A B.C. physician who has provided unapproved fecal transplants for everything from Lyme disease to mental illness says he doesn't believe he's doing anything illegal.
Dr. Bill Code, an anesthesiologist based in Duncan, says he's provided these transplants to about 40 people since he and his wife Denise opened the Taymount Canada clinic in July 2018 as a partner location to the Taymount Clinic in the U.K.
Though he acknowledges that Health Canada only permits fecal microbiota transplants (FMT) as a treatment for recurrent infection with C. difficile, a bacteria that causes diarrhea, Code said he hopes he's just ahead of the curve.
"Perhaps I'm to some degree a maverick in that I like to encourage things toward change. But the No. 1 rule in my mind ... is patient safety," Code told CBC in an interview last week.
Health Canada is investigating whether Code is in violation of the Food and Drugs Act, and a link to the Vancouver Island clinic disappeared from Taymount's U.K. website after CBC began asking questions earlier this month.
But Code doesn't believe he's operating outside the law.
"I've been a practitioner for 40 years and a Canadian for 66 and I'm not noted for doing things that are illegal," he said.
Susan Prins, a spokesperson for the College of Physicians and Surgeons of B.C., said that all doctors must seek Health Canada approval for any use of FMT other than treatment of C. difficile, and "the college expects physicians to comply with Health Canada directives."
But she said she couldn't disclose whether the college is investigating Code's clinic.
FMT is largely an experimental treatment
FMT uses bacteria and other microbes that have been taken from the poop of a healthy person. They're processed into pills or liquid form and then given to a patient either anally or orally, with the goal of restoring a normal environment inside the gut.
The last few years have seen a lot of excitement about the potential applications of FMT, and extensive research is underway about the possibilities for treating a wide range of conditions.
But in Canada and the U.S., FMT is only approved for use with C. difficile, unless it's happening within the confines of an authorized clinical trial — that is, a carefully controlled experiment to determine the safety and efficacy of a treatment.
Provincial Health Officer Dr. Bonnie Henry has previously described unapproved use of FMT as an "experimental, unproven treatment that has dangers" — including serious infection.
Code's clinic is not conducting clinical trials. He's currently charging just under $7,000 for a 10-day program of transplants to treat things like irritable bowel syndrome, mental health concerns and chronic Lyme disease for a largely American patient base.
Code said he became interested in FMT after visiting Taymount's clinic in the U.K. for treatment of his multiple sclerosis.
"I improved quite a bit," Code said. "So we decided, Denise and I, that we would start to explore that for ourselves."
In the U.K., as in the U.S. and Canada, FMT is only recommended for treatment of C. difficile infections.
Besides providing rectal transplants at his Duncan clinic, Code said he has sold implants to families who have taken their children to Taymount partner clinics in Slovakia and the Bahamas for treatment of autism. He said he hasn't actually performed transplants on those children.
Code said he has had no connection with the patients or business of Jason Klop, a Vancouver naturopath who's facing scrutiny for $15,000 US FMT "retreats" for autistic children at a clinic near Tijuana, Mexico.
"I'm a little stressed out about how he went about things, but there's always somebody doing a different curve, I guess," Code said of Klop.
'A tremendous probiotic'
Code argued that Canadian agencies work very slowly to approve worthy new medical treatments, suggesting that "big pharma" has too large of an influence on the process.
He also objects to the term fecal microbiota transplants, preferring to call his implants gut flora transplants instead.
"We take the stool component off so all that's left is the bacteria, the single-celled organisms and the fungi. In my mind, in most minds in the world, they're closer to a tremendous probiotic than they are to a fecal transplant," he said.
A Health Canada spokesperson said there is no legal difference between a fecal microbiota transplant and a gut flora transplant.
At the moment, Code said the future of his clinic is up in the air because of the COVID-19 pandemic. Apart from the recently relaxed restrictions on health-care services in B.C., he said it's been difficult to get shipments of the FMT product from his supplier, the U.K. company TML Science.
"My goal was not to do this for remunerative reasons. My wife and I invested a fair bit in this, but it is what it is," Code said.
"It has incredibly helped a number of people. We had an email the other day where the woman was quite sure that it had saved her life."