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Professional publics in transitional/digital China: medical controversies, justifications, and mobilizations

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Professional publics in transitional/digital China: medical controversies, justifications, and mobilizations

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Content Copyright 2021 Yue Yang

PROFESSIONAL PUBLICS IN TRANSITIONAL/DIGITAL CHINA:
MEDICAL CONTROVERSIES, JUSTIFICATIONS, AND MOBILIZATIONS

by

Yue Yang

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(COMMUNICATION)

August 2021

ii

Acknowledgements
I am grateful to all of those who have helped me with this dissertation project. My
advisors, Prof. Tom Goodnight, has provided me endless insights and infallible support
over the years. He saw me through the whole project and provided encouragement,
advice, and guidance through our innumerable conversations, in person, via email, and
over the phone. These conversations have significantly expanded my theoretical
imaginations about the communicative and the medical. They have encouraged me to be
a more poetic thinker and a better writer. Prof. Nina Eliasoph has also been a great friend
and an intellectual mentor. Her analytical acumen, humor, and generosity have
continuously been my source of inspiration. Prof. Robert Scheer has invited me into
many powerful discussions about contemporary media and socio-political challenges. His
life-long commitment to social justice has molded my teaching and research philosophy.
Prof. Paul Lichterman, a crystal sharp thinker, has demonstrated the charm of intellectual
puzzle-solving and encouraged me to explore the world of meaning-making. These
scholars would forever be my academic role models.
My sincere gratitude also goes to the fruitful conversations at Things China
Workshop, with Dr. Ben Lee, Dr. Clayton Dube and many others at the US-China
Institute at USC. Dr. Dube has been a spring of knowledge while Prof. Ben Lee has
offered me valuable opportunities to join international collaborative research and expand
my fieldwork. I appreciate all the wonderful learning resources and research experiences
that Annenberg School for Journalism and Communication has provided. The diverse and
dynamic intellectual communities here at Annenberg have taught me what
iii

communication could be and should be. I thank Prof. Tom Hollihan, Prof. Patricia Riley,
Prof. Larry Gross, Prof. Mike Ananny, Prof. Colin Maclay, Lin Zhang, Liyue Shi, Wei
Wang, Bei Yan, Ruqing Ren, Lei Zheng, and many others for their friendship and
encouragement. I also thank Sarah Holterman, Anne Marie Campian, and Li Tang for
their infallible support to navigate administrative procedures and obtain resources.
When my research about medical controversies and professional communication
just gained momentum around 2016, it was Prof. Yu Hong, Prof. Guobin Yang, Prof.
Zhongdang Pan, and Prof. Zelin Yao who provided me helpful comments at conferences
or through more informational discussions. I also benefited from the funding provided by
USC-Shanghai Jiaotong University Institute of Cultural and Creative Industry to conduct
multi-sited field studies in China. While these field studies are not included in the current
dissertation, they prepared me with a deeper understanding of the medical issues and
societal dynamics in contemporary China.
I also thank my roommates and Caltech friends who have provided me company
and care before and during the pandemic. The past few years could not have been
productive if I do not have good friends to cook, chat with, dance, play badminton and
study with. I also thank them for cultivating a community of warmth, happiness, and
vitality.
Last but not least, I thank my parents for their unconditional support. The years I
spent overseas are when my parents long for more company from their only child.
Nothing can be compared to the love and patience they have provided me. This
dissertation is dedicated to them.

iv

Table of Contents
Contents
Acknowledgements ............................................................................................................. ii
Table of Contents ............................................................................................................... iv
List of Tables ................................................................................................................... viii
List of Figures .................................................................................................................... ix
Abstract ............................................................................................................................... x
Chapter One: Medical Controversies and Mobilizations in Transitional China-- Civil,
Uncivil, and/or Something Else? ........................................................................................ 1
Literature Review 1: Digital Media and Political/Public Communication in China ...... 7
Literature Review 2: Professional Distinction, Legitimacy, and Embeddedness ......... 14
Methods for A Double Inquiry ..................................................................................... 20
Justification/Engagement Analyses .......................................................................... 22
Applying Justification/Engagement Analyses to Medical Controversies in China .. 26
Scene Style of Civic Actions .................................................................................... 28
Assessing Compatibility, Combining Insights .......................................................... 32
Operationalization, Positionality and Reflexivity ..................................................... 34
Plan of the Dissertation ................................................................................................. 38
Chapter Two: Embedding Professional Publics in Changing China ................................ 42
v

Medical Profession in Pre-Socialist and Socialist China .............................................. 42
Institutional Transitions and Grievances ...................................................................... 44
Mediation of Medical Problematics in the Reform Era ................................................ 49
The Rise of Media Reports about Medicine ............................................................. 50
Professional Mobilization on the Chinese Internet ................................................... 56
Conclusion and Discussion ........................................................................................... 62
Chapter Three: Vexing News! Medical Controversies and Media Critiques ................... 64
Methodological Considerations and Empirical Operationalization .............................. 65
Data Collection ......................................................................................................... 68
Situated Judgment, Justification, and Critiques ............................................................ 72
Findings......................................................................................................................... 75
The Industrial World: Deficient, Polluted by Market and Domestic, or Adequate? 76
Civic Justification, Civic-Industrial Critiques, and Market Pollution ...................... 80
Discussion and Conclusion ........................................................................................... 84
Chapter Four: “Doctors, Unite!” Plural Justifications and Incomplete Individualism
among Medical Professionals ........................................................................................... 87
Developing A Corpus of Doctors’ Campaigns and Advocacy ..................................... 87
DXY Medical Garden (Yi Yuan) Magazine ............................................................. 89
The Nanping Website ............................................................................................... 90
Blog Posts of Medical Celebrities............................................................................. 91
vi

