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Fish oil trade group inflates findings on heart disease risk reduction

New study finds EPA and DHA omega-3s lower risk of coronary heart disease

Our Review Summary

This news release summarizes a recent paper published in Mayo Clinic Proceedings that evaluated the effect two types of omega-3 fatty acids — eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — had on reducing risk of coronary heart disease. The report was a meta-analysis, meaning researchers evaluated the findings of multiple published studies. Specifically, the meta-analysis looked at 18 randomized controlled trials (RCTs) and 16 prospective cohort studies. RCTs are designed to measure the effect of a specific intervention under clearly-defined, experimental conditions. This means that researchers aim to determine, with some degree of certainty, whether a specific intervention is causing a specific outcome. Prospective cohort studies follow large groups of people over extended periods of time, allowing researchers to determine what characteristics or behaviors may be associated with specific outcomes. Because of the nature of these cohort studies, they can only tell researchers if a behavior or practice is correlated with an outcome — but not whether the behavior is causing the outcome.

These sorts of meta-analyses can be extremely valuable tools for assessing a broad body of work on a given subject. However, this news release is problematic. It is written in a way that is confusing, if not misleading, and fails to make clear that the scientific-sounding organization that funded the study (and wrote the release) is an industry group that was created to promote the global use of omega-3 supplements or foods that are high in omega-3s.

 

Why This Matters

According to the National Heart, Lung and Blood Institute, approximately 370,000 people die of coronary heart disease each year in the United States. Many adults make decisions about their diet, activities and lifestyle based on how those decisions may affect their heart health. Research on subjects such as how omega-3 fatty acids affect heart disease risk play an important role here. According to a 2015 Washington Post article, people in the U.S. spend $1.2 billion each year on fish oil supplements, largely because they contain omega-3s that consumers think will reduce their risk of heart disease. But increasingly consistent evidence shows that fish oil does not, in fact, protect against heart disease. If people are going to make informed decisions about their personal health — and how they spend their money — they need to have good information that they can actually understand. News releases like this one make it hard for most consumers to understand exactly what the research says.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

Cost is only addressed in a quote from the executive director of an omega-3 industry organization, who refers to increasing one’s omega-3 intake as an “inexpensive” lifestyle change. What does “inexpensive” mean? What may be cheap for one consumer could be cost-prohibitive for another. What’s more, it’s difficult for any reader to work out what the cost may be, because the release doesn’t make it easy to determine how much of EPA or DHA one needs to take in order to see any potential benefit. It is only in the tenth paragraph, which quotes an editorial suggesting that taking “at least 1 gram of EPA+DHA per day…continues to be a reasonable strategy.” That’s still not necessarily clear for many consumers, since it’s not directly linked to the benefits discussed elsewhere in the release, but it’s the only reference to how much an individual might need to consume — and it’s buried near the bottom of the release.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The release tells readers that, among the RCTs, “there was a statistically significant reduction in [coronary heart disease] risk in higher risk populations, including…16 percent in those with high triglycerides and 14 percent in those with high LDL [low-density lipoprotein] cholesterol.” So the release is claiming that seafood, supplements and pharmaceuticals offer a 16 percent reduction in risk of coronary heart disease for people with high triglycerides. That sounds good, right? But over what time span? A year? A lifetime? And how high does a person’s trigylceride count need to be in order for that person to have “high triglycerides?” The release doesn’t tell us. And then things get really confusing. Consider this statement: “A non-statistically significant 6 percent risk reduction among all populations in RCTs, a finding supported by a statistically significant 18 percent reduced risk of [coronary heart disease] among prospective cohort studies.” Does the statistically significant finding somehow make the non-statistically significant finding more, well, significant? No. Does bundling those two things together into one sentence muddy the waters for readers? You bet. Does the release still fail to explain the time-frame it is using when discussing risk reduction? Yes.

