In recent times, optimistic views have been advanced about the convergence of nanotechnology, biotechnology, information technology, and cognitive science and the way in which this so-called “NBIC convergence” could and should be used to enhance human performance, such as to improve our sensory, motorial and/or cognitive abilities, as well as our moods and physical appearance. These ideas have been elaborately developed and presented in several “NBIC workshops” in the US. This contribution focuses on two claims made by the proponents of the NBIC convergence. First, it is argued that the project of “Converging Technologies for Improving Human Performance” represents something genuinely new and quite unique. Second, it is maintained that the future prospects of this project are extraordinarily positive. In order to critically assess these two claims I will first focus on the question of whether there is indeed anything genuinely new about the project of improving human performance by means of converging NBIC technologies. Next I will analyze whether the project warrants that we be optimistic about its future prospects.

The practice of using race or ethnic origin as a distinguishing feature of populations or individuals seeking health care is a universal and well-accepted custom in medicine. Although the origin of this practice may, in part, reflect past prejudicial attitudes, its use today can certainly be defended as a useful means of improving diagnostic and therapeutic efforts. Indeed, the tradition of dividing populations by some racial distinction in clinical research has nearly always revealed differences in mechanisms of disease and disease frequency that can enhance diagnostic and therapeutic precision.

At the conference occasioning this symposium, Professors Duster and Rotimi provided persuasive evidence that so-called race is not an accurate way to distinguish populations and that identification by race has led to serious prejudice. Professor Cho pleaded that race should never be used to characterize population differences.

Just after midnight on March 21, 2003, a drunk stood on a footbridge over a motorway in a village in Surrey in southern England. After eight pints of beer, he was drunk enough to decide to drop a brick from the overpass into traffic to see if he could hit something; unfortunately, he was not so drunk that he missed. The brick crashed through the windshield on the driver's side of a truck. It hit the driver, Michael Little, in the chest, triggering a fatal heart attack. He stayed conscious long enough to pull the truck safely to the side of the road, thereby perhaps saving other motorists; then he died. The crime was widely publicized, as was the driver's role in preventing any further accidents.

The World Health Assembly (WHA) adopted the new International Health Regulations (IHR) on May 23, 2005. The new IHR represent the culmination of a decade-long revision process and an historic development for international law and public health. The new IHR appear at a moment when public health, security, and democracy have become intertwined, addressed at the highest levels of government. The United Nations (UN) Secretary-General Kofi Annan, for example, identified IHR revision as a priority for moving humanity toward “larger freedom.” This article analyzes the new IHR and their implications for global health and security in the 21st century.

The WHA instructed the WHO Director-General (DG) to revise the IHR in 1995 because the Regulations did not provide an effective framework for addressing the international spread of disease. Doubts about the IHR's effectiveness had, however, been present long before 1995. The critiques identified the narrow scope of the regulations (applying only to a small number of infectious diseases), the lack of compliance by states, and the absence of a strategy for responding to rapid changes in public health's global economic and technological environments.

Many believe that nanotechnology will be disruptive to our society. Presumably, this means that some people and even whole industries will be undermined by technological developments that nanoscience makes possible. This, in turn, implies that we should anticipate potential workforce disruptions, mitigate in advance social problems likely to arise, and work to fairly distribute the future benefits of nanotechnology. This general, somewhat vague sense of disruption, is very difficult to specify – what will it entail? And how can we responsibly anticipate and mitigate any problems? We can't even clearly state what the problems are anticipated to be. In fact, when we move from sweeping policy statements to more concrete accounts, nanotechnology seems to bifurcate into two divergent streams: one is fairly continuous with current developments, extending extant science in a quantitative way; the other is radically new, and includes science fiction-like dreams of molecular manufacturing and assemblers, with their utopian (or dystopian) scenarios of absolute plenty (or runaway self-replication). In these cases, “disruption” takes on the valence of Huxley's brave new world.