Analyses and Findings .................................................................................................. 92
Doctors for Patients: Industrial + Civic + Domestic Compromise and Critique ...... 94
Doctors Against Violence: A Laminated Civic World (Civic + Inspiration +
Domestic + Industry) ................................................................................................ 96
Doctors Against Misunderstanding: Fame + Civic + Industrial ............................. 102
A Market-Civic World for Better Provider-Patient Relationship? ......................... 106
Slippage between the Justification and Individual Interest ..................................... 110
Discussion and Conclusion ......................................................................................... 114
Chapter Five: The Styles of Doctors’ Advocacy ............................................................ 117
Scene Style .................................................................................................................. 118
Studying Scene Styles in Online Setting .................................................................... 122
Online Sites of Data Collection and Internet Research Ethics ............................... 123
Analyses and Findings ................................................................................................ 125
Dramatizing Conflicts and Radicalizing Visions .................................................... 127
Contracting Bond, Sidelining Publicness and Civility ........................................... 131
Crowding Out Self-Reflections and Patient-Centeredness ..................................... 134
Expanding Alliance and Toning Down Criticism ................................................... 141
Discussion and Conclusion ......................................................................................... 145
Chapter Six: Conclusion ................................................................................................. 148
For China-focused Political/Public Communication Studies ..................................... 150
vii

For Studies on Profession ........................................................................................... 153
A Model Build-out for Studying Controversies.......................................................... 154
Towards an Inquiry of “Professional Publics”............................................................ 157
Limitations and Future Studies ................................................................................... 161
References ....................................................................................................................... 168

viii

List of Tables
Table 1. Plan of the Dissertation as a Double Inquiry ...................................................... 40
Table 2. Distribution of Media Justifications and Engagement ........................................ 75
Table 3. Descriptions of Medical Celebrities' Blog Content ............................................ 92
Table 4. Distribution of Doctors’ Justifications and Engagement .................................... 93
Table 5. Breakdown of Doctors’ Justifications ................................................................. 93
Table 6. Future Research of Professional Publics .......................................................... 166

ix

List of Figures

Figure 1.Doctors’ Mobilizations Against Xin'an Evening News on Weibo. ...................... 2
Figure 2. Demand for Health Information (compared with other topics) (June 2006-
September 2020); source: Baidu Index. ............................................................................ 52
Figure 3. Rise of Health News in China (Source: Duxiu). ............................................... 53
Figure 4. Example of Online Deliberation around Health Care System Reform in China
(source: Sohu.com). .......................................................................................................... 56
Figure 5. DXY 404 Page Not Found as an Online Memorial for Murdered Providers in
China. ................................................................................................................................ 61
Figure 6. Major Medical Controversies in Mainstream Chinese Media (2005-2016) ...... 71
Figure 7. Distribution of engagement and justifications in media reports about medical
controversies. .................................................................................................................... 76
Figure 8. Image Widely Circulated during the Nanping Campaign (left) Emulated
Nanking! Nanking! film poster (right) ............................................................................ 129

x

Abstract
This dissertation conducts a double encasement of “professional publics” that emerged
through medical controversies and mediated mobilizations in 21st-century China.
Specifically, rising medical controversies and media mobilizations are examined as both
instances of public and political communication and as cases of contested professional
legitimacy, agency, and embeddedness. The dissertation presents background
institutional history and public communicative contexts of a changing medical profession
in China. Inquiries draw upon the perspective of justification/engagement to assemble
multiple mediated sites and stories to understand media discourses and doctors’
advocacies. In addition, the study analyzes scene styles through which the medical
professionals coordinate among themselves to prepare for and develop advocacy online.
The three empirical studies illustrate the distinctive claims-making and cultural patterns
among the medical professionals, who participate in widely shared moral orders as well
as local, communicative settings. The dissertation develops a model through which
China-focused political/public communication studies can grow to better gather, read and
interpret the specificity, complexity, and ambivalence of issue publics (that manifest
surface contestations) and their communicative stress points (that illustrate deeper
structural struggles). The dissertation at once appreciates and reads critically the variety
of energetic efforts to defend and advance a relatively young and changing profession by
going public online.

xi

Keywords: medical controversies, public communication, professional legitimacy,
internet, China in transition
1

Chapter One: Medical Controversies and Mobilizations in
Transitional China-- Civil, Uncivil, and/or Something Else?
In 2014, the Chinese public was astonished by a seemingly sudden rise of an
active and even aggressive “medical professional public.” On Sina Weibo, China’s
Twitter-like social media platform, medical professionals “encircled and suppressed”
(wei jiao) a famed Southern Weekend
1
journalist, accusing the latter of manufacturing
multiple misleading reports about China’s medical institutions. Offline, the said journalist
was also subject to an ad-hoc press hearing that appeared to be co-set-up by the medical
professionals and state authorities to control speech in China (Chai, 2015; International
Federation of Journalists, 2015, 2016). Chinese doctors’ attacks against media amplified
and multiplied. In June 2015, “White Coat Mountain Cat,” a medical personality boasting
of 4 million followers on Weibo, asked people to “light up candle” – that is, to post
candle images – so as to jam or spam the Weibo pages of a newspaper that he denounced
as “unconscious” (wuliang meiti) and defamatory:
#Mountain Cat debunking rumors# @Xin’an Evening News has created
rumors about “the lost kidney gate,” and till this date, it has refused to
apologize or dealt with the responsible personnel. I ask internet friends to

1
Southern Weekend (also Southern Weekly) is a renowned commercialized, liberal media based in
Guangzhou, China. Despite (and because of) its affiliations with the provincial party-state, Southern
Weekend has produced many important investigative reports that mobilized critical discussions nation-
wide, particularly between the 1990s and early 2000s. In 2009, during his first visit to China, US former
president Obama requested an exclusive interview with Southern Weekend, as to “highlight an edgy,
aggressive Chinese paper that has run stories that others don’t run” (The Alantic, 2009).
2

abide by the law and light up candles in the comment sections of every
@Xin’an Evening News’ post. We are not to call names, attack people or
take a walk.
2
We just use @Xin’an Evening News’ Weibo page as an
online memorial space for the unjustly murdered doctors, and we light up
candles lawfully.

Figure 1.Doctors’ Mobilizations Against Xin'an Evening News on Weibo.

