Donna Dickenson on How Neoliberalism Is Shaping Science and Medicine

“Who would have predicted twenty years ago that you could get people to pay to … have a spit sample ana­lyzed to predict their personal propensity to common diseases?”—Donna Dickenson, Me Medicine vs. We Medicine

In the following excerpt from the chapter A Reality Check for Personalized Medicine from her new book Me Medicine vs. We Medicine: Reclaiming Biotechnology for the Common Good, Donna Dickenson explores the connections between neoliberalism, science, and biotechnology:

Personalized medicine hasn’t just sprung up in a political or economic vacuum. It has coincided with the ascendancy of “neoliberal” political ideol­ogy, which, as [Nobel prize-winning geneticist] [John] Sulston argues, has affected science and medicine profoundly.

This viewpoint isn’t unique to Sulston: it is taken up and analyzed at consider­able depth in Philip Mirowski’s cleverly titled Science-Mart: Privatizing American Science. As a professor of both economics and philosophy of sci­ence, Mirowski is well qualified to track what he believes to be a deliberate political effort over the past four decades to incorporate neoliberal economic and political policies into academic science….

This dominance of the market is the source of the ideology of “private good, public bad,” which I linked earlier in this chapter to the rise of Me Medicine and the decline of We Medicine. If the notion of common welfare is to be distrusted, and if interventions such as public health programs are regarded as interference with individual rights, We Medicine will automatically be suspect. Hostile reac­tions to vaccination programs, for example, aren’t just a matter of a few vitu­perative cranks: they’re sanctioned in an indirect way by a more general climate of distrust for any state initiative.

But although the official message of neoliberalism is “hands off,” the actual policies pursued everywhere from banking to biotechnology involve state in­tervention to subsidize loss-making activity for the private sector. For banks, that’s meant the losses made on junk bonds and subprime mortgages; for sci­ence, it’s the non-profit-making research and development phases. In both cases, we often witness the conversion of the asset to private hands once it’s profitable: what the sociologist Stuart Hall calls “siphoning state funding to the private sector.”.. In the UK banking sector, for example, the government res­cued the failed bank Northern Rock with taxpayers’ money, to avoid another collapse like that of Lehman Brothers in the United States. But it then overrode calls to keep the bank in national hands and sold it in November 2011 to Virgin Money, reportedly for something like half what it had paid for it.

In the United States, the Bayh-Dole Act of 1980 encouraged private capital to enter the scientific marketplace and promised to subsidize any losses in­curred in the process. “To allow wealth from discoveries to be realized, the Act turned the principle of capitalism on its head: ‘private risk yields private loss or gain’ became ‘public risk yields public loss or private gain’—a form of ‘heads I win, tails you lose.’ ”.. In April 2012, the Obama White House an­nounced its “National Bioeconomy Blueprint,” which “outlines steps that agen­cies can take to drive the bioeconomy” in a time of economic uncertainty, much in the spirit of Bayh-Dole… Mention of any risks from genetic engi­neering or other technologies is confined to a footnote, otherwise framed as “beyond the scope of this document.”..

We can trace this same neoliberal trajectory in the development of fi rms such as deCODE Genetics, which depended on the free public resource of the Icelandic national population database but retained all profits for itself… It’s also evident in the way that private umbilical cord blood banks in the United Kingdom often piggyback on NHS hospital staff provision and rely for their marketing appeal on the hope that stem cell research—typically funded by government research councils and thus by the taxpayer—will “add value” to the stored blood.

So it’s not just a coincidence that personalized medicine has flourished at the same time that the majority of governments throughout both the devel­oped and developing world—including India and China—are pursuing neolib­eral policies. In many cases, the profitability of Me Medicine depends directly on those policies. At the highest governmental levels, public backing has been solicited to underpin private-sector profit making from biotechnology.

In Executive Order 13326 of September 2001, President George W. Bush established the Presidential Council of Advisors on Science and Technology (PCAST). This was a private-sector body with cabinet-level status—as if it were an arm of elected government. Its mandate was to “assist the National Science and Technology Council [the public body] in securing private sector involve­ment in its activities.” Under President Obama, a new Executive Order, num­ber 13539, reestablished PCAST on a less obviously proindustry footing but re­tained private-sector involvement. Its mission is now to “solicit information and ideas from the broad range of stakeholders, including but not limited to the research community, the private sector, universities, national laboratories, State and local governments, foundations, and nonprofit organizations.”..

Where does the biotechnology industry see profits in personalized medi­cine? It’s crucial to bear in mind the adage about capitalism not serving exist­ing markets so much as creating demand where none existed before. Even the solidly middle-of-the-road Nuffield Council on Bioethics in the United King­dom remarks of personalized medicine that “personalisation is sometimes represented as a response to demand, but in some cases at least it seems to be a case of supply looking for demand.”.. Private cord blood banking and retail genetics are both perfect examples of creating demand where none existed before. Who would have predicted twenty years ago that you could get people to pay to bank their infant’s umbilical cord blood or to have a spit sample ana­lyzed to predict their personal propensity to common diseases?