Ken Rudin joins The Great Battlefield podcast to talk about his career as a journalist at NPR, hosting his podcast, The Political Junkie and why he's changed his nonpartisan orientation in the Trump era.
Generative AI and surgical robotics are advancing toward autonomous surgery, raising new questions about safety, regulation, payment models, and trust.
In medicine’s history, the best technologies didn’t just improve clinical practice. They turned traditional medicine on its head.
For example, advances like CT, MRI, and ultrasound machines did more than merely improve diagnostic accuracy. They diminished the importance of the physical exam and the physicians who excelled at it.
Now, an even more radical upheaval is headed for the operating room. Generative AI and surgical robotics are advancing so quickly that procedures once done solely by surgeons may soon be performed autonomously by robots. How soon this happens depends on the willingness of (a) clinicians to support the transition, (b) regulators to approve the applications, and (c) patients to trust a machine with the scalpel.
How Generative AI Plus Robotics Would Perform Surgery
The idea of a robot performing autonomous surgery (that is, completing an operation without a human guiding the controls) sounds like science fiction. But the rapid rise of generative AI since ChatGPT’s debut in 2022 has made it possible.
Hundreds of millions of people use tools like ChatGPT, Gemini, and Claude, yet most have only a vague sense of how large language models work. Contrary to popular assumptions, these large language models do far more than “predict the next word.” If that were all they did, then GenAI tools would routinely produce incoherent paragraphs and nonsensical explanations. Instead, they consistently provide sophisticated reasoning, detailed plans, and expert-level summaries.
They accomplish this through imitation. In medicine, generative AI systems are trained on a massive corpora of medical textbooks, scientific journals, surgical videos, and clinical conversations. With billions of internal parameters, the model learns to mimic how humans solve diagnostic problems, interpret images, and execute procedural tasks. With more training, its responses increasingly resemble those of expert clinicians.
Today’s models can already describe the precise steps required to remove a gallbladder. But executing those steps requires two additional capabilities:
That’s where existing surgical robots come in.
Modern Surgical Robotics: The Missing Link
Over the past two decades, operative robots have allowed doctors to work through smaller incisions with enhanced visualization, increased precision, and tremor-free control.
A typical robotic procedure involves the surgeon sitting at a console, watching a high-definition video feed of the operative field. Then, using hand controls, the physician directs the robot’s arms. The robot carries out movements inside the patient with sub-millimeter accuracy.
For generative AI to operate autonomously, developers would provide information and video from tens of thousands of recorded procedures. The large language model would analyze the data coming from the operative cameras inside the patient and match it to the precise hand movements surgeons make at the console in response. Over time, the model would learn to reproduce the same stimulus-response patterns that expert surgeons use — just as it currently learns to generate accurate answers or create videos following verbal or written prompts.
This approach parallels how self-driving cars are trained. But unlike the chaos of city streets (where vehicles, cyclists, and pedestrians constantly move in unpredictable ways) an operating room is a controlled space, and human anatomy is more predictable than the external environment. Generative AI will have an easier time distinguishing anatomical structures than a self-driving car has when deciding whether an object leaving the curb is a scrap of paper, a rolling ball, or a child running into the street.
In the meantime, progress in robotics continues to accelerate. Elon Musk recently predicted that Tesla’s humanoid robot project Optimus would soon be able to perform “sophisticated medical procedures — perhaps things that humans can’t even do.”
Putting The Robotic Pieces Together
The building blocks for autonomous robotic surgery already exist. Whether it becomes reality in five years or 10 will depend less on technological progress and more on how quickly and effectively hospitals, surgeons, and technology companies collaborate to train these systems.
Three changes are needed now to prepare for that future.
A. Payment models must be updated
U.S. healthcare’s fee-for-service reimbursement system rewards higher volume, not superior clinical outcomes. Hospitals earn more when operations take longer. And when reimbursement is tied to each inpatient day, there is little financial incentive to schedule procedures after hours or on weekends.
Shifting to bundled payments (a single rate for an entire surgical episode) will financially reward hospitals that perform safe, efficient surgical procedures at night and on weekends when surgeons aren’t available. By eliminating clinical delays, patients will recover sooner, reducing the demand for inpatient beds while lowering costs.
