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Nevertheless, virtually every court to consider the question has concluded that a knowing, interstate or foreign transmission is an indispensable element of any Wire Act prosecution. Principal among these have been questions as to Congress's legislative power under the Commerce Clause, restrictions imposed by the First Amendment's guarantee of free speech, and due process concerns about the regulation of activities occurring at least in part overseas.Commerce Clause

患者是一名56岁藏族男性，因“丙肝史6年，发现肝占位10天”入院。患者既往有丙肝史，予抗病毒治疗后好转。10天前在外地医院查核磁发现肝内占位，考虑肝癌可能，建议行手术切除治疗，但患者拒绝。遂转诊至拉萨市人民医院援藏专家李建军主任医师门诊，李主任结合患者病史及影像资料，认为肝癌诊断明确，建议患者行肝动脉化疗栓塞术序贯肝肿瘤微波消融术。但患者不放心拉萨市人民医院的设备和医疗水平，执意想去北京治疗。李建军主任耐心地和患者解释，说明医院使用的是目前国内最先进的医疗设备，同意亲自为患者手术，并说明消融术是一种根治性治疗方法，和外科手术切除、肝移植一样都是肝癌的三大根治性治疗方法之一，且具有微创、费用低、术后恢复快等优势。患者及家属欣喜同意住院治疗。

图1 红色圆圈内为肝癌病灶