Providing readers with figures describing the absolute risk reduction would have been very helpful here.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The release does not mention any potential problems associated with omega-3s. And there are potential harms. For example, the University of Maryland Medical Center notes that patients should consult with their doctors about potential interactions with prescription drugs before taking omega-3 supplements, and adds that “High doses of omega-3 fatty acids may increase the risk of bleeding, even in people without a history of bleeding disorders, and even in those who are not taking other medications.” There are concerns about other potential harms as well, such as whether fish oil supplements may increase risk for prostate cancer. We don’t expect a news release to include an exhaustive summary of all the possible harms associated with a particular intervention. But we do expect a news release to at least acknowledge that the potential for harms exists, when appropriate.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

The release does tell readers the total number of RCTs and cohort studies that the meta-analysis looked at, as well as the overall number of study participants involved. That’s good. The release also articulates the difference between the two types of studies — which is also a good thing. However, things get dicey when the release starts discussing benefits. For example, the release tells readers that “The study reviewed 18 randomized controlled trials (RCTs) and 16 prospective cohort studies, with 93,000 and 732,000 subjects, respectively.” As noted above, the release also states that the study found a “16 percent [risk reduction] in those with high triglycerides and 14 percent in those with high LDL cholesterol.” It would be natural for readers to assume that those risk reduction numbers are based on the 18 RCT studies, which evaluated 93,000 study participants. But that would be wrong. According to the journal article, only six of the RCT studies looked at patients with “high triglycerides,” and only five of the RCT studies looked at patients with high LDL cholesterol. So, while the release is not technically incorrect, it’s misleading — and that’s not okay.

Does the news release commit disease-mongering?

Not Applicable

No disease mongering here. But there’s also no context about the prevalence of coronary heart disease.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

This is a really close call. The story makes clear that the research was funded by the Global Organization for EPA and DHA Omega-3s (GOED) — which also issued this news release, through AAAS’s EurekAlert! news service. The release also quotes two GOED employees, and clearly identifies them as such. However, the release doesn’t include any language explaining what GOED is, what it does, or who its members are. And that’s important, because GOED is not an independent research organization, it’s an industry group that exists to promote consumer use of products that contain omega-3 fatty acids.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

There are many actions that invididuals can take to reduce their risk of coronary heart disease, including losing weight, exercising regularly, and managing stress. The release doesn’t mention any of them. This is particularly problematic given that these are actions which are not mutually exclusive: one could lose weight, exercise regularly, manage stress and eat more fish (for example).

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

The release refers to consuming EPA and DHA in the form of either seafood or supplements, so we’ll give this a pass. However, that single reference to sources of EPA and DHA is only found in a quote in the tenth paragraph.

Does the news release establish the true novelty of the approach?

Not Satisfactory

There are a ton (to use a technical term) of studies on omega-3 fatty acids and heart disease, including lots (and lots) of meta-analyses (like this one or this one, for example). What sets this meta-analysis apart? The release doesn’t tell us.

As noted above under the Why This Matters section, there’s considerable evidence and recent consensus that fish oil doesn’t have much if any effect on cardiovascular disease.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Not Satisfactory

A few points here. First, the release states that increasing their consumption of omega-3s is a “change that most consumers need to make.” That’s over-reach, and that alone would give the release an unsatisfactory rating here.

But there’s one other note that we’ll make here, since it doesn’t really fit anywhere else: at no point does the news release tell readers what EPA and DHA stand for. Nor does it explain what they are, or even what omega-3 fatty acids are, much less how they may be beneficial for heart health. If you’re going to use terms that are not common knowledge — such as “DHA omega-3s” — please give your readers some idea of what you’re talking about.

Total Score: 1 of 9 Satisfactory

Comments (2)

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Adam Ismail

January 10, 2017 at 12:44 am

My name is Adam Ismail and I am the Executive Director of GOED. Thank you for reviewing our press release. I am a big fan of HealthNewsReview (HNR) and in fact, our team tried to use the HNR criteria as a guide when drafting this press release. Obviously we did not meet your expectations and will strive to do better in the future.

It was certainly not our intent to mislead anyone, so I want to take this opportunity to provide the information you felt was missing for anyone who visits this page.