B. Regulators will need to apply different approval standards
The FDA’s current evaluation framework for AI-enabled devices focuses on the specific data sets used to train an algorithm and the consistency of its outputs. That approach works for narrow AI tools (like those that read mammograms or flag suspicious skin lesions) that are trained on specific datasets.
It does not work for generative AI, which is trained on vast, multimodal information sources and personalized inputs. A more appropriate method would evaluate actual clinical performance. For AI-directed robotic surgery, expert surgeons would review anonymized operative recordings — some performed by humans, others by the AI — without knowing which is which. Approval would be granted only when the generative AI consistently matches the quality, safety, and outcomes achieved by expert clinicians.
C. Medical culture will have to evolve
Clinicians have long resisted technologies that threaten professional autonomy, judgment, or income. Autonomous robotic surgery will be no exception.
But rising economic pressure from the growing unaffordability of care, combined with the promise of safer and more consistent outcomes, will ultimately drive adoption.
Patients will hesitate at first. Technologies that take over tasks once performed exclusively by humans always generate concern. When ATMs were first introduced, many Americans worried their deposits might disappear. But as people gained experience and the systems proved reliable, trust grew, and the technology became routine.
Generative-AI-enabled surgical robots will follow a similar trajectory.
Robert Pearl, the author of “ChatGPT, MD,” teaches at both the Stanford University School of Medicine and the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group.
Hand holding smart phone with US flag case
WASHINGTON — In 2022, Jay Jones sent text messages to a former colleague about a senior state Republican in Virginia getting “two bullets to the head.”
When the texts were shared by his colleague a month before the Virginia general election, Jones, the Democratic candidate for attorney general, was slammed for the violent rhetoric. Winsome Earle-Sears, the Republican candidate for governor, called for Jones to withdraw from the race.
Despite the scandal, Jones won, defeating incumbent Jason Miyares with 52.9% of the vote.
Some voters were concerned about Jones’ comments. Others said the texts did not affect their vote.
For Imani Moore, a 25-year-old Dumfries resident who identifies as a non-binary lesbian, Jones’ comments did not matter.
“I can see how it would change someone’s mind,” Moore said. “But for me, I don’t really care.”
Kaira Sullivan, 25 and Moore’s wife, is a transgender woman who works in the military.
“I definitely think the comments probably went a bit too far, but compared to Republican comments in the past, it’s nothing,” Sullivan said.
Scandals involving digital footprints such as Jones’ are not isolated. In October alone, several political scandals were revealed because of digital footprints.
When Jones’ texts went public, hateful messages from a group chat featuring Young Republican leaders were leaked as well. Later that month, footage of Maine Democratic Senate candidate Graham Platner dancing shirtless revealed a chest tattoo resembling a Nazi skull and crossbones. Platner has since apologized and covered up the tattoo. Shortly after, Paul Ingrassia withdrew from consideration to lead the U.S. Office of Special Counsel after racist and anti-Semitic texts surfaced where Ingrassia claimed to have a “Nazi streak.”
‘Digital footprints didn’t really exist before’
As candidates running get younger, digital footprints are becoming a focal point for opposition research and attacks.
Jen Psaki, who served as White House press secretary for President Joe Biden and as communications director for President Barack Obama, said digital footprints are unique to our time.
“This is new, because digital footprints didn’t really exist before, what, 20 years ago, 15 years ago, 10 years ago,” Psaki said. “I guess it’s something — if you’re working on a campaign or thinking you may ever run for office — then you got to be mindful of that.”
Lis Smith was the senior advisor for Pete Buttigieg's 2020 presidential campaign and the director of rapid response for Obama's 2012 campaign.
“The average age of voters continues to go down. There are a lot more people who have digital footprints, who have a long Twitter, Instagram, Reddit history,” Smith said. “And so I think we’re adapting with that.”
Smith said voters recognizing their own shortcomings is why public tolerance is evolving.
“That’s why a lot of people understand like, ‘Man, there’s a time in my past where I posted something dumb online,” Smith said. “‘I don’t want to be judged for the rest of my life by the worst thing I send in a text or the worst thing I said online.’”
Chris Hinman is the chief executive officer at TheBestReputation, an online reputation and crisis management firm that recently focused on political figures and people who might run for office.
“I think this is the first generation of candidates where they’ve grown up with an online persona,” Hinman said. “Whether it’s like chat rooms or things that they’ve again posted on Facebook or Twitter back in the day, to any mistakes or gaffes they may have made along the way.”
