Suicide with inert gases: addendum to Final Exit

Suicide by asphyxiation with a plastic bag placed over the head is a method that has been advocated by right-to-die groups. Recently, such groups have proposed the introduction of helium into the plastic bag as a means of hastening death. Helium is readily available at toy stores, where it is sold in tanks for balloon inflation. It produces asphyxiation by the exclusion of oxygen in enclosed spaces. We report 7 fatalities throughout an 18-month period involving plastic bag suffocation in conjunction with helium use. These fatalities coincide with publication of an update to a popular right-to-die text in which this method is described. Although right-to-die literature was absent from all scenes, this method was not previously observed in our jurisdiction, and the deaths likely reflect exposure to this information. Because of analytical difficulties in testing for helium in biologic specimens, death certification rests on scene investigation.     

Prothrombin G20210A mutation and sudden death

The authors present a case of sudden death in a previously healthy 36-year-old male. At autopsy there were bilateral pulmonary thromboemboli and right ventricular dilatation. Histologic findings in the lungs included recanalized, old thrombi and evidence of pulmonary hypertension. Genetic analysis for hereditary risk factors was heterozygous positive for the prothrombin G20210A mutation. Implications of this finding, its history and the diagnostic technique shall be discussed. The authors recommend that all cases of deep venous thromboses and pulmonary thromboemboli lacking known risk factors be evaluated for newly described genetic variations associated with an increased risk for venous thrombosis.     

Is the doctor in? The evolving role of organized medicine in health policy

Until recently, physicians were viewed as the dominant player in health policy. Now, however, they compete with many other effective interest groups. This article analyzes this changing role, and specifically how organized medicine has changed its approach to influencing health policy. The essay begins with a review of the reasons for the growth and subsequent decline of physicians' influence. This is followed by a case study of physician payment reform under Medicare, which illustrates the ways in which organized medicine chooses when and when not to cooperate with government. The article concludes with a discussion of where physicians are likely to continue to be influential in future health policy reform. Three such areas are noted: payment policy, quality and clinical innovation, and medical education and training.     

North America's first supervised injection site opens in Vancouver

The number of injection drug users frequenting the long-awaited supervised injection site in the Downtown Eastside has steadily increased since the site opened in September 2003. However, there are concerns about the restrictions imposed by Health Canada and about the activities of the Vancouver Police.     

Supervised injection sites: Health Canada approves Vancouver pilot sites, but concerns remain

The paperwork has been processed, and Health Canada says that two pilot supervised injection sites (SISs) in Vancouver can now proceed, but operational funding for the site to be located in the Downtown Eastside has yet to be secured. Meanwhile, tired of waiting for the sanctioned SISs to open, community groups in Vancouver have begun to operate unsanctioned sites. There are also concerns that even if operational funding for the Downtown Eastside site is obtained, the pilot SIS project is too small in scope to make a major impact on public health in the area.     

The Illusion of Transparency in Negotiations

The authors examined whether negotiators are prone to an illusion of transparency, or the belief that their private thoughts and feelings are more discernible to their negotiation partners than they actually are. In Study One, negotiators who were trying to conceal their preferences thought that their preferences had leaked out more than they actually did. In Study Two, experienced negotiators who were trying to convey information about some of their preferences overestimated their partners' ability to discern them. The results of Study Three rule out the possibility that the findings are simply the result of the curse of knowledge, or the projection of one's own knowledge onto others. Discussion explores how the illusion of transparency might impede negotiators' success.     

Trends in explosive contamination

This study sought to assign a rough order of magnitude for the amount of explosive residue likely to be available in real-world searches for clandestine explosives. A variety of explosives (TNT, TATP, HMX, AN, RDX, PETN) in various forms (powder, flake, detonating cord, plastic) were carefully weighed or cut into containers, and the amount of residue inadvertently remaining on the work area, hands, or containers was quantified. This was used to evaluate the spillage potential of each explosive. The adhesion of each explosive to a glass surface was quantified from amount of explosive adhering to the inside of a glass vial into which the explosive had been placed and then removed by vigorous tapping. In powdered form, most of the explosives--TNT, PETN, RDX, HMX, and TATP--exhibited similar spillage and adhesion to glass. However, PETN as sheet explosive and plasticized RDX (C-4), showed very little potential to contaminate surfaces, either by spillage or adhesion to glass.