Yang’s forecast is blunt: somewhere between 20 and 50 per cent of America’s 70 million white-collar workers displaced in the next several years. Not eventually. Now. A CEO he spoke to described three tranches of redundancies — 15 per cent now, another 20 per cent in two years, another 20 after that — as if he were announcing a building refurbishment. Sell anything that consists of people sitting at a desk looking at a computer, one investor told him. The stock market will reward headcount cuts and punish the companies that don’t follow suit.

His advice, in the end, is practical to the point of being bleak: cut your expenses, build your savings, make a plan, because a lot of people are about to lose their jobs and you could easily be one of them.

I can already hear the health communications response to this. We’re different. We’re regulated. You can’t just run AI output through MLR and call it a medical claim. Regulatory agencies have views. HCPs can tell when the science has been garbled. The structural constraints of this industry are real, and they will slow things down.

This is true. It is not sufficient.

I made a version of this argument in the first essay I published here, which was about the framework knitters who called themselves Luddites. They, too, had quality controls: guild structures, expert buyers who understood the craft, customers who had complained about inferior product before. None of it was enough, because the economics changed who was making purchasing decisions and what they were optimising for. The market for hand-finished hosiery didn’t disappear — it shrank, and the people serving it had to accept that the volume work had moved permanently somewhere else.

The regulatory apparatus of health communications is a more robust quality control than the hosiery guild. MLR is a forcing function that doesn’t yield to market pressure in the way that consumer goods can. But watch what’s happening at the client side. Large pharma companies are signing enterprise AI agreements — Bristol-Myers Squibb’s deal with Anthropic being the most visible recent example — and framing them as infrastructure investments. When AI becomes infrastructure, it changes the procurement question. Not “is this the best possible output?” but “given what we can now produce internally, what exactly are we paying agencies for?”

That’s not a regulatory question. It’s an organisational one. And organisations tend to answer it with headcount reduction.

The specific character of the Fuckening in health communications is that it will arrive on delay, and then arrive all at once.

The regulatory layer means you won’t get a letter this quarter. You’ll get two or three years of enterprise AI getting embedded in client workflows, junior roles quietly not being backfilled, scope creep in what “AI-assisted” means on a deliverable, and then a procurement conversation that has already concluded before you were invited to it. Yang’s CEO describes three tranches of cuts because the maths only becomes undeniable in stages. The regulated nature of pharma communications means the stages will be longer. It does not mean there won’t be stages.

The Luddites didn’t see the end coming because the early machines were genuinely inferior — and the early objections were genuinely valid. By the time the machines were good enough, the infrastructure to deploy them was already in place, and the economic logic was irreversible.

So what would Yang advise, adapted to this specific professional context?

He would say: cut your expenses and build your savings now, while you still have income and while the role still exists in its current form. Not because you’ll definitely lose your job, but because the people who survive disruptions of this scale are the ones who had optionality — who could take a risk, turn down a bad deal, wait for the right thing — rather than the ones who needed next month’s salary the moment it was threatened.

He would say: make yourself genuinely useful in the parts of the work that AI cannot replicate. Not “AI can’t replace expertise” as a general reassurance — that’s the quality argument the framework knitters made, and it’s true and insufficient in equal measure. Specifically useful: you know what a medical director is actually worried about; you know how an MHRA reviewer reads a data table; you know what the trial results actually imply as opposed to what they appear to imply. That’s the supervisory and judgment layer. It’s where the premium will concentrate.

And he would say — and this is the part that the reassuring voices in health communications tend to skip — that being right about the quality argument will not protect you from the market’s eventual indifference to it. The weavers were right. It didn’t save Nottinghamshire.

The Fuckening will come for health communications. It will take a little longer than it takes for tech and finance and marketing. Use the time.

— Ned

Sources

[1] Andrew Yang — “The End of the Office”, February 2026

[2] The Irreplaceables — “The Weavers Were Right”

[3] Bristol-Myers Squibb press release — BMS Announces Strategic Agreement with Anthropic

History has not been kind to them. "Luddite" is now shorthand for someone who fears technology out of ignorance or sentiment. The actual Luddites were neither ignorant nor sentimental. They were skilled framework knitters who understood exactly what the new machinery would do, and they were largely right.

The frames didn't just make stockings faster. They made them cheaper, and in doing so they destroyed the economic basis of an entire craft. Not gradually, over generations, in a way that allowed for adjustment. In a decade. The Luddites' mistake wasn't misunderstanding the technology. It was believing that being right about the quality argument would protect them from the market's indifference to quality arguments.

