In Making Medicine a Business, Pierre-Yves Donzé has developed a multifaceted approach to understanding the history of the X-ray industry in Japan during its formative years. In addition to studying the development of the businesses that manufactured, imported, and sold X-ray equipment in Japan, he also devotes separate chapters to the main consumers—radiologists—and their development as a profession; the interaction and cooperation between suppliers and consumers; the effects of the spread of X-ray equipment on hospital management; and the role of government, insurers, and professional associations in regulating the business and the health care system more broadly. Donzé argues that all of these actors contributed to the social, institutional, regulatory, and technological structures that influenced the particular direction of the X-ray industry in Japan. For example, he shows how the prevalence of smaller hospitals and clinics with a need for inexpensive equipment opened an opportunity for domestic manufacturers—such as Shimadzu Corporation—that were responsive to local needs. This material offers a revealing case study of some of the specific, local mechanisms underlying the global development of medicine and health care. The book will be of considerable interest to business historians with an interest in medical technology, and to historians of Japanese medicine.

The strength of the book lies in its pulling together of diverse threads of knowledge to develop a rich narrative of both the production, marketing, and consumption of X-ray equipment in the first half of the twentieth century and the development of Japanese health care more generally. This was not easy information to acquire. In order to develop his multifaceted approach, the author delved into corporate histories and archives in both Japan and Europe; professional society journals and histories; the histories of hospitals, clinics, and other medical institutions; patent records and other government reports; and biographies of notable individuals. I found his chapter on the birth and development of specialized radiology in Japan particularly interesting and well researched (chap. 3). In this chapter, Donzé introduces us to key figures in the creation of this new field; the creation of specialist societies, and ultimately, of the Japanese Society of Radiology; the development of training programs for radiology; and the establishment of radiology as an academic discipline. Not only does Donzé pull these diverse strands of historical knowledge together, he also adds valuable social context, taking, for example, one representative radiologist and describing his family background, education, professional affiliations, and medical practice through his career, and including actors who have been almost invisible in the historical record, such as X-ray technicians. The result is a dense study of a little-known topic that includes rich strands of social history—though I wish that Donzé had included more material on the end users of Japan's X-ray industry: the patients.

The book develops a satisfying narrative of the little-studied field of X-ray technology and markets in Japan, and it is quite successful in putting together various perspectives that inform one another to produce a dynamic and nuanced analysis. That said, the book fails to realize its potential in a number of areas.

First, although it opens with an extended discussion of the size and importance of today's global health care industry, Donzé’s analysis fails to connect his prewar narrative with Japan's postwar success in the medical imaging industry. (I must add that the book contains a shocking inaccuracy in the very first paragraph: the size of the global health care industry is surely closer to 8.7 trillion USD than the 8.7 billion cited in the text.) Three Japanese firms are currently in the top ten of global manufacturers, with Fujifilm the world's largest. While Donzé describes the emergence and early growth of two of the three (Shimazdu and Tokyo Electric, later Toshiba), he offers no analysis or explanation (or even mention) of the connection between their prewar roots and their global expansion in the postwar era, nor of the decisive impact of the wartime economy in all sorts of vacuum-tube and imaging-related industries.

In a related point, Donzé’s discussion of the government's involvement in the X-ray industry is far too limited, focusing as it does primarily on regulatory issues. He correctly points to the rapid rise in market share of domestically manufactured equipment from the 1930s on, but he fails to discuss the role that government policy might have played in this. During the 1930s, the Japanese government embarked on a massive program of “domestication of production” (kokusanka) aimed at reducing imports and achieving self-sufficiency in a wide array of strategic industries. Vacuum tubes and imaging technology were targeted by this policy, which aimed to marginalize foreign multinationals and bring Japanese firms up to global standards in cutting-edge technologies. The protective policies implemented by the government are widely recognized as a foundation stone in the postwar success of the Japanese electronics industry. Given the fact that vacuum tubes were a key targeted sector, and given the military importance of diagnostic imaging, I would be surprised if the X-ray industry was not affected.

Instead, Donzé’s theoretical framework focuses on an unrelated question that I find puzzling at best and deeply misleading at worst: namely, “why, when, and how medicine and healthcare became a business” in twentieth-century Japan (p. 173). Donzé claims that until the mid-nineteenth century most doctors were independently wealthy and not profit oriented, while most consumers “used self-medication or traditional healers to recover from sicknesses” (p. 173). These stunning generalizations completely ignore Japan's highly developed system of (for-profit) medical practice and drug production that extends back at least to the seventeenth century. Does he mean that only modern Western techniques count as “medicine and healthcare”?

These quibbles aside, Making Medicine a Business is an informative survey, and its revealing combination of business, social, and medical history offers a thought-provoking model for historians in each of these fields.