Criterion 1 – Cost of the Intervention
As you point out, our only mention of cost was when I stated that increasing EPA and DHA intakes is an inexpensive lifestyle change. In many prior reviews of omega-3 stories on HNR, this criterion was not assessed because the cost of fish was “not in question” in those stories. I assumed the same would hold true for this study since it was a meta-analysis that was designed to confirm an effect of the nutrient from studies that used varying dosages and products, rather than a specific intervention. Addressing this point more precisely is difficult. With seafood, the net cost of increasing your intakes of EPA and DHA depends on what you are replacing in the diet and to our knowledge, there are no studies on what foods consumers displace when they eat more seafood (that would be an interesting study, by the way). We can make some non-systematic, anecdotal illustrations though, which appears to be a consistent approach with other reviews on HNR. The study authors found no dose-response effect and no statistically significant difference between EPA+DHA dosages above and below 1g/day, but the Dietary Guidelines for Americans and World Health Organization both recommend eating two servings of fatty fish per week to reach intakes of 250mg of EPA+DHA per day for cardioprotection. If a chicken breast ($0.85 per serving according to the BLS) is being displaced by a salmon fillet ($2.34 per serving according to Consumerist), then the monthly additional spending would be $11.92. If, however, the consumer chose a can of tuna ($0.74 per can for the top selling product at Wal-Mart), then a consumer could save $0.88 per month.

With supplements, we would not assume a consumer is displacing foods with an omega-3 pill, so all spending is additional. One of the most popular omega-3 supplements in the US is the Kirkland fish oil from Costco. One softgel supplies 250mg of EPA+DHA, or the daily target. A 400-count bottle retails for $9.49, so the monthly cost would be $0.71. At the premium end of the price spectrum, Nordic Naturals Ultimate Omega is one of the most popular selling products. A single softgel contains 550mg of EPA+DHA per day, so one would only have to take a single softgel approximately every other day to reach the 250mg target. A 360-ct bottle of this product retails for $102.95 on Amazon, or the monthly equivalent of $4.29. So to summarize, there are significant differences in price depending on which product one chooses to purchase. To reach 250mg per day of intake from fatty fish it could cost -$0.88 to +$11.92 per month, or by supplements +$0.71 to +$4.29 per month. Our organization and some expert scientific groups believe that 500mg should be recommended per day for basic nutritional needs, so you would need to double those costs to achieve these levels. The American Heart Association recommends 1g per day for people with pre-existing coronary heart disease, and this study found a stronger effect in the high TG population at intakes greater than 1g/day, so the costs would have to be quadrupled. Again, this is not a systematic, scientific approach to assessing the cost of increasing omega-3 intakes, but given that the range of costs goes from a net savings to an additional $45 per month if one had CHD, I would argue that no matter what type of consumer you are there is an inexpensive option for you to increase EPA and DHA in the diet.

Criterion 2 – Adequately Quantifying the Benefits
Your review questioned many aspects of how the study findings were characterized in our release, so I will try to tackle them one at a time. For the relative risk reductions in higher risk populations, the study authors used triglyceride levels of 150mg/dL and LDL cholesterol levels of 130mg/dL as the cutoff in their analyses for elevated levels of these biomarkers. According to the CDC and American Heart Association, about a quarter of the US population is above one of these levels.

Addressing your question about the length of time needed to achieve the levels of risk reduction observed in this study is more difficult. This paper was a meta-analysis that pooled studies of varying designs. In the high risk groups to which you refer, these studies lasted 1-5 years in the elevated triglyceride groups and 3-5 years in the elevated LDL cholesterol groups. Regardless, EPA and DHA are nutrients that experts/scientists believe should be consumed regularly in the diet over one’s lifetime, so focusing on a timeframe may not be the relevant point. Like other diet and lifestyle factors, one should not assume that making a positive change for a short period of time confers a lifetime benefit.
Your review also noted it was difficult to interpret this statement summarizing one of the study’s findings: “A non-statistically significant 6 percent risk reduction among all populations in RCTs, a finding supported by a statistically significant 18 percent reduced risk of [coronary heart disease] among prospective cohort studies.” This is a quote from the study’s lead author, an epidemiologist that specializes in meta-analyses, so we chose not to simplify it. However, you make a very good point that it is confusing and if one was not reading the sentence literally he/she could take away that the prospective cohort study findings strengthened the significance of the RCT finding, when they are actually separate analyses.

