The Patient-Centered Outcomes Research Institute (PCORI) is a nonprofit, nongovernmental organization established by the U.S. Congress to fund comparative clinical effectiveness research focusing on patient-centered outcomes through the engagement of stakeholders. Evaluation of emerging healthcare innovations is one of PCORI’s five National Priorities for Health. One such initiative is PCORI’s Emerging Technologies and Therapeutics Reports program, established to provide timely overviews of evidence on new drugs and other healthcare technologies. This article provides an overview of completed and ongoing Emerging Technologies and Therapeutics Reports including lessons learned to date. In addition to systematic searches, systematic selection of studies, and transparent reporting of the available evidence, informed by a select number of stakeholders (i.e., key informants), these reports focus on contextual factors shaping the diffusion of emerging technologies that are often not reported in the medical literature. This article also compares processes and methodologies of health technology assessments (HTAs) from a selected number of national and international publicly funded agencies with a goal toward potential future enhancement of PCORI’s Emerging Technologies and Therapeutics Reports program. HTAs vary considerably in terms of funding, types of assessments, the role of manufacturers, stakeholder engagement, timeline to complete from the start to the finish of a draft report publication, and communication of uncertainty for informed decision making. Future Emerging Technologies and Therapeutics Reports may focus on rapid reports to support a more expedient development of evidence. Future research could explore the role of contextual factors identified in these reports on targeted evidence generation.

How do emerging technologies affect nuclear stability? In this paper, we use a quasi-experimental cyber-nuclear wargame with 580 players to explore three hypotheses about emerging technologies and nuclear stability: (1) technological uncertainty leads to preemption and escalation; (2) technological uncertainty leads to restraint; and (3) technological certainty leads to escalation through aggressive counterforce campaigns. The wargames suggest that uncertainty and fear about cyber vulnerabilities create no immediate incentives for preemptive nuclear use. The greater danger to strategic stability lies in how overconfidence in cyber exploits incentivizes more aggressive counterforce campaigns and, secondarily, how vulnerabilities encourage predelegation or automation. Both of these effects suggest worrisome relationships between cyber exploits and inadvertent nuclear use on one hand and cyber vulnerabilities and accidental nuclear use on the other hand. Together, these findings reveal the complicated relationship between pathways to escalation and strategic stability, highlighting the role that confidence and perhaps-misplaced certainty—versus uncertainty and fear—play in strategic stability.

Major theories of military innovation focus on relatively narrow technological developments, such as nuclear weapons or aircraft carriers. Arguably the most profound military implications of technological change, however, come from more fundamental advances arising from ‘general-purpose technologies’ (GPTs), such as the steam engine, electricity, and the computer. Building from scholarship on GPTs and economic growth, we argue that the effects of GPTs on military effectiveness are broad, delayed, and shaped by indirect productivity spillovers. We label this impact pathway a ‘general-purpose military transformation’ (GMT). Contrary to studies that predict GPTs will rapidly diffuse to militaries around the world and narrow gaps in capabilities, we show that GMTs can reinforce existing balances if leading militaries have stronger linkages to a robust industrial base in the GPT than challengers. Evidence from electricity's impact on military affairs, covering the late nineteenth and early twentieth centuries, supports our propositions about GMTs. To probe the explanatory value of our theory and account for alternative interpretations, we compare findings from the electricity case to the military impacts of submarine technology, a non-GPT that emerged in the same period. Finally, we apply our findings to contemporary debates about artificial intelligence, which could plausibly cause a profound GMT.

In the past decade, international actors have launched “brain projects” or “brain initiatives.” One of the emerging technologies enabled by these publicly funded programs is brain-computer interfaces (BCIs), which are devices that allow communication between the brain and external devices like a prosthetic arm or a keyboard. BCIs are poised to have significant impacts on public health, society, and national security. This research presents the first analytical framework that attempts to predict the dissemination of neurotechnologies to both the commercial and military sectors in the United States and China. While China started its project later with less funding, we find that it has other advantages that make earlier adoption more likely. We also articulate national security risks implicit in later adoption, including the inability to set international ethical and legal norms for BCI use, especially in wartime operating environments, and data privacy risks for citizens who use technology developed by foreign actors.

Will AI-enabled capabilities increase inadvertent escalation risk? This article revisits Cold War-era thinking about inadvertent escalation to consider how Artificial Intelligence (AI) technology (especially AI augmentation of advanced conventional weapons) through various mechanisms and pathways could affect inadvertent escalation risk between nuclear-armed adversaries during a conventional crisis or conflict. How might AI be incorporated into nuclear and conventional operations in ways that affect escalation risk? It unpacks the psychological and cognitive features of escalation theorising (the security dilemma, the ‘fog of war’, and military doctrine and strategy) to examine whether and how the characteristics of AI technology, against the backdrop of a broader political-societal dynamic of the digital information ecosystem, might increase inadvertent escalation risk. Are existing notions of inadvertent escalation still relevant in the digital age? The article speaks to the broader scholarship in International Relations – notably ‘bargaining theories of war’ – that argues that the impact of technology on the cause of war occurs through its political effects, rather than tactical or operational battlefield alterations. In this way, it addresses a gap in the literature about the strategic and theoretical implications of the AI-nuclear dilemma.

