Fish oil and the perverse logic of hospitals

Hospitals are now starting to carry prescription fish oil, known as Omacor, on their formularies. It's used by some thoracic surgeons after bypass surgery, since fish oil has been shown to reduce the likelihood of atrial fibrillation (a common rhythm after heart surgery).

Why now? The data confirming the benefits of fish oil on atrial fibrillation has been available for several years.

It's now available in hospitals because it's FDA-approved. In other words, when fish oil was just a supplement, it was not available in most hospitals. Whenever I've tried to get fish oil for my patients while in hospital, you'd think I was trying to smuggle Osama Bin Laden into the place. The resistance was incredible.

Now that FDA-approved Omacor is available, costing $130 dollars per month for two capsules, $195 for the three capsule per day dose for after surgery, all of a sudden it becomes available. Why would this irrational state of affairs occur in hospitals?

Several reasons, most of which revolve around the great suspicion my colleagues have towards nutritional supplements. In addition, there's the litigation risk: If something has been approved by the FDA, their stamp of endorsement provides some layer of legal protection.

However, I regard those as pretty weak reasons. I am, indeed, grateful that fish oil is gaining a wider audience. But I think it's absurd that it requires a prescription to get it in many hospitals. Imagine, as the drug companies would love, vitamin C became a prescription agent. Instead of $3, it would cost far more. Does that make it better, safer, more effective?

Of course, no drug sales representative is promoting the nutritional supplement fish oil to physicians nor to hospitals. I now see people adding the extraordinary expense of prescription fish oil to their presription bills.

In my view, it's unnecessary, irrational, and driven more by politics and greed than actual need. Take a look at the website for Omacor ( Among the claims:

"OMACOR is the only omega-3 that, along with diet, has been proven and approved to dramatically reduce very high triglycerides..."

This is a bald lie. Dozens of studies have used nutritional supplement fish oil and shown spectacular triglyceride-reducing effects.

Their argument against fish oil supplements:

"Dietary supplements are not FDA-approved for the treatment of any specific disease or medical condition. Get the Facts: nonprescription, dietary supplement omega-3 is not a substitute for prescription OMACOR."

Does that make any sense to you? Should you buy a GM car because only GM makes genuine GM cars? This is the silly logic being offered by these people to justify their ridiculous pricing.

How about: "The unique manufacturing process for OMACOR helps to eliminate worries about mercury and other pollution from the environment."

Funny...mercury in fish tends to be sequestered in the meat, not the oil. Independent reports by both Consumer Reports and Consumer Lab found no mercury, nor PCB's, in nutritional supplement fish oil. But just suggesting a difference without proving it may be enough to scare some people.

Just because something is used by a hospital does not make it better. The adoption of fish oil is hospitals is a good thing. Too bad it has to add to already bloated health care costs to enrich some drug manufacturer.

Comments (6) -

  • Cindy

    1/4/2007 3:38:00 AM |

    I'm not surprised at all. I've "met" people on forums that are on this, and they rave about how much better it is than non-prescription fish oil.

    Reminds me of years ago, when patients were given (in my area) "Anacin" in the hospital, then would ONLY take it for pain....other brands, or heaven forbid generic just didn't work as well!

    Amazing, huh?

    On the other hand, like you say, at least now they're giving it to patients.

    Now how about Mg? CoQ10? Are they starting to show up too?

  • Soundhunter

    1/4/2007 9:31:00 AM |

    Not sure if you find this interesting or not, but after stumbling on your blog not knowing anything about Pectus Excavatum, I went googlin' and got a bit depressed, as it's not as benign a malformation as I was led to believe.

    But I found this site which suggests that Vit D deficiency/rickets causes the malformation in many cases, and also that celiac disease might cause rickets in some due to malabsorbtion of vitamins/minerals etc.  I thought it was interesting as you've been posting about wheat and vitamin D and heart health, while perhaps they are also necessary for chest wall health.  I take heparin and low dose aspirin while pregnant to prevent fetal demise due to antiphospholipid antibody syndome (aware of that? causes blood clots), but I'm wondering if it somehow inhibited Vit D absorbtion in me when pregnant, couldn't have been a normal deficiency I was gardening in the sun during the entire pregnancy and I don't use sun block. I assume some of your patients are on blood thinners as I was? I know it effects calcium.

    As for fish oils, Udo's blends are supposed to be incredible, several moms I know use it on themselves for exhaustion and over all health, and many moms swear that fish oils have helped their toddlers with speech delays.

    Let me know if you'd rather I didn't yammer at your blog, I've linked to it from my little blog because I find your blog fascinating.

    Happy 2007

  • Soundhunter

    1/4/2007 10:08:00 AM |

    As for hospitals, well, there's a reason homebirthers and women into birth politics are as passionately anti-hospital as they are, many bad medical practises continue in the litigation crazed society of the USA medical system, from what I read. Forward thinking countries like Germany and Sweden incorporate natural remedies and holistic medicine right in with the mainstream medical system...great role models for us north americans, but impossible in a litigation-mad culture. But, the pharmaceutical companies are to blame too, though that discussion requires tin oil hats.

  • Dr. Davis

    1/4/2007 4:45:00 PM |

    Coenzyme Q10, no. Magnesium, yes. In fact, magnesium is pretty routinely checked and replaced via intravenous supplementation to avoid diarrhea. However, magnesium levels are checked because of heart rhythm disorders, not for general health.

  • Dr. Davis

    1/4/2007 4:46:00 PM |

    I know of no interaction between blood thinners and vitamin D. However, you're absolutely right on the increased likelihood of vitamin D deficiency in the presence of bowel diseases like celiac.

  • Cindy

    1/6/2007 5:47:00 PM |

    I use to check any and all medications I am prescribed (or friends/family are prescribed).

    This about Omacor on their site:
    The empirical formula of DHA ethyl ester is C24H36O2, and the molecular weight of DHA ethyl ester is 356.55. Omacor®  capsules also contain the following inactive ingredients: 4 mg α-tocopherol (in a carrier of partially hydrogenated vegetable oils including soybean oil), and gelatin, glycerol, and purified water (components of the capsule shell).

    I mentioned in another comment that I am intolerant to soy, so I avoid it whenever possible.....but to put hydrogenated oils in a preparation touted as "pure"????

    I realise it's a very small amount....but from what I've read on trans-fats, the only amount of transfat that is good for us is NONE!!!

    Of course, the AHA also promotes foods that contain transfats in their "No Fad Diet" (see Regina Wilshire's blog post here: