The critiques of fish oil — the commonly use term for omega-3 fatty acids — are varied, creative and harsh. The family of critical polyunsaturated fats have been called everything from “fish tales” to “fool’s gold” to “foes.” And those peddling the benefits of omega-3s haven’t fared much better, being dubbed “snake oil salesmen” on more than one occasion.
Ironically, that last claim is somewhat accurate.
Starting in the mid-1800s, thousands of Chinese workers came to the U.S. as indentured laborers to work on the Transcontinental Railroad. They brought various Chinese medicines with them, one of which was snake oil. After a hard day’s work laying tracks and driving spikes into mountains by hand, the workers would rub oil made from the Chinese water snake on their joints.
The oil was quite effective in reducing inflammation. So effective that some enterprising Americans decided to make their own and hawk it as a cure-all. (As it turns out, the dry, 19th century frontier lacked a supply of Chinese water snakes and mineral oil was a poor substitution, which eventually gave “snake oil” the bad rap it carries to this day.)
Over a century later, an analysis published in the Western Journal of Medicine revealed why the Chinese water-snake oil was so effective — it contains 20 percent eicosapentaenoic acid (EPA) — the same critical omega-3 found in fish oil.
To date, there are more than 42,000 published studies, including 4,000 human clinical trials, on EPA and its important counterpart, docosahexaenoic acid (DHA). In many ways, the abundance of information and interpretation of data has created more confusion than clarity.
But still, this vast body of research overwhelmingly supports the health benefits of omega-3s in areas such as cardiovascular health, mental health and depression, gastrointestinal diseases, eye diseases and even rare genetic disorders. Benefits like these have caught the eye of the pharma industry.
True, omega-3 pharma applications have been somewhat limited. There are just four branded drugs approved by the FDA with omega-3 fatty acids as active ingredients, and only two of those drugs are commercially available in the U.S. Until recently, all of the approvals were restricted to the same niche patient population – adults with severely high triglyceride levels.
And yet, one of those drugs (GSK’s Lovaza) reached blockbuster status in 2010 and the second (Amarin’s Vascepa) is close behind. In late 2019, Vascepa’s approval was expanded, making it the first and only drug approved to reduce cardiovascular risk among patients with elevated triglyceride levels — and greatly widening the treatment population.
In addition to approved drugs, there are currently 88 drugs in pharma’s preclinical and clinical pipeline that use EPA, DHA or derivatives — some of which are seeing promising results in late-stage trials. (Read the details in our recent cover story.)
As the clinical and financial significance of omega-3 treatments continues to grow, pharma might just become the newest version of snake oil salesmen — but this time around, the elixir works.