Ask people how much they expect to change over the next 10 years, and most will say “not much.” Ask them how much they’ve changed in the past decade, and the answer flips. Regardless of age, the past always feels more transformative than the future.
This blind spot has a name: the end-of-history illusion. The result is a persistent illusion that life, and the values and behaviors that shape it, will remain unchanged.
The illusion plays out not just individually, but generationally. Older generations assume that younger ones will follow the traditional, familiar paths. And, of course, they never do. Most of the time, those differences are harmless. However, when leaders in politics, the military, and medicine repeat the same mistakes, the consequences prove far more severe.
The high cost of ignoring change
Two recent events reveal what happens when institutions fail to recognize that the world around them has undergone significant changes.
In New York City, a little-known 33-year-old Democratic Socialist, Zohran Mamdani, defeated a former governor and establishment favorite in the mayoral primary. Despite being massively outspent on TV advertising, Mamdani won by embracing Instagram, short video,s and grassroots tactics to mobilize voters.
Half a world away, in Ukraine, the most effective weapon against the Russian military hasn’t been fighter jets or tanks but cheap, camera-mounted drones. Some cost only a few hundred dollars, yet they’ve repeatedly destroyed military hardware worth millions. Analysts warn that future wars will be shaped by low-cost, decentralized technologies rather than the armaments of the past. It’s a shift that traditional military powers (including the U.S.) have been slow to embrace.
These aren’t just political or military anecdotes. They’re cautionary tales about individuals and institutions that assumed yesterday’s strategies would deliver tomorrow’s results — and failed when they didn’t.
Medicine now faces the same risk. For decades, physicians assumed their title and training guaranteed patient trust. Likewise, public health agencies like the CDC and CMS believed their official guidance would be accepted without question.
Today, younger generations increasingly tune them out. With Gen Z and Millennials comprising more than 40% of the U.S. population, if healthcare professionals and leaders fail to adapt to a changing world, their voices will go unheard, and their influence will be lost.
3 ways to win the battle of attention, trust
While Boomers and Gen Xers continue to rely on information from medical experts, younger generations now turn to TikTok videos, Reddit threads, Google reviews — and increasingly to large language models like ChatGPT and Claude — for healthcare decisions. Whether physicians and public health officials consider these sources credible is irrelevant. Gen Z and Millennial patients already do.
This schism isn’t about one generation being right and another wrong. It’s the classic pattern of cultural evolution, creating a generational mismatch. If the medical profession fails to (a) recognize its existence and (b) close the gap, then these patterns will solidify, and the health of our nation will deteriorate. Here are three opportunities to begin the process:
1. Share decisions, don’t just give orders
For decades, doctors and government agencies have been trained to “tell” patients the right answer. And many patients still want that.
But for Gen Zs and Millennials, a top-down approach backfires. Studies confirm that when a clinician’s style doesn’t match a patient’s expectations, trust and adherence decline. By contrast, share in decision-making (i.e., presenting options and inviting patients into the process) has been shown to improve understanding and outcomes. For younger generations, especially, that principle applies whether the setting is a doctor’s office or a public policy health campaign.
2. Speak their language (digitally)
Boomers and Gen X may still tolerate phone trees and paper handouts. Gen Z and Millennials don’t. These patients expect text reminders, digital scheduling, and mobile apps, not voicemail.
Public health agencies face a similar challenge. Even the clearest message will be missed if it’s delivered through the wrong channel. Agencies and physicians alike must meet younger audiences where they’re at, communicating in ways that resonate loudly: fast, visual, and mobile-first.
3. Make access easy, even if continuity is difficult
Older generations tend to value long-term relationships with a personal physician. Younger generations prioritize speed, convenience, and flexibility.
They are more likely to choose urgent care, telemedicine, or even GenAI-powered tools for routine or embarrassing problems. If health systems and agencies don’t adapt, they risk losing these patients altogether. Expanding telehealth, offering asynchronous communication, and designing digital intake tools aren’t luxuries. They’re essential if the next generation is to receive timely preventive and acute care.
Similarly, public agencies like the CDC and CMS will need to meet the needs of younger patients where they are. Think: short videos, Instagram stories, and plain-language guidance on the issues that matter most to them (e.g., mental health, dermatology, sexual health).
