Ava Sochor had spent years researching medications and specialists who could help treat her son’s myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). By the time Evan was accepted into treatment at a specialized clinic in BC, Sochor said she had almost given up hope. 

Now, after a year of virtual appointments with physicians and specialists through the BC Centre for Long Covid, ME/CFS and Fibromyalgia (BC-CLMF), Sochor said he’s improved dramatically.

The debilitating chronic migraines that used to plague Evan throughout the week have been cut in half. Where he was once bed-bound 90% of the time, he now has days where he can be out of bed for half the day.

“I know he’s feeling well when he starts baking,” said Sochor. “The last few weeks he’s started cooking again, he’s a really good cook.”

But this week’s changes to the province’s Medical Services Plan (MSP) fee schedule threaten the model of care that patients like Evan have found so helpful.

Starting November 1, the number of patients who can attend virtual group appointments is limited to 30 participants, and the per-patient fee paid out to service providers for virtual groups has gone down from $14.71 to $11.42.

Fees and participant limits for in-person group appointments have not changed.

The BC-CLMF’s virtual group sessions typically have up to 50 patients and feature allied health professionals — including psychologists, physiotherapists, dietitians, and occupational therapists — who help patients deal with the wide variety of symptoms associated with complex chronic illnesses.

Patients can participate in group sessions as soon as they have received a referral to the clinic, but can only get prescriptions and paperwork completed by the clinic after a one-on-one consultation.

Dr. Lana Dyment, a physician with the BC-CLMF who focuses on pediatric patients, said changes to the MSP fee schedule mean the BC-CLMF can no longer afford to offer virtual group sessions with allied experts, meaning she’s losing “a huge piece of support for her pediatric population.”

A study of the effectiveness of the clinic’s virtual care model, undertaken by consulting firm MNP and commissioned by the clinic, found that for every $1 invested in the virtual group medical visit model through MSP billings, about $6.85 in social and economic value is generated for patients, caregivers and the broader healthcare system in BC. 

The study also surveyed BC-CLMF’s patients and found that 83% reported improvements in physical health, and 86% reported improvements in mental health.

“Financially, we save the government money. Scientifically, we’re serving a population who really, literally can’t get out of bed sometimes without causing post-exertional malaise,” said Dr. Dyment.

She said virtual care is essential for her patients not only because they’re located all over the province, but because the nature of their illnesses means that many are house-bound or bed-bound. Forcing those patients to attend in-person medical appointments could actually make their symptoms worse.

One of the most common side effects is post-exertional malaise (PEM), a delayed form of severe fatigue that can set in days after activity and leave patients bed-bound for days or even weeks. 

“They would experience post-exertional malaise just from the travel,” said Dr. Dyment. “So they have to attend virtually for their own health and safety and benefit.”

If patients who experience PEM try to ‘push past’ their fatigue, their baseline activity envelope — the amount of activity they’re regularly capable of — can lower over time. Continuing to push could permanently lower their baseline.

Dr. Dyment said the fact that the changes only impact virtual care creates a double standard for patients with complex chronic illnesses.

“If you’re well, there’s no limitation to the benefit that you can receive. But if you’re not well, you’re being curtailed,” said Dyment.

A recent report from researchers at Simon Fraser University (SFU), based on a survey of 621 people with Long Covid, found that virtual healthcare delivery is “vital for patients with energy-limiting conditions.” The most common reason given for wanting virtual care was “reducing post-exertional malaise.”

Sochor said that despite her own medical background and her familiarity with many of the medications that are often prescribed ‘off-label’ (prescribing drugs for an unapproved use or dosage) for conditions like ME/CFS, finding doctors and specialists who would prescribe them for underage patients like Evan was very challenging. 

She said that simply finding medical professionals who are knowledgeable about ME/CFS, and take the condition seriously, was difficult. 

“He’s been brushed off by everyone,” said Sochor. “There’s a lot of stigma with these conditions, and people are made to feel unheard and like it’s psychiatric and not a [real] thing.”

A majority of the Long Covid patients surveyed by the SFU researchers who had access to a primary care provider perceived those providers as having “low to no awareness” of Long Covid, and reported that their primary care providers often gave inappropriate care advice or invalidated their symptoms. 