Since its origins in the mid-1980s, DNA profiling has become the most powerful tool for identification in contemporary society. Practitioners have deployed it to determine parentage, verify claims to identity in various civil contexts, identify bodies in wars and mass disasters, and infer the identity of individuals who have left biological traces at crime scenes. Thus DNA profiling can be used to implicate or exonerate individuals from participation in particular social relations and activities; this affords it a growing importance in major social institutions such as the family, the criminal justice system, immigration services, and health services. There are key state, security, civil liberty, personal, and commercial considerations surrounding the reliability and social implications of DNA profiling in establishing the identities of “family members,” “claimants,” “customers,” “suspects,” and “citizens.”

Given that DNA profiling is increasingly influential in forensic inquiries, the recently-developed practice in the UK of “familial searching” of DNA databases has the potential to become a significant aspect of investigations.

Taking notice of race is both risky and inevitable, in medicine no less than in other endeavors. The literature on race as a classifying tool in clinical research poses this core dilemma: On the one hand, race can be a useful stand-in for unstudied genetic and environmental factors that yield differences in disease expression and therapeutic response. On the other hand, racial distinctions have social meanings that are often pejorative or worse, especially when these distinctions are cast as culturally or biologically fixed. Our country's troubled past in this regard and the persistence of race-related disadvantage should keep us on notice about this hazard. Yet paying attention to race in order to ameliorate past wrongs sometimes supports the quest for social justice, as Dorothy Roberts points out in this issue. And at times, as Jay Cohn and Raj Bhopal note, attention to race can make a therapeutic difference, to the point of saving lives.

To circumvent objections that the death penalty was “cruel and unusual punishment” and therefore a violation of the Eighth Amendment to the Constitution, advocates proposed lethal injection and the involvement of physicians to overcome the negative perceptions associated with the death penalty, and to increase public acceptability of the practice. Initiated in 1982, lethal injection is now the primary method of execution in 37 of the 38 states with the death penalty. “To be exact, this method has been used to kill 788 of the 956 men and women who have been executed in the United States since 1976, when the death penalty was reinstated by the Supreme Court.” More recently, of the 191 executions performed in the United States since 2001, 189 have been by lethal injection.

This “medicalization” of the death penalty has ignited a debate, by those within the medical profession and by others outside it, about the appropriateness of physicians participating in executions.

Increasing reports of financial entanglements involving scientist and industry have led some to question the neutrality of research results. In December 2003, a story in the Los Angeles Times shocked readers by exposing several cases of NIH scientists embroiled in serious financial conflicts of interest.1 It was revealed, for example, that senior NIH official Stephen Katz was a paid consultant to Schering AG, a German pharmaceutical company with which he was involved in conducting clinical trials. In a similar case, John Gallin, director of the NIH's Clinical Center, was discovered to have co-authored an article on a company's gene-transfer technology, while being paid as a consultant to a subsidiary of the same company. Jeffrey Schlom, director of the National Cancer Institute's Laboratory of Tumor Immunology and Biology, helped direct NIH-funded studies examining wider use for a particular cancer drug while serving as a consultant whose highest-paying client was looking to genetically engineer that drug.

There is growing recognition of the need to understand societal impacts of nanotechnology. Global interest in nanotechnology implies many nations will see a need to seek out advantages for military use. Militarization will inevitably include consideration of both offensive and defensive goals. This presents emerging implications for military forces in the near future, and will greatly influence the nature of warfare and peacekeeping in the distant future. The development of nanotechnology creates possibilities for both beneficial opportunities and adverse consequences as a result of application to the military strategies of both large and small nations.

The promise of nanotechnology for military and security roles derives from several innate characteristics. For example, further improvements in sensors are expected and already there are numerous reports of successful developments in research and development. Material properties can be tailored on a fine scale through nanomachining, scanning force microscopy, molecular self-assembly, and other techniques.

In 1982, cinemas around the world screened Sophie's Choice, a film starring Meryl Streep and Kevin Kline, adapted from the book by William Styron. The film opens with Stingo, a young journalist from the South, who arrives in New York in 1947 and rents a room in Brooklyn. Stingo is drawn into a relationship with Sophie and Nathan, the couple who live upstairs. Sophie is a Polish concentration camp survivor; Nathan is the man who saved her when she arrived in America. Nathan is charismatic, schizophrenic, and violent.

In one of the film's flashbacks, a German soldier imposes a terrible choice on Sophie, a young mother who arrives at Auschwitz with other prisoners from Krakow. Sophie is ordered to choose which of her two children will be sent to the ovens, and which will live.

