The world is a dangerous place. And in biological terms it is getting more so. As more new territory is converted to human use more unknown diseases are encountered. AIDS, and Ebola are such diseases. By 2020 this could be very much worse. But there is also a great deal more hope in 2020, at least in regards to medicine. Nanotech, cloning and cyber replacements will vastly alter the world in which we live.
Even today medical science is making huge leaps. There is no reason to assume to pace of improvements will slow in the next 21 years. But aside from cybernetics (almost available now, we have electrical muscle fibers, we just lack a true nerve to computer interface) there is very little advanced medicine in the cyberpunk world. This is strange. Especially in a world where nanotech is a common technology.
So I propose that we begin to approach nanotech from a more intelligent perspective. There is no need to go all the way to "Star Trek" type volatile-nanotech machines (able to learn and adapt). We can make medicine far more effective without using nanotech machines any more intelligent than the ones used to make muscle and bone lace. But how does a nonvolatile nanotech machine create muscle and bone lace. Well there are three options as I see it. The first is probably the one used in the game, a nanotech machine that can be programmed to perform several tasks (in this case take material A to any locations marked B and attach material A to structure 1). Each step must be painstakingly calculated and each location plotted with absolute precision. The second method allows the doctor to alter the programming of the nanotech machines during the process (this is closer to a realistic approach, I mean how much can you program a molecule sized robot to do anyway), this allows a more flexible and recyclable procedure. The last method uses all the same ideas as the second but incorporates a wider variety of specialized nanotech machines (this is the way I see things, and again please feel free to disagree with me if you wish).
So what kind of miraculous things can be preformed by this type of nanotech, and what are the drawbacks? The draw backs first. This type of nanotech machine cannot be left unsupervised, it lacks enough programming of its own to be truly independent. At the very least a control module must be included (can be part of clinic facilities or a smaller unit that can be rented out to patients). As the nanotech machines are programmable after insertion there is one other problem. If someone gets a hold of your personal nanotech frequency they can attempt to reprogram the machines and cause untold chaos (very cyberpunk by the way). However control of long term nanotech machines could be based upon an implant (after all where do those toxins binders go when they are not protecting you liver from harm, they return to an implant for new instructions and recharging).
Now the benefits. Since each person receives a personal programming set there are less chances of incompatible cybernetics and less chance of bioware malfunction (how much is up to the Gamemaster). But the major advances come in the hospital. Imagine a tank filled with a super-oxygenated medium (like the liquid breathing mix used in 2020 deep diving suits). The patient is placed in the tank that can also perform the functions of a cryotank. Suspended in the medium are a wide array of nanotech machines (both organic and inorganic) controlled by computers at the doctor's control. The doctor is then able to program advanced medical procedures without any of the normal surgical problems. Say the patient has a bad appendix? The doctor orders a series of nanotech machines to enter the patient (injected by specialized nanotech machines that cause no cellular disruption, or breathed in directly via the fluid medium). The nanotech machines are then directed to the appendix that has been precisely mapped by on board medical imaging systems attached to the tank. One set of machines seals the appendix off from the intestine and the second group is used to detoxify any of the appendix's contents. A third group begins to cart the appendix away, moving the waste material to the rectum for elimination. The surgery takes a couple of hours and aside from a bad taste in the mouth the patient is able to leave immediately and recovery is accomplished before the patient even gets out of the tank. To make things simpler specialized nanotech machines can turn off pain receptors so there is no risk of complication by way of anesthesia. But why a fluid filled tank? The reason is simple, speed and size. If you have to inject the nanotech machines into a host then you are limited to a certain number of machines, a set size of task and the patient is forced to consume very bad tasting supplements. In the tank the nanotech machines have direct access in vast number to whole regions of the body. Imagine a patient who has been shot. Stick him in the tank (the super-oxygenated material has a side effect of destroying any gangrene bacteria that may have developed in the absence of circulation) and instruct the nanotech machines to cart away the bullet. Seal the torn arteries and veins, and then clear away all the disrupted cells that will hinder healing. Combine the tank with cyber-linked manipulators and the doctor can examine injuries and close wounds. Using nanotech machines to provide perfect sterilization. It should be noted that nanotech cannot close large wounds, the machines are far to small to pull the edges of the wound together on their own, but there again cyber-linked manipulators come in handy. This type of set up is also perfect for burn victims who must be kept unconscious due to the pain of any physical contact. The fluid is body temperature, at air pressure and its buoyancy value ensures no contact with any surfaces. And then finally the patient needs no masks or catheters. It fact it should be possible to set up sensor nanotech machines that act as a fluid links to the diagnostic computer and remove the need for any solid contact with the patient at all.