‘The devolution of standards in politics’
Political scandals are not new. What is changing is voter tolerance and the ability to forgive past transgressions.
Daron Shaw is a professor of political science at the University of Texas, Austin, and an advisory board member for the Pew Elections Performance Index. He said the public’s willingness to forgive candidates’ pasts dates back to the 1990s.
“If you're going to take a look at the — I guess you say the devolution of standards in politics — Bill Clinton is an obvious focal point,” Shaw said. “You had a candidate who was accused of things that would have been disqualifying even 10 years prior.”
In the past, harsher penalties were imposed for less severe actions. Michael Dukakis, the 1988 Democratic presidential candidate, was photographed in a tank for a campaign photo. The photo backfired, drawing criticism for appearing awkward, and paving the way for George H.W. Bush to secure the presidency. Howard Dean, a 2004 Democratic presidential candidate, became the first viral political meme for his “Dean Scream.”
Shaw says polarization plays a role in how voters view candidates and politicians in office.
“Because polarization is so intense these days, people on your side will simply convince themselves that it's not relevant and it's better than having somebody from the other side,” Shaw said. “And I'll be darned, in purely crass political terms, I think that's right.”
Psaki said the broad scope of digital footprints results in “a lot of information competing at the same time.”
“But I think what we’ve learned from all of this is that scandals may not matter as much as they did years ago, ” Psaki said.
Tim Miller served as a spokesperson for the Republican National Committee and the communications director for Jeb Bush’s 2016 presidential campaign.
Miller said President Donald Trump changed the political landscape, particularly regarding opposition research, the practice of collecting information on a political opponent to discredit them.
“I'm not saying that oppo doesn't matter anymore, but I'm just thinking that most Trump era things are very different,” Miller said. “When I was doing oppo research in the 2010s, one video of somebody saying something mean about farmers could hurt their Iowa Senate race. I just, I don't think we're in that place anymore.”
‘Just be open, don’t be defensive’
Hinman said a common misconception is that digital content can be removed entirely. Hinman’s firm prepares for any digital footprint scandals in advance.
“That content often can’t be removed; it is going to be found,” Hinman said. “Rather than working to remove it, we work to rectify or correct it if we can.”
For Psaki, transparency is key in response.
“If you’re advising a candidate who has things come out, you want to get it all out, as much of it out at the same time,” Psaki said. “And then the candidate has to speak to it — this was true even before digital footprints were a thing.”
When something does come out, Smith said accountability is what connects with voters.
“We need to have a little bit more openness and permissive attitude to this stuff, because the next crop of candidates is coming up, all their entire adulthood will be spent online,” Smith said. “Just be open, don’t be defensive.”
In the case of Platner, Miller and Smith said it is possible that Platner will come back from these incidents.
“I think the way Graham Platner has handled it has been smart,” Smith said. “Politicians don’t need to be these perfect people who, from the second they came out of the womb, were thinking about running for office, and never posting anything online.”
According to the latest polling, Platner currently has a 20-point lead over Governor Janet Mills in Maine's U.S. Senate Democratic primary race.
“Look, I think people can overcome their digital footprint a lot more easily than in the past,” Miller said. “You've seen a backlash effect to the Platner oppo in a big way, you know, with a lot of people who are like, ‘You know, this kind of makes me like him more... in a way that he's being honest about his past.”
Psaki pointed to this year’s Virginia attorney general race as a harbinger.
“Jay Jones is now going to be the attorney general in Virginia,” Psaki said. “His texts were terrible, but people voted for him for other reasons, right?”
For other young candidates like Platner or Jack Schlossberg, a social media personality of Kennedy lineage running for Congress, these upcoming elections will be a litmus test of where the line is for voters today.
“Partisans will find a way to justify voting in a partisan manner,” Shaw said.
Katareena Roska is a reporter with Medill News Service.
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I first encountered Leszek Kołakowski, the Polish political thinker, as an undergraduate. It was he who warned of “an all-encompassing crisis” that societies can feel but cannot clearly name. His insight reads less like a relic of the late 1970s and more like a dispatch from our own political moment. We aren’t living through one breakdown, but a cascade of them—political, social, and technological—each amplifying the others. The result is a country where people feel burnt out, anxious, and increasingly unsure of where authority or stability can be found.