2
“Taking a walk” is a non-contentious protest strategy employed in the anti-PX protest in Xiamen, China
in 2007.
3

White Coat Mountain Cat’s call received enthusiastic responses. For months,
streams of candle images and messages wishing death and demise to the newspaper and
its editorial crew were placed on Xin’an Evening News’s Weibo page. The Chinese public
and academic perceptions of these expressions were divided. Many readers celebrated
Chinese doctors’ mobilizations as the weak-challenging-the-powerful by “extending
Chinese online civil society” with “liberation technology” (L. Chen, 2018). Others
deemed the agitating doctors to be “medical hooligans” who carried out trolling and hate
speech. For instance, Fang (2017) criticized the doctors for sabotaging journalism and
fragmenting the public sphere, aligning with the strategies of the authoritarian state. Even
the state media’s receptions were mixed: some praised the doctors for defending medical
authority (Feng & Shi, 2018; Shi, 2014, 2018) while other criticized them for creating
chaos (People’s Daily, 2016a, 2016b) and “planting thorns” (Su, 2017).
If the ultimate questions of Maoist politics are “who are our enemies, and who
are our friends” (Dutton, 2008), then the arch questions of political communication in
reform-era China appear to turn upon observing, differentiating, and understanding ever-
more complicated phenomena: What are the “civil/civic” and “public” realms? What
constitutes the “political”? From a liberal, democratic perspective, why are some
communicative practices “empowering” and others not? What are the possibilities of
“democratic” activities with “emancipatory” ends? These questions come with the
proliferation of Internet communications and China’s social changes. So, contemporary
controversies over medical mobilizations represent a new and common puzzle, as
contesting sides in distinct debates draw upon the positive labels to justify and bolster
4

themselves, while seeking out antonyms to attack and demean opponents. The solutions,
as suggested by the scholarly community, are to moderate initial Utopian optimism about
the Internet and social change (Han, 2018; Jiang & Esarey, 2018). This dissertation
critically examines the rising “incivility” around the medical profession
3
in contemporary
China.
This dissertation argues for a complex, critical review of evolving cases. While
modern communications are multifarious and ever-changing, explanations of social
dynamics have been slow to catch up. The latter by and large remains grounded on
categorical thinking. Thus, the puzzlement mentioned above partly arises from how
China-focused political/public communication scholarship has developed and been
organized. By consistently prioritizing political concerns over local practice and
meanings, building analyses with implicit, preconceived judgments, and repeatedly and
disproportionally relying upon a small set of frozen categories such as “state” and
“society,” “control” and “freedom,” communication scholarship about China tends to
cherry-pick empirics, produce ahistorical, disembedded analyses, expend nuance,
complexity, and ambivalence, and arrive at one-dimensional evaluations. Without
addressing these internal inadequacies, this scholarship does not grasp meaningfully “the
controversial” of public controversies.

3
This dissertation examines medical controversies of modern medical profession in China, not practitioners
of traditional Chinese medicine (TCM). While TCM has continuously capitivated western imagination of
the Orient, it is their modern competitors that have constituted the core of health care delivery and medical
stresses in today’s China.
5

This dissertation considers an alternative: instead of “pinning down” the civil or
political qualities of the controversies, it assembles controversial cases to probe into the
diverse, complex, and conflicted universe of meanings and attributed actions that
energize controversies. In other words, it studies discursive disputes that manifested
contested ways of understanding and labeling civility/incivility, justice/injustice, as well
as institutional agent’s own ways of acting upon these labels and articulating stakes. In
transitional China, the time-honored, Confucian concern over zhengming (rectification of
names) – or the politics of justification -- is still paramount (Lynteris, 2012, p. 5; Shue,
2004). Relatedly, “harmony” is prized and relentlessly pursued. Yet neither legitimacy
nor harmony are guaranteed or could be easily secured. Within this broad, cultural
context, evaluations of “(in)civility” and (un)ethicality have themselves become
contested stakes, struggled over by the medical providers, media/journalists, the general
public, and the state. These public discursive disputes are used frequently to feed the
regulatory apparatus. Such rich dynamics and high stakes therefore require a more
“patient” and non-reductive approach to public controversies.
The exploration of complexity requires a better understanding of local (to a
dispute) meanings and stakes articulated by actors in the controversies. To achieve such
understandings, the dissertation pursues public contestations over and related to the
medical profession in China: Why are the medical professionals advocating and
mobilizing online? Why are they aggressively attacking the journalists? What
implications do their advocacies and mobilizations have upon their institution? While
6

some of these questions may be answered through empirical data, others also introduce
the literature and inquiry of “profession.”
The current study connects with a sociological and communicative inquiry about
the profession in contemporary societies. So far, communication research about medical
controversies and mobilizations in China has primarily adopted an administrative
approach (Lazarsfeld, 1941) and a communication-as-transmission view (Carey, 1989).
In such an orientation, media discussions are reviewed to assess informational accuracy
and evaluative proclivity. A smaller number of studies have taken a public/political
communication view. They tend to lump medical controversies and mobilizations into the
general discussions about civil society and state governance, with some smacking of a
regulative undertone (L. Chen, 2018; Fang, 2017; Feng & Shi, 2018; B. Liu, Wang, &
Dong, 2019; C. Liu & Hou, 2015, 2017a, 2017b; C. Liu & Hou, 2019; Z. Liu, 2019; Z.
Liu, He, & Chen, 2019; Shi, 2014; Zhefeng, Su, & Zhang, 2019). Rarely has
communication studies considered the institutional or cultural distinctiveness of a
profession or medicine itself, let alone their unique tensions with both the state and civil
society in the Chinese society. Yet not all issue-publics are the same. Not all
mobilizations share similar opportunity structures, cultural skills, or political styles (G.
Yang & Wang, 2016). Dispute exhibit local specifics and invite deeper inquiries about
Chinese public communication (G. Yang, 2014a). The “professional” is salient in
empirics and critical to the inquiry about medical controversies and mobilizations.
Thus, the dissertation is tasked with a double inquiry: how can greater nuance
and complexity be added to China-focused political/public communication studies, when
7

