GPs Banned from Prescribing Fish Oils

  • 26 Jun 2018
  • Reading time 6 mins
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Omega 3GPs have been banned from prescribing fish oils (yet paid commission for prescribing less effective drugs). Doctors have been told to stop prescribing omega-3 fish oils for heart disease or anything else for that matter, but paid commission to prescribe statins. Why? To save £6 million a year in omega-3 prescriptions and because, apparently, they don't work.

Early randomized controlled trials (RCTs) demonstrated the health benefits of omega-3 fats, whereas recent RCTs, provided you include all low-dose studies and pool the results together, have been apparently negative (see below). Why the difference? French scientists say its because statins interfere with the action of omega-3, and almost all patients in recent trials have been on statins. ‘Statins favor the metabolism of omega-6 fats, which in turn inhibits omega-3 and, contrary to omega-3, they increase insulin resistance and the risk of diabetes. Thus, omega-3 and statins are counteractive at several levels and statins appear to inhibit omega-3.’ says Dr Michel Lorgeril from the University of Grenoble’s Faculty of Medicine.1 In trials, such as in those with arrhythmia, or in primary prevention in people not on statins, or separating out those in trials not taking statins, omega-3 fish oils show clear benefit.

For example, a long-term study comparing the effects of giving patients with heart failure cholesterol-lowering statin drugs or omega-3 fish oil found that the omega-3 fats cut the risk of death or hospitalisation, compared to placebo, while the statins didn’t. Those taking 1g a day of omega-3 fats cut their risk of mortality by 9 per cent and risk of admission to hospital by 8 per cent compared to placebo. Those taking statins had no reduction in risk.2

Another study gave over 18,000 Japanese people with high cholesterol (above 6.5mmol/l) either high-dose fish oils (1.8g of EPA) with statins, or just statins. After six years those on the EPA had reduced the risk of a major coronary event by 19 per cent in those who had cardiovascular disease.3 There were also fewer non-fatal coronary events and angina problems in those who did have heart disease at the start of the study. (Bear in mind that people in Japan have a much higher intake of omega-3 to start with so an even greater benefit would be expected in British people.)

In fact, even this apparently negative meta-analysis of ten recent trials, includibng trials with very low dose omega-3,  involving 77, 917 individuals, on shows a 7% lower risk of major vascular events and a 10% lower risk of CHD associated with omega-3 FA supplements (page 232). That means that, if 100 people were given fish oils seven wouldn't have a heart attack as a result. it menas that one in ten bebefit with reduced risk. However, the ‘conclusion’ of this very influential paper however completely glosses over this and contradicts its own results saying ‘This meta-analysis demonstrated that omega-3 fatty acids had no significant association with fatal or nonfatal coronary heart disease.’ For so,me reason NHS England seemed to have jumped to the same conclusion without really looking properly at the evidence. Major studies are also under way to dig deeper into the extent by which omega-3 reduce cardiovascular disease, certainly more than statins. It was co-authored by Rory Collins, the 'king of statins' and Robert Clarke, previously accused of jiggery pokery with statistics to render B vitamins, potential competitors for drugs, apparently useless for dementia prevention. Clarke works with Sir Rory Collins, whose research group has received mega bucks for their research on statins.

According to Dr James Le Fanu, medical correspondent for the Telegraph and author of ‘Too Many Pills’ statins may benefit ‘one in every 250 people’ - that's twenty five times less people helped than omega-3, but with considerable risk of side-effects. (See my recent report on How GPs are Paid to Prescribe Ineffecive Drugs). Many studies show no change in mortality in those taking statins versus placebo – just a very small decreased risk of a non-fatal heart attack, and considerable risk of debilitating side-effects. Yet the NHS not only pay for prescriptions, they also pay GPs commissions through the QOF system set up ten years ago to reward GPs for taking actions to theoretically reduce the NHS disease burden. The QOF reward system has cost the nation an estimated £30 billion and has done nothing to reduce healthcare costs or mortality, according to a ten-year study published in the Lancet, and a further review in the British Medical Journal4.

According to Food Supplement Europe (FSE) If all over 55s in Europe took 1g of omega-3 EPA-DHA every day the EU could collectively save about €12.9bn in cardiovascular disease health care spending every year. About 24% of this older EU population are expected to experience a ‘hospital event’ due to cardiovascular disease (CVD) over the next five years – with a total of 38.4 million such events forecast at a cost of €1.3 trillion.

Omega-3 fish oils are also effective for the treatment of depression. A ‘gold standard’ meta-analysis of 19 randomised controlled trials concludes ‘the use of omega-3 is effective in patients with diagnosis of major depressive disorder (MDD) and on depressive patients without diagnosis of MDD [minor depression].5 Despite working and having no side-effects, unlike conventional anti-depressants, GPs are not allowed to prescribe them for depression, nor for dementia prevention in older people.

With the UK government committed to pumping £20 billion into the NHS – for exactly what and from exactly where - this kind of cost saving is just going to end up adding to the NHS burden, with more damaged babies, heart attacks and depression. How stupid is this?

This recent ruling, to ban omega-3 prescriptions, adds insult to injury. Ironically, the latest issue of the British Medical Journal  argues for nutrition to become top of the medical agenda, not side-lined, in the recognition that it is sub-optimal nutrition, including lack of omega-3 fats, that is driving the major diseases, not a deficiency of drugs.

Come on Theresa May and NHS England. Wake up!

 

References

1. M. Lorgeril et al., BMC Medicine 2013, 11:5 

2. Gissi-Hf Investigators, ‘Effect of n-3 polyunsaturated fatty acids in patientswith chronic heart failure (the GISSI-HF trial): A randomised, doubleblind, placebo-controlled trial’, Lancet, 2008 Aug;372(9645):1223–30

3. M. Yokoyama, Origasa, ‘Effects of eicosapentaenoic acid on major coronaryevents in hypercholesterolaemic patients (JELIS): a randomised open-label,
blinded endpoint analysis’, Lancet, 2007 Mar;369(9567):1090–8

4. A Ryan et al., ‘Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: a population study’ Volume 388, No. 10041, p268–274, 16 July 2016 

L.Forbes ‘The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review’ Br J Gen Pract 25 September 2017 [Br J Gen Pract 25 September 2017] 

5. Grosso G et al., PLoS One. 2014 May 7;9(5):e96905. 

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