Medtech. The Formation and Growth of a Global Industry, 1960–2020, by Pierre-Yves Donzé, is an ambitious new book from one of the best experts in the world on the business history of health of the twenty-first century. Once again, after a series of recent books and articles about the dynamics of the industry of medical equipment in Japan, Switzerland and Germany, Donzé opens the box for a new analysis, with new data, about the dynamics of such an industry in other regions of the world like the United States, France and China. Donzé acknowledges his intellectual debts: to authors who have recently appealed for the need to go beyond national approaches, and to efforts to establish international comparisons as was done in the recent book The Emergence of Modern Hospital Management and Organisation in the World. Footnote 1 Donzé is a great specialist in medical equipment, and we knew from his work about the expansion of German equipment in the world in the last century. But now, Donzé goes beyond his expertise on X-rays and includes an identification of the main industrial players in the world over the last six decades, and the supply and demand factors that explain their success.
The book starts with three general chapters about the dynamics of the global medtech industry, the dominance by big multinationals, the coexistence with clusters of small- and mid-sized enterprises and spin-off chains, as well as with the more personal networks of doctors and firms. He covers regulation by the state, the identity of the largest medtech players, the global trade of products of a very diversified industry and the wave of mergers and acquisitions that created a huge concentration of big players. All of this is important, not just to understand the endogenous features of the industry in a dynamic long-term perspective, but also to understand the directions of research and production in the industry. These are not always correlated with the directions that public health needs have had in history and today, reflected in the difficulties that states (and therefore, we) have had in regulating prices and access to the products of this industry. Anyone who needs to understand the rigidities faced by patients and consumers who need to access life-saving products and devices may find some clear answers and facts in these three chapters.
A second group of six chapters approach from a national perspective the relationship between leading medtech corporations (exploring strategies of innovation and strategies of growth) and the market (mainly through foreign trade statistics). One misses somewhat in these chapters the role of the state and how public policies have allowed the creation of giants with an impressive capacity to impose: 1) research into certain illnesses, 2) production of some drugs and equipment over others, 3) prices and 4) investment in employment at the local level (or its financial outsourcing abroad unbalancing potential taxes they could pay at home with their outward direct investment strategies). The six chapters focus on the old key leading players (the United States, Germany, Japan and France); on new key players (China) and on intermediate very specialised niche market players like Switzerland. The sources are public and private records difficult to gather and still more difficult to present in an analytic and clear way as the author does in this very well written book. It is, indeed, an example for future researchers in the field.
The reader may wish for additional chapters on other typologies of national approaches to the industry, including maybe examples of reverse innovation players in the medtech industry like India or Brazil. Or, one wonders, maybe the author could have written a chapter about what happened in the industry before World War II, when so many innovative companies and networks started that came to an end in the 1950s, with examples of countries where there had been very innovative medtech medium-sized players or networks of innovative scientists producing patents of world impact in the first half of the twentieth century, that had no commercial success in the distribution of their products abroad after the 1940s and 50s for diverse reasons. This was the case in Russia, for example, where paediatric incubators had been produced and introduced before the Revolution, but Stalin prohibited innovations to be done in private firms or sold abroad; Argentina (in surgery equipment); or Cuba (in tropical medicine before the Castro revolution that dramatically exiled leading producers and closed labs and companies) or Spain (where outstanding pioneering networks of doctors in the medtech industry, like the Sindicat de Metges de Catalunya, were abruptly dismantled after the Spanish Civil War and the coming of the Franco regime).