the study accounts for the legitimacy stress and dynamics of China’s medical profession?
Before addressing this challenge, the study puts the burdens of inquiry into perspectives.
The following section turns to two research paradigms that illuminate and encase medical
controversies in China in different manners: China-focused scholarship on digital media
and public/political communication, and studies about the profession and professional
communication, mainly in “western” societies.
Literature Review 1: Digital Media and Political/Public
Communication in China
China established full Internet connectivity in the mid-1990s. Since then,
platforms and digital practices have quickly proliferated and continued to grow. With
these societal advances, a vibrant and vital scholarship has emerged, expanded, and
evolved around digital media, democratic politics, civil society, and public life in China
(Jiang, 2009, 2016; Kluver & Yang, 2005; Lagerkvist, 2006; Lei, 2013; Leibold, 2011; H.
Li, 2011b; Lindtner & Szablewicz, 2011; F. Liu, 2011; Meng, 2011; Tang & Sampson,
2012; Tong, 2015; A. X. Wu, 2012; Xu, 2011; G. Yang, 2003b, 2009b). In the 1990s,
many studies pursued topics such as “Will Internet democratize China” or “how would
the Internet contribute to China’s civil society” (Kluver & Yang, 2005; G. Yang, 2003a).
Such inquiry assumes deterministic impacts of new technologies while downplaying the
socio-historical specificities of the society engaging with the technologies (G. Yang,
2003a). Despite their problematic framing, questions about the Internet and democracy in
8

China have captivated consistent research and public interest, leading to two streams of
endeavors and answers.
4

Issue publics exist as the object of inquiry for the first stream. Scholars write
about “online public incidents” or hot-button issues in China, where they find and
highlight the rise of public opinion/public sphere, civil society, and citizen agency, as
well as their empowerment effect. For instance, G. Yang (2003a, 2009b) examined the
interaction among the Internet, civil society, the state, and other social forces in China,
leading to an identification of the reciprocity and co-evolution between the Internet and
China’s nascent civil society. Examining various issues and mediated communities, G.
Yang (2003b, 2009b); G. Yang and Calhoun (2007) maintained that the social use of the
Internet has fostered public debate and problem articulation, facilitated the production of
new discourses and issue publics, expanded associational activities, and introduced new
elements to popular protests. While not dismissing state control, Jiang (2008, 2009)
identified the digital spaces and communication as conducive to democratic deliberations
and civil subjectivities in China. Examining the rise of online public opinion, citizen
mobilizations, and government responses in 2007 around three cases, Xiao (2011) also
saw the Internet as more of a game-changer for China’s democratic development than
simply a safety valve for releasing public anger. Such positive assessment was echoed in
more recent studies by Harvard sociologist Ya-wen Lei and colleague (Lei, 2013, 2019;
Lei & Zhou, 2015). According to Lei (2019), at least between the 1990s and 2003,

4
To note, this division of answers is analytical and mainly in service of the current literature review. Many
fine studies combined both streams of thoughts to enhance their nuance and sophistication.
9

Chinese Internet users used the language of law and the affordance of digital technologies
to bring to life a “contentious public sphere” in China, that is, they openly discussed
socio-political problems, challenged state framing and ideologies, developed a shared,
pro-democratic or civil identity, and built social capital across various social spheres to
circumvent or resist state control.
Shifting attention away from serious deliberation and rational problem
articulation, Yang discussed the affective mobilization in China, that is, how playfulness,
anger, and grievances, and dramatic narrative forms often energize online collective
action (G. Yang, 2007, 2009a, 2012). Drawing upon Bakhtin’s discussions about
carnival, Li (2011a) understood various parodies on the Chinese Internet, including
famed examples such as the steamed bun saga and “grass mud horse”, as creative symbol
plays to “defy the current regime and to mock the lack of social justice and freedom in
China” (p.86).
To be sure, the optimism and celebration of digitally enabled democratization,
empowerment, and mobilizations are to be balanced with more critical, and even cynical
and pessimistic concerns over the authoritarian state and its impact. Therefore, the second
stream of China-focused political communication studies examines the state’s arbitrary
and formidable suppression, its adaptive capacities, increasingly sophisticated control
mechanisms, changing governmentalities, regressive politics and conservative ideologies
(Lei, 2019; MacKinnon, 2008, 2011; Repnikova & Fang, 2018; Roberts, 2018; G. Yang,
2014b, 2017a), etc.
10

So far, the above studies largely present, or do not challenge, a view of state
versus society, control versus freedom, grassroots empowerment versus official
disempowerment. Such a view is prevalent and persistent in scholarship about China,
even though it has been repeatedly criticized. The pre-occupation with liberal politics has
led to many cliché studies that fit empirics into pre-existing categories for predictable
findings. Therefore, Jiang (2016, p. 28) alerted researchers to expand categories and
attend to the “uncivil society online” in China. This new term denotes “the extreme
incivility of online exchanges between individuals and groups over public issues, which
not only fail to produce solutions to problems but also accentuate group identities and
widen the ideological chasms between them.” Wenhong Chen (2014) encouraged more
theoretical and empirical explorations of the contingent, nonlinear, and sometimes
paradoxical impact of digital media and technologies on Chinese citizens’ civic
engagement. Han (2018, pp. 153-154) noted that “concerns about the detrimental impact
of the Internet on civil society and civil participation (in China) are largely nonexistent”,
and “few have truly gone beyond the state-versus-society dichotomy to fully appreciate
the richness, diversity, and complexity of online expression in China.” To improve, Han
(2018) studied the digital communicative practices among Chinese nationalistic netizens,
commonly known as the “voluntary fifty-cent parties” or “ziganwu” to highlight China’s
fragmented public sphere. According to Han (2018), the voluntary fifty-cent parties are
witty, seemingly neutral, rational, and well-informed; they actively and skillfully engaged
in online discursive competitions, framing dissidents, political activists, and foreign
forces as national enemies, while representing the authoritarian state as a “necessary evil”
for national interests. Somewhat speculatively, Han (2018) also argued that the
11

