Last week, internal Republican Party divisions spilled onto the floor of the House of Representatives in a way rarely publicly seen in Washington. In this installment of the FiveThirtyEight Politics podcast, the crew looks at why it took 15 votes to get Rep. Kevin McCarthy elected House Speaker and what that process says about the two years ahead and the GOP more broadly. They also consider how Rep. George Santos’s scandals will affect his tenure in Congress and whether he would have been elected at all if his fabricated biography had received more scrutiny during the campaign.
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Generative AI Can Save Lives: Two Diverging Paths In Medicine
Aug 10, 2025
Generative AI is advancing at breakneck speed. Already, it’s outperforming doctors on national medical exams and in making difficult diagnoses. Microsoft recently reported that its latest AI system correctly diagnosed complex medical cases 85.5% of the time, compared to just 20% for physicians. OpenAI’s newly released GPT-5 model goes further still, delivering its most accurate and responsive performance yet on health-related queries.
As GenAI tools double in power annually, two distinct approaches are emerging for how they might help patients.
One path involves FDA-approved tools built by startups and established technology companies. The other empowers patients to safely use existing tools like ChatGPT, Gemini, and Claude.
Each path has advantages and tradeoffs. Both are likely to shape healthcare’s future.
To better understand what’s at stake, it’s first helpful to examine how generative AI differs from the FDA-approved technologies used in medicine today.
Narrow AI
Medicine has relied on “narrow AI” applications for more than two decades, using models trained to complete specific tasks with structured clinical data.
These tools are programmed to compare two data sets, identify subtle differences, and assign a precise probability factor to each. In radiology, for example, narrow AI models have been trained on thousands of mammograms to distinguish between those demonstrating early-stage breast cancer and those with benign conditions like fibrocystic disease. These tools can detect differences too subtle for the human eye, resulting in up to 20% greater diagnostic accuracy than doctors working alone.
Because narrow AI systems produce consistent, repeatable results, they fit neatly within the FDA’s current regulatory framework. Approval requires measurable data quality, algorithmic transparency, and reproducibility of outcomes.
Generative AI: A new kind of medical expertise
Generative AI models are built differently. Rather than being trained on structured datasets for specific tasks, they learn from the near-totality of internet-accessible content, including thousands of medical textbooks, academic journals, and real-world clinical data.
This breadth allows GenAI tools to answer virtually any medical question. But the large language model responses vary based on how users frame questions, prompt the model, and follow up for clarification. That variability makes it impossible for the FDA to evaluate the accuracy and quality of the tools.
Two distinct pathways are emerging to bring generative AI into clinical practice. Maximizing their impact will require the government to change how it evaluates and supports technological innovation.
1. The traditional path: FDA-approved, venture-backed
As medical costs rise and patient outcomes stagnate, private technology companies are racing to develop FDA-approved generative AI tools that can help with diagnosis, treatment, and disease management.
This approach mirrors the narrow AI model: high-priced tools that are highly regulated and largely dependent on insurance coverage for American families to afford them.
With venture funding, companies can fine-tune open-source foundation models (like DeepSeek or Meta’s LLaMA) using a process called “distillation.” This involves extracting domain-specific knowledge and retraining the model with real-world clinical experiences, such as tens of thousands of X-rays (including radiologists’ readings) or anonymized transcripts of patient-provider conversations.
Consider how this approach might impact diabetes management. Today, fewer than half of patients achieve adequate disease control. The consequences include hundreds of thousands of preventable heart attacks, kidney failures, and limb amputations each year. A generative AI tool trained specifically for diabetes could replicate the approach of a skilled chronic disease nurse: asking the right questions, interpreting patient data, and offering personalized guidance to help users better manage their blood sugar levels.
This path already appears to have federal backing. The Trump administration recently launched its Medicare-funded Health Tech Ecosystem initiative, partnering with more than 60 tech and healthcare firms to pilot AI-enabled tools for chronic disease management, including diabetes and obesity.