As you note in the Our Review Summary, prospective cohorts are observational studies that provide evidence of correlation and not causation. However, I do think it is worth noting that prospective cohorts often provide evidence over much longer periods of time than most RCTs. In this study, the RCTs ranged from 1-7 years in duration while the prospective cohorts ranged from 6-40 years. Since the focus of this paper is a set of nutrients that should be part of the diet throughout life, the findings from these longer term studies are also interesting when taken with the findings of other types of studies, all of which have their limitations. Findings from RCTs are only valid in the context of their specific design and should be replicated before being relied upon, meta-analyses may not show an actual effect that gets buried in the noise from pooling studies with varying designs, animal studies do not necessarily translate to human studies, etc. This is why looking at the totality of evidence is important and also why our release included recommendations for future studies that could address some of the questions raised by this paper.

Also, we could not provide the absolute risk reductions because the underlying paper did not provide this data, but agree that this information would be interesting, particularly from the prospective cohort studies that tend to have more generally representative populations than the RCTs.
I also want to make one point about some possible bias in your review. In your assessment of this criterion you made the following statement: “So the release is claiming the supplement offers a 16 percent reduction in risk of coronary heart disease for people with high triglycerides.” No such claim was made in our press release. This was NOT a study on the provision of a specific supplement, it was a meta-analysis on the provision of EPA and DHA and the RCTs included in the study utilized seafood, supplement and pharmaceutical interventions to deliver the EPA and DHA, while the prospective cohorts focused on EPA and DHA intakes from seafood in the background diets. In fact, the only place in our release where supplements are mentioned is a quote from the cardiologists who wrote the accompanying editorial in the journal, and it is mentioned alongside seafood consumption. A more accurate statement would be: “So the release is claiming provision of EPA and DHA may offer a 16 percent reduction in risk of coronary heart disease for people with high triglycerides.”

Criterion 3 – Harms of the Intervention
It is true that EPA and DHA pharmaceuticals and supplements can lead to some adverse impacts, usually fishy burps and some gastrointestinal distress, and that seafood can lead to allergic reactions in sensitive individuals. We could have mentioned that in the release. However, your review notes two specific adverse events, an increased risk of bleeding and prostate cancer. I have commented previously on the bleeding aspect in another review on HNR, but this is not an evidence-based adverse event, instead it is limited to a handful of case reports which resulted in early omega-3 researchers believing (incorrectly) that the cardiovascular benefits observed in early studies may be due to anti-coagulant effects. You cited a statement by the University of Maryland Medical Center, which in turn does not cite the specific papers where this evidence exists, and in fact their reference list includes no clinical data to suggest that EPA and DHA increase bleeding risk. In fact, in this meta-analysis, none of the RCTs found an increased risk of bleeding in their monitoring of adverse events and none of the prospective cohorts did either (although intakes in the prospective cohorts are lower than the RCTs). The most comprehensive review of the evidence on bleeding was published in 2014 by Wachira et al in the British Journal of Nutrition (https://www.ncbi.nlm.nih.gov/pubmed/24472372) and found that omega-3s, alone or in combination with anti-coagulants, did not increase the risk of bleeding.

