I definitely agree with some of your post above, IsthmusSIBO.
@Aim for NaN and
@blackpilledFMT seem to be effectively trying to copy HM without adding anything new, except maybe things that are tangential to the actual success of FMT, like web coding.
On the other hand, the lack of people joining forces with Michael's project likely has more to do with other things, namely the lack of concrete plans to address the "efficacy gap" between HM's previous donors and the "cure" that sick people are actually looking for.
It's likely that HM was operating long enough that most of the people who wanted to try one or more of his donors were already able to do so, and it's quite possible that many if not most of them, like myself, found the effectiveness underwhelming and not too different from other sources that were out there for at-home FMTs. Some of us have experienced other forms of FMT that seemed qualitatively more effective--
in my case it was with the now-defunct OpenBiome but for others it may have been other methods. The "open problem" for us is how to bridge that efficacy gap.
I have come to the conclusion that reproducibly getting a "cure" using stool is likely too difficult without a team of scientists involved in the project, with lab space and all that. Not that simply having scientists with lab space will
in and of itself solve the problem like magic, but just private people trying donor after donor using similar methods is not likely to get us there. It is very likely the case that truly "solving" this problem will require tests to come out of basic microbiome science that we don't even have yet,
and then practical work applying that to the clinical process of FMT. I know Michael might disagree because he had success with two DIY donors early in his process, but there's no clear roadmap on how to get those back other than "just offer more people more money and
hope one shows up".
The only way I was able to proceed past the "wall" I had hit with FMT and begin to close the efficacy gap was to shift away from stool entirely, and use a completely different process: (
https://forum.humanmicrobiome.info/threads/experience-so-far-with-oral-microbiome-transplant.1359/).
If stool is to be made to work as well or better than this for home use, I'm convinced it will still take a similarly large "paradigm shift" to get there, albeit in a different direction. And the thing is, HM did not seem on the verge of any paradigm shifts when it closed.
So, we don't need umpteen copycats of HM. What we need is someone to propose a direction to search for a new paradigm that's laid out clearly enough that it's actually investable-in. Again, just "we will offer a million dollars for effective stool" won't cut it. The only benefit of new people like
@Aim for NaN and
@blackpilledFMT getting into the game is that possibly one of them would have the resolve or connections to try and catalyze a paradigm shift that Michael would not have tried. Like, suppose that vancomycin pretreatment is important--would any of the new people getting into FMT be up to try and assemble a list of providers who are willing to prescribe and manage vancomycin pretreatment for patients purchasing FMT for home use (from HM or others)--or are they, like Michael seems to be, so stuck on the idea that "all antibiotics are bad mmkay" that they wouldn't think of doing this?
Newcomers to this field are likely to be successful NOT because they can do what Michael was already doing better than he did, but because they do something that he didn't do at all. If all people want to do is copy HM then they should be working for HM to get it back up and running, but as I said I suspect that the chance of that actually leading to a cure for a large number of patients is slim.
