In 1811, a group of skilled textile workers in Nottinghamshire began breaking into factories and smashing the new stocking frames that were threatening their livelihoods. They called themselves Luddites, after a probably-fictional apprentice named Ned Ludd who had, legend had it, done the same thing thirty years earlier in a fit of rage.
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