This crisis doesn’t have a single architect. Liberals can’t blame only Trump, and conservatives can’t pin everything on "wokeness." What we face is a convergence of powerful forces: decades of institutional drift, fractures in civic life, and technologies that reward emotions over understanding. These pressures compound one another, creating a sense of disorientation that older political labels fail to describe with the same accuracy as before.
For generations, the institutions that shaped everyday life acted as the community’s informal infrastructure, propping up society. Churches didn’t just offer a place to worship, but also offered childcare, shared meals, and weekly bingo nights that gave people a place to gather. Local newspapers kept residents informed about school tax referenda, zoning disputes, and neighborhood issues. Political party associations held fish fries and ward meetings where voters could meet the candidates seeking their support. Today, many of these anchors have thinned out or disappeared. A church that once ran a weekly food pantry shutters after membership declines. A small-town paper closes, leaving residents dependent on cable news and social‑media rumors. Local parties dissolve into little more than automated fundraising emails. Screens replace shared spaces, and as those real-world ties fade, so does the trust and connection they once made possible. None of this should surprise us—Neil Postman and Robert Putnam warned more than two decades ago that these civic foundations were eroding—and why--and that the consequences would be far-reaching.
That erosion leaves citizens mentally exhausted. Protest movements draw millions, but engagement rarely translates into sustained civic renewal. People show up in the streets, go home, and feel just as unmoored as before. The vocabulary of past ideological battles—left vs. right; big government vs. small—doesn’t capture the hollowing out of confidence that Kołakowski and others identified. This moment is about something deeper: a frayed sense of meaning. The connective tissue that once gave politics its purpose has worn thin.
Technology has accelerated this shift. What once promised connection now delivers outrage cycles instead. Social platforms sort people into warring tribes, reward the loudest voices, and spread half-truths faster than accurate reporting can catch up. Algorithms built to keep people engaged now drive wedges between them. Instead of broadening public debate, digital platforms splinter it into hostile enclaves. As misinformation grows easier to produce—thanks to AI-- and harder to correct, trust in both institutions and each other falls further.
Some remedies are already visible. Stronger privacy protections in Europe have curbed the most aggressive forms of surveillance advertising. Experiments that reduce the reach of engagement bait show real drops in viral misinformation. Several cities that invested in community journalism, public libraries, and adult media-literacy programs report higher turnout and more civic participation. These may be small steps, but they show how concrete local initiatives can rebuild public life.
At the national level, the work begins with restoring competence and clarity to the federal government. Congress can reestablish its role by passing a real data privacy law, strengthening oversight of digital platforms, and updating antitrust rules so a handful of companies cannot dominate public discourse. The White House can improve public confidence by speaking consistently, limiting policy whiplash, and giving agencies the stability they need to do their jobs. The courts can help by strengthening judicial ethics rules and explaining major decisions more clearly, closing the distance between legal reasoning and public understanding.
Trust grows when institutions do what they claim to do. People notice when benefits arrive on time, when rules are applied evenly, and when large projects move forward without years of delay. Visible competence matters. It’s one of the few things that reliably cuts through polarization.
But the deeper work to be done concerns meaning. No policy—however well-crafted—can endure without a public that believes in the institutions carrying it out. Technology transformed how Americans live together; now those institutions must shape the conditions under which technology operates. They must reward behaviors that strengthen the civic commons rather than erode them. And they must do so in a way that benefits ordinary people, not just the already powerful.
Kołakowski’s point remains as urgent now as it was then: a crisis without a name is still a crisis. The task ahead is more than fixing broken systems. It is rebuilding a politics capable of producing meaning rather than noise—one that encourages people to trust one another enough to act together. If we fail at that, the crisis will no longer be unnamed. It will simply feel permanent.
Robert Cropf is a Professor of Political Science at Saint Louis University.
AI is transforming how people seek help, share stories, and connect online. This article examines what’s at stake for social media and the future of human connection.
No doubt social media and online discussion forums have played an integral role in most everyone’s daily digital lives. Today, more than 70% of the U.S. adults use social media, and over 5 billion people worldwide participate in online social platforms.
Discussion forums alone attract enormous engagement. Reddit has over 110 million daily active users, and an estimated 300 million use Q&A forums like Quora per month, and 100 million per month use StackExchange. People seek advice, learn from others’ experiences, share questions, or connect around interests and identities.