nationalistic netizens “manufacture distrust” against democracy while contributing to the
resilience of the authoritarian state in China (p. 27).
Undoubtedly, the above reviewed studies offer important answers regarding
digital, public communication and their relevance with civility, democracy, and politics
in China and beyond. At the same time, as mentioned, this scholarship has been subject to
multifarious criticism for its persistent inadequacies. Meng (2010) criticized the
democratization approach for its narrow understanding of politics and power (manifested
through an over-emphasis on state politics), its western-centric perspective, and cold war
mentality. After reviewing over two thousand domestic (i.e., Chinese-language) and
overseas (i.e. English-language) publications on Chinese Internet Communication
Technologies (ICT), Qiu and Bu (2013) noted “obsession with (Chinese) state politics”
among the overseas scholarship, and they recommended more diversity in topics and
frameworks, more attention to micro-and-meso level dynamics, and more incorporation
of social development perspectives. Herold and Marolt (Herold & Marolt, 2011; Marolt
& Herold, 2014) co-edited two books to advocate for more anthropological
understandings about the multiplicity, complexity, everydayness, and wildness in the
online Chinese society. More recently, Guan (2019) argued that many China-focused
political communication studies suffer from “authoritarian determinism”, as they tend to
focus on (and celebrate) state-society conflicts rather than other social relationships,
focus on one-time-off events rather than longitudinal developments, and homogenize
internal dynamics of groups rather than explore the complexity and diversity inside
China. To move forward, G. Yang (2017b) drew upon insights in anthropology and
12

literary studies to invite deeper inquiries about the Chinese Internet, by attending more to
human experiences, history, and by deploying rich descriptions to circumvent theoretical
straitjackets.
The dissertation joins these emerging, critical movements towards more
complexity and ambivalence about public/political communication in China. Two ways
to overcome the reviewed orientations -- and thereby to advance a critical inquiry --
furnish the rationale for the empirical studies of public medical controversy that comprise
this dissertation.
First, the dissertation examines controversies to understand stresses in the
ongoing constructions and dismantling of communication relationships in health and
medicine. Current scholarship has been disproportionally concerned with state-society,
control-resistance dynamics at the expense of other topics and perspectives. Medical
professionals’ public controversies, communication, and mobilization in transitional
China are important and under-studied. These unfolding disputes invite communication
scholars to consider systemic problematics and distinctive institutional stress in China’s
health care. Specifically, most existing modern lines of research take a liberal political
orientation to read and interpret various public issues and their controversial disputes
about such concerns as labor rights, environmental protection, food safety, etc. So,
scholars focus on state control, speech freedom, citizen empowerment, mobilization, and
resistance, while noting little the intrinsic specificity at odds in the unfolding publicity of
shifting issues. Sharing political concerns over Chinese public communication, this study
nonetheless foregrounds a range of relationships between media and medicine, profession
13

and public as articulated on the Internet. Yet how can such foregrounding be achieved?
What are the particularities about medical controversies and professional mobilizations
beyond liberal politics, and with what implications? How can our shift of perspective
generate new insights about the multiplicity and complexity of digital, public
communication in China?
Second, the study develops contexts, maps the historical unfolding of
contestations, and identifies institutional practices and boundaries that have been put
under attack and defense. As suggested earlier, existing studies about medical
controversies and mobilizations in China appear to select different segments or aspects of
the empirics and fit them into pre-existing categories. The resultant evaluations are
therefore partial, episodic, de-contextualized, and ahistorical. To improve, this
dissertation recognizes a Chinese history of medical and professional tension. It thereby
re-embeds the recent medical controversies and professional dynamics in the broader
socio-historical changes and institutional trajectories.
Adequate understanding of digital communicative practices, as Pohjonen and
Udupa (2017) argued in their comparative studies about extreme speech online, also
requires contextualization “with an attention to user practices and particular histories of
speech cultures.” Similarly, de Seta (2018) argued that “Chinese online civility and
incivility are socially constructed by Internet users themselves in relation to their
everyday lives, media practices, and events.” These researchers recommend against
applying preconceived labels and categories to controversies, constructing less
sustainable opposition (e.g. acceptable speech vs. hate speech), and collapsing different
14

communicative practices and motivations, (Pohjonen & Udupa, 2017). Instead, they
encourage a more endemic understanding of the variety and ambiguity of online
communicative practices. Such considerations about emic categories and specific
communicative contexts are highly needed in the studies on political/public
communication in China, as this literature has often traded off nuanced understanding to
advance arguments about general patterns and broader implications (Herold & Marolt,
2011; Marolt & Herold, 2014; Qiu & Bu, 2013). Yet what specific approaches or
methods are to be employed to enable a more embedded and endemic understanding of
medical controversies and mobilizations in China? The double burden of the dissertation
requires that in studying the cases, attention be given not only to the discourse of disputes
but also to the struggle to establish and maintain institutional powers, internal to a
profession and external to the public. So, the following turns to studies about the medical
profession in sociology and other disciplines.
Literature Review 2: Professional Distinction, Legitimacy, and
Embeddedness
There are many different approaches to researching things “medical” and things
“professional.” As far as the current study is concerned, sociological studies on the
(medical) profession hold the most promise for inter-disciplinary synergy with inquiries
about political and public communication in transitional societies. The sociological
studies on professions have long recognized the profession as distinctive and important
for modern societies, at least in the claims of those advancing, practicing, and supporting
such social arrangements and activities. Earlier studies were functionalist, taxonomical,
15

and structuralist. These approaches often take professional privilege and distinction for
granted, seeing them necessary results of multiple valuable traits: for instance,
professionals have received formal training, they have a systematic knowledge base, they
hold an altruistic orientation to their work and clients, etc. (Greenwood, 1957). Therefore,
the lay public needs to offer respect and deference to the professionals, as to gain the
latter’s reliable, non-exploitive employment of valuable knowledge (Goode, 1960; also
see S. Liu, 2006; Saks, 2016 for a review on the sociology of profession) .
Communication with and among professionals was later recognized as a social
role that changed over time. For instance, symbolic interactionist Becker (1962) and
Hughes (1963) challenged the deferential and naturalized notion. As Hughes (1963, p.
658) argued,
Professionals profess. They profess to know better than others the nature
of certain matters, and to know better than their clients what ails them or
their affairs. This is the essence of the professional idea and the
professional claim. Form it flow many consequences.
In other words, “profession” is but an arbitrary label, and profession-public
communication is no more than symbolic manipulation. A profession appears to create an
ambivalent communication state. The asymmetrical quality of knowledge over a matter
of significant personal importance (law, money, health, development) leaves spaces for
controversy. Even if professional risks are assessed with the best of intent, judgment is
contingent and even successful outcomes are not without costs. Particularly, as research
continues to evolve in medical areas, gaps open among traditional home health practices,
16

