A little bit of fish oil

The British National Health Service (NHS) has announced that, in light of the substantial data documenting that omega-3 fatty acid intake from fish reduces likelihood of cardiovascular events by around 40%, that Brits discharged from hospital following a heart attack should be "prescribed" 1000 mg of prescription fish oil per day.

Hardly a revolutionary concept. Part of the timidity of the British NHS seems to relate to the potential cost to the government, since apparently much of the cost will be borne by the government-subsidized health system.

But prescription fish oil? Why prescription fish oil? Prescription Omacor, one capsule per day, costs around $70 (U.S.) per month. If I go to Sam's Club the same quantity of omega-3 fatty acids (in three capsules) will cost around $2.50. That's less than 5% of the cost of the prescription form.

Omacor is clearly more concentrated. But is the prescription form better--more effective, more purified, less contaminated, etc.? I have seen no independent verification of this. Of course, manufacturers make all sorts of claims. The only independent, unbiased testing I'm aware of comes from organizations like Consumer Reports and www.consumerlabs.com. Omacor has not been compared to non-prescription fish oil in any of their analyses. Head-to-head comparison of Omacor to nutritional supplement fish oil is unlikely to come from Solvay, the manufacturer of Omacor. Drug companies powerfully resist head-to-head comparisons, fearing it will not play out in their favor. Let the public remain ignorant and hope marketing conquers all.

Why would the NHS only recommend eating fish and prescription fish oil? I don't know, but it smells awfully fishy to me. As soon as an opportunity for profit is built into a treatment, all of a sudden it gains endorsement. Perhaps lobbying by those parties with potential for profit drove the process.

Nonetheless, despite the filthy politics and under-the-table dealings, some good comes out of the NHS's action: broader recognition of the power of fish oil. Perhaps when a British patient or an American patient gets discharged with a prescription for Omacor, the patient will take the initiative and go to the health food store instead and save him (or his insurer) $67.50 per month.

For your coronary plaque control program and control and/or reversal of your heart scan score, we start at 4000 mg per day of standard fish oil, providing 1200 mg per day of omega-3 oils. This amount as a nutritional supplement costs only a few dollars a month. And you have the satisfaction of not only taking a powerful step for your health, but also not enriching the overflowing pockets of drug companies.

Comments (12) -

  • Anonymous

    11/6/2006 4:30:00 AM |

    Many of the non distilled forms of Fish oil seem to specify varying amounts of cholesterol contamination , + saturated fat etc.  In the pharmaceutical or distilled types most of the fat content is accounted for by the omega-3 content while in most over the counter types you will find varying amounts of additional fat and cholesterol specified. (Nature Made for example has the following:
    Per 2 Softgels: Calories 25 (Calories From Fat 20); Total Fat 2.5 g (Saturated Fat 1 g; Polyunsaturated Fat 1 g; Monounsaturated Fat 0.5 g); Cholesterol 25 mg; Protein 2 g; Fish Oil Concentrate 2400 mg (Omega-3 [EPA] Eicosapentaenoic Acid 360 mg; Omega-3 [DHA] Docosahexaenoic Acid 240 mg); Gelatin (Non-Bovine); Glycerin; Water; Tocopherol.

  • Bix

    11/6/2006 11:35:00 AM |

    Will insurers cover Omacor?  I don't know...

    If so, I know a number of people who would go get a script today.  The out-of-pocket costs for supplements just aren't in some people's budgets.  But I agree with you, it's a shame the system is designed to support such blatant profit for so few people.

  • Anonymous

    6/16/2007 4:10:00 PM |

    Omacor is a prescription drug and it is covered by my insurance. I pay $90 for a three-month supply, that is four capsules a day for a total of 360 capsule. It is also covered by my flexible spending account, so that saves me about 30% tax. I effectively pay about $63 for three months. So the cost per capsule is about 17.5 cents.

  • Dr. Davis

    6/16/2007 5:50:00 PM |

    Don't kid yourself:

    You may pay $63 for a prescription out of pocket, but you and society pay a far larger price of $240 per month through increased health insurance costs. All of us ultimately bear the higher price. In this instance, all the excess profits go into Omacor's pockets, thanks to the brainwashing of the public and physicians.

