Are there hopeful representations of public health policy in speculative fiction? Are there, for example, visions of a well-governed biomedical commons?Within SF, dystopia and public health policy go hand-in-hand. In fact, SF seems practically incapable of imagining any holistic stance on the myriad factors that inform the happiness and flourishing of populations, unless the interested party is some sinister elite: a paternalistic and unaccountable dystopian government, as in Aldous Huxley’s Brave New World, or perhaps a clandestine sect of eugenicists like the Bene Gesserit of Frank Herbert’s Dune. Perhaps there are some partial exceptions. In threads of transhumanism and biopunk traceable through works by Iain M. Banks, Octavia Butler, Ted Chiang, Samuel R. Delany, Cory Doctorow, Greg Egan, Gwyneth Jones, Nancy Kress, Yoon Ha Lee, Annalee Newitz, Kim Stanley Robinson, Justina Robson, Bruce Sterling, Charles Stross, Jeanette Winterson, and others, the somatic becomes vividly tractable to speculative technologies. Bodies and consciousnesses become the raw material for design and experiment. Bodily distresses, diseases, disorders, disabilities, and limitations may be eradicated altogether, or transformed or recontextualised to de-pathologize them. Often such SF goes beyond crudely fantasizing medical techno-fixes, and examines how notions of ‘healthy’ and ‘normal’ are constructed in the first place. But what such SF almost never does is offer any account of the democratization of medicalized desire, expertise, techniques, and resources. There are mavericks who work outside of the medical-industrial complex, or there is its wholesale displacement by biomedical abundance supremely responsive to individual desire … and that’s it.