Cancerous Human Cell Created

Scientists for the first time have created a cancerous human cell by genetically altering a normal one in the laboratory, an advance that could speed the development of drugs that eradicate tumors.

A team led by Robert Weinberg of the Massachusetts Institute of Technology's Whitehead Institute for Biomedical Research built the cancer cell by first inserting a gene-turned-bad called ras that causes cells to grow incessantly. Then, the researchers disabled two tumor-suppressing proteins with another bad gene. Finally, they added a telomerase catalyst, which allows cells to continue dividing indefinitely, according to a report in today's issue of the science journal Nature.

Researchers know that cancer is caused by genes turned bad, and they have been trying to develop drugs that fix these flaws. But until now, they have been unsure exactly which combinations of flaws cause the many types of cancer. Nor do they know precisely which drugs repair which faulty genes.

With this latest advance, scientists should be able to create specific genetic flaws in the lab and then try to find drugs that work. Moreover, they can use this advance to work backward and determine which flaws cause which types of cancer, experts said.

The Trouble With HMOs

Consumers and physicians report widespread trouble getting needed care from health maintenance organizations, according to two surveys released yesterday.

The Kaiser Family Foundation surveyed 1,053 doctors and 768 nurses by mail between February and June. Both groups were randomly chosen. The margin of error for physicians' responses was plus or minus 3 percentage points; for nurses, it was plus or minus 4 percentage points.

Eighty-seven percent of doctors said their patients had experienced some type of denial of coverage over the last two years. Most common (79 percent) was trouble getting approval for a drug they wanted to prescribe. Sixty-nine percent said they had trouble getting a diagnostic test approved; 60 percent, a hospital stay; 52 percent, referral to a specialist; and 38 percent, mental health or substance abuse referrals.

Depending on the type of care denied, one-third to two-thirds of physicians believed it resulted in a serious decline in health. Denials of mental health were most likely to be serious, followed by referrals to specialists; denials of drugs and hospital stays were least likely to be seen as serious.

Similarly, about half of nurses said they had seen a decision by a health plan that resulted in a decline in a patient's health in the last two years.

Meanwhile, an annual survey by the National Committee on Quality Assurance evaluated 523 health plans offered by 247 insurance companies.

Of those, 410 plans serving nearly 70 million Americans allowed their data to be publicly released, a big jump from last year, when many companies feared negative publicity and insisted on secrecy. Overall, there was little change on measurements such as immunizations, advising smokers to quit, screening for breast and cervical cancer and giving early prenatal care.

The report also looked at consumer satisfaction and found that 26.5 percent of respondents had trouble getting needed care, including difficulty seeing a doctor they liked and getting referrals to specialists. Patients gave higher overall marks to the office staff and physicians and nurses than to the health plans. Nearly half the people said they had a problem with paperwork, understanding written materials or getting help from a customer service line.