  • Anonymous

    11/22/2007 4:03:00 AM |

    Its amazing that Physicians, who lead their life using medicines and treatment protocols which are based on clinical research, discourage the use of the only truely clinically proven, regulated, prescription Omega 3 acid available.  The benefits of this product extend far past its triglyceride lowering effects, which makes it a product that should be considered for positive health as well as disease treatment.  The clinical studies are horrifically expensive, a natural based product is unpatentable, therefore making whomever is willing to put millions of dollars into making sure the clinical background is well tested, take a large risk. Copycat, unproven, dietary supplements (by the way which are monitored by the same people who monitor kit kats and gatoraid)make unsubstantiated claims. Shouldn't the developers and companies of this pharmaceutical product be  repaid, profit, and also be supported enough to continue the clinical research and development of such products.  If only the worlds medications were made up of more natural based solutions I believe we would be much more satisfied and less at risk of side effects from strictly chemically "isolated" molecules.  Omacor (which is now Lovaza) provides a glimpse of what practitioners have been looking for, a natural based prescription medication, effective, clinically proven to lower triglycerides similarly to other available therapies (with less expected drug to drug interactions or adverse events) and controlled so it is easier to recommend and use by health care professionals.  What is the sociatal cost of frequent LFT's, myopathy, rhabdo, Drug to Drug interactions from 145 fenofibrate?  Not the POOLED representation of Adverse events in the PI, that my good Doctor is trickery.  The 48mg might be more innocuous, but the 145mg is still risky and even recently had many other interactions and warnings added.  That is still considered a good drug, effective, possibly safer than the alternative of no treatment, but it does say to mind the "risk benefit ratio" which is thrown to hell when products like Omacor (Lovaza) come to market proven to work without expected side effects.  You might want to rethink how you see the companies and industries that develop the future of medicine.  No one is perfect, nor totally disclosed, however this product is certainly a step in the right direction and should be supported, not stiffled.

  • Dr. Davis

    11/22/2007 2:26:00 PM |


    I think you may have missed the point of the post.

    I was not bashing Omacor/Lovaza because it is fish oil. I have been using fish oil for years with excellent results, preparations that work wonderfully and cost around $3 per month.

    Now, there's a fish oil that costs $130+ per month? Purer? I would like to see side-by-side comparisons; I have seen no such thing. There are over-the-counter, highly purified preparations available without prescription and for less than a tenth of the cost of Omacor/Lovaza.

    I agree that fish oil in some form should precede the use of fibrates like Tricor. I rarely use Tricor, even though much of my cardiology practice has evolved into a lipid consulting practice.

  • Biomed007

    11/24/2007 3:53:00 PM |

    I guess my point is specifically, if you support $3 fish oils and their use, will those companies obediently go out and do the clinical studies that you need to feel secure to treat your patients?  Business and price per product does not come cheap.  The studies done, the missed compounds, the intergration into a patented item, the production, and the standards and guidelines all factor into the price of a product.  I just believe it to not only be unfair to recommend that patients use other than the proven product (unless there is no alternative) but also bad business sense.  If there is not loyalty or ethical appreciation to the developers and testers of these pharmaceutical products, who will then develop medicine?  I believe it would be futile to compare regular fish oil to Lovaza, just as it would be futile to compare most other drugs head to head.  The difference between relative/ actual and clinical vs. theraputic significance is very hard to show.  However, the dosing (4per day vs 8 t0 15 of reg fish oil), the purity (excursions from storage parameters render the compound less or ineffective = lack of controled standards)the purity (many manufactures are continuously being warned from FDA about the consistancy of product) and the lack of attributable cause data linking other less pure concentrations to actual clinical outcomes are all reasons that a seasoned medical professional like yourself should support the use of Lovaza instead of Fish oil capsules whenever possible.  I do know there are studies in europe about dosing regimin vs. clinical lipid results.  I would expect that at 8-15 fish pills per day the outcome results would be similar, however more variation and much more fat and omega 6's per pill.  Compliance would be less than optimal, outcome would be less than optimal, and with any alternative prescription that provides confidence in all variable and clinical aspects, this should be commended and supported whenever possible rather than talking about "brainwashing the public and physicians."  I wish someone would figure out that for every product that is developed, tested, and brought to market there are 20 other products that are in some stage of development and fail to be approved.  If EACH drug that comes to market costs approx $1.2 billion dollars (Tufts CSDD 2006), how much do you think is lost with the other 10-20 drugs that fail to gain approval?  Somewhere between 100 and 500 million PER FAILED DRUG!  Multiply that times the 10-20 that failed and you have approximately  6,000,000,000 (6 billion dollars).  With that said, it takes a lot more than just actual production cost to reimburse for past, present, and future research and development, business expenses, and of course profits to keep the company developing key breakthrough products.  All I am saying is that I understand and commend you for using an agressive alternative therapy addition in your patients to increase their health and hopefully life.  I do however believe that there is a blame game in medicine created or exacerbated by insurance companies that leads to finger pointing about medical necessity and cost.  People look towards trimming expenses in all places, however if drugs like Lovaza (not just fish oils) are not appreciatively embraced by practitioners and supported/ recommended whenever possible, there will be no more drugs or better yet, alternative large scale studies done on this kind of unpatentable compound because physicians assume similarities and switch to a compound like Dietary supplements.  Sorry, Ill step down from my soap box now, however this is definitely a sore spot for me.

