivizing well-designed RCTs of stool and stoolderived microbial products. The proposal would require that FDA change its current enforcement approach, but it would not require any change in statutes or regulations.
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  • Where Stool is a Drug: International Approaches to Regulating the use of Fecal Microbiota for Transplantation.Alexandra Scheeler - 2019 - Journal of Law, Medicine and Ethics 47 (4):524-540.
    Regulatory agencies vary widely in their classification of FMT, with significant impact on patient access. This article conducts a global survey of national regulations and collates existing FMT classification statuses, ultimately suggesting that the human cell and tissue product designation best fits FMT's characteristics and that definitional objectives to that classification may be overcome.
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  • The Ethics of Fecal Microbiota Transplant as a Tool for Antimicrobial Stewardship Programs.Thomas S. Murray & Jennifer Herbst - 2019 - Journal of Law, Medicine and Ethics 47 (4):541-554.
    Multidrug resistant organisms are a public health threat that have reduced the effectiveness of many available antibiotics. Antimicrobial stewardship programs have been tasked with reducing antibiotic use and therefore the emergence of MDROs. While fecal microbiota transplant has been proposed as therapy to reduce patient colonization of MDROs, this will require additional evidence to support an expansion of the current clinical indication for FMT. This article discusses the evidence and ethics of the expanded utilization of FMT by ASPs for reasons (...)
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