WEAI Author Q&A: Timothy Yang on 'A Medicated Empire'
We are excited to announce a new title in the Studies of the Weatherhead East Asian Institute book series: A Medicated Empire: The Pharmaceutical Industry and Modern Japan published by Cornell University Press. The book’s author, Timothy Yang is an Assistant Professor in the department of history at the University of Georgia.
In A Medicated Empire, Timothy M. Yang explores the history of Japan's pharmaceutical industry in the early twentieth century through a close account of Hoshi Pharmaceuticals, one of East Asia's most influential drug companies from the late 1910s through the early 1950s. Focusing on Hoshi's connections to Japan's emerging nation-state and empire, and on the ways in which it embraced an ideology of modern medicine as a humanitarian endeavor for greater social good, Yang shows how the industry promoted a hygienic, middle-class culture that was part of Japan's national development and imperial expansion.
Yang makes clear that the company's fortunes had less to do with scientific breakthroughs and medical innovations than with Japan's web of social, political, and economic relations. He lays bare Hoshi's business strategies and its connections with politicians and bureaucrats, and he describes how public health authorities dismissed many of its products as placebos at best and poisons at worst. Hoshi, like other pharmaceutical companies of the time, depended on resources and markets opened up, often violently, through colonization. Combining global histories of business, medicine, and imperialism, A Medicated Empire shows how the development of the pharmaceutical industry simultaneously supported and subverted regimes of public health at home and abroad.
Q: First could you introduce yourself and your research interests?
I am currently assistant professor of history at the University of Georgia where I teach a wide variety of courses in East Asian history. I focus on modern Japanese history, and I have research interests in a variety of subjects including the history of science and medicine, the history of business and capitalism, and colonial and postcolonial studies. More recently, I have become interested in agrarian and environmental history.
Q: Can you give us a primer on the pharmaceutical industry of imperial Japan for the uninitiated? How advanced were the medicines of the time relative to the rest of the world and how strong was Japan’s public health?
The pharmaceutical industry in imperial Japan, like those of other nation-empires from the late-nineteenth through early-twentieth centuries, was an industry that was coming into being. It was a time when the state, both in Japan and its colonies, was in the process of developing its system of public health based on biomedicine (applying the principles of natural science to cure illness and disease), which was often simply called Western medicine. It was a time characterized by heterogeneity in the medicinal marketplace—from Chinese and herbal remedies to patent medicines to medicines developed according to scientific standards—as well as a time when professional regulations and industry standards were being established (and were highly contested).
The nation with the most advanced pharmaceutical industry in the late-nineteenth century, not to mention the most comprehensive system of state public health, was Germany. And it was no coincidence that so many of Japan’s leading medical scientists such as Nagayo Sensai or Kitasato Shibasaburō, as well as the so-called father of Japan’s pharmaceutical industry, Nagai Nagayoshi, had trained in German universities. The outbreak of World War One was a turning point for Japan’s pharmaceutical industry, just as it was for its industrial development more broadly. The Great War created a shortage of Western medicines and skyrocketed their prices. In order to remedy this situation, the government created economic incentives for producing medicines deemed vital for public health, and it even provided technological know-how by voiding German pharmaceutical patents, which had been a reason for the global dominance of that nation’s drug industry. Pharmaceutical firms, including the one that I focus on, Hoshi, took advantage of this situation to expand production and increase market share, both at home and abroad.
Q: Can you introduce Hoshi Pharmaceuticals, the focus of A Medicated Empire? How did you first come to learn about the company?