Hand-knitted hosiery was, in fact, better. Machine-produced hosiery was cheaper. Cheaper won.

I think about this a lot when I look at what's happening in health communications.

The standard reassurance you'll hear — and I've heard it, and perhaps offered versions of it myself — goes something like this: AI can produce text, but it can't replace expertise. It doesn't understand regulatory context. It can't navigate MLR. It doesn't know what a medical director is actually worried about when they push back on a claim. The deep craft of health comms is safe because it's the deep craft that matters.

This is probably true. It is not necessarily reassuring.

The framework knitters were also in possession of deep craft. They had spent years — apprenticeships, journeymanship, mastery — developing an understanding of materials, tension, pattern and structure that no machine of 1811 could replicate. They were right that machine-knitted hosiery was inferior in construction. The market found that it didn't care enough about the difference to pay for it.

The question isn't whether your expertise is real. It is. The question is whether the people buying communications services will be able to tell the difference between AI-assisted output and expertly crafted output — and whether, if they can, they'll be willing to pay the premium.

Here is where I think the parallel gets uncomfortable.

Health communications has, for structural reasons, always had quality controls that the hosiery market lacked. MLR is a forcing function. Regulatory agencies have views. HCPs can tell when something is clinically imprecise. These are real constraints that don't disappear because AI can generate plausible-sounding sentences.

But the Luddites had quality controls too, in their own way. Guild structures. Expert buyers who knew the difference. Customers who'd complained about inferior product before. None of it was sufficient, because the new economics changed who was doing the buying and what they were optimising for.

Watch what's happening at the client side. Large pharma companies are signing enterprise AI deals — Bristol-Myers Squibb's Claude deployment being just the most recent visible example — and framing them as infrastructure investments. When AI becomes infrastructure, it gets embedded in procurement decisions. The person buying communications services starts asking a different question: not "is this the best possible output?" but "given what we can produce with our internal AI tools, what are we actually paying agencies for?"

That's not a technology question. It's an organisational one. And it's the one the framework knitters didn't see coming until it was too late.

So what did survive?

Not the craft as it was practised. The hand-knitters who continued to produce high-end, hand-finished hosiery found a market — a smaller, premium market that explicitly valued what machines couldn't replicate. Some framework knitters moved into supervisory roles in the factories. Some moved into quality control and inspection. Some moved into design, where the judgment layer above the machinery remained human.

None of these were the same job. They were adjacent jobs that preserved some of the expertise while accepting that the core production economics had changed permanently.

For health communications professionals, I'd read that as three things worth paying attention to.

The premium market for craft exists, but it's smaller than the current market for competent execution. If your value proposition is "we write better than AI," you need to be operating in contexts where that difference is detectable and valued. Specialist therapeutics. Genuinely complex science. Regulatory submissions where a wrong word has consequences. Not everything qualifies.

The supervisory and quality layer is real and will grow. Someone has to know what good looks like in order to catch what bad looks like. That's a genuine expertise premium — but it's a different role than the one most senior health comms professionals currently occupy. It requires knowing the territory of AI failure modes as well as you know the territory of clinical science.

The judgment layer — the part that requires knowing what a medical director is actually worried about, or what an MHRA reviewer will focus on, or what the trial data actually says as opposed to what it appears to say — is genuinely defensible. For now. The honest qualifier is "for now."

The Luddites lost, but they weren't wrong. The Industrial Revolution did eventually create more jobs than it destroyed — but not in Nottinghamshire, not in that generation, not for those workers. The economists who point to net job creation as evidence that the Luddites were mistaken are, with respect, answering a different question than the one the Luddites were asking.

The question the framework knitters were asking was: what happens to us?

That's the question worth sitting with. Not "will health communications exist in ten years?" It will. Not "will there be work for people who understand clinical science and regulatory context?" There will. But in what form, at what volume, and compensating what skills?

The weavers were right about the quality argument. They were right that their craft was superior. They were wrong that being right about that would be enough.

I find that clarifying rather than depressing. Not because the answer is reassuring — it isn't, particularly — but because it's at least honest about what the question is.

That's what this newsletter is for.

— Ned

Sources

[1] Smithsonian Magazine — What the Luddites Really Fought Against

[2] IntuitionLabs — Big Pharma & Hyperscaler AI Deals: 2026 Industry Tracker

[3] Anthropic — Claude for Life Sciences

[4] Bristol-Myers Squibb press release — BMS Announces Strategic Agreement with Anthropic

[5] Knowable Magazine — What happens to the weavers? Lessons for AI from the Industrial Revolution