By Robert S. Goldman, global head of clinical operations, Contraline, Inc. I want to start with a reality most of us already know but have not fully processed yet: artificial intelligence is already operating inside clinical trials. Not in controlled sponsor environments. Not someday. Not in pilot programs. Right now, at the site level, every day, often without the sponsor knowing it. Over the past year I have watched a rapid rise in AI tools marketed directly to research sites promising efficiency.