Making Medicine a Business: X-ray Technology, Global Competition, and the Transformation of the Japanese Medical System, 1895–1945 by Pierre-Yves Donzé (review)

In his monograph, Pierre-Yves Donzé analyzes the impact of X-ray equipment on the transformation of Japanese medicine into a business between 1895 and 1945. He argues that in pre–World War II Japan, the radiological device industry, doctors, and hospitals all played a decisive role in the shift. Japan's exceptionally competitive market resulted from a large number of small hospitals that competed by investing in compact and cheap X-ray instruments and employing radiologists to lure patients for profits. X-ray equipment manufacturers like Tokyo Electric, a Japanese partner of U.S.-based General Electric (GE), and Shimadzu worked closely with medical doctors, who sought to establish radiology as an autonomous specialization rather than an auxiliary field. Japan's health care market evolved without either a Christian/philanthropist tradition or strong state intervention.

The strengths of this book lie in its multicontinental and multilingual research, comparativeness, and data visualization. Donzé examines Japanese, English, French, and German sources, including documents held at the Siemens Archives in Germany. He is well versed on comparative literature in business history and puts his case study in the context of similar experiences in the West. Although desirable data were often unavailable (pp. 17, 19, 32, 47, 75, 86, 92, 134, 138, and 150), the author converts accessible data into thirty charts and graphs.

I find discrepancies between common perceptions and Donzé's findings fascinating. Japanese industrialization is often characterized as state-led, and the Japanese market is frequently criticized as closed to foreign companies.¹ However, this study challenges such generalizations, as the state intervened in the technomedical business market minimally and GE did well in prewar Japan. German and U.S. multinational enterprises (MNEs), Siemens and GE, originally dominated the X-ray machine market in pre–World War I Japan. While Siemens protected its patented inventions and used its Japanese partners only to assemble and distribute expensive high-end products (pp. 118–19), GE collaborated with Japanese subsidiaries by sharing technology and involving local partners in patent management, R&D, and marketing (pp. 116–18), which resulted in Siemens' struggle and GE's success. Strategies mattered in opening business frontiers for foreign MNEs.

Typical of any pioneer work, this book invites further analyses. Patients' role in shaping the medical market place is noticeably missing. What supports the author's assumption that patients chose hospitals because of their X-ray devices? What kind of diseases did patients suffer from? For what medical ailments did orthopedic surgeons, internists, dermatologists, obstetricians, and dentists utilize radiological tools diagnostically as well as therapeutically? The answers may have better explained the nature of tensions between radiologists and specialists in existing medical fields. Were different X-ray tools developed and marketed according to the needs specific to specializations and diseases? Unlike Donzé, who is generally silent to these questions, Barbara Bridgman Perkins reveals that radiation therapy was applied to cancers of the uterine cervix as surgeries often killed women and GE's high voltage X-ray technology was a promising new invention for cancer treatment in the interwar West.² Also, the book does not analyze the colonial and military dimensions extensively. However, Imperial Universities in Taipei and Seoul were an integral part of Japan's elite academic network, doctors moved around the empire, and companies operated in these colonies before 1945.³ Wars, including World War I, prompted and diffused medical technological advances.⁴

This book could have benefitted from thorough editing and indexing. But its content offers a fresh way to look at the history of medicine in Japan from a techno-business and comparative perspective. It also provides valuable insights into prewar Japanese history.