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A program designed to boost doctor-patient communication and patients’ compliance with treatment may not have the intended effects, a new study suggests.

The study looked at a program dubbed “Ask Me 3,” which encourages patients to ask three basic questions at each doctor visit: “What is my main problem?” “What do I need to do (about the problem)?” and “Why is it important for me to do this?”

The goal is to help patients better understand any health problems they have, and make them more likely to stick with treatment or lifestyle changes.

But in the new study, patients at medical practices that promoted the “Ask Me 3″ program were no more likely to ask those questions or to fill their prescriptions than patients at a group of practices used for comparison. Nor did they show a greater understanding of any recommended lifestyle changes.

However, the researchers point out that most patients at all practices in the study were good at asking questions. So it may simply have been too hard for the “AM3″ program to improve upon that.

In a report in the Annals of Family Medicine, they say future studies should look at the program’s effects among patients whose communication with their doctors is not so strong.

For the study, researchers led by Dr. James M. Galliher, of the American Academy of Family Physicians National Research Network, randomly assigned 20 U.S. medical practices to an intervention or a control group. Staff at the 10 practices in the intervention group gave patients pamphlets with the AM3 questions and reminded them to ask their doctor the three questions.

The researchers used audio recordings of patient visits, along with follow-up interviews, to see how effective the program was.

Overall, they found that among 829 patients across the 20 practices, there were no clear benefits from the AM3 program. Ninety-two percent of patients in both the intervention and control groups asked at least one of the three questions. And patients in both groups averaged six to seven questions of any kind per visit.

The two groups also showed little difference when it came to treatment compliance, based on interviews done within three weeks of their visit.

Of patients who said their doctor had given them a new prescription, 81 percent to 82 percent of patients in each group said they had filled it. And of those who said their doctor had recommended lifestyle changes, 91 percent to 92 percent in each group claimed to have attempted the changes.

The only clear difference was that patients in the comparison group were more likely to accurately recall that their doctor had advised lifestyle changes: 68 percent did so, versus 59 percent in the AM3 group.

According to Galliher’s team, the high rates of question-asking and treatment compliance in the study group as a whole may have been too tough to improve upon. They also note that the study group had fairly strong scores on a questionnaire of “health literacy” — a measure of, for instance, how well a person can fill out medical forms or understands written information on their health condition.

“We believe that programs like AM3 should be systematically implemented and studied across time with patients whose health literacy skills are challenged,” Galliher noted in an email to Reuters Health.

“Our view is that asking questions opens the door for good patient and (doctor) communication and thus hopefully a better understanding by the patient of his/her possible health conditions and needs that can then be addressed by the patient and the (doctor),” Galliher added.

Conventional wisdom has dictated that fat from red meat is a risk factor for heart disease, but a new analysis from Harvard researchers finds it’s eating processed meat — not unprocessed red meat — that increases the risk for heart disease and even diabetes.

The term “processed meat” refers to any meat preserved by smoking, curing or salting or with the addition of chemical preservatives. The researchers defined “red meat” as unprocessed meats such as beef, hamburger, lamb and pork.

“To lower risk of heart attacks and diabetes, people should avoid eating too much processed meats — for example, hot dogs, bacon, sausage or processed deli meats,” said lead researcher Renata Micha, a research fellow at the Harvard School of Public Health. “Based on our findings, eating up to one serving per week would be associated with relatively small risk.”

Micha was scheduled to present the finding Friday at an American Heart Association conference on cardiovascular disease in San Francisco.

For the study, Micha’s team analyzed data from 20 studies that included more than 1.2 million participants. Among them, 23,889 had coronary heart disease, 2,280 had had a stroke and 10,797 had diabetes.

The researchers found that people who ate unprocessed red meat did not significantly increase their chances of developing heart disease or diabetes. However, eating processed meat was linked to an increased risk for the two conditions.

In fact, for every 50-gram (1.8-ounce) serving, the risk for heart disease jumped 42 percent and the risk for diabetes increased 19 percent.

