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What problems arise when medicine is both a humanitarian and for-profit enterprise?

Photo of Dr. Yang teaching a class

Doctoral student Devin Jerome talked to Timothy Yang recently about his new book, A Medicated Empire: The Pharmaceutical Industry and Modern Japan (Cornell University Press, 2021).

Tell us about your new book and the research behind it:

Book cover of Tim Yang's A Medicated EmpireIt is a business history that intervenes into histories of science and medicine. The anchor is a company called Hoshi Pharmaceuticals, which I used to examine the relationship between pharmaceutical companies and the state in the making of Japan and its empire in the early twentieth century. This company had its heyday at a time when laboratory research was less important for drug development. It relied, instead, on medicines derived from natural substances such as quinine, opium, and cocaine.

One part of this book concerns the nature of medicines as commodities, and how they are produced and distributed as well as marketed and sold. Another part of the book is how this company worked in connection to the Japanese state and its regime of public health, both within the Japanese home islands and in its expanding empire in Asia.

Through Hoshi, I talk about how the pharmaceutical industry supports public health but also simultaneously subvert it, for example, through its involvement in opioids. And because fundamentally it is a business, so the guiding question for the book is: can medicine—as a business—be both humanitarian and for profit?

What is the division between a drug and medicine in your book?

That’s fundamental to the book. Drugs have connotations of inducing sleep and making people unproductive. The term is often used as a synonym for narcotics. I think the key differentiation is whether a substance will help you be more productive or not? Because productivity is what is is valued in industrial society, which is what Japan was at this time. If it makes you healthier and more productive, then a substance is often deemed a medicine. If it does not, then, it is often deemed a drug. Public health is about how states manage a productive and healthy population so people can go work the factories and the fields, and during times of war, it is about managing a healthy population so people can fight on battlefields.

Where did your initial interest in the project come from?

I actually wanted to do a history of medicinein colonial Taiwan. But when I began reading a memoir of a Japanese doctor, he mentioned a company called Hoshi, which sponsored a scientific expedition to Java to look at cinchona plantations. (Cichona is the raw material for quinine.) I thought that was interesting, and when I looked further, I found out that this company had failed and that many of its papers were at a school of pharmacy in Tokyo, which had once been affiliated with the company. That was exciting because successful businesses often write their own company histories, and this company failed before a company history could be written.

Also, my parents were both research scientists for major pharmaceutical companies in New York and New Jersey. So at least subconsciously, the interest in drug companies was always there.

If there is one message you could impart upon your readers, what would it be?

That’s a good question. In our current time of COVID19, I am worried that this book will be read as an anti-science or anti-vaccine screed. It is a book about how medical science can be subverted through its relationships to business. Public health is so politicized nowadays. But I think we can still maintain—and need to maintain—a critical eye on drug companies. As historians, we have to be wary of letting current events influence our reading and writing of history, but it’s also impossible not to have current events in mind. That’s why history constantly get revised and reinterpreted. The key point in this book is that medicine as a business is, fundamentally, a contradiction between humanitarian and for-profit motives. This was true in early 20th century Japan, this was true before COVID, and this will be true after the time of COVID. So how do we, as a global society, deal with that?

You teach a popular and I think provocatively-titled course in the department called the global history of drugs. How significantly your research from A Medicated Empire figures in that class and how students are responding to it?

Actually, I developed that class while writing the introduction. It’s a course about examining medicine as commodities to help us explore interconnections among colonialism, capitalism, modernity, etc. It traces medicines as commodities to analyze, in a sense, the making of public health across the world. The course jumps around the globe. I deliberately tried to de-center the class from the US, even though a lot of it does tend to ultimately focus on the US. So Latin America and Asia figure heavily in my course. We talk about things like regulations, medical professionalization, and medicine marketing. And, of course, we talk about how drug companies market and sell medicines. These are all things that are also covered in my book. The book that I wrote is about a Japanese pharmaceutical company, but it’s a book that I think can be written about almost any pharmaceutical company of its era.

I previously mentioned my worry that my book will be read as an anti-vaccine screed. Well, one of the first questions I got when I assigned readings was: is it really OK to challenge medicine and science? I think it is OK and that we have to do so. There is a whole field about it called the history of science! There are legitimate issues with how the medical system has developed in the US, as elsewhere, and these will not go away when COVID is over.

Laying aside well-deserved laurels, what’s next on the docket? Where do you see your next project heading?

Since I’ve been involved in Dirty History, I’ve been more and more interested in agrarian history. So I’m thinking of writing a new history of land reform during the Allied Occupation of Japan after World War II. Land reform has been seen as the most successful reform of the US policymakers under General Douglas MacArthur. What they did was confiscate large landholdings and redistribute them to create a countryside of peasant-proprietors. The goal was to raise the standard of living for a peasant farmer, and these farmers in the countryside became  the backbone for a conservative voting bloc that developed in a democratic and prosperous postwar Japan. This was celebrated as something bestowed upon Japan by the United States. But this was not really the case. Japanese scholars and policymakers had been talking about the land reform in the 1930s and 1940s, and their work inspired the policymakers in that General MacArthur relied upon. So basically, I am intending to write a new history of land reform that takes a more transwar perspective.


Associate Professor, Director of the Center for Asian Studies

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