Although distillation is faster and cheaper than building an AI model from scratch, the timeline to FDA approval could still span several years and cost tens of millions of dollars. And any adverse outcome could expose companies to legal liability.
2. The alternate path: Empowering patients with GenAI expertise
This second model flips the innovation equation. Instead of relying on expensive, FDA-approved tools developed by private tech companies, it empowers patients to use low-cost, publicly available generative AI to manage their own health better. This can be accomplished through digital walkthroughs, printed guides, YouTube videos, or brief in-person sessions.
For example, a patient might input their blood pressure, glucose readings, or new symptoms and receive reliable, evidence-based advice from ChatGPT or Claude: whether a medication change is needed, when to alert their doctor, or if emergency care is warranted. Similarly, patients working with their physicians could use these LLMs to detect early signs of post-operative infection, worsening heart failure, or neurological decline.
With 40% of doctors already engaged in “gig work,” an ample supply of clinicians from every specialty would be available to contribute their expertise to develop these training tools.
This model would bypass the need for costly product development or FDA approval. And because it offers education, not direct medical care. It would create minimal legal liability.
Government support for both models
These approaches are not mutually exclusive. Both have the potential to improve care, reduce costs, and extend access. And both will benefit from targeted government support.
The traditional path will require companies to evaluate the reliability of their tools by testing the accuracy of their recommendations against clinicians. When these tools are equivalent, the FDA would give its approval.
The alternate path of educating patients to use existing large language models will benefit from educational grants and added expertise from agencies like the CDC and NIH, partnering with medical societies to develop, test, and distribute training materials. These public-private efforts would equip patients with the knowledge to use GenAI safely and effectively without waiting years for new products or approvals.
Together, these models offer a safer and more affordable future for American healthcare.
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.
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The Battle Over Truth: Trump, Data, and the Fight for Reality
Aug 10, 2025
I. The Battle Over Facts
When Donald Trump fired Dr. Kristine Joy Suh, head of the Bureau of Labor Statistics, after a disappointing July jobs report, it wasn’t merely a personnel decision—it was a sharp break with precedent. Suh’s removal upended decades of tradition in which BLS commissioners, regardless of who appointed them, were shielded from political retaliation to preserve statistical integrity. In his second term, Trump has made it clear that data isn’t merely information to be reported—it’s a narrative to be controlled. If the numbers align with his message, they’re hailed as proof of success. If they don’t, they’re dismissed as fake—or worse, subversive.
This shift signals more than a partisan impulse—it marks the erosion of institutions designed to uphold objective truth. For decades, federal statistics have anchored democratic governance, offering policymakers, markets, and the public a shared factual baseline. Trump’s approach upends that legacy, promoting the idea that data should serve political ends rather than public understanding.
The war on truth isn’t new, but under Trump, it has escalated into a sustained campaign against independent information. This is no longer just about spin; it’s about restructuring government to control the public’s understanding of social reality. At stake is whether democracy can function at all without a foundation of facts.
II. Data as Narrative: When Numbers Tell a Political Story
Presidents have always tried to spin the numbers. But Trump has gone further—casting doubt not just on interpretations but on the legitimacy of the data itself. During his first term, he routinely dismissed unfavorable jobs reports, distorted trade figures, and undermined the Federal Reserve’s credibility. In his second term, this distrust has hardened into policy: statistical professionals are fired, and institutions are reshaped to serve partisan objectives.
This tactic mirrors authoritarian regimes. Argentina manipulated inflation statistics for years. China’s economic numbers are widely viewed as political theater. The consequences in both cases are well known: investors hesitate, policy flounders, and public trust collapses. Without reliable data, no one—from executives to voters—can make informed decisions.
Trump’s economic storytelling follows this pattern. He claimed to have created “7 million jobs,” despite a slowdown in job growth compared to the Obama years. According to a July 2020 FactCheck.org report, 7.8 million jobs had actually been lost since Trump took office, including 274,000 manufacturing jobs and 7,100 coal mining jobs. Meanwhile, a low unemployment rate disguised stagnant wages and shrinking labor force participation.