BC-CLMF’s pediatric care program is unique in Canada. Dr. Dyment said that when she was developing the program, she had to look at clinics in the US and the UK, because aside from a handful of individual practitioners, there are no other clinics that offer pediatric Long Covid programs. 

“Kids with Long Covid get really sick,” said Dr. Dyment. “They’re the ones who can’t get out of bed. They’re the ones who can’t go to school.”

Dr. Dyment said she fears that outdated ideas about complex chronic illnesses that tend to downplay the severity of symptoms and their biological origin could be driving the decision-making around limiting access to virtual care.

“There’s a lot of good evidence that our patients are very sick for very biological reasons,” said Dr. Dyment. “But the powers that be are not looking at the science.”

The decision to make these changes was made by the Medical Services Commission on September 24, two days before the provincial election was called. The commission is made up of three representatives from the government, three representatives from Doctors of BC, and three members of the public. 

In a statement to PressProgress, Doctors of BC President Adam Thompson wrote that the organization “successfully advocated for increasing the cap on participants in Telehealth Group Medical Visits from 20 to 30 and for pushing back the implementation deadline to give doctors sufficient time to pursue alternative funding models.”

Thompson added that Doctors of BC “supports expanding access to virtual care where it can improve patient care and help address barriers to accessing health services.”

“We believe physicians should have the flexibility to determine when virtual care is appropriate based on their patients’ individual needs. Virtual care should complement in-person services, support continuity of care, and provide patients with more options for accessing timely, appropriate care.”

PressProgress reached out to the BC Conservatives to ask if the party has plans to reverse the changes once the legislature resumes later this month, but did not receive a response by the time of publication. 

 

The post Pediatric patients with complex chronic illnesses impacted by BC’s quiet changes to virtual care appeared first on PressProgress.

The president replaces Susie Wiles with the architect of his immigration crackdown, signalling a confrontational approach toward newly empowered Democrats

For two decades, researchers debated whether adeno-associated viruses, the small viruses used to deliver new genes into thousands of patients, could in certain cases drive tumors. That debate is over.

A series of cases this year has presented powerful evidence that adeno-associated viruses, or AAVs, can cause cancer, forcing researchers and families to weigh the newly confirmed risk against the technology’s life-saving potential — and hopefully determine how to design better therapies in the future.

“It will change the calculus for some patients,” said Sam Mackenzie, a neurologist at University of Rochester, speaking specifically about spinal muscular atrophy patients. 

Continue to STAT+ to read the full story…

In Eating The Seed Corn I wrote about AI's destruction of entry-level jobs. But Karen Weise's Microsoft Offers Buyouts to 60,000 Employees as It Spends on A.I. reports on a different impact (my emphasis):

Microsoft on Monday offered buyouts to a quarter of its work force, the latest effort by the company to rein in costs as it spends heavily on artificial intelligence.
...
The “time-limited, voluntary” program grew out of the company’s first ever buyouts earlier this year, she wrote. In April, Microsoft offered early retirement to 8,600 long-tenured U.S. employees, and about 30 percent accepted the packages and left over the summer. Microsoft said it heard from additional employees who would have taken the buyout if they had been eligible. That informed the company’s decision to create this new, expanded program.

Microsoft expects many fewer acceptances in this new program, but the people leaving are not entry-level, they are well-paid senior staff. If the goal is to divert cash from salaries to capex getting rid of senior staff is much more effective.

Below the fold I look into the non-obvious implications of AI's impact on well-paid employees' jobs.

The buyout program isn't the only predator stalking Microsoft's employees:

Microsoft has already slightly shrunk its work force even as business has boomed. For several years, the company maintained a flat head count of about 228,000 employees.

But as of June 30, the end of its fiscal year, Microsoft’s work force had edged lower to 223,000 employees. Over that same fiscal year, Microsoft brought in $332 billion in revenue, up 18 percent from the previous year, and profit grew 31 percent to $134 billion.

In July, Microsoft announced it was cutting 4,800 jobs, particularly in its video game division. The company is scheduled to report quarterly results on Wednesday.

Many of these lost jobs will have been lower on Microsoft's pay scale, but still well-paid relative to the US average. The victims will have lost not only their salary, but also after a delay their health insurance. Crucially for this post, their and Microcoft's contributions to their 401(k) pension will have stopped. In the current economy they will struggle to find a new job.

