Fishy Evidence on Fish Oil


I recently wrote a letter to the editor to JAMA Internal Medicine on the article posted above. The editors rejected it, but I’ve posted it here for your viewing pleasure.

Dr. Curfman recently highlighted the lack of benefit of ω-3 fatty acids in recent studies, despite their initial promise, in the secondary prevention of cardiovascular disease. His editorial also mentions the American Heart Association’s recommendation that adults consume fish at least twice weekly and himself concludes with similar advice for his readers.

The consumption of fish on a regular basis was brought to the forefront because of the ω-3 fatty acids within fish oil and their presumed beneficial properties on cardiovascular health, as Dr. Curfman mentioned. However, subsequent studies, including large meta-analyses using endpoints like all-cause mortality and primary prevention of cardiovascular disease, have failed to show any benefit of ω-3 fatty acids. Additionally, one of the original studies, the DART-2 trial, even showed a statistically significant increase in sudden cardiac death with increased fish oil consumption.

The continued consumption of fish is all the more concerning given the elevated concentrations in fish of toxic substances like polychlorinated biphenyls (PCBs), mercury, lead, cadmium, and dioxins, all of which can adversely affect human health. Additionally, a meta-analysis of fish consumption has shown that a single serving of fish in the U.S. per week has been associated with an increase in the risk of diabetes, possibly from the PCBs or mercury, or both. Further, both childhood and current consumption of fish has been shown to decrease cognitive performance in older Americans, who are most likely to suffer from cardiovascular disease. Until we have strong, compelling evidence on the health benefits of fish or fish oil, it may be safer to avoid its consumption entirely or obtain fatty acids from sources with lower concentrations of pollutants, like algae.

Puzder Will Not Help Americans be Healthier

This article was written prior to Puzder’s withdrawal of his nomination as labor secretary. I am well aware that he is no longer the nominee, but have posted the article for its points on the minimum wage and public health.

President Trump’s nomination of Andrew Puzder, the current CEO of the company that operates Hardee’s and Carl’s Jr., for labor secretary is not only a poor choice for protecting the American workforce, but also undermines important public health issues that have their roots within the fast-food industry. Puzder has notoriously opposed increases in the minimum wage and paid sick leave, both of which have impacts on healthcare at a national level.

Addressing the economic pitfalls of a minimum wage hike is the first step in addressing the public health concerns associated with minimum wage workers, as any public health measure will likely not take hold if it is thought to be financially untenable. Puzder has tritely argued that raising the minimum wage will reduce jobs, slow the economy, and hurt workers, when, in reality, none of which have actually happened during the nearly two dozen times the minimum wage has been increased. Ironically, the Department of Labor’s own website features a “Minimum Wage Mythbusters” webpage debunking common arguments against any federally mandated pay increase, which might be of benefit for Puzder to read for the office he may soon take over–at least before it disappears like other federal websites unfavorable to the new administration.

Not only have increases in the minimum wage created jobs in most cases, but they have also been shown to improve health outcomes. In a 2014 analysis examining the effects of a wage increase in California, researchers found that increasing the minimum wage would decrease the rates of hunger, smoking, obesity, premature death, depression, and bipolar illness. The results are not surprising as minimum wage workers are living paycheck to paycheck and any additional disposable income might then be used towards important health-related costs, including food, medications, and copays.

Unsurprisingly, minimum wage fast-food workers depend heavily on public benefits, like Medicaid, food stamps, and the earned income tax credit. According to a 2013 study by the Center for Labor Research and Education at the University of California-Berkeley, fast-food worker subsidies amount to nearly $7 billion a year–of that, of which an estimated $247 million goes to the workers of Puzder’s Carl’s Jr. and Hardee’s annually. A raise in the minimum wage could translate into savings of billions of dollars that could be used for other government services, like other public health measures.

Raising the minimum wage seems like the obvious choice when considering the cost to consumers: only two cents to every burger purchased for every dollar added to the minimum wage. Thus, raising the minimum wage by two dollars would add less than a nickel to a Hardee’s Thickburger.

Another seemingly obvious public policy measure is giving restaurant workers paid sick-leave when they are sick. Restaurant workers, who are already stretched thin, shouldn’t be compelled to work during illness for fear of financial ruin. The Centers for Disease Control estimates that nearly 48 million people–1 in 6 Americans–are sickened by a foodborne illness each year, with 60% of outbreaks starting within restaurants. Having a restaurant worker be sick, it turns out, is the single most common cause of an outbreak, which can be mitigated by having paid sick-leave for workers. It’s a policy Puzder might have already taken note of: In 2015, more than 3,700 people were treated for possible exposure to a foodborne illness after eating from two South Carolina Hardee’s where one of the employees was infected with Hepatitis A.

Puzder’s nomination for labor secretary reminds us of George Orwell’s concept of doublethink–where the offices entrusted with protecting us may actually be hurting us. It may be one reason why so many of Hardee’s and Carl’s Jr. employees have protested his nomination. In addition to being anti-labor, his policies are decidedly anti-health, which is why the Center for Science in the Public Interest has also decried Puzder’s nomination. Lest anyone had forgotten the obvious, Puzder’s Hardee’s is the home of the 2/3rd pound Monster Thickburger, a dietary abomination with 1,340 calories, 96 grams of fat, 34 grams of saturated fat, 275 grams of cholesterol, and 3,130 grams of sodium. To say the least, Thickburger policy will not be making anyone healthier under Puzder’s reign.