Though neither unprocessed red meat nor processed meats were linked to an increased risk for stroke, the researchers pointed out that just three studies looked at the connection between eating meat and stroke, so the data was insufficient to draw a valid conclusion.

“When we looked at average nutrients in unprocessed meats and processed meats eaten in the U.S., we found that they contained similar amounts of saturated fat and cholesterol,” Micha said. “In contrast, processed meats contained, on average, four times higher amounts of sodium and two times higher amounts of nitrate preservatives.”

This suggests that salt and other preservatives, rather than fats, probably explain the higher risk for heart attacks and diabetes seen with processed meats, Micha said.

“Health effects of unprocessed red meats and processed meats should be separately considered,” she said. “More research is needed into which factors in meats — especially salt or other preservatives — are most important for health effects.”

Samantha Heller, a registered dietitian, clinical nutritionist and exercise physiologist in Fairfield, Conn., said that “scientists are looking into why processed meats are so hazardous to our health.”

“They may never know the exact reason, but we do know that people should limit their consumption of foods such as bacon, hot dogs, salami and pepperoni to reduce the risk of chronic diseases,” Heller said.

“In addition, studies show that eating unprocessed red meat does increase the risk for disease as well,” she said. “A study of over 500,000 people found that people who ate the most both red and processed meats had a higher risk of mortality, cancer and cardiovascular disease than those who ate lesser amounts of these foods.”

Both red and processed meat and other foods, such as butter and cheese, that are high in saturated fat have been linked to chronic disease, Heller said, adding that people should limit consumption of them as well.

“Going low- or no-fat with dairy products helps lower our intake of saturated fat,” she said. “Choosing healthy protein sources — such as white-meat poultry, low-mercury fish, soy, nuts and beans — and focusing on moving in the direction of a more plant-based diet will help us all live longer, healthier lives.”

Dr. Gregg Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles, said that “various studies have suggested that higher levels of consumption of red and processed meat is associated with higher risk of heart disease, stroke, diabetes, cancer and premature death.”

However, the results have not always been consistent, and some earlier studies have suggested there may be differences in health risk between unprocessed red meat and processed meat, he said. More study is needed to verify the link and explore the mechanisms behind it, Fonarow said.

Although unprocessed red meat might not increase the risk for heart disease or diabetes, it might increase the risk for some cancers, according to a 2007 report from researchers at the U.S. National Cancer Institute.

They found elevated risks for colorectal and lung cancer with high consumption of both processed and unprocessed meats, along with borderline higher risks for advanced prostate cancer. High intake of red meat was also associated with an increased risk for esophageal and liver cancer and a borderline increased risk for laryngeal cancer. And high consumption of processed meat was linked to a borderline increased risk for bladder cancer and myeloma, a kind of bone cancer.

SOURCES: Renata Micha, R.D., Ph.D., research fellow, Harvard School of Public Health, Boston; Samantha Heller, M.S., R.D., dietitian, nutritionist and exercise physiologist, Fairfield, Conn.; Gregg Fonarow, M.D., professor, cardiovascular medicine, University of California, Los Angeles; presentation, American Heart Association’s Cardiovascular Disease Epidemiology and Prevention annual conference, San Francisco.

People with Parkinson’s disease face an increased risk of the most deadly type of skin cancer, new research confirms.

Exams of more than 2,000 people with Parkinson’s disease found that about 1 percent currently had melanoma, Dr. John M. Bertoni of the University of Nebraska Medical Center in Omaha and his colleagues found. Based on the findings, they say, people with the degenerative nerve disease should receive regular skin cancer screening.

A number of studies have found a higher risk for melanoma among people with Parkinson’s disease, which occurs when brain cells that produce dopamine — a signaling chemical with many important functions in the brain — die off. But it hasn’t been clear whether this increased risk is due to the drugs people take to treat Parkinson’s disease or to the disease itself.

To investigate further, Bertoni and colleagues at 31 different centers across North America studied 2,106 patients with Parkinson’s disease. The patients first underwent a neurological exam, and then at a second visit had a dermatologic exam, which included biopsies of any suspicious moles or growths.