conventional state-market medical availability, and the latest, risk-averse informed
medical practices.
From the 1970s onward, many Anglo-American studies about profession became
interested in accounting for professions’ success in achieving exclusive social closure
(Weber, 1978), that is, the creation of state-sanctioned occupational monopolies through
interest group politics (Saks, 2016). These studies, therefore, illustrate highly political
and competitive processes, in which professionals’ obtainment of public respectability,
legitimacy, and cultural authority are among the primary stakes. For instance,
highlighting inter-occupational competition as key to the formation of the profession,
Abbott (1988) noted the need of professionals to use television programs, newspapers,
advertising, and public relations to communicate in front of the general public to make
claims and establish their jurisdiction. Writing at a time before media convergence or the
rise of agentic, organized consumers, Abbott (1988) assumed mass communication to be
simple, straightforward processes of persuasion from the professionals to the public. He
did not consider public controversies or scandals that challenge professional legitimacy,
nor did he probe the complex processes through which profession and public
communication interact to shape each other.
Using a mixture of Marxist and Weberian perspectives, Larson (1979) introduced
the lens of “professional project,” which emphasizes professionals’ organized actions to
enhance their mobility and respectability on the one hand, and their tendencies to
monopolize opportunities in a market of services on the other hand. These two tendencies
are interlinked, so professionals pursuing market domination or monopoly need to
17

establish respectability. Particularly, Larson (1979) argued that professionals’ status
enhancement could be achieved and maintain by a matrix of four (2 X 2) sources, from
(1) autonomous sources that lie within the control of profession or (2) heteronomous
sources that relate to the culture of the society; and from (a) modern sources such as
legal-rational knowledge base of the occupation or (b) traditional conformity to pre-
modern values. Despite the framework’s potentials for studying multifarious ways in
which the profession achieves prestige, Laron’s book is mainly interested in professional
education and largely ignores media or public communication. Offering a remedy,
MacDonald (1988) explored how a number of professions in London achieved
respectability through impressive buildings, which connect with the traditional and
heteronomous dimension of professional prestige in Larson’s typology. MacDonald’s
(1988) study is rich and detailed as it drew upon Veblen’s theories of status symbolism
and Baltzell’s (1962) account of gentlemanliness. Yet MacDonald’s and following
studies continue to miss professional groups’ intersections with modern media
technologies and mediated, public communications.
In summary, the sociological writings about (medical) profession have stressed
the importance of authority, legitimacy, and social standing for the functioning of the
modern profession(als). In his research about subjectivities in modern China, Kleinman
(2011) also noted the particularly salient quest for respect among Chinese medical
professionals. Recall the Chinese doctors’ campaigns for more understanding and against
media “defamation,” one may safely recognize this pursuit for authority and legitimacy
18

as a potentially distinctive motive in medical controversies and mobilizations in
transitional China.
Another finding of the above literature review points to the lack of empirical
studies of profession-public communication that pertain to professional authority,
legitimacy, and respectability. As suggested earlier, most studies assume little agency
among the laity vis-à-vis the organized, powerful professions, and they over-simplify the
communicative processes through which professional authority may be constructed or
maintained. These tendencies are likely results of the particular time and space where
scholarship is produced. The history of the profession in American and European
societies suggests that a long time ago, “western” professions have been “split apart into
minorities of specialists who put their reason to use nonpublicly” (Habermas 1989, p.
175), preoccupied with further enhancing their organizational autonomy and elevating
their collective market position (Lo, 2002, p. 189). By contrast, 19
th
- and 20
th
-century
history has seen frequent public expressions and participations of the emergent medical
profession in mainland China and Japanese-occupied Taiwan. In early modern mainland
China, medical professionals use public communications and participation to compete
with traditional Chinese medicine, negotiate with the government, as well as mobilize
against imperialism and colonialism, to “save the race and nation”(Yin, 2007, 2013).
These distinctive socio-historical trajectories of the medical profession in China serve as
a reminder that the modern profession is highly embedded and by no means universal.
Against this background, the current case of Chinese medical professionals
constructing their reputation and legitimation through digital, public communication
19

helps close a number of wide and important gaps: first, it promises to provide an update
about profession-public communication in contemporary conditions, mediated via digital
technologies and related to the contestation and maintenance of professional legitimacy;
second, it promises to provide further understanding about the embeddedness of
profession beyond western contexts; third, it also answers Cheney and Aschcraft’s (2007)
call to extend the limited communicative inquiry about the profession; finally, it offers a
long over-due communication-as-culture rather than communication-as-transmission
perspective (Carey, 1989) to the growing studies about the contested medical profession
in changing China.
This dissertation is a study in China-focused political/public communication
studies. Controversies are the subject of inquiry. The following section considers two
complementary, research strategies that may “kill two birds with one stone.” The first
concept draws from justification/engagement analyses. The perspective is introduced to
illustrate what to look for and analyze when people themselves evaluate justice/injustice
as well as how people’s agentic actions strive to legitimate themselves in public. The
second approach -- scene styles of civic actions – also enable research about how people
engage in civic life, though with local meanings that might elude external perspectives.
Attention to scene style discloses the patterning of situated communicative practices and
provides an explanation of the predictable “filtering (out)” of certain communicative
elements in situations. The following section illustrates these methods in detail.
20