Hoshi Pharmaceuticals was founded in Tokyo in 1906, and it enjoyed a meteoric rise, particularly in the years after World War One. By the mid-1920s, it was Japan's largest pharmaceutical company. It was well known for its patent medicines—what we might call "over-the-counters" today—as well as its household goods. It was also Japan's leading producer and trader of alkaloids—naturally occurring plant-based nitrogenous compounds, the most famous of which are morphine, quinine, and cocaine. In 1925, however, disaster befell the company when it became embroiled in an opium trading scandal, which destroyed its finances and reputation. Although Hoshi recovered from bankruptcy in the 1930s to become a key supplier of medicines for the Japanese military during World War Two, it succumbed to a similarly damaging opium scandal during the early years of the Allied Occupation of Japan. Today, the company is best-known through the work of the founder’s son, Hoshi Shin’ichi, who became a major novelist in the postwar era. In my book, I use Hoshi Pharmaceuticals as the anchor through which to explore how the development of the modern pharmaceutical industry supported—and simultaneously subverted—Japan’s public health regime.
I first came across this company in the memoirs of a Japanese doctor named Oda Toshio who played a major role in the development of medicine in colonial Taiwan. He wrote about how Hoshi had sponsored a 1916 expedition to cinchona plantations (the raw material for the anti-malarial drug, quinine) in Java, in order to examine the possibility of growing cinchona in Taiwan, in case of a malaria outbreak. After I did a bit more research, I realized that Hoshi University, a pharmacology school in Tokyo that had been affiliated with the company, held a large trove of documents about the company. Successful corporations write their own (often hagiographic) histories, which in Japan, has become its own historical subfield known as shashi. Hoshi was a company that had failed before it could write its own company history. This made it exciting to research.
Q: How has the pharmaceutical industry of Japan changed since the country abandoned its imperialist ambitions and since the collapse of Hoshi Pharmaceuticals? And what were the lasting impacts of Japan’s development of modern medicine as a biopower to control people?
I actually see more continuity than change in the Japanese pharmaceutical industry after the formal end of Japan’s empire, which was marked by the end of World War Two. Perhaps the most important continuity has been the state’s prioritization of affordable medicine rather than on Research and Development (R&D). Hoshi failed during the Allied Occupation, when US-led authorities not only encouraged the transfer of intellectual property and the technology to produce important medicines such as penicillin, but also purchased them for distribution to soldiers and civilians, which helped spur pharmaceutical production. After the Occupation’s end, the Japanese government continued to emphasize access to low-cost medicines through import substitution, which dovetailed with the creation of a universal healthcare system. Maki Umemura has an excellent book on this, which argues that this was to the detriment of industry because it created little incentive for innovation (compared, say, to the world-leading American or German or Swiss pharmaceutical firms). Research and Development (R&D), in other words, was not incentivized in the postwar era. Innovation may have suffered, but it kept medicine affordable in order to keep the population healthy.
The emphasis on affordable medicines is a lasting impact from the period that I cover in the book. The idea of “biopower to control people” sounds negative—especially amid the current politicization of the COVID-19 pandemic—but “biopower” is not a new term and simply refers to the technologies and practices that modern nation-states use to manage populations. Public health has been one important area, and, in this sense, my history of pharmaceuticals is one part of a larger history of public health in Japan. Another important part is the history of Japan’s aforementioned universal healthcare system, which is excellent, low cost, and efficient. There should be a new book on that soon, written by Ryan Moran, which I am looking forward to reading.
Q: In your introduction you write, “In Japan, Asia, and across the world, public health regimes have often encountered controversy if not outright resistance. Scholars have analyzed how nation-states used biomedicine and public health to control individuals and subjugate populations, particularly in colonial contexts. Scholars have also explored how individuals and subject populations used medical knowledge and medicinal practices to assert their own subjectivity.” Do you have any thoughts on the current state of global public health given the pandemic and resistance to public vaccination campaigns. Such resistance is very visible in the United States, but also exists to a lesser extent in Japan as well. [Is there a link between the past actions of global public health regimes and today’s resistance to vaccination efforts?]
