Impact of Political Structures and Informal Political Processes on Health Policy: Comparison of the United States and Canadab

A number of factors, including cultural, social, economic, political, and historical, influence policy. United States and Canada's health care systems are the conscious and subconscious outcomes of formal political structures and informal political processes. The Canadian parliamentary political system encourages centralized, organized, planned policy in health care. However, this is accomplished at the risk of leaving some individuals—physicians in this case—quite frustrated. American constitutional features, the presidential system, weak political parties, and the tireless participation of interest groups in the political process all function to discourage the formation of highly rational and efficient policy. While few special interests are ever completely satisfied with the legislation produced, seldom is any organized group completely thwarted. Therefore, it is no surprise that a tightly integrated national program of universal health insurance was not adopted by Congress in 1993–1994. Political structures and processes discourage effective, comprehensive health care reform in the United States.     

An unusual death by transcranial stab wound: homicide or suicide?

Penetrating stab wounds of the brain are uncommonly seen in modern times and occur almost exclusively in homicides. We report an unusual death by self-stabbing. A 24-year-old man was found dead at home, the handle of a kitchen knife protruding from his forehead. Data such as the psychiatric history of the victim, the multiplicity and site of wounds, the implement used, the presence of hesitation, and defense wounds were studied to elucidate the manner of death, and the suicidal nature of the event was established after police investigation. Atypical injuries require a careful forensic investigation, and medico-legal aspects of the differentiation between homicide and suicide are discussed in this particular case. A review of the literature revealed few cases of suicidal transcranial stab wounds.