These distortions are reinforced by conspiracy rhetoric. Trump and his allies have accused career civil servants of being part of a “deep state.” In 2019, he even blamed the Federal Reserve for supposedly using flawed data to suppress economic growth. In his second term, that rhetoric has justified a sweeping purge and restructuring of federal statistical agencies.
The infrastructure for producing trustworthy data still exists—but its foundations are being chipped away. If people stop trusting official statistics, even accurate ones lose their power. And when truth becomes negotiable, democracy begins to rot—not in a dramatic collapse, but in slow, unnoticed decay.
III. How U.S. Economic Data Is Supposed to Work
For generations, the United States has been the global gold standard for independent economic data. This credibility relies on institutional safeguards that keep politics at bay.
The Bureau of Labor Statistics surveys about 60,000 households and 120,000 businesses each month to report on jobs, wages, and labor force dynamics. These processes are governed by strict scientific protocols and carried out by nonpartisan professionals. The same holds true for the Census Bureau, the Bureau of Economic Analysis, and other statistical arms of government.
Equally vital is the release protocol: data is published on a rigid schedule—without political preview or interference. Agencies disclose their methodologies, acknowledge margins of error, and correct mistakes publicly. Independent economists and journalists vet the results. These checks are not ceremonial—they’re essential.
The system has withstood pressure before. In 2020, the Census Bureau resisted attempts to manipulate its count of undocumented immigrants. But what once required vigilance now requires urgent defense.
This year, Trump’s Department of Government Efficiency (DOGE) executed a mass purge of federal employees. Over 200,000 workers—many of them statisticians and data analysts—were fired. Elon Musk briefly led the “agency” (it was never officially authorized by Congress), claiming efficiency as the goal. But internal watchdogs saw something else: a targeted dismantling of statistical capacity.
The results are already visible. Survey sizes are shrinking, data processing is slower, and regional offices—especially in underserved areas—are closing. The result is a federal data system that’s less accurate, less comprehensive, and more susceptible to distortion.
This isn’t an abstract threat. When the numbers fail, the system fails. Legislators can’t budget. Businesses can’t invest. Voters can’t judge performance. Without trusted data, democracy becomes guesswork. And once trust erodes, restoring it is far more difficult than sustaining it.
We don’t need a scenario of outright falsification to sound the alarm. Eroding staffing, politicizing leadership, and slashing oversight are enough to poison the well. In today’s fractured environment, even a whisper of doubt can be weaponized.
Defending public data may seem technical, even dull. But it’s fundamental to safeguarding democracy itself. If we can’t trust the numbers, what’s left to guide policy, accountability, or civic debate? Truth is infrastructure. And in an era when power seeks to bend reality, that infrastructure must be defended.
A democracy cannot function in the dark—though you wouldn’t know it from the Washington Post, which once emblazoned a similar phrase as a slogan during Trump’s first term, only to quietly retire it when the marketing calculus changed. At a time when media vigilance is essential, walking away from that commitment accelerates the erosion of facts. The truth, inconvenient or not, still matters.
Robert Cropf is a professor of political science at Saint Louis University.
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Michael Chippendale, Minority Leader of the Rhode Island House of Representatives
Credit: Hugo Balta
Michael Chippendale: Realistic, Not Idealistic Government
Aug 10, 2025
Michael Chippendale is a seasoned Republican legislator and the current Minority Leader of the Rhode Island House of Representatives. Representing District 40—which includes Coventry, Foster, and Glocester—Chippendale has served in the General Assembly since 2010, steadily rising through the ranks of GOP leadership.
Chippendale was unanimously elected House Minority Leader in June 2022 and re-elected in December 2024. Prior to this, he served as Minority Whip from 2018 to 2022. His leadership style is marked by a focus on government efficiency, tax reform, and regulatory relief for small businesses.