Is this just a problem for the victims? In The Retirement Machine: AI, high earners, and the hidden risk to global stock markets Duncan Lamont asks:

how consequential would it be for equities if the US experienced a rise in AI-linked unemployment among high earners which led to a fall in pension contributions.

This turns out to be a really interesting question. Lamont writes:

In their AI-boom scenario, our economists model unemployment rising to 10% as workers are displaced by technology. Importantly, whereas past technological revolutions have displaced lower earners, this time higher-earning white-collar workers are in the firing line. And they are the ones who disproportionately contribute to the monthly pension flows into equity markets. This article puts numbers on just how material a risk this is. Spoiler alert: it’s big.

Lamont Figure 1

US pensions are a seriously big business. Lamont's Figure 1 shows that the value of US pensions investments are 47% bigger than all non-US stock markets combined, ond 82% of the US stock market. Lamont points out that:

The (dollar-weighted) average allocation to equities across 401(k)s is 75%. Younger individuals have more, with those in their 20s having 90% on average but even those in their 60s still hold over 60%.

How big are the "monthly pension flows into equity markets"? Lamont looks at 2024:

Assuming the 75% equity allocation also applies to new contributions, US DC plans and IRAs funnelled around $735 billion into global equity markets in 2024. Given the US weight in the global stock market and typical [target duration fund] allocations, 60-70% of that will have gone into US equities, translating into approximately $480 billion. DC and IRA pension accounts bought an estimated nearly half a trillion dollars of US equities in 2024.

DC (Defined Contribution) plans are 401(k) and similar plans to which employees and (typically) companies contribute monthly. Lamont estiimates that their purchases represent about 26% of the net purchases of US equities that year. Because this is a steady, predictable demand it plays a major role in keeping the US stock market growing in good times and cushions the fall in bad times.

Lamont Figure 3

Which employees contribute to DC plans? Lamont's Figure 3 shows that participation is much higher in industries that pay well. So there aren't just more of them, but they contribute more each month. The 26% keeping the US market afloat depends heavily upon the contributions of higher-paid employees.

Lamont cites evidence to support this skew. First:

The Congressional Budget Office’s most recent comprehensive distributional analysis of retirement-related tax expenditures — the closest available proxy for the distribution of contribution dollars — found the highest-income quintile captured 63% of the tax benefits in 2019, against 1% for the bottom quintile. The tax-benefit share will overstate the contribution share to some extent because higher earners face higher marginal tax rates. Even so, this is broadly consistent with IRS data which shows that 62% of contributions to IRAs in 2023 came from people earning over $100k a year. Only about 15% came from people earning what was then the median income of around $50k or less.

Lamont Figure 4

And second:

There is also direct evidence from within company plans. As Figure 4 shows, the best paid 20% of employees at a given firm have, on average, taken in 44% of employer contributions.

It is these these top earners who are at risk:

A growing body of research reaches the same broad conclusion: higher-income, white collar occupations requiring postsecondary education show the highest exposure to AI capabilities (Brynjolfsson and others (2018); Webb (2020); Muro and others (2019); Felten and others (2023); Eloundou and others (2024); Kinder and others (2024); and Hampole and others (2025)).

Dodini & Smith Chart 3

As I disucussed in Eating The Seed Corn, Stanford reseach concludes:

1. We find no evidence of widespread, economy-wide job displacement.
2. However, employment of young workers (ages 22–25) in AI-exposed occupations now stands 19% below where it would be had it kept pace with that of their less-exposed peers; experienced workers show no comparable gap.
3. This divergence has widened steadily since we first documented it in August 2025.
4. It operates primarily through reduced hiring of young workers rather than increased separations.

Lamont points out that this isn't good news:

You could take the junior-first pattern that the data currently shows as reassurance for the pension channel since junior workers contribute less than managing directors. But that would be naive. Junior workers in high-paying industries are still high earners by economy-wide standards. A 25-year-old software engineer on $140,000, or a first-year banking analyst on $120,000, sits comfortably in the top quintile of all US earners. The displacement happening right now is concentrated in industries where even the juniors out-earn the median American worker by a factor of two. These are exactly the contributors identified earlier. In addition, participants in their 20s hold 90% equity on average, the highest allocation of any age cohort. So even a junior-first shock would hit a group whose pension contributions are unusually equity-heavy.

