Would You Like Some Freshly Ground Placenta On Your Salad?

Whenever I write on Skeptoid about medical topics, it seems a majority of both the content of my posts as well as most of the responses to comments is spent in repeating over and over that anecdote is not evidence. Your personal story, a bunch of stories put together, or even the story of an "expert" do not constitute proof of your hypothesis. Do not misunderstand my meaning here. Observation and anecdote certainly can be valuable to science. This can often be the basis for forming a hypothesis, and can provide direction for the design of a study in which to test the hypothesis. That is a very important distinction.

Let me repeat: anecdotes are not evidence. While anecdotes have value, only a repeatable, controlled study can provide the proper evidence to verify a hypothesis.

An article posted on the Common Health page of WBUR - Boston's NPR station - is a perfect example of anecdote being presented as evidence.Kira Kim, the author of the article, describes herself as, "a Certified Lactation Educator, labor doula and student midwife..." While this might give Ms. Kim some experience in both the delivery process and lactation, it does not necessarily signify any medical training. This is evident in her presentation of "proof" that eating the placenta after giving birth somehow has health benefits.

The top claim she presents as evidence is a quote from Amanda Englundwho runs a service which puts a placenta in pill form (encapsulation). Ms. Englund's "proof:"

More folks are learning about it through media sources and more mothers are sharing their experiences about how positive the effects have been on their recovery.

Withing the same paragraph Ms. Kim further provides "proof:"

Want more proof? Kim Kardashian is considering it. And mean “Glee” cheerleading coach Sue Sylvester took her placenta home.

That's better than a controlled study, right?

I won't further quote the article, but instead list the remaining "evidence" Ms. Kim presented. First was a survey of 189 women who reported their results from eating placenta, and sure enough the women reported more energy and better mood. Once again - there is no control and the demographics seem to indicate a certain bias as to who participates in placenta eating.

The paper in which the survey is reported, as well as Ms. Kim's article, also point to traditional Chinese medicine as further "evidence" of the benefits. Ms. Kim even talks about how a Chinese medicine practitioner prescribed her placenta to "balance [her] qi." Chinese medicine, as pointed out in a Skeptoid episode, was a way to try to bring some basic medical care to rural areas of China. It advocates scientific medicine, but offers alternative medicine as a last resort - mostly for comfort when standard care isn't available. It isn't evidence-based in any way.

Ms. Kim's final evidence is her own anecdotes of mothers she helps through the placenta eating process. Once again, there is no control. In fact, there is no mention of how mood and energy are quantified. It seems to be more of a classic case of the placebo effect: if you take something or do something that people say will make you feel better, it probably will make you feel better, at least temporarily or a little bit.

Is it possible that eating placenta is beneficial? I don't think the hypothesis is completely without merit. The number of anecdotes lead us to at least consider performing a study that is controlled and gives good, quantifiable measurements. We can also look at other animals as we do share many commonalities. Most mammals do eat their placenta. Again, this isn't evidence, but it is an observation scientists do sometimes use to determine if something has merit to study in humans. However, there are both concerns with the plausibility and with possible negative effects of eating placenta.

Placenta eating advocates claim that the placenta is dense in many nutrients, and try to justify it with limited animal studies. As Dr. Harriet Hall writes:

All they’ve got is rats and speculation. The best they can do is to mention the need for adequate iron and speculate that placenta-eating might be a useful source of iron. To counter that, we know enough about iron metabolism to make us think it is highly implausible that a one-time ingestion of placenta would contribute very much to effectively replenishing the body’s iron stores.

Dr. Jennifer Gunter also addresses the hormone issue, animal studies, the comparison to other mammals, and the fact that this tends to be more of a cultural and not a scientific idea:

Board-certified gynecologist Jennifer Gunter of Kaiser Permanente San Francisco says she cannot recommend it as medically beneficial until she sees a study, and that's hard because placentas -- and pregnancies, for that matter -- vary so much in human populations.

Until then, she judges it as a cultural practice that has garnered "a lot of chatter."

"Some scant animal studies suggest that the placenta has beneficial effects on pain, and yes it has a lot of hormones, but whether we need that biologically no one knows," says Gunter, director of Kaiser's Center for Pelvic Pain."You can't really compare our reproductive organs to animals. They eat their stillborns, too."

Dr. Steven Novella addresses the animal comparison in his post on the matter:

I also did find an interestingpaperthat suggests that there may be a reason why humans do not habitually consume the placenta, while most other placental mammals do. Mammals eat their placenta as a behavioral adaptation likely because it provides needed nutrition, so why waste it. It may also provide the benefit in that otherwise the placenta may attract predators.

Dr. Novella also points out that the placenta serves as a filter for things headed to the baby. While there isn't any science measuring the levels of things good or bad in the placenta, he hypothesizes there could be a concentration of bad things in there just as much as the claim of good things. There is no reason to believe the placenta is all rainbows and unicorns.

Dr. Amy Tuteur - the skeptical OB - is more critical and makes a more direct statement on eating placenta in a post she titled "Eat your placenta and show just how gullible you are:"

When it comes to placentophagia, homebirth advocates are batting zero, as usual. Eating the placenta is NOT a natural process for humans. Indigenous peoples around the world did NOT eat the placenta. There is NO evidence that eating the placenta improves iron stores. There is NO evidence that eating the placenta prevents postpartum bleeding. There is NO evidence that eating the placenta improves milk supply. And there is NO evidence that eating the placenta prevents or treats postpartum depression.

There is one thing that eating the placenta reliably does, though. It does highlight the fact that homebirth advocates are gullible and woefully uneducated about human childbirth.

The final point made by several skeptics is typical of why we fight the alternative medicine crowd. When people skip traditional treatment because they believe an alternative treatment will work, there is the potential for harm. Postpartum depression is a serious issue. Various estimates in a quick search put the number at anywhere from 10-20% of women suffer a serious bout with depression within weeks of giving birth. This can have serious consequences for mother and baby if not properly treated. I would rather use the best science we have to treat someone dealing with depression than some belief, as one of the mom's interviewed who ate her placenta said:

It felt powerful and magical and important.

I don't want magic. I want evidence.

Studying eating placenta is not completely without merit. However, when weighing the observations we have to this point, it would appear that even if there was some benefit, the benefit could be obtained by other means, and probably in a much more controlled, safe, and inexpensive manner. Unless a study can show some significant benefit not revealed in evaluating the plausibility, I would say bring your baby home and leave the placenta at the hospital.