In Europe it’s fish oil after heart attacks, but not in U.S.

Our Review Summary

This story did not go far enough to present information on all sides of the fish oil debate; instead, it focused on the availability of one prescription product. Embedded within this story are some concepts that are very important to understanding medical recommendations and health claims.

The story states that “The fact that heart patients receive such different treatments in sophisticated hospitals around the world highlights the central role that drug companies play in disseminating medical information, experts said.” Actually,even within the United States, there is great variation in the way that medicine is practiced even among similarly sophisticated hospitals. And while the drug companies may have a role in this, there are a number of other factors (number of specialists in the area, number of hospital beds, where the majority of physicians were trained, etc.) that influence the treatment variation seen.

The overall focus of this story is that because fish oil is more often prescribed in Europe than in the United States, that the disease is better treated there than here. The study cited to support the contention that fish oil reduces the number of deaths 3 years after a heart attack involved patients that consumed a Mediterranean diet which differs than typical American fare, and also did not compare the patients taking fish oil to a placebo control. The story credits the salubrious effects for the heart from the Mediterranean diet on its high content of broiled and baked fish, without mentioning the other ways in which the diet differs from standard American fare – also with cardiovascular benefit (e.g., high reliance on monosaturated oil instead of hydrogenated or partially hydrogenated fats). The article contains more enthusiasm for the use of fish oil than examination of the data supports. The story also framed trial results only in relative terms (20% reduction in the number of deaths and 40% reduction in the number of sudden deaths), not in absolute terms.

The story mentioned an article which found that only 17% of family physicians surveyed prescribed fish oil. This was defined in the study as advice to eat more fish or more fish oil supplements. However, this story is all about the benefit of taking fish oil supplements, specifically the prescription fish oil FDA approved for the treatment of very high triglyceride levels. Although this story mentioned that doctors might not recommend increased fish oil consumption because doctors think of it as “just a dietary intervention”, the above mentioned article found that 99% of physicians surveyed reportedly agreed that nutrition is important in cardiovascular disease prevention. It is also possible that physicians prioritize the dietary recommendations that they make to patients and they may perceive it is more important to talk about other dietary issues rather than fish oil.

The story skimmed the surface of some very important issues regarding fish oil and prevention of cardiovascular disease. It could have done much more.