Just as politicians must adjust strategies to win elections and generals need to revise tactics to win wars, doctors and governmental agencies will need to evolve their approach if they seek to improve the nation’s health and achieve the best clinical outcomes.
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.
A deep look at how "All in the Family" remains a striking mirror of American politics, class tensions, and cultural manipulation—proving its relevance decades later.
All in This American Family
There are a few shows that have aged as eerily well as All in the Family.
It’s not just that it’s still funny and has the feel not of a sit-com, but of unpretentious, working-class theatre. It’s that, decades later, it remains one of the clearest windows into the American psyche. Archie Bunker’s living room has been, as it were, a small stage on which the country has been working through the same contradictions, anxieties, and unresolved traumas that still shape our politics today. The manipulation of the working class, the pitting of neighbor against neighbor, the scapegoating of the vulnerable, the quiet cruelties baked into everyday life—all of it is still here with us. We like to reassure ourselves that we’ve progressed since the early 1970s, but watching the show now forces an unsettling recognition: The structural forces that shaped Archie’s world have barely budged. The same tactics of distraction and division deployed by elites back then are still deployed now, except more efficiently, more sleekly.
Archie himself is the perfect vessel for this continuity. He is bigoted, blustery, reactive, but he is also wounded, anxious, and constantly misled by forces above and beyond him. Norman Lear created Archie not as a monster to be hated (Lear’s genius was to make Archie lovable despite his loathsome stands), but as a man trapped by the political economy of his era: A union worker who feels his country slipping away, yet cannot see the hands that are actually moving it. His anger leaks sideways, onto immigrants, women, “hippies,” and anyone with less power than he has. The real villains—the wealthy, the connected, the manufacturers of grievance—remain safely and comfortably offscreen. That’s part of the show’s key insight: It reveals how elites thrive by making sure working people turn their frustrations against each other rather than upward.
Edith, often dismissed as naive or scatterbrained, functions as the show’s quiet moral center. Her compassion exposes the emotional void in Archie’s worldview and, in doing so, highlights the costs of the divisions that powerful interests cultivate. Meanwhile, Mike the “Meathead” represents a generation trying to break free from those divisions but often trapped in its own loud self-righteousness. Their clashes are not just family arguments but collisions between competing visions of America’s future. And those visions, tellingly, have yet to resolve themselves.
The political context of the show only sharpens its relevance. Premiering in 1971, All in the Family emerged during the Nixon years, when the “Silent Majority” strategy was weaponizing racial resentment, cultural panic, and working-class anxiety to cement power. Archie was a fictional embodiment of the very demographic Nixon sought to mobilize and manipulate. The show exposed, often bluntly, how economic insecurity was being rerouted into cultural hostility. Watching the show today, it’s impossible to miss how closely that logic mirrors the present, from right-wing media ecosystems to politicians who openly rely on stoking grievances rather than addressing root causes.
What makes the show unsettling today is that its satire feels less like a relic and more like a mirror. The demagogic impulses it spotlighted have simply found new platforms. The working-class anger it dramatized has been harvested by political operatives who, like their 1970s predecessors, depend on division to maintain power. The very cultural debates that fueled Archie’s tirades — about immigration, gender roles, race, and national identity—are still being used as tools to distract from wealth concentration and political manipulation.
If anything, the divisions are sharper now because the mechanisms of manipulation are more sophisticated, for much has been learned by The Machine. The same emotional raw material Lear mined for comedy is now algorithmically optimized for outrage. The same social fractures that played out around Archie’s kitchen table now play out on a scale he couldn’t have imagined. But the underlying dynamics haven’t changed at all.
That is why All in the Family feels so contemporary. The country Lear dissected never healed or meaningfully evolved: It simply changed wardrobe. The tensions, prejudices, and insecurities remain, not because individuals failed to grow but because the economic and political forces that thrive on division have only become more entrenched. Until we confront the political economy that kept Archie and Michael locked in an endless loop of circular bickering, the show will remain painfully relevant for another fifty years.
Ahmed Bouzid is the co-founder of The True Representation Movement.