I think we should differentiate between vaccine hesitancy and the current anti-vaccine movement. Vaccine hesitancy is not a new phenomenon, and it is fundamentally about an erosion of trust in medical authorities. Since vaccines were first introduced, there has often been some measure of vaccine hesitancy due to the nature of public health and vaccines in general. Governments rely on public health to promote healthy and productive citizens. Many public health measures—such as getting a good night’s sleep, eating a balanced diet, and exercising daily—are things that people often take for granted. Vaccination programs, however, seem more coercive, and vaccines seem more invasive at a material level (They break the skin! Needles can be scary!). Vaccines thus require more trust.
Also, perhaps more than any other type of medical technology, vaccines signify the “one size fits all” characteristic of biomedicine, which privileges the collective over the individual. Public health is about maintaining the health of the body politic as a whole. But people react to vaccines, like they do to all medicines, in somewhat different ways, and there are often side effects. All of this sows mistrust in medical authorities (and, as an aside, helps explain the persistent popularity of so-called traditional and/or homeopathic remedies, which seem more natural, holistic, and personal).
In the case of Japan, Andrew Gordon and Michael Reich have an excellent recent article that helps explain Japan’s so-called puzzling vaccine hesitancy. What they show is that there actually has been widespread acceptance of vaccines, contrary to perceptions that Japan has “among the lowest vaccine confidence in the world.” Yet they also point out that there have been periods of vaccine hesitancy stemming from cases of defective vaccines that eroded confidence and fostered mistrust in the government.
I actually do not talk about vaccines in my book. Hoshi was not a major producer of vaccines, and I was writing about pharmaceuticals during an era when the research laboratory was comparatively less important. My book is about the relationship between capitalism and medicine, and it addresses the subversion of trust in public health through seemingly collusive ties between government organs and pharmaceutical companies. I wrote much of the book during a different pandemic, namely, the opiate crisis devasting suburban and rural America. And I was finishing my book during the height of the Sackler family scandal about Purdue Pharma and Oxycontin. It’s sad, in many ways, that the COVID-19 pandemic has pushed aside public consciousness of an opiate pandemic that is still ongoing.
The anti-vaccine movement in the United States during the current COVID-19 pandemic has more to do with the dire political polarization of this country. Many of the most vocal anti-vaxxers don’t really seem to have a problem with modern medicine at all. For example, these are the same people who encourage Remdesivir, Regeneron, or monoclonal antibody treatments. And they overlap with those who preach the power of Ivermectin or Chlorox bleach, which, last I checked, are not exactly herbal or homeopathic substances. The anti-vaccine movement thus seems quite happy to take drugs produced by major pharmaceutical companies and does not seem too worried about toxic chemicals. Members of this movement also seem fine going to hospitals when they fall gravely ill from COVID-19. Their deep mistrust of medical authorities seems to stem more from an intense hatred of the political party that they think controls the entire medical apparatus in this country.
Q: What was the most challenging part of your research for this book?
The most challenging part of my research was gaining access to the aforementioned collection of documents held at Hoshi University. A pharmacology professor had organized the documents as a hobby, and he was skeptical of my intentions at first. I didn’t know what to do until I realized that the founder of the company had a Master's degree from Columbia University (where I was getting my PhD) and that his thesis was located in a collection down the hall from my library cubicle. So I made sure to copy the thesis when I returned to New York during a holiday break. And when I made it back to Tokyo, I presented the thesis to Hoshi University as an act of goodwill. It worked, and I was allowed almost unfettered access to the collection. I remain very much indebted to the administrative staff there.
Writing the book was also hard, and what was most difficult was trying to write a coherent narrative that unfolds at multiple scales. What I find so fascinating about the history of pharmaceuticals is that it combines so many different types of history: the history of science and medicine, business history, legal history, environmental history, etc. Tracing the rise and fall of Hoshi Pharmaceuticals was a way for me to write about all of these things. It was fun to do, but it was also quite difficult because almost every chapter has a different set of historical questions, based on different types of sources. I’m proud of my book. But I’m not sure how successful I was in tying this all together—that is for the reader to decide!