Methods for A Double Inquiry
The China-focused political/public communication scholarship has been highly
evaluative. Generally, categories such as democratic/authoritarian,
empowering/disempowering, rational/extra-rational, civil/uncivil are applied in the hope
of explaining communicative dynamics. Such an evaluative tendency is also performative
– naming practice or phenomenon democratic or civil could be facilitative to the
materialization of such democratic or civil prospect, while calling out and critiquing the
authoritarian, the disempowering, and the uncivil are also contributing symbolic forces to
their containment. Nevertheless, as critiqued previously, the China-focused scholarship
about digital media and public communication has long been organized by a limited set
of dichotomies such as state and society, control and freedom, civility and incivility. An
expansion of analytical and theoretical tools is urgently needed to broaden and further
explorations about politics and socio-cultural dynamics in China (Meng, 2010).
Not only does current scholarship traffic in stay-the-course binaries, but it also
consistently foregrounds etic (from the perspective of the observer) categories over emic
(from the perspective of the subject of a social group) ones.
5
Such a tendency has led to
criticism of the imposition of western perspectives (Meng, 2010), wishful thinking
(Herold, 2014), and even digital orientalism (Leibold, 2011). Etic naming preferences
have also undermined the capacity of the current literature to account for the growing

5
The emic/etic distinction originated in linguistics in the 1950s to designate two complementary
standpoints for the analysis of human language and behavior. Later in anthropology, etic stand for “the
ambitions to establish an objective, scientific approach to the study of culture, whereas emic refers to the
goal of grasping the world according to one’s interlocutors’ particular points of view.” (Mostowlansky &
Rota, 2020)
21

emic complexity, diversity, and ambivalence in Chinese society, online and off.
Anthropologists have noted that the landscape of morality and subjectivities in post-
socialist China has greatly expanded and diversified, leading to the rise of an incomplete
version of individualism, the co-existence and entanglement of pre-socialist, socialist and
post-socialist ethics, as well as “selves” divided and torn by past versus present, public
versus private, moral versus immoral, local versus global (Kleinman, Yan, Jun, Lee, &
Zhang, 2011). Political ideologies have also multiplied. As Jiang and Esarey (2018) put
it, “politically pathetic, populist, and extremely conservative individuals have joined
China’s netizenry” (see also Damm, 2007; Le, 2014; Pan & Xu, 2015; Wu, 2007). Under
this context, the current studies on professional controversies and communication would
benefit greatly from analytical approaches that are sufficiently open, flexible, and
grounded.
Controversies across time and cultures always appear as dramatic events, with
opposing narratives of an incident, views of its meaning, implications for fixing praise or
blame, and invitations to keep the story rolling. The discovery of a past sequence of steps
where negligence, indifference, corruption, and profiteering are followed raises the thrill
of bringing to light hidden events. The repudiation of these narratives, acts of apology,
spurs to reform, stories of promise also hold interest. This situation is an active one with
much at stake. Parties imitate strategies of attack and defense over time as certain
elements become rehearsed, expected, and fulfilled. Rather than getting straight to the
meat of medical disputes in China, a pause is necessary to understand a full range of what
is at issue. China has a Maoist legacy, and a commitment of the socialist party to modern,
22

state-based (yet market-incentivized) medical practice. Additionally, the state closely
regulates news while tolerates internet activities within limits. The opening of China
presents an opportunity to follow interactions among state and market agents, practices of
medicine, and responses of agents (journalists, citizen-journalists, family members, and
gossips) championing patients. Therefore, the next section of this chapter describes the
research strategies in a detailed manner. The immediate goals are to develop a flexible
method that is true to the controversies assembled and studied--while constructing a
conceptual model that will attend to understanding societies and communication in
transition.
Justification/Engagement Analyses
The study maps controversy first through taking up justification/engagement
analysis. Justification/engagement analysis as a methodology draws mainly from a
framework on justification co-developed by French sociologists Boltanski and Thévenot
(2000, 2006). It also incorporates Thévenot’s later work on engagement and recent
developments by other authors. Luc Boltanski and Laurent Thévenot published their now
classic work De La Justification in French in 1991 and its revised, English version On
Justification in 2006. In this book, Boltanski and Thévenot (2006) proposed a post -
Bordieuan, pragmatic sociology of critique and justification that is “at the intersection
between social justice theory and pragmatic linguistics” (Godechot, 2009, p. 193). This
sociology is to account for a number of seemingly mundane yet important questions:
How do individuals justify their actions to others? How could they instinctively draw on
23

their experience to appeal to principles they hope will command respect? How could
people discern injustice, make criticisms, reach agreements, and on what moral basis?
Justifications are located in economies of worth where value pursuits are
constructed from terms that gel together actions that are right or wrong, of greater or
lesser worth, connected or disconnected from other contexts of value. The justification
approach (also often referred to as “pragmatic sociology,” “order of worth” or
“economies of worth”) consists of two levels: the polity and the common world. The six
polities denote the “higher common principles” that derive from the canonical political
philosophies of the common good. The common world is where the worth and quality of
people or things are “tested” or assessed, often together with qualified beings as the
material extensions of the polities. To make situated evaluations or settle judgments in
everyday life, people resort to “tests” that are grounded on different principles of
common good. According to Boltanski & Thévenot, a test is highly material -- it does not
“depend on the viewpoint of an individual, nor is it a ritual or a ceremony that could be
properly called symbolic on the grounds that it depends on objects or relationship that are
deviant or artificial” (p. 132). Instead, a test challenges the distribution of worth in
situations by bearing upon the factual, objective nature of the elements that have been
invoked to establish worth (p. 133).
Boltanski and Thévenot (2006) described in detail six orders of worth that pairs
six principles of common good with material beings and issues, a “market” world values
competition and transactions; an “industrial” world that values efficiency, technical
competence, and long-term planning; a “civic” world that pursues equality and solidarity;
24

a “domestic” world that values traditions and trustworthiness entrenched in local and
personal ties, an “inspired” world that values creativity, emotion, or religious grace; and a
world of “fame” or “renown” that is based on public opinion (Thévenot, Moody, &
Lafaye, 2000, p. 273).
6

