INFORM October 2024

16 • inform October 2024, Vol. 35 (9)

These fatty acids support healthy heart, brain, and vision func tion. Fish oil is a rich source of EPA. Whether through natu ral sources such as fatty fish or through supplements, experts have recommended that people take in an adequate amount of omega-3 each day. The Global Organization for EPA and DHA Omega-3s (GOED), an organization representing the worldwide EPA and DHA omega-3 industry, recommends a daily dosage of 500 mg of omega-3 fatty acids from some combination of food and supplements. Multiple studies have found decreased risks of cardio vascular disease and improved outcomes associated with increased omega-3 intake. However, a new study published in the journal BMJ Medicine reports that people without car diovascular disease who regularly take omega-3 supplements may have a higher risk of atrial fibrillation (a-fib), a type of abnormal heartbeat that can lead to blood clots and stroke (https://www.bmj.com/content/368/bmj.m456). This finding captured widespread media attention despite other results in the study showing several improved health outcomes among people who already have cardiovascular disease (nytimes. com/2024/06/24/well/eat/omega-3-fish-oil-heart-health. html). At the same time, the study has also drawn the inter est of other researchers who have issue with media cover age of these findings and with the study itself (https://tinyurl. com/3u7x399j). For instance, GOED notes that only eight out of the more than 90 long-term clinical trials involving omega-3 supplementation and cardiovascular disease out comes reported on a-fib. Similarly, the reported 13 percent increase in relative risk of a-fib reflects a small difference in a-fib incidence between people with and without cardiovascu lar disease. RISKY BUSINESS Researchers have questions about the study and its find ings. Because of this, GOED is planning to publish a paper using a health economics perspective to provide a risk-ben efit assessment and will commission a research project that takes a look at patient data from other studies to bet ter understand the implications of this study’s findings. But what do these findings mean for assessing health risks? Regulators set policies intended to keep the public safe from health risks. At the same time, the public makes their own decisions about health risks every day. However, while these two groups aim to assess health risks, their methods can differ drastically. Regulators have an important and challenging role in assessing health risks. Not only do they have to assess a large volume of research, they have to weigh risks and ben efits for a wide range of people. Regulatory agencies fol low guidelines on properly evaluating research, which is sometimes inconsistent or, like the recent omega-3 study, contradicts other scientific knowledge. Some assessment approaches focus solely on data, with some guidelines hav ing rules in place to handle conflicting evidence, while oth ers rely more heavily on expert judgment.

However, the growing volume of research and increased demand for transparency has raised the need for updated risk assessment approaches. One approach is outlined in a 2015 paper published in the journal Risk Analysis (https://doi.org/10.1111/risa.12206 ). In that paper, author Lorenz Rhomberg, describes the challenges of integrating dif ferent sources of data when assessing health risks and pro poses a hypothesis-based, weight-of-evidence assessment method. This approach builds on existing methods to evalu ate contradictory evidence and make use of expert judgment that is informed by research. The intent is a flexible approach that transparently shows how evidence supports expert conclusions. SAFE AT HOME While regulatory agencies play an important role, the pub lic also needs to make informed decisions about health risks. However, this can be challenging because many lack the in-depth knowledge needed to evaluate complex research. Complicating matters further is the way popular media often overemphasizes findings that are new or show the potential for harm. The new omega-3 study may have found an elevated risk of a-fib in some people, but that was only part of the study’s findings. The researchers found that omega-3 sup plements were associated with improved outcomes in other areas. For instance, people who were already diagnosed with a-fib showed a lower chance of having a stroke or other adverse event. However, the negative outcome is the one that attracted the most media attention. Bill Harris, president of the Fatty Acid Research Institute and professor of medicine at the University of South Dakota, said that this tendency is one thing to consider when evaluat ing health risks. “You have to be even-handed about it,” said Harris. KNOWING THE SCIENCE The fact that the study contradicts the majority of other research on omega-3 and health outcomes is something that should make the public take notice. It could be pointing to something important, but it also could indicate a problem with the study or with its media coverage. However, without a good understanding of what to look for, it can be hard to find accu rate health information. The National Institutes of Health (NIH) created an initiative called Know the Science to assist the pub lic in these cases (tinyurl.com/3kn4dhfj). Through this initiative, NIH is giving the public tools to make better decisions about health risks, determine the quality of a health news story, and make sense of scientific publications. One such tool is a list of questions to guide the public when consuming health news media. These questions include whether a study was done on animals or people, if enough people were included in the research, whether the study pop ulation represents the whole population or different sub groups, how well the story discussed the study’s limitations,