Accepted Preprint, Social Theory & Health

Final version: https://link.springer.com/article/10.1057/s41285-017-0058-x

Book review

Birch, Kean. (2015) We Have Never Been Neoliberal: A Manifesto for a Doomed Youth.
Winchester UK: Zero Books.

Paperback £11:95/$19.95, doi: 978-1-78099-534-2;

e-book £6:95/$9.95, doi: 978-1-78099-535-9

Neoliberalism is an unjust system, but the system in which we actually find ourselves is much worse.
This is the premise of Kean Birch’s important book, We Have Never Been Neoliberal: A Manifesto for
a doomed Youth. The rhetoric of neoliberalism, Birch argues, has been enthusiastically peddled by
politicians, economists and industrialists, and while it has been used to justify severe cuts to public
services and to demolish labour protections, the fiscally prudent small State has been a myth. In
reality, state spending has been redirected (rather than reduced) to finance ballooning debt, and as
states have become beholden to international finance, their potential potency at managing their
economies has been thwarted. This, Birch argues, has resulted in a situation whereby many of us
are indeed subject to the brutality of free market forces, but in which the big, important transactions
and decisions that may impact many millions of lives take place outside of the market (and beyond
democratic oversight) within privileged networks, such as within corporate monopolies and bank
boardrooms. The argument chimes of course with accounts of the global financial crisis: a too-big-to-
fail network of financial services and rating agencies sunk itself and millions of others with innovative
financial instruments that become toxic, only to be bailed out by panicked governments with public
money.
In his polemic, Birch argues that the original laissez-faire tenets of neoliberalism have been
distorted to facilitate and justify the rise corporate monopolies and multinational financial
institutions. Neoliberalism has, in other words, been hijacked and transmuted by powerful practices
that remain obscured if we continue to adopt ‘neoliberalism’ as an analytical term. Birch provides a
well-supported account of these practices and the disfiguring of neoliberalism. We are provided with
easily-accessible introductions to the history of neoliberal thinking, monetary policy, public debt and
its causes, the globalisation of capital, and the consequences of these developments for a generation
of ‘doomed youth’. Birch outlines his manifesto in the final chapter. This is not, he states, “a radical
call to arms”, but rather “a mundane programme centred on getting out of our entanglement in the
current financial and economic systems” (15). This ultimately entails avoiding debt including,
interestingly, eschewing home ownership – a giant Ponzi scheme which “militates against rising real
wages and rising living standards” (165). Birch’s passionate indignation provides his text with an
engaging energy, and his arguments appear, at least to this reviewer (who is no expert on

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Final version: https://link.springer.com/article/10.1057/s41285-017-0058-x

international finance), to be well-supported. The writing style is certainly appropriate for non-
academic readers, and importantly, so too is Zero Books’ reasonable paperback price
(£11:95/$19.95).
Of particular interest to this reviewer are the implications of Birch’s contribution for the
sociological explorations of health, healthcare and biomedicine. The healthcare system and
biomedical R&D are of course deeply and often troublingly entwined in the processes of
financialisation described by Birch, and his arguments highlight some important avenues of inquiry.
First and foremost, we must be vigilant in our use of the term ‘neoliberalism’ to explain the current
state of affairs. On this point, Birch’s caution aligns with those made by other scholars (e.g Bell &
Green 2016): while ‘neoliberal’ has been a meaningful term for denoting modern subjectivities
based on individualistic, self-governing ‘practices of the self’, as a descriptor of wider society, it has
become a clumsy shorthand for unfavourable state-of affairs which loosely includes deregulation
and privatisation. A more productive avenue of inquiry is to explore the specific practices of
assetization by which elements of healthcare and biomedicine become entwined in chains of finance
which often, Birch argues, envelope significant sections of society. A good example of this are the
private finance initiatives (PFI) used to fund the construction of hospitals in the UK’s National Health
Service (NHS). Within this, the NHS is having to pay over £3,700 per minute to pay for privately
funded hospitals (Mendick, Donnelly and Kirk 2015). A few well-connected financiers have made
huge profits, but because a significant amount of investment in these assets has come from local
authority pension funds, many of us have become entwined in this NHS-crippling arrangement. This
is an example of what Birch refers to as cannibalistic capitalism, the details of which are elided by
evoking the term ‘neoliberalism’. Carefully tracing how and why such arrangements come about,
and who stands to profit, is an important task for social scientists.
Birch’s suggestion to focus on the practices of assetization also has ramifications for how we
understand the dynamics of biomedical innovation. Birch himself has been critical of social scientists
embrace of the notion of ‘biovalue’ which implies that biological material has – or can be –
configured as commodities with use-value (Birch and Tyfield 2013; Birch 2016). In reality, Birch
argues, value in biotech research and development has been generated by turning things – ideas and
entities – into assets such as intellectual property. This analysis appears to hold some weight in
recent examinations of the emerging field of regenerative medicine: a thriving regenerative
medicine industry is animated by the government-supported development and trading of assets, but
it has yet to generate any widely adopted therapeutic products (Gardner and Webster 2017). Again,
tracing such assetization practices and their effects, and testing Birch’s analysis by closely examining

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Final version: https://link.springer.com/article/10.1057/s41285-017-0058-x

how value is actually enacted and managed ‘on the ground’ in biomedicine is an important avenue
of inquiry for social scientists.
More generally, We have Never Been Neoliberal is an important reminder to cast a critical
eye over current government-mandated ‘national prosperity’ initiatives in many countries aimed at
facilitating translational medicine. In the UK, for example, elements of the healthcare system and
biomedical R&D infrastructure are being reimagined and reconfigured to facilitate innovation in the
name of ‘health and wealth’. This involves, via agencies such as the UK Cell and Gene Therapy
Catapult, using some public funds to support the formation of privately owned assets. Some recent,
more optimistic analyses (particularly James Mittra’s recent The New Health Bioeconomy (2016))
have suggested that the collaborative nature of translational medicine means that it is ultimately a
more socially responsible form of innovation: unlike the previous era of pharmaceutical industry-
dominated innovation, translational medicine provides spaces for the enactment of multiple values
beyond commercial value, such as values relating to ‘ the public good’ and ‘patient-centredness’.
Birch’s analysis, however, would encourage us to see many innovation-facilitating initiatives within
translational medicine as a problematic concentration of economic power.

List of references

Birch, K. 2016. “Rethinking Value in the Bio-economy: Finance, Assetization, and the Management of
Value.” Science, Technology, & Human Values 42 (3): 460–490. doi:10.1177/0162243916661633.

Birch, K. and Tyfield, D. (2013) Theorizing the Bioeconomy Biovalue, Biocapital, Bioeconomics or . . .
What? Science, Technology & Human Values. 38(3): 299-327.

Bell, K, and Green, J. 2016. "On the perils of invoking neoliberalism in public health critique." Critical
Public Health 26 (3):239-243. doi: 10.1080/09581596.2016.1144872.

Gardner, J. and Webster, A. (2017). Accelerating Innovation in the Creation of Biovalue: the Cell and
Gene Therapy Catapult. Science, Technology & Human Values. Early access online.

Mendick, R., Donnelly L. and Kirk, A. (2015) The PFI hospitals costing NHS £2 bn every year. The
Telegraph. 18th July 2015. http://www.telegraph.co.uk/news/nhs/11748960/The-PFI-hospitals-
costing-NHS-2bn-every-year.html

Mittra, J. (2016). The New Health Bioeconomy: R&D Policy and Innovation for the Twenty-First
Century. Basingstoke UK: Palgrave.