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I spoke with Rep. Chippendale while on assignment in Providence, producing the first episode of The 50, a four-year multimedia project in which the Fulcrum visits different communities across all 50 states to learn what motivated them to vote in the 2024 presidential election and see how the Donald Trump administration is meeting those concerns and hopes.
Chippendale acknowledged the concerns many people are having about President Donald Trump’s heavy-handed approach and the speed with which changes are being implemented. He also said that the American public has started to become disenchanted with politicians who promise things that they never do.
"He had to act quickly. He had to fulfill those promises," Chippendale said. "So, when he made such bold promises on the campaign trail and then immediately enacted so many of them, I think that weathered the people who are going to feel the pain from the economic policies enough to say, 'I'm going to be ok. I trust that he's going to do what he says he's going to do."
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Rep. Chippendale shared how a family trip to Philadelphia inspired him to run for public office. "So, we went to the Pennsylvania State House. I saw the desk at which the two delegates from Rhode Island sat when the Declaration of Independence was signed, when the Constitution was being argued. And this patriotic, romantic American spirit took over." When the family left Philadelphia, the next day, Chippendale said he told his wife he was going to run for office.
The Democratic Party controls the office of governor and both chambers of the state legislature. Rep. Chippendale also spoke to the Fulcrum about being strategic as a political superminority. "When you set your goals to a level that is realistic and not idealistic, you have a better chance of realizing those goals. And I'm going to run with that if I think it will improve the lives of the people I represent. If it's a good enough idea, I've found, and if you approach it the right way, you can even win the support of the supermajority if you can make a persuasive argument."
Mr. Chippendale collaborates with fellow elected officials to improve people's participation in the electoral process, starting with investing time in students.
Secretary Amore hosts the Rhode Island Civic Leadership Program, in which State Representative Chippendale has participated. The immersive, year-long nonpartisan initiative is designed to connect high school students to their government and build skills and habits that foster lifelong civic engagement.
SUGGESTIONS:
Johanny Cepeda-Freytiz: Connecting With Community
David Guo: Combining Art and Civic Engagement
Rich Harwood: A Philosophy of Civic Faith
Hugo Balta is the executive editor of the Fulcrum and the publisher of the Latino News Network.
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dollar bill reimagined with President Trump's picture
Trump’s Use of Tariffs Is Another Sign of Democratic Decay
Aug 09, 2025
Until recently, tariffs had the sound of something from the nineteenth century. The famous Senator Henry Clay was so enthusiastic about them that, in 1832, he designated the protection they afforded “the American System.”
At that time, Clay argued that the “transformation of the condition of the country from gloom and distress to brightness and prosperity, has been mainly the work of American legislation, fostering American industry, instead of allowing it to be controlled by foreign legislation, cherishing foreign industry.”
More than half a century later, Congressman (and later president) William McKinley championed tariffs and embraced Clay’s belief that import duties would protect domestic industries and workers from foreign competition. In 1890, he sponsored the legislation that raised tariff rates dramatically, saying that doing so would boost the American economy.
Today, all of this sounds very familiar, having been brought back into the American lexicon since President Donald Trump entered the political scene. On July 31, the president issued an Executive Order “imposing additional ad valorem duties on goods of certain trading partners.”
The order was another unilateral exercise of presidential authority rather than the result of democratic deliberation.
The order claims that tariffs are needed to protect “the domestic manufacturing base, critical supply chains, and the defense industrial base.“ However, it is challenging to discern how this purpose justifies the complex array of tariff rates it imposes on various countries.
No economic logic would result in a 25% tariff on goods from India and a 19% tariff for Pakistan, or a 15% rate for Jordan and a 41% rate for Syria. But that should not be surprising.
The president seems to care more about imposing tariffs as an exercise of power than about any such logic. That has been apparent for months as his on again-off again tariff policy unfolded. Or consider the president's actions with Brazil.
As the BBC notes, “Trump has raised Brazil's rate to a whopping 50% – potentially launching a trade war with Latin America's biggest economy, which sells large amounts of beef, coffee, steel and other products to the United States. The announcement on Wednesday means Brazil will face one of the highest US tariff rates in the world, at least so far.”