In August 2005, the Competitive Enterprise Institute (CEI), a conservative “think tank” and advocacy organization, filed a lawsuit in the Federal District Court for the Western District of Louisiana against the Louisiana Attorney General challenging the legality of the 1998 Master Settlement Agreement (MSA). If successful, this lawsuit could lead to the unraveling of one of the most significant opportunities to improve public health in United States history.

Under the MSA, forty-six states agreed to end their litigation against the four largest tobacco companies in the United States, who in turn agreed to pay the states an estimated $206 billion. The CEI alleges that the MSA is unconstitutional. Specifically, the suit alleges that the MSA established a cartel under which the states receive monetary payments and the four major tobacco companies are insulated from price competition – and that this arrangement violates the Compact Clause of the U.S. Constitution.

Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation, or signs of torture. Mounting information from many sources, including Pentagon documents, the International Committee of the Red Cross (ICRC), Amnesty International, Human Rights Watch, etc., indicate that medical personnel failed to maintain medical records, conduct routine medical examinations, provide proper care of disabled and injured detainees, accurately report illnesses and injuries, and falsified medical records and death certificates. Medical personnel and medical information was also used to design and implement psychologically and physically coercive interrogations. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism.

To promote informed reproductive decisions, prenatal carrier testing is offered to women and couples to provide information about the risk of having a child with one or more genetic conditions. Tay Sachs Disease (TSD) was one of the first conditions for which prenatal carrier testing was developed. Today, many additional conditions can be tested for, depending on prospective parental interest, family history, or ethnicity. Interestingly, most individuals and couples do not request prenatal carrier information prior to conception, and carrier testing early in gestation allows only a narrow set of reproductive options. Programs have been designed to increase preconception testing, with variable success. One of the more successful attempts to increase preconception carrier testing uptake internationally has been to offer it to adolescents in high schools.

The use of restraints on psychiatric patients has long been criticized, and the need for self-restraint of professionals in response to new technologies has been documented from the nineteenth century. Since the middle ages, when leprosy disappeared from civilized society, individuals with a “deranged mind” came to occupy the public space of outcast once reserved for the leper. This diminished social status conflicts with the ethical precept of respect for all patients and the need for humane treatment within the clinical care setting. Psychiatric patients may be presented as a physically dangerous presence in clinical care facilities. New technologies may seem to offer a solution to the problem of balancing the safety of staff with the ethical requirement to treat patients with respect and attention to their medical needs. The Taser, promoted as a safe method of law enforcement, has received notoriety in at least one case involving restraint of psychiatric patients.

During the past four years, the International Institute for Indigenous Resource Management has sponsored and co-sponsored a series of discursive roundtables on the ethical, legal, social, and cultural implications of genetic research on Indian tribes and Indian people. The deliberations of the tribal leaders, legal scholars, researchers, representatives of non-governmental organizations, and others who participated in these roundtables laid out a range of barriers to informed tribal participation in genetic research and proposed a policy, legal, and scientific research agenda to fill gaps in knowledge and to otherwise support indigenous peoples' decision-making on genetic research issues.

An understanding of Native American attitudes toward genetic research on their community cannot be fully understood absent an appreciation of the interrelationship among native peoples, genetic research, and the landscape, contaminated as it is by governmental and other factors. The deliberations described herein present invaluable insights into tribal attitudes toward genetic research that have application to ethical, legal and social aspects of forensic DNA databanks, sample collection and retention, and, in particular, issues of secondary non-forensic uses of such DNA.

Investigator and institutional financial conflicts of interest have raised concerns about both the integrity of clinical research and protecting the rights and welfare of research participants. In response, professional groups and governmental bodies have issued guidance for managing conflicts of interest to minimize their potential untoward effects. Although a variety of approaches have been offered, a common protection is to disclose financial interests in research to potential research participants as part of the recruitment and informed consent process. This approach reinforces a basic norm of candor, ideally allowing potential research participants to evaluate whether financial interests should affect their decision to participate in research. Disclosure to potential research participants is viewed as an alternative to having regulators or research institutions limit or prohibit all financial interests in research, assuming that not all such interests are unacceptable.