The FDA has approved four pharmaceuticals for the treatment of hypertriglyceridemia based on EPA and/or DHA and does require a statement on their labels about interactions with anticoagulants, but it notes that none of the studies observed prolonged bleeding time beyond normal bleeding. Also, it is worth noting that the pharmaceutical dosage of EPA and/or DHA is equivalent to about two servings of salmon and that the maximum allowable dose in supplements is about the same as a serving of salmon, so any risk from normal dosages and servings seems inconsequential and not backed by data. I should note that some observational studies have found native Inuit populations with slightly higher rates of nosebleeds and hemorrhagic stroke risk, but keep in mind that the average intake of EPA and DHA in these populations exceeds 16,000mg per day. That would be the Western equivalent of eating eight servings of salmon per day or taking 64 of the Costco fish oil pills mentioned previously per day.
As for prostate cancer risk, the study you cite did not provide EPA and DHA to the subjects. It was an observational study that correlated omega-3 blood status with prostate cancer risk, but the omega-3 levels were so low in the group with the highest omega-3 levels that it does not seem possible that they were consuming EPA and DHA with any regularity, and in fact had levels lower than the national average. Part of the reason for this may be that fish oil supplements routinely include vitamin E as an antioxidant and the study you cite was originally designed as a study on vitamin E and selenium in prostate cancer, so subjects were counselled to avoid dietary supplements that contained vitamin E that would interfere with the results of the study. An editorial on HNR also pointed out other issues with this study: http://www.healthnewsreview.org/2013/10/omega-3-fatty-acids-prostate-cancer-study-and-stories-off-base/. So, it is inaccurate to suggest that “fish oil supplements may increase risk of prostate cancer” on the basis of a study that did not provide fish oil supplements to the subjects…and actually our release was on a study that did not focus on fish oil supplements anyway, it was on EPA and DHA from any source.

Lastly, I think it is worth noting that evaluation of this criterion on HNR has also been inconsistent. Some of the reviews on stories about omega-3 studies rate this question N/A and state that the harms of eating fish are not in question. In one case, the reviewers even noted that the study found no adverse effects, but gave the story an X because they felt the reporters should have mentioned that there were no adverse effects observed.

Criterion 4 – Grasping the Quality of the Evidence
You are correct that we described the studies included in the meta-analysis for the total populations, but not the high risk populations. Our intent was not to mislead, and we never attempted to directly connect the high risk populations with the statistics on the overall study. We apologize if that was the appearance. For clarity, the meta-analyses comparing subjects with high and low triglycerides included 48,775 subjects from RCTs, while the analyses comparing high and low LDL cholesterol included 48,235 subjects. The prospective cohorts did not stratify subjects by triglyceride or LDL cholesterol levels, so similar analyses were not conducted on those studies. Regardless, these analyses still seem to be substantially large.

Criterion 5 – Disease-mongering
Thank you for recognizing that we did not attempt to disease monger. I should note that we did include some context on coronary heart disease, including a quote from the lead author that stated CHD account for half of all CVD deaths in the US. We did not state the overall scope of CVD or CHD in the US, but I would argue that most people know that CVD is a leading cause of death in the US.
Criterion 6 – Identification of funding sources and conflicts of interest

This is a significant oversight on our part. Our press releases typically carry a standard “About GOED” paragraph at the end and somehow it got dropped from this release. This looks really bad on our part, but at least the consumer news outlets that wrote about the paper appropriately identified us as a trade group and issued a note of caution in interpreting the results because we funded it. So we hope no consumers were misled by this. One video on MSNBC stated that GOED actually makes supplements and seafood, which is not true, so perhaps had we not mistakenly dropped that, there would be more accurate descriptions of who we are and what we do. For the record, here is the paragraph we include in releases:

“GOED, the Global Organization for EPA and DHA Omega-3s, is a trade association representing 200 companies worldwide active in the EPA and DHA omega-3 industry. EPA and DHA are critical components of the diet that are backed by more clinical science than any other nutrient. GOED’s membership includes all segments of the omega-3 supply chain from fishing and seafood companies, to refiners, supplement manufacturers, food and beverage marketers and pharmaceutical companies. GOED’s members agree to adhere to product quality and ethical standards that are as strict or stricter than any set of regulations in the world. GOED focuses specifically on addressing the insufficient consumption of EPA and DHA in the human diet by promoting global consumption of EPA and DHA and protecting the consumer by making sure our members produce quality products. Visit GOEDOmega3.com for more information.”