But, as the BBC observes, “this new policy isn't even really about trade….It's political, and part of a growing feud between the US and Brazil…..” Trump is using tariffs “as retaliation over the prosecution of his ally, right-wing former Brazilian President Jair Bolsonaro.”
Since he took office in January, the president has ignored the fact that the Constitution assigns the authority to impose tariffs to Congress. He claims authority under “The International Emergency Economic Powers Act… (IEEPA), the National Emergencies Act, section 604 of the Trade Act of 1974, as amended…and section 301 of title 3, United States Code.”
What’s the emergency?
As the Brennan Center for Justice argues, there is none. “Emergency powers,” it says, “are designed to let a president respond swiftly to sudden, unforeseen crises that Congress cannot act quickly or flexibly enough to address. Presidents can rely on these powers to create temporary fixes until the crisis passes or Congress has time to act.”
But, the Brennan Center continues, “Emergency powers are not meant to solve long-standing problems, no matter how serious those problems may be. Nor are they intended to give a president the ability to bypass Congress and act as an all-powerful policymaker.”
In fact, no president claimed emergency powers “to impose tariffs for 48 years…., until Trump did so this year.” But emergencies, real or not, and emergency powers are never good for democracy.
In May, the United States Court of International Trade recognized that when it ruled that nothing in the laws of the United States “delegates… powers to the President in the form of authority to impose unlimited tariffs on goods from nearly every country in the world. The court,” it added, “does not read IEEPA to confer such unbounded authority and sets aside the challenged tariffs imposed thereunder.
The Administration’s position did not receive a better reception on July 31 in a hearing before the U.S. Court of Appeals for the Federal Circuit in Washington. The lawyer representing the administration conceded that “no president has ever read IEEPA this way.”
Members of the court, the Washington Post reports, “appeared unconvinced by the Trump administration’s insistence that the president could impose tariffs without congressional approval, and it hammered its invocation of the International Emergency Economic Powers Act to do so.”
Neal Katyal, Solicitor General in the Obama Administration, got it right when he told the court that what President Trump has done with tariffs is a “’ breathtaking’ power grab that amounted to saying ‘the president can do whatever he wants, whenever he wants, for as long as he wants so long as he declares an emergency.’”
The president is using tariffs to reward those he likes and punish his enemies. He seems to want to stand astride this country and the world, making them both bend to his will.
Tariffs are a key weapon in his arsenal to be wielded as the president wants, regardless of the economic damage they do or the pain they inflict. Many economists warn that such damage will be substantial both here and abroad. According to CNBC, “The tariffs are expected to cost U.S. households an average $2,400 in 2025, with the levies disproportionally impacting clothes.”
While Trump’s tariffs are bringing additional revenue to the federal government, they are slowing economic growth and destabilizing the world economic order that for decades has been important to the prosperity this nation has enjoyed.
They are also not good for our political system. In April, the economist Paul Krugman identified what he called “The secret sauce of the Trump tariffs….Nobody knows what they will be. Nobody knows what comes next.” That may be bad for businesses trying to make plans, but it is good news for a political leader seeking to make his will and whims the center of the political universe.
The president has compared his role in imposing tariffs to that of a storekeeper who owns the store where everyone wants to shop. As he told The Atlantic, “I have to protect that store. And I set the prices.”
Note the singular.
And President Trump is not shy about channeling Clay and McKinley and again emphasizing his singular role. “I’m resetting the table. I’m resetting a lot of years….Our country was most successful from 1850 or so to, think of this, from 1870—really, from 1870 to 1913. And it was all tariffs.”
“And then some great genius said, ‘Let’s go and tax the people instead of taxing other countries.’”
The president, who frequently refers to himself as a genius, is using tariff policy in a way that the people who wrote the American Constitution would never have imagined. It is just another sign of trouble for our democracy.
Austin Sarat is the William Nelson Cromwell professor of jurisprudence and political science at Amherst College.
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