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 interventionâ€Â, 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.
This story did not discuss the costs of any of the means to increase dietary omega-3 fatty acid intake.
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 three 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 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.
There was no mention of harms, side effects, or anticoagulation effects with excess doses. The story also failed to mention that fish oil can be a source of mercury with its potential neurologic risks (although there was a brief mention of mercury without context).
The story did mention “a critical review of existing research in BMJ, The British Medical Journal, ‘cast doubt over the size of the effect of these medications’ for the general population.” And it mentioned that the Italian study had “methodological weaknesses.”
But this story failed to present a clear description of the nature of the evidence. In the FDA’s announcement of its qualified health claims for omega-3 fatty acids, it states, “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.” Explaining the nature of the data, where the evidence was weak, and how conclusions were reached would have greatly improved the usefulness of this story.
The story included input from several individuals expert in cardiology and the role of omega-3 fatty acids for decreasing risk of heart attack. It would have been informative for readers to have someone explain the nature of the information on heart disease and omega-3 fatty acids and why conclusive data was not available.
The story made scanty reference to consumption of fish as a method of increasing omega-3 intake as well as the use of over-the-counter preparations of fish oil as means of increasing intake of omega-3 fatty acids. However. the story focused disproportionately on the fish oil product with FDA approval for one application. There was too much discussion of a single product, when many products exist. The story needed to give more information on diet and risks of mercury exposure.
The article explicitly states that prescribed fish oil is not approved by the FDA for use in heart patients as a treatment. This is not an accurate statement. The FDA announced approval of a qualified health claim of reduced risk of coronary heart disease for omega-3 fatty acids in 2004. And while not FDA approved for use for all coronary disease, there is currently an omega-3 fatty acid product on the market that has been approved for the treatment of very high triglycerides. Fish oil is widely available over the counter, which is the most important piece of information for readers. This story focuses too much on the availability of one prescription fish oil brand.
Because the story used multiple sources, it does not appear to have relied on a news release, although it does focus
disproportionately on one commercially available product.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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