In the next 20 years...

Welcome to my world. Enjoy!

Scientists may think that's a good idea when applied to moon-hoax conspiracy theorists, intelligent-design backers or black-hole doomsayers - but such an algorithm also could help authorities stack the deck when it comes to Net-moderated discussions of political or social issues in places like present-day Iran or China.
Medical promise and peril
Personalized medicine has even more good-news, bad-news potential in the decade ahead. So far, researchers haven't made as much headway as they had hoped when it comes to connecting the human genetic code with human diseases and capabilities. Why is that? For one thing, relatively few humans have had their full genome sequenced, which has given geneticists a meager data set to work with.
That situation is rapidly changing, thanks to the falling cost of gene sequencing and the rising market for DNA services. "Over the next decade millions of people could have their genomes sequenced," says David Goldstein, director of the Center for Human Genome Variation at Duke University's Institute for Genome Sciences and Policy.
As we learn more about the genome, we're likely to find that disease risks are determined by the interaction of many genetic factors. During the next decade, Goldstein says geneticists could well discover lots of low-frequency, high-impact risk factors for diseases such as schizophrenia, epilepsy and autism.
"The identification of major risk factors for disease is bound to substantially increase interest in embryonic and other screening programs," he writes. "Society has largely already accepted this principle for mutations that lead inevitably to serious health conditions. Will it be so accommodating of those who want to screen out embryos that carry, say, a twentyfold increased risk of a serious but unspecified neuropsychiatric disease?"
Goldstein says the time to debate the ethics and the practicalities of personalized genetic screening is now.
Gut check ... literally!
Another big theme in the future of medicine is the analysis of the human microbiome - that is, the microbial communities that live inside your gut and other organs. Some of the more stubborn and hard-to-diagnose diseases that afflict us - such as obesity, diabetes and autoimmune disorders - may have as much to do with our microbes as with our own genome.
David Relman, chief of infectious diseases at the Veterans Affairs Palo Alto Health Care System in California, says that the microbiome is really our "extended self," but adds that we are "relatively ignorant" about how it works. That is likely to change over the next 10 years.
"By 2020, personalized health care could involve doctors monitoring the metabolic activities of a patient's gut microbes and, possibly, modulating them therapeutically," says Jeremy Nicholson, head of Imperial College London's department of surgery and cancer.
Future climate
Several experts said climate change could force dramatic shifts in the world's energy economy. Jeffrey Sachs, director of the Earth Institute, says a "new world environmental organization" should be established to provide the technical know-how for heading off the worst climate effects and adapting to the effects that can't be avoided. He also predicts that societies will have to come up with new approaches to public-private investment in environmental technologies and international development.
"Global financing for poorer countries must improve if international agreements on climate, land use and biodiversity are to succeed," Sachs writes. "The record of aid delivery to poor countries is dismal. Rich countries regularly promise support that never arrives. Two proposals have been made that could improve things: a small tax on cross-border financial transactions, and a global levy on carbon emissions."
Sachs says both proposals should be implemented, along with the more traditional forms of international aid.
David Kammen, director of the Renewable and Appropriate Energy Laboratory at the University of California at Berkeley, agrees that it is "essential to put a price on carbon emissions, through either well-managed cap-and-trade schemes or carbon taxes." Can we afford to make the energy transition? Can we afford not to? Kammen supports experiments in creative financing, such as his own lab's Property-Assessed Clean Energy mechanism, to make it easier for homes and businesses to buy into a new energy economy.
If societies throw their support to more efficient, renewable energy technologies, by 2020 "the world would be on the way to an energy system in which solar, wind, nuclear, geothermal and hydroelectric power will supply more than 80 percent of electricity," Kammen writes.
All this is just the tip of the iceberg when it comes to this week's visions for 2020. For the full set of essays, including the outlook for laser fusion and drug discovery, check out Nature's special report. The journal is providing an online forum to discuss the outlook for the next decade, but you can also throw in your comments right here. Don't miss our earlier discussion about "decades of future science." And to find out how fallible forecasters can be, take a look back at my three-year-old technology forecast for 2012.