Just as importantly, junior-first describes where current AI tools are biting first. We don’t know where it will end. The substitution frontier has moved up the capability curve every year since 2022, and there is no obvious reason to expect it to stop at the entry level.

After staring at the barrage of AI adds on the London Tube in summer 2025, I wrote The Selling Of AI:

The irresistible pitch to CEOs is that they can "do more with less", or in other words they can lay off all these troublesome employees without impacting their products and sales.

The effect is that CEOs will fire the workers first based on the ads and the hype, before finding out whether the AI agents can really replace them, and when they find out they can't will be unwilling, and unable to afford, to hire them back. And if they hype is right the upward movement of the "substitution frontier" will have the same effect — hugher unemployment for longer.

Either way the result will be a reduction of the flow of pension funds into the stock market. Lamont estimates:

A 10% hit to that exposed flow would remove roughly $20–30 billion of annual equity buying; a 25% hit would remove $50–75 billion; a 50% hit would remove $100–150 billion. In a normal year that is material. In a downturn, when buybacks, foreign demand and retail risk appetite are likely to weaken at the same time, it could matter a lot more.

As I write this the financial press is flooded with headlines such as:

• Stocks Slump as Wall Street Gets AI Wake-Up Call
• Amazon, Alphabet, SpaceX, and Meta are all to blame for the new tech stock rout
• Tech Stocks Tumble, but Broader Market Is Holding On
• Nasdaq 100 Hits Third Correction of 2026 on Unwinding Tech Stock Bets
• Meta, Alphabet, Intel Share Sales Leave Buyers Far Underwater
• US Tech Stocks Enter Correction on AI and Midterm Election Risks

The downturn may have already started.

The Peter Principle posits that people are promoted until they reach their level of incompetence. What happens after that point? The implicit assumption is that they stop getting promoted and linger at whatever level they’ve arrived at, and surely all of us can point to mediocre leaders who seem to exhibit exactly that circumstance. But in fact, that situation is not stable but subject to career pressure, as Christian Gläßel and Adam Scharpf define it in Making a Career in Dictatorship. Unable to move up, and very possibly unable to meet expectations, the person who is subject to the Peter Principle is at risk of losing their job, or even their entire career. Which means they might take an even greater risk to save it. Gläßel and Scharpf write:

The logic of career pressure also offers a compelling twist to the Peter Principle. The Principle posits that individuals in hierarchical organizations are promoted until they reach their level of incompetence, where they can no longer perform effectively and cease to advance. In contrast, our logic shows how these individuals may surpass this point and climb the hierarchy even further. Career-pressured individuals often take on high-risk, labor-intensive, or morally contentious tasks. By loyally executing the organization’s dirty work, they can reestablish their value, regain competitiveness, and even outpace peers who were previously ahead of them. Alternatively, they may resort to sabotaging superiors or higher-ups by making false allegations or revealing secrets to create vacancies above them and forcibly advance their careers.

Gläßel and Scharpf, Making a Career in Dictatorship, page 182

In other words, someone promoted up to their level of incompetence, sensing a threat to their own livelihood, becomes a threat to everyone else. I’m reminded here of David Graeber’s theory in Bullshit Jobs, that a great many management jobs are basically feudal retainers—people kept around in order to make the folks above them look good. Very often, making someone else look good may well mean tackling the dirty work for them so that they can keep their hands clean.

The petered leader has in effect been made an imposter—a real imposter, not a “syndromed” or perceived one. They must seem competent, to preserve the appearance that they belong in the role; while in fact they are not capable of delivering on their actual responsibilities and may have been quietly tasked with unrelated services both illegal and unethical. As a result, one of the primary tools of the real imposter is obscurity. Imposters cloak themselves in a fog of obfuscation and busyness, so that the people around them can never say for sure what it is they are doing, or how well (or not) they are doing it.

What we call imposter syndrome was originally termed imposter phenomena, a term that makes plain that it is something that can be observed, not merely felt. The transformation into a syndrome shifted the experience of being impostered by a patriarchal, white supremacist society into a medicalized disorder, something for which the impostered person must be treated. That’s a neat trick: to shift the locus of treatment to the mistreated person, rather than the system that caused her harm. But perhaps there’s even another, more diabolical move here. What if the popularity of imposter syndrome is, in part, a means of obscuring the actual imposters in our midst? What are we missing when we look inward instead of around?

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