April 27, 2022 – Every day, vital information about your health is flushed down the toilet – literally. Bowel movements contain a veritable treasure trove of biomarkers that can uncover a wide array of conditions, from things you lack in your diet to deadly diseases, including COVID-19.
“Assessing fecal matter can help doctors detect certain types of cancers, give insight into the microbiome, and provide a deeper look into nutrition and lifestyle habits,” says Jessie Ge, MD, of the Department of Urology at Stanford University School of Medicine.
“I don’t even know how many conditions can be examined,” Ge says, “because there are a lot.”
The problem is today’s methods for stool assessment are expensive, inconvenient, and kind of gross. Many tests make you to poop in a tray, scoop out a sample, and mail it to a lab. This creates a huge barrier for use, since a patient must be very motivated to do it.
One solution, according to Ge and other scientists, is to create “smart toilets” that can capture lab-quality samples where they’re first dropped off. That way, doctors and their patients can gain key insights with little to no action required. In fact, a recent paper Ge and others wrote in the journal Nature explains how smart toilets might be the next tool for monitoring COVID-19 and keeping the virus in check.
A Short History of Smart Toilets
One could argue that we’ve been souping up toilets almost since we invented them. Sir John Harrington came up with the modern flush toilet in 1596, and by the 1700s, Europeans were enhancing them with bidets and other luxury features.
Fast-forward a couple of centuries, and we’ve added even more. Today’s toilets will not only wash, warm, and air-dry your tush; they’ll let you shine light on the target, play music, and add aromatherapy – all from the convenience of your mobile device.
But the smart toilets Ge and her colleagues wrote of in Nature would go a step further: examining your health.
The late Sanjiv “Sam” Gambhir, MD, PhD, was an early pioneer in smart toilet technology, dating back to the 1980s. His goal was to focus health care on early detection and prevention, known as precision health. Today, a colleague of Gambhir’s, Seung-min Park, PhD, carries on the work. (Park was a co-author and lead data scientist on Ge’s paper.)
Park designed the Kanaria, a smart toilet prototype that analyzes urine and stool. The Kanaria can assess amount, frequency, color, and consistency; identify the presence of blood or mucus; and track changes over time.
Other smart toilets also use scanning technology to examine stool for blood or other issues. For example, researchers at Duke University in 2021 unveiled its version, which analyzed stool for consistency and the presence of blood.
But Park’s new smart toilet concept goes even further, he says, by using an automated fecal sampling and analysis system that can identify specific diseases – including, he says, COVID-19.
Smart Toilets and COVID-19
Scientists already check wastewater for COVID-19. While this allows public health officials to spot changes among communities, it doesn’t provide insights for individuals.
Park’s new smart toilet concept, nicknamed the Coronavirus: Integrated Diagnostic (COV-ID) Toilet, would include a mechanical arm that can collect and test samples for the virus. A user would first consent to the test by scanning a QR code with their smartphone. Results would be available in 15 minutes.
The big idea isn’t to just diagnose patients, but to “understand the virus in epidemiological studies,” Park says.
“Frequent and widespread testing of fecal matter for the presence of COVID-related RNA could help science better understand how the virus behaves,” he says.
For example, taking multiple samples from one person would allow scientists to monitor viral shedding as the disease progresses and ends. This might offer clues into the mysteries of COVID, like why some people who have it don’t get symptoms and others, who have what’s known as long COVID, deal with symptoms for weeks or months.
Are Smart Toilets Coming Soon to a Bathroom Near You?
The COVID-tracking toilet Park and colleagues envision could be available within the next 3 years, provided proper funding and FDA approval come through. (Neither is guaranteed.) Meanwhile, some smart toilet prototypes already exist and should be available to the public within a year or so, Park says.
These models collect general information such as sitting time, time to first bowel movement, defecation color, and Bristol scale data (a measure of shape and consistency). This can unveil physical and behavior changes a person may need to make to improve their health, such as drinking more water or eating more fiber.
“In the future, [smart toilets will be able to assess] more health markers, like chemistry of the body, but we aren’t there yet,” Park says. He predicts that something like cancer diagnostics, which are far more challenging, may be possible in the next 5 years. And because so much about the microbiome isn’t known, it may be 7 years or more before smart toilets can offer insights that lead to diagnosis or treatment.
Other than funding and testing, the big hurdle smart toilets face is determining what security and health privacy rules must be in place to use them safely and effectively.
Many questions remain: What is the most secure way to handle and store the personal data captured? What happens when a toilet identifies a sensitive health condition? How can it be ensured that all of this will comply with theHealth Insurance Portability and Accountability Act (HIPAA)?
“The goal is to help people,” Park says. “The benefits must outweigh any potential risks, like security or privacy. Which makes bioethics a top priority right now.”