It requires an idea on what to do, and also know what speculation is.
Black Jack fluctuates between being about modern medicine and surgery, to being about speculative surgery. You also need an idea on what the aesthetic is there for if its not speculative, like Alita.

If you want a current take on the hell we are facing in the next century, the speculation award would go to Rainbow's End by that guy who also wrote Stranded in Realtime and A Deepness in the Sky