Let’s be more critical
No one likes a critic. Criticism is often shared in harsh ways, in which case it can be destructive rather than constructive. And let’s face it, even constructive criticism is seldom appreciated at the time!
On the other hand, perhaps we should all be a bit more critical in how we read and understand things. Reading (and thinking) critically are more important today than ever, living as we are in an age of tweets, sound bites and screeds.
As a case in point, I’d like to share with you an exchange I had this week with a reader who felt a Q & A column we published was misleading.
We headlined the story, written by a Harvard Medical School professor, “Most of us don’t need fish oil supplements.” The story appeared in our November Greater Washington edition, and was scheduled to appear in the December issues of the Baltimore Beacon and the Howard County Beacon.
I want to share some relevant parts of both that article and the reader’s criticism in this column. This way, I believe I will not only fill you in on the story and the controversy, but also bring you up to date on the science and illustrate the importance of critical reading.
First, our Q & A column answered a reader’s question about whether he should take fish oil supplements because he doesn’t eat fish.
The doctor’s response began by noting that those who regularly eat fatty fish (like salmon, herring and mackerel) have lower rates of heart attack and stroke, and that this is attributed to the fishes’ fatty acids, EPA and DHA.
But that didn’t mean all people who don’t eat fish should be taking ordinary over-the-counter fish oil supplements, as the questioner seemed to be asking.
The doctor pointed out that studies show fish oil is effective at reducing high levels of triglycerides in the blood (which raise the risk for heart attack and stroke), and may somewhat reduce the risk of a second heart attack.
So he suggested those with these conditions speak with their doctor, and also that they ask whether they should take a prescription fish oil rather than an OTC product.
His conclusion was that “for everyone else…even those prone to cardiovascular disease…there is no evidence that taking fish oil supplements offers any benefit.”
Our reader took exception to the column because he had been reading about a recent study that seemed to show fish oil supplements were extremely beneficial to people in general.
Even though we published our Q & A column before that study had been announced at the American Heart Association conference in November, and before it had been published in the New England Journal of Medicine (NEJM), the reader criticized us for ignoring “well-reported” results that a particular fish oil product (Vascepa) produced by a small company (Amarin) “showed a 25 percent reduction in cardiovascular events with placebo-like side effects.”
He noted that “it is already being called a ‘Wonder’ drug,” and suggested our Harvard professor should attend more meetings and “be updated on recent findings.”
He also chided the Beacon for doing our readers a disservice, and added “your readers have been given incorrect info about a product that significantly reduces their cardio risk because the Dr. did not do basic research.”
We appreciate readers keeping us honest and informing us of errors we no doubt will make on occasion. In this case, however, the reader was overstating his case, probably because he was reading hyped reports online before the study was officially published.
In actuality, the study credited a high dose of Vascepa, a purified, prescription fish oil, with a 25 percent reduction in heart problems and heart-related deaths among people with high triglycerides who were already taking a statin drug for high cholesterol.* That jibes closely with what our column stated.
Furthermore, the same issue of the NEJM featured results of another study, this one of a generic, over-the-counter EPA/DHA fish oil that was tested in ordinary people. In describing the results of that study, the Associated Press reported: “Fish oil taken by healthy people, at a dose found in many supplements, showed no clear ability to lower heart or cancer risks.” Again, just as our column stated.
In conclusion, whenever you read reports of new studies (whether in the Beacon or elsewhere) — especially about something hailed as a “wonder drug” or “breakthrough” — you probably should remain skeptical until all the facts come out.
Before you tout the results, you’ll want to find out exactly who was tested, with what product(s), and whether or not the study was a double-blind placebo-controlled study (where neither the researchers nor participants know who gets a placebo and who gets the drug being tested).
Furthermore, it is a good idea to wait until a study is published in a reputable peer-reviewed journal before making any judgments. That means the study has been reviewed by other experts in the same field, and any discrepancies or doubtful practices have been examined, or at least will be noted together with the study results upon publication.
And before we criticize any particular story about a study, let’s be careful not to generalize the study’s conclusions or ignore crucial details. We can and should read critically before we become a critic.
*I’d like to add an explanatory note regarding the meaning of “reduced risk.” The Amarin study correctly reported “a 25 percent reduction in risk” with its drug. What that means is that major cardiovascular problems (heart attack, stroke, hospitalization for stenting, etc.) occurred in 17 percent of patients taking Vascepa, versus 22 percent of patients taking the placebo.
Viewed that way, the result doesn’t seem so spectacular. But that does constitute a 25 percent reduction in risk, relatively speaking. This is always the case when “lower risk” percentages are announced in studies.