I would also like to ask HNR to correct one aspect of your review. The headline and your tweets about the review both state that we are a fish oil trade group. This is not accurate, but is understandable since we did not include a description of our organization. Our trade group is focused on the nutrients EPA and DHA from any source and in any application. This means our scope of work and membership includes activities from the following sectors: seafood, supplements, pharmaceuticals, infant formulas, clinical nutrition and medical devices (yes, there are medical devices that contain EPA and DHA). Also, the EPA and DHA from our members are sourced from fish, other marine species, algae, yeast, and even oilseeds. I believe a more accurate statement would be to call us an EPA and DHA omega-3 trade group than a “fish oil trade group.” One reason I think this correction is important is because after you tweeted the review’s headline out, it was retweeted by Tim Caulfield of the University of Alberta with his addition “fish oil hype?”. I believe he probably assumed the study was conducted on fish oils because of the headline in the HNR review, and that simply is not the case as mentioned previously. In the interest of accuracy in discussions on science in the media, I believe this aspect should be corrected.

Criterion 7 – Comparison with Existing Alternatives
Your review states that there are many things consumers can do to reduce the risk of coronary heart disease and we do not mention any of them. Actually there is a quote from me in the ninth paragraph where I specifically mention that increasing EPA and DHA intakes is similar to increasing fiber and reducing sodium intakes, which are dietary alternatives to contribute to heart health. You are right that I could have mentioned others like exercising, maintaining a healthy weight, and managing stress, but it is not accurate to claim that we mentioned no other heart-healthy lifestyle interventions. We agree completely that none of these lifestyle changes are mutually exclusive and would never suggest otherwise.

Criterion 8 – Establishing Availability of the Intervention
Thank you for giving us a pass on this one, although the review does imply we were hiding this a little by not noting the sources of EPA and DHA until the tenth paragraph. This is probably splitting hairs, but all prior paragraphs were focused on the study results, and then we moved into the practical implications of the study where the sources were mentioned, and lastly on to the limitations and how future studies could be improved. The study was not on a particular source, so it would seem strange to focus on the sources before discussing the study results.

Criterion 9 – The Novelty of the Study
Your review claims we did not state what was novel about the study in the results. I agree that we could have been clearer about this, but the second paragraph starts with this quote from the lead author: “What makes this paper unique is that it looked at the effects of EPA and DHA on coronary heart disease specifically, which is an important nuance considering coronary heart disease accounts for half of all cardiovascular deaths in the U.S.” This is the most important aspect of this study and is the reason we decided to fund it in the first place, so it bothers me that we were not crystal clear about this. The two other meta-analyses you linked to in the review and nearly all others have looked at the outcome of cardiovascular disease, but cardiovascular disease is a composite of coronary heart disease, vascular disease and other heart diseases.

One thing the literature has uncovered recently is that omega-3s may have effects in coronary diseases but not necessarily in vascular diseases, so this meta-analysis focused specifically on CHD outcomes while the previous studies have focused on the composite CVD outcomes. This is an important distinction about this study because mixing an outcome where there may be an effect with an outcome where there might not only muddies the waters and makes it more difficult to detect an actual effect. The distinction between CVD and CHD is subtle, but many people erroneously believe that if a chemical entity is good for heart health, it must be good for all aspects of heart health. Thus, it is important to look at CHD specifically.

Criterion 10 – Unjustifiable, Sensational Language
I stated in the release that increasing EPA and DHA omega-3 consumption is a change that most consumers need to make. Your review considered that sensational language. I should have cited the evidence to make that claim; however, I believe it is an accurate statement. Papanikolaou et al mined NHANES dietary intake data to estimate intakes of EPA and DHA in the US from foods and supplements and found that the mean intake from all sources in the US was 155mg/day, but more importantly only the 90th percentile of Americans reached the goals of 250mg/day and two servings of fatty fish in the Dietary Guidelines for Americans (http://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-13-31). In addition, another paper by Murphy et al looked at omega-3 status from NHANES blood samples and found that 80.6% of Americans have omega-3 levels lower than those associated with cardioprotection (http://www.mdpi.com/2072-6643/7/12/5534). These are not cherry picked papers, they are the most recent and comprehensive studies in this area and are in agreement with the other papers that have estimated intakes from foods alone and usually find that mean intakes are between 80mg and 100mg per day. The Murphy paper is the only paper to calculate omega-3 status in the general US population.