In mental health contexts, online peer support communities offer a place to share and disclose personal struggles, hear others’ experiences, and receive social support. Research supports the success of these online communities, which enable people to candidly self-disclose and seek support from others.
When people engage with personal narratives on peer-support sites, they often feel more confident in coping with stressful events. At the same time, these platforms also expose individuals to online trolling, harassment, misinformation, and other antisocial behaviors.
The familiar dynamics of those communities took a turn about three years ago, when conversational AI tools like ChatGPT entered the public sphere and quickly captured widespread attention.
This marked the start of a new era of interactive AI in day-to-day lives and society. People tried recipes, coding help, emotional support, creative writing, and more. The ease of asking a machine a question, receiving a coherent response, and doing so privately sparked a new kind of engagement.
Shortly after ChatGPT’s release, Google issued a “code red,” citing the tool’s rapid adoption as a threat to traditional search behavior and the information-seeking habits that long supported online forums.
At that moment, many wondered, "What is the future of social media and online discussion forums when people increasingly turn to AI instead of each other?"
That question warrants attention because the value of online communities depends on active participation. When fewer users post questions, share responses, or react to others, the foundational mechanisms of online forums—reciprocity, belongingness, narratives of shared experience—become weaker. If a user can ask an AI privately and immediately, the incentive to engage publicly changes.
A recent report by Anthropic warns that AI models can exhibit “natural emergent misalignment,” including reward hacking—where systems learn to game feedback signals in ways humans did not intend. It’s a timely reminder that AI can sound empathetic and coherent without having lived experience or genuine understanding.
However, one of the crucial aspects of a supportive response from a peer is the presence of personal narratives and lived experiences. A systematic review noted that young people in online communities seek both informational and emotional support through stories of peers who have faced similar challenges. This suggests that narrative exchange is not simply transactional—it works when users engage as part of a community of peers, not as isolated speakers into the void.
By contrast, AI lacks lived experience. It can simulate empathy, but it cannot draw from a personal story.
In our research comparing AI-generated responses with peer responses in online communities, AI’s language was more formal, structured, and polite, but it rarely used first-person pronouns (which signal personal narratives).
Even when an AI’s replies appear personalized, they show limited diversity. Across many queries, the AI often reuses the same templates with minor variations. Online communities, in contrast, produce a range of viewpoints. Even a single question elicits diverse stories and perspectives from multiple individuals.
In a new study of teens' use of AI, results show more than 70% of teens have used AI companions, with one-third discussing serious personal issues with them rather than people.
Another survey found that 58% of users think that ChatGPT is “too nice,” and argue that the lack of realistic push-back undermines authenticity. These point to a tension: on the one hand, convenience and immediacy win; on the other, authenticity and narrative connection may suffer.
So what is at stake?
The forms of online social life are evolving. Large general-purpose platforms that once relied on high-volume question-and-answer interactions may see that function increasingly handled by AI. Participation may decline, not because people stop connecting, but because their first step becomes private and AI-mediated.
In that scenario, online community spaces may become more selective, more identity-driven, and oriented toward authentic human experience rather than mechanical problem-solving.
At the same time, platforms may adapt. Many already integrate AI to moderate content, summarize discussions, or help users articulate questions. In the future, AI may become part of the community infrastructure—filtering, guiding, even prompting human interaction, rather than replacing it.
The enduring value will be human presence: the voices of people who have lived the story, the shared recognition of someone else’s struggle, the sense of belonging created when users see that others have walked the same difficult path.
The future of social media, therefore, depends on which interactions people continue to value. Efficiency and convenience will not alone sustain the community. The presence of narratives rooted in human experience, and the recognition that someone else has faced a similar challenge, are what give forums their emotional traction. As AI becomes a more capable first responder, the discussion spaces that thrive will be those that prioritize experience, connection, and mutuality over instant answers.
In this emerging online and digital era, the question is not only whether people will use AI alongside communities—they already do. The more pressing question is how many choose AI instead of online (or offline) communities. The answer will determine not simply which platforms survive, but what form meaningful online connection takes in the years ahead.
The question then becomes, do people really need people?
Dr. Koustuv Saha is an Assistant Professor of Computer Science at the University of Illinois Urbana-Champaign’s (UIUC) Siebel School of Computing and Data Science and is a Public Voices Fellow of The OpEd Project. He studies how online technologies and AI shape and reveal human behaviors and wellbeing.
Journalist and Political Junkie Ken Rudin