Three decades after what is widely referred to as the transition from a First to a Second Nuclear Age, the world stands on the cusp of a possible Third Nuclear Age where the way that we conceptualise the central dynamics of the nuclear game will change again. This paradigm shift is being driven by the growth and spread of non-nuclear technologies with strategic applications and by a shift in thinking about the sources of nuclear threats and how they should be addressed, primarily, but not solely, in the United States. Recent scholarship has rightly identified a new set of challenges posed by the development of strategic non-nuclear weaponry (SNNW). But the full implications of this transformation in policy, technology and thinking for the global nuclear order as a whole have so far been underexplored. To remedy this, we look further ahead to the ways in which current trends, if taken to their logical conclusion, have the capacity to usher in a new nuclear era. We argue that in the years ahead, SNNW will increasingly shape the nuclear order, particularly in relation to questions of stability and risk. In the Third Nuclear Age, nuclear deployments, postures, balances, arms control, non-proliferation policy, and the prospects for disarmament, will all be shaped as much by developments in SNNW capabilities as by nuclear weapons. Consequently, we advocate for an urgent reassessment of the way nuclear order and nuclear risks are conceptualised as we confront the challenges of a Third Nuclear Age.

This study analyzes the issue attention cycle for print and online media coverage of a scientific publication examining the deaths of Chinese factory workers due to lung damage from chronic exposure to nanoparticles. The results of the nanoparticle study, published in 2009, embody news values that would make the study a prime candidate for press coverage, namely, novelty, negativity, controversy, and potential widespread impact. Nevertheless, mentions of the event in traditional English-language print media were nearly nonexistent. Online media, on the other hand, gave the story greater coverage. This case study exemplifies why online media may not be bound to the same issue attention cycle that print media are for controversial scientific events.

Three years ago James Mullan delivered a presentation called “Emerging technologies” and followed this up with an article in Legal Information Management (LIM) called “Making mountains out of molehills: a look at some emerging technologies”1 Two years further on and the Editor of LIM asked him to re-visit the issues and to write a follow-up article on the subject. As a result this paper looks at the current state of play with those technologies and identifies some of the significant technological developments to have taken place since his original article.

The objectives of the feasibility study were to evaluate sources of information for an eventual Danish system for early identification and assessment of emerging health technology, to identify potential users of the system, and to clarify their specific need for information concerning emerging health technology. The methods used were questionnaires to informants within and outside the health services and to decision makers on different levels in the health services, and follow-up telephone interviews. Our study reveals a strong, and to some extent unsatisfied, need among policy makers, planners, and managers in the Danish health services for information concerning emerging health technology. The requested information should in particular concern indication for use, number of patients affected, clinical effectiveness and side effects, running cost, and investments. The time horizon most relevant to the decision makers seems to be only zero to 2 years. Furthermore, we found that numerous sources are available that frequently display information on emerging technology important to the health services. The challenges seem to be to select information of sufficient importance and quality, and to combine information, since very few, if any, single primary sources cover all the requested information. In conclusion, we recommend the establishment of a Danish national system for early identification and assessment of emerging health technology, consisting of a small secretariat that collaborates nationally and internationally, the latter in particular on identification of technology and on development of methods for early assessment.

Objective: Somatic gene therapy is a new method in the rapidly expanding field of molecular medicine. Due to recent encouraging results and the promising prospect for some disease groups, Norwegian health authorities wanted to assess somatic therapy with evidence-based standards for strategic use. This article presents the results of this assessment, discussed in the context of the policy-making process in Norway, including ethical and legislational considerations.

Methods: Clinical gene therapy protocols, ongoing or completed with published results, where available, were identified through a systematic survey of descriptive protocols and publications. Preclinical literature was also reviewed.

Results: Gene therapy is dominated by preclinical and clinical research. Most of the gene therapy protocols identified are in early phases (phases I and II) with only a few patients in each study. Of the protocols included in the assessment, only three phase III studies are represented. Except for the use of soluble antisense oligonucleotides against cytomegalovirus eye infection, gene therapy is presently not an established treatment modality. Promising results have been observed in treatment of cancer and cardiovascular diseases and, most recently, in inherited severe combined immunodeficiency and hemophilia. Several interesting principles addressing a large panel of conditions are currently being developed and tested.

Conclusions: Gene therapy is developing into an important medical concept that needs to be included within the Norwegian healthcare system. It is recommended that the Norwegian Ministry of Health and Social Affairs fund a national program to boost infrastructure in selected scientific groups both in preclinical and clinical research. The national procedures regulating approval of gene therapy trials should be made more efficient while at the same time allowing for proper control and ethical considerations. It is emphasized that gene therapy trials should be carefully monitored for side effects.

Objective: Extracorporeal shock wave therapy (ESWT) as an emerging technology in orthopedics has been assessed in Austria with the objective to establish a scientific basis for pending and pressing health policy decisions. Despite encouraging results within some indications and the promising prospect of a noninvasive treatment for some orthopedic diseases, it seemed crucial to assess this new field of application in the light of evidence-based standards, without forgetting the reality of healthcare decisions. This article presents the results of the abovementioned assessment in the context of the policy-making process in Germany, Austria, and Switzerland.

Methods: The study is based on an overview of the already existing reviews on the effectiveness of ESWT as carried out by different actors (health insurances and orthopedists), and on an overview of additional literature covering all relevant aspects (mode of action, recommendations, economic estimates). Orthopedic societies, several institutions involved in health technology assessment, and health insurance agencies were contacted in search of further relevant literature, ongoing studies, and assessments.

Results: Until now, clear evidence has not been available on the effectiveness of ESWT in four currently recommended indications (tendinosis calcarea of the shoulder, epicondylopathia humeri radialis, calcaneal spur, and pseudarthrosis), although a substantial body of literature has been produced. Despite encouraging results in some indications, the lack of coherent therapy schemes and the poor quality in the design of clinical studies has been serious enough to hinder the drawing of reasonable conclusions.

Conclusions: Due to the rapid diffusion of ESWT and the pressure on reimbursement agencies to prove the ineffectiveness of ESWT, the policy option of a pragmatic approach is recommended to controll the diffusion of an uncertain health technology, alongside active research that would allow a more comprehensive appraisal of this potentially interesting treatment strategy in orthopedics.