Data is a little harder to come by outside the US, but Micha et al conducted a large study mining national nutrition databases from around the world. Their study showed that approximately 5.5 billion people live in countries where the mean intakes of EPA and DHA do not reach 250mg/day (http://www.bmj.com/content/348/bmj.g2272). Additionally, Stark et al have created an international map of omega-3 status for countries where data is available and similarly found that omega-3 status is low in most countries, with the exception of some select Asian and Arctic populations (http://www.sciencedirect.com/science/article/pii/S0163782715300333). Taken together, I would argue that this supports the statement that increasing intakes of EPA and DHA is a change “most consumers need to make.”

Your review also makes a good point that we do not explain what EPA and DHA are in the release, other than that they are omega-3 fatty acids. We will include an “About EPA and DHA” paragraph in future releases.

Reply

    Kathlyn Stone

    January 10, 2017 at 3:52 pm

    Dear Adam,

    Thank you for your comments. We’re always happy to give those we’ve reviewed space to respond and clarify. We’re glad you saw some valuable elements in the review and we appreciate your noting where you might have done better. You made a few calls for changes and we’ll address those here.

    1). You wrote: “So the release is claiming the supplement offers a 16 percent reduction in risk of coronary heart disease for people with high triglycerides.” No such claim was made in our press release. This was NOT a study on the provision of a specific supplement, it was a meta-analysis on the provision of EPA and DHA and the RCTs included in the study utilized seafood, supplement and pharmaceutical interventions to deliver the EPA and DHA, while the prospective cohorts focused on EPA and DHA intakes from seafood in the background diets. ”

    Our response: Our review should have listed the combined EPA and DHA interventions as “seafood, supplements and pharmaceuticals” as you point out. We will revise the review accordingly. However, that still would not change the substantive criticism under the Benefits criterion.

    2). You took exception to the way reviewers addressed potential harms, but the news release didn’t address potential harms at all. If this is an issue that GOED thinks needs to be addressed in a certain way then the release should have addressed it.

    3.) You alluded to “inconsistency” in our reviews. It’s true that different reviewers have taken different positions on different subjects in the 10+ years we’ve been reviewing health news. While our reviews are systematic and based on 10 distinct criteria, as long as humans are the ones doing the reviewing, there’s going to be some variation. The comments, rather than the ratings, are what we hope readers will pay most attention to.

    4). Under disease-mongering you state that you did provide some context on coronary heart disease. When we looked again at the release we agree that this statement does allude to prevalence but we wonder if it provides sufficient context to fill readers in on the scope of coronary heart disease. What does “half of all cardiovascular deaths” mean?

    5). You also took exception to GOED being referred to as “a fish oil trade group” in the headline and suggested “EPA and DHA omega-3 trade group” is a better descriptor. We agree that GOED is more than a fish oil trade group. It is described in the summary as “an industry group that was created to promote the global use of omega-3 supplements or foods that are high in omega-3s.”

    6). In regard to your concerns about the Alternatives criterion, it seems you are re-writing the news release quote to add context that was NOT in the original. Here’s what the release says: “Remember that increasing omega-3 intakes is basically just improving the quality of one’s diet slightly, like reducing the amount of sodium or increasing your dietary fiber. It is a simple, inexpensive, and achievable change that most consumers need to make to optimize their health.” There is nothing in that quote that makes clear the source is talking specifically about cardiac health in general or coronary heart disease risk in particular. And, frankly, most non-experts would not see a link between dietary fiber and coronary heart disease risk.

    7). Finally, under the Unjustifiable Language section, we stand by our judgment that increasing their consumption of omega-3s is a “change that most consumers need to make” is unjustifiable. Why? Because extraordinary claims need extraordinary support, and that support is nowhere to be found in this news release.

    The vast majority of the criticism fails to appreciate that we are judging the news release. If information exists, but the news release doesn’t mention it, that doesn’t count in the news release’s favor.

    Again, thank you for your feedback. We always invite those we’ve reviewed to respond either in the comments or through email.

    Kathlyn Stone, Associate Editor

    Reply