  • Dr. Davis

    11/24/2007 4:18:00 PM |

    Do you work for a pharmaceutical manufacturer?

    Is it the same sort of economics that allows the founder/CEO of Kos Pharmaceuticals to cash out for $2.3 billion in personal payout, followed by the company raising the price of Niaspan?

    The answer, in my view, is not to gouge the public with extravagant drug prices, but to support non-profit-seeking research.

  • Anne

    2/5/2009 4:47:00 PM |

    Dear Dr Davis,

    I had to comment on this old blog as I am in the UK. Up until yesterday I was buying omega-3 fish oil from my health food shop, an amount to give me 2250 mg per day, that is 1125 mg EPA and  750 mg DHA, and it was costing me in the region of £25 per month. I have a bicuspid aortic valve with moderate stenosis and talking about omega-3 fish oils with my cardiologist he suggested that I be prescribed Omacor instead. The Omacor is courtesy of the NHS and is therefore free for me ! I'm very happy to have got it Smile

    I would love to have some studies, though, which show the positive effect of omega-3s on coronary calcification.


  • Anonymous

    3/12/2009 8:11:00 PM |

    Anne said, "...my cardiologist...suggested that I be prescribed Omacor...The Omacor is courtesy of the NHS and is therefore free for me ! I'm very happy to have got it Smile".
    I left hospital a month ago with a prescription list that included Omacor but when I visited my NHS GP for a repeat prescription I was told that I could buy this item for myself, over-the-counter. :-(

  • futurepharmer

    10/13/2009 4:37:26 PM |

    "If I go to Sam's Club the same quantity of omega-3 fatty acids (in three capsules) will cost around $2.50. That's less than 5% of the cost of the prescription form."

    Lovaza capsules contain >80% purified EPA and DHA (465 mg and 375 mg, respectively), which are purified from fish oil.  The other oils are fish oils, and could possibly be omega-3s.  You must take at 2-4 for triglyceride lowering (at least one for CV risk reduction in AVD patients).  

    I don't know about any specific manufacturers OTC, but I do know that typical products contain 120mg DHA and 180mg EPA per GRAM of capsule. This means that only 30% have been confirmed to be the beneficial oils.  What else is in there?  This is why Lovaza does not have a fishy aftertaste, but OTC ones do.  Also, look how many you would have to take to equal the DHA and EPA in Lovaza.  It is not ANY fish oil, but specifically DHA and EPA that is necessary for CV benefit.

    Alpha linoleic acid MUST BE ACTIVATED to give CV benefits, and humans only activate 10% of alpha linoleic acid, so products claiming to have a ton of omega 3s using this compound are giving their values of omega-3s via a technicality (alpha linoleic acid is "technically" an omega-3).  

    This is not to mention the whole issue of herbal/supplement companies basically able to put anything in a capsule as long as it isn't harmful, REGARDLESS of what they say it is.  The FDA just doesn't care to watch these companies much.  

    Therefore, if I had the money, I would go Lovaza, but I am a cheap @$$ and would rather go with a USP Verified OTC product and take my chances Smile

  • buy jeans

    11/3/2010 6:16:42 PM |

    Why would the NHS only recommend eating fish and prescription fish oil? I don't know, but it smells awfully fishy to me. As soon as an opportunity for profit is built into a treatment, all of a sudden it gains endorsement. Perhaps lobbying by those parties with potential for profit drove the process.