The researchers found 20 localized melanomas among the study participants and 4 that had spread beyond the original site, while another 68 patients reported having a history of melanoma.

Among the patients living in the US, the likelihood of having melanoma was more than double that of the general US population, the researchers found. When the findings were compared to statistics from skin cancer screening programs run by the American Academy of Dermatology, the researchers found a more than seven-fold increased risk of melanoma for US Parkinson’s patients.

Since the 1970s, a number of case reports have suggested that levodopa therapy for Parkinson’s disease increases the risk of skin cancer. In the current study, nearly 85 percent of the patients had taken levodopa, but the researchers found no evidence that this drug was associated with melanoma risk.

This study, conclude Bertoni and colleagues, provides more evidence that melanoma occurs more often in patients with Parkinson’s disease than in the population at large and “supports increased melanoma screening” in patients with Parkinson’s disease.

SOURCE: Archives of Neurology.

New research suggests that the type of specialist a prostate cancer patient sees — rather than the patient’s own preference — may determine the treatment he receives.

This is problematic, the study’s authors say, because none of the options now available for treating localized prostate cancer have been shown to be any better than the others.

“The different treatments for prostate cancer…entail different side effects, different recovery profiles, and they require different time commitments,” Dr. Thomas L. Jang of The Cancer Institute of New Jersey in New Brunswick, one of the study’s authors, told Reuters Health. For this reason, he and his colleagues say, it should be the patient’s preferences — rather than the physician’s specialty — that guides treatment decisions.

Current options available for treating prostate cancer that has not spread include watchful waiting, in which a patient receives no treatment but is monitored closely; hormone therapy; radiation therapy; or surgery to remove the prostate. Radiation and surgery both carry the risk of urinary incontinence and impotence; hormone therapy can cause hot flashes, breast tenderness, and loss of sex drive; while watchful waiting may lead to anxiety in men who fear their cancer will spread.

Surveys have suggested that specialists are more likely to recommend the type of treatment they provide; for example, radiation oncologists prefer radiation therapy, while urologists choose surgery.

To investigate whether the type of physician a prostate cancer saw would actually influence the type of treatment he got, Jang and his team looked at Medicare data on more than 85,000 men 65 and older diagnosed between 1994 and 2002 with localized prostate cancer. Within nine months of diagnosis, 21 percent had undergone prostate removal; 42 percent had radiation; 17 percent had hormone therapy; and 20 percent watchful waiting. Jang conducted the study, which is published in the Archives of Internal Medicine, while at Memorial-Sloan Kettering Cancer Center in New York City.

Half of the men had only seen a urologist, while 44 percent had seen a radiation oncologist and a urologist, 3 percent had seen a urologist and a medical oncologist, and 3 percent had seen all three specialists.

One-third of the men who had only seen a urologist underwent prostate surgery, and surgery was the most common treatment for the men who were 65 to 74 years old and only saw a urologist. However, among men of any age who saw a radiation oncologist as well as a urologist, radiation therapy was the most common treatment; 83 percent of these men received radiation therapy.

And men who had been seen by a urologist and a medical oncologist, or a urologist only, were more likely to receive watchful waiting or hormone therapy than men who had seen both urologists and radiation oncologists.

Only about one in five men saw their primary care physician after their diagnosis of prostate cancer and before they received treatment (or within nine months of diagnosis). Nearly 60 percent of these men received watchful waiting, compared to 7 percent of men who hadn’t seen their primary care doctor.

When the researchers looked at individual urologists who had cared for at least 10 of the study participants, they found sharp doctor-to-doctor differences in whether a patient was referred to a radiation oncologists; some urologists frequently made these referrals, while others did so much less often.

Men newly diagnosed with prostate cancer face “a lot of confusion,” Jang noted, because there are so many treatment options available. “The physician who is providing the counseling for these patients should go to great lengths to provide a balanced perspective, an unbiased perspective, on these treatment options.”

And if patients don’t feel they are getting unbiased advice, Jang added, they should get a second opinion. “It’s really our responsibility to provide these men with every single available treatment option.”

SOURCE: Archives of Internal Medicine.