The tank above would in effect be the regeneration chamber listed in the Mekton Zeta rule book without any of the need for extremely advanced tech levels. Such a tank could also be used for major cybernetic replacement. The nanotech machines would be used to prepare the patient for surgery, and attach any nerve tissues to the electronic control systems. But this use of nanotech is very crude compared to what molecular robots could really accomplish. Toxin binders are just the beginning. What about nanotech machines designed to eliminate a particular type of virus or bacteria (how about a nanotech based contraceptives, an after the fact treatment that removes the fertilized zygote, either to storage or elimination). How about a stomach pocket designed to digest abnormal materials from plastics to cellulose (chrome book 4 has a system for cellulose). Or how about nanotech construction facilities that turn out industrial and medical chemicals (ever wanted an unlimited amount of aspirin or CHOOH2). Nanomachines can even create tailored molecules from endorphins (natural pain medication with no physically addictive qualities) to new types of structural polymers. There are limits however to nanotech. I cannot see a nanotech machine that can be programmed with the complexities of DNA, so no complete reworking of a character's inheritable qualities. But there are ways to use nanotech on DNA without killing the patient. Viruses work by adding their own DNA code to the host's, in a sense they add a new blueprint that only builds what they want with the cell's resources. It should be possible to cut this DNA out and neutralize it but the process would need to be repeated in millions of cells. To make this even more difficult the cell will fight back and try correct what it thinks is the true DNA sequence. There is a material called PNA (protein nucleic acid), a material with all the information carrying qualities of DNA but built with a solid protein backbone. PNA can be built to precise specifications, and the builder has complete control over nucleic acid sequencing. Even more useful is the way PNA interacts with DNA. PNA binds to the section of DNA that it has been built for. And once bound cannot be removed by the cell. This means that a PNA strand built to block the AIDS virus would render the virus completely neutralized and unable to express itself. The problem with PNA is that the cell cannot pass it through the nuclear membrane. But attach a limited use nanotech machine to the PNA strand and it could get through a nuclear membrane in any cell assigned. The whole procedure would be controlled from either a hospital or an implanted nanotech factory. By using this method any DNA based medical problem could be corrected for (well not actually corrected for but any disease that requires an active expression of DNA could be turned off permanently, this means things like Huntingdon's or the various oncogenes related to cancer). Such a procedure would be able to stop lethal gene combinations from being expressed during the critical period during pregnancy and may be able to completely counter such conditions as Down's Syndrome.
Gives you something to think about doesn't it. Imagine what the little bastards could do for engineering, construction computer design... Or even killing, a nanotech poison could be deadly. And what about the gray goo scenario?
The Grey Goo Scenario (GGS) is the ultimate nanotech nightmare. Consider the possibilities. A nanotech machine can alter molecules. It can build them or destroy them (well not destroy, but radically alter). Now imagine a nanotech machine let lose anywhere. Designed to replicate itself with any available material. The nanotech machine can be inorganic or organic and it would have little effect on the outcome. The escaping nanotech machine would begin to reproduce at an exponential rate and could theoretically destroy the whole planet, leaving nothing but starving nanomachines. Fortunately there are some counter measures. Inorganic machines can be electrically polarized and overloaded (some may even be vulnerable to magnetic fields of sufficient strength). Organic nanomachines can be destroyed by an internal structure called a lysosome, which contains self destructive enzymes.