The number of times I have been declared dead is statistically insignificant,although admittedly non-zero. - James Nicoll

A common issue with SF settings is that causally disconnected civilizations nevertheless are close enough in technological development that conflict is possible, rather than it being a matter of laser cannons against a thin film of single celled organisms.

Let's step back and think about the likely outcome of a scenario that involves the words "James Nicoll", "a box of sharp needles" and "possibly without ever having achieved full consciousness" for a moment, shall we?

It's very difficult to convey how alien and horrifying accounts of how American health care works sound to a Canadian. Seriously, if I didn’t know they were real — if, for example, I didn't know an American reviewer who died because she had to choose between paying her mortgage or having a doctor investigate her incapacitating chest pains — it would seem like something from a particularly silly and Garbageman novel. About the only thing about the US that seems even less believable is the collective enthusiasm for frequent mass murders.