© FreeDigitalPhotos.net
Placenta encapsulation has been making the rounds recently – it was all over the news since January Jones admitted to doing it. There’s quite a lot of practical information on how to do it and why you might want to. However, there really isn’t a lot of medical evidence on the subject, which leaves women needing to make up their mind, based mostly on others’ experience.
Saying there’s no evidence for something working sounds pretty bad – it’s almost like saying that it doesn’t work. You probably wouldn’t feel too confident if a doctor gave you a drug saying “I hope this helps but there’s no evidence it actually works.” However, in the case of placenta encapsulation it’s worth taking about why there isn’t that much evidence.
Currently, in clinical practice evidence based medicine (EBM) is becoming the new normal – which is pretty great! The central premise is applying the best available evidence gained from the scientific method to clinical decision making. Basically, it means doing things which have been shown to be effective and safe in appropriately designed studies.
Relying on evidence means doctors and patients are better informed and less likely to make mistakes. Ultimately, evidence allows everyone involved to make better treatment choices. However, what if there is no evidence and worse even, what if it is unlikely that there will ever be any substantial evidence? The thing with evidence-based medicine is that the data have to be collected during trials on humans (sounds menacing, right?) For the evidence to be high quality and relevant to clinical practice (i.e. ultimately the patients), the trials need to be safe and fulfill a number of criteria:
- Everyone taking part in a trial has to be informed about it and consent (this rule was introduced after WWII.)
- It needs to be well-powered (i.e. include many people)
- It has to have an appropriate design (randomized, placebo-controlled, double-blinded). Patients need to be randomly placed into different treatment groups and neither they nor the medical staff attending them should know whether they are receiving the placebo or the treatment.
- It should be long enough to supply meaningful conclusions (e.g., a two-month study on breastfeeding will not really give much useful perspective on the issue. Something of longer duration is necessary).
These are all important factors which contribute to the significance of these studies (statistical and clinical – so both in terms of being good science and being relevant to patients). However, they also contribute to their costs. And, by golly, randomized clinical trial (RCT) costs can be enormous.
According to a National Institutes of Health study the mean cost of a randomized clinical trial is $12 million USD. This is not exactly an affordable sum for most — not charities, not universities, and certainly not for the majority of those most concerned with the results: the patients. However, $12 million USD (or more) is not a sum a large pharmaceutical company will balk at. The biggest pharmaceutical companies make from $5 to $13 billion USD profit annually. That leaves a lot of cash lying around for conducting trials, which pharmaceutical companies do all the time.
Pharmaceutical companies need to do trials to get their drugs approved and then convince doctors that their drugs are better than the competition’s. Significantly, however, they have no business in conducting trials which will not result in increased sales of their products (the ethics of trial design is a whole other issue). It doesn’t take much thinking to realize that confirming the effectiveness of placenta pills is not going to provide profit for any industry. No one who already has a lot of money will have more if placenta pills are shown to be effective. What’s more, money might actually be lost for companies (and saved by their clients). It’s feasible that women will buy fewer supplements if they’re ingesting their own placenta for nutrients.
Yes, universities or the NIH could potentially spend their limited resources on a trial, but it’d likely be a small one (and so not high quality evidence); and let’s not kid ourselves – more money goes to looking for cures than preventing disease (especially mental disease). Truth of the matter is: there is no one who has a vested interest in showing placenta encapsulation works and it’s too much below the radar for healthcare professionals to be considered worthy of an independent investigation.
My background is in science and evidence used to be my religion (it largely still is). I’m one of those arrogant, cocky patients whom (some) doctors hate – I walk into to the appointment having read the past years’ worth of the most important developments concerning whatever I’m being seen for. But I’ve also worked in healthcare and spent a lot of my time looking at clinical trials and how they work. After having my nose buried in medical research for a considerable period of time, I realized that there are some things that will never be properly investigated. It may sound cynical, but it’s true: most of the time, medicine is too important and too lucrative for trials and investigations to be motivated simply by looking for the best solution for patients.
Good post! (This is also what kills me about the “breastfeeding has no benefit after one (or 2!)” BS — yes, I understand we don’t have much data, and that of what we do have, most of the studies are small and none of them are random, but A) how in god’s name could it be a RCT? B) who in hell is going to pay for it? and C) where would you find enough people still BFing into toddlerhood to come up with a meaningful sample size?
@crystalbuffaloe A cohort study could be done but women who breastfeed are generally more educated and healthier than those who do not. It’s reasonable to hypothesize that those who breastfeed past age 2 are statistically different from mothers who do not. Differences in the groups of women might confound results and making interpretation difficult.
You know what really bothers me? When I was looking for the safest anti-anxiety medication to take during pregnancy, one drug was suggested as safer than another. Then, I found out that the reason doctors think it is safer (and I’ve heard of this happening to other women) is that there is no evidence that it is harmful, but the reason for *that* is that it’s rarely prescribed! Lack of evidence = safer for a pharmaceutical medication. Lack of evidence = untrustworthy for any medicine that’s not traditional!
Thank you for this informative, well written piece. I mostly agree with your argument but, I am left thinking that even if you were able to conduct a fully powered, RCT it might be confounded by volunteer bias. Additionally, I have a hard time believing that the results would change behavior. If it’s shown that placenta encapsulation has no significant effect on postpartum health people will say that the funding agent is conspiring to keep women from taking control of their health and disregard the findings. If it’s shown to have benefits I believe it will just reaffirm for those who already believe in the use rather than reaching the general public.
I wish it were SOP to ask ALL women, including C-section Moms, if they want their placenta. I had planned to encapsulate mine, but wound up with a C-section and with all the drugs that wish went by the wayside. I never even saw the placenta.