Later, Thévenot and colleagues’ sociology of engagement further extended the
analytical framework, adding the regime of individual interest and the regime of
familiarity to the established regime of justification. While justifications must respect
common humanity and common dignity (Boltanski & Thévenot, 2006, pp. 74-76), the
other two regimes could accommodate less publicly justifiable arguments (Eranti, 2018).
Regime of Individual Interest: In their collaborative and comparative research,
Moody and Thévenot (2000) considered the place of strategy of individual interest vis-à-
vis common good in public arguments and actions. Later, Thévenot (2007, 2014)
proposed a framework of four regimes of engagement, including the regime of individual
plan, regime of familiarity, and regime of exploration. As the last regime has hardly made
any appearances in the empirical study later, the introduction shall not discuss this regime
in detail. According to Thévenot (2014), the regime of individual plan is where
individuals project their will into the future for functional accomplishment. People are
evaluated not by orders of worth but by their accomplished will -- becoming autonomous

6
Later the authors and colleagues also noted the seventh worth – the environmental or “green” world that
emerged in contemporary society. This dissertation does not introduce the green worth because of its lack
of relevance in the data and analysis.
25

and willful means ascendance in this regime. Passing on functional information, people
engage with one another through joint projects or contracts.
Eranti (2018) built upon Thévenot framework and clarified the regime of
individual interest through studying arguments visible in land-use conflicts in Helsinki,
Finland (Eranti, 2017). According to Eranti (2018), people in the regime of individual
interest build commonality not by referring to shared, higher principle, but by way of
mutually accepting each other’s stakeholder views, preferences, choices, and interests,
and brokering deals in order to follow a plan. In this regime, the actors are legitimate if
they can present their preferences as if drawn from a publicly available pool of options.
In public discussions, the central rhetorical move is to construct the interest-holding actor
as a legitimate representative of a large or small community. The community is an opt-in
one of preferences. Unlike higher principles, preferences and interests can be adopted,
discarded, haggled over, and compromised by the actors (p. 59).
Regime of Familiarity: The regime of familiarity or affinity is at the lowest level
of commonality or generalizability, since it is “mainly concerned with personal affinity,
experience, and emotions.” Familiarity is perhaps best described “by the phrase:
‘inhabiting a home’.” (Thévenot, 2001: 69). When in familiar surroundings, people can
act based on habit, without critical reflection on the value-basis of their actions, while
maintaining a feeling of ease (Thévenot, 2007, p. 416, 2011, p. 14–16, 2014, p. 13–15,
19–28). Objects that people engage with in the familiar regime can be material or cultural
artifacts (see also e.g., Latour, 2005). Called “common-places”, they are invested with a
“strongly personal engagement” and breed “confidence” (Thévenot, 2011a: 49). They
26

“are not merely symbols, or signs, because they are the vehicle for deeply personal
attachments” (Thévenot, 2014, p. 20). Such familiar engagement using common-places
can take the form of political action, even though it is “not taken into account in most
approaches to politics.” (Thévenot, 2014, p.10) Common-places can even be
“instrumental in support of authoritarian power” (Thévenot, 2015, p. 98), since they are
“by construction, rather foreign to strangers.” (ibid) In other words, common-places may
exclude others, while they form a strong bond between those who share them.
Applying Justification/Engagement Analyses to Medical Controversies in China
To be sure, justification/engagement analyses are not grounded research methods
that allow emic categories to emerge. The method is arguably structuralist and even
deterministic, consisting of well-structured orders of worth based on “western” canons
that promise to illuminate universal moral orders (Godechot, 2009). The risk of imposing
foreign perspectives still exists. Still, in comparison with previous studies that heavily
rely upon categories such as “state” vs. “society”, “empowerment” vs.
“disempowerment”, “civility” vs. “incivility”, the wide range of categories provided by
the justification/engagement analyses provide a fresh and significant extension. For
instance, in addition to accounting for the civic world that pertains to solidarity, legality,
state accountability, citizen rights – issues often discussed in China-focused
political/public communication, the justification/engagement analyses also consider
moral actions related to the order or worth of “market,” “industry,” and “fame.”
Additionally, by studying medical provider’s public justifications and critiques, one
approximates these agents’ own ways to understand and articulate justice/injustice,
civility/incivility, appropriateness/inappropriateness in their situations, rather than
27

prioritize the researcher’ own assessments. As a result, the justification/engagement
approach appears to facilitate pragmatic analyses, but it is to be applied with caution. In
the current study, it will be combined with a more ethnographic understanding of the
moral contradictions, multiplicity, incompleteness and diversity in post-socialist China
(Kleinman, 2011; Palmer, 2019; Yan, 2011). This way, the resultant approach promises a
finer and more local understanding of multiple motives and modes of practices in public
communication in digital China.
Attention to the nuanced steaks of a great dispute is important. At the same time,
the justification/engagement approach can illuminate Chinese medical providers’
constructions and maintenance of their contested legitimacy and authority. As noted,
legitimacy and authority are among the primary stakes for the profession, particularly the
profession under formation. Medical providers’ public justifications and critiques do not
only convey the actors’ sensemaking and understanding; they are also performative,
actively constructing and maintaining the providers’ legitimacy and authority. The
usefulness of the justification/engagement approach to studying medical providers’
legitimation is made more explicit when the approach is situated within the scholarship of
institutional and organizational legitimacy. Also recognizing legitimacy as a fundamental
stake for institutions, many organizational and institutional scholars have researched the
communicative processes of institutional legitimacy (Bitektine & Haack, 2015;
Deephouse & Suchman, 2008; Joutsenvirta & Vaara, 2009, 2015; Suddaby, Bitektine, &
Haack, 2017; Vaara, 2014; Vaara, Tienari, & Laurila, 2006). Recently,
justification/engagement analyses have been received welcomely in this literature as an
28

addition and improvement to the communicative approach.
7
On the one hand,
justification/engagement analyses provide more comprehensive categories with less
ideological baggage than the critical discursive approaches (Joutsenvirta & Vaara, 2009,
2015; Vaara, 2014; Vaara et al., 2006). On the other hand, compared with rhetorical
approaches to legitimacy that are informed by the institutional logic perspective,
justification/engagement studies better illuminates actors’ agency, their cultural
resources, while highlighting the salience of normativity and the fragmentation,
instability or multiplicity of institutional environment in legitimacy contestation (Cloutier
& Langley, 2007, 2013; Patriotta, Gond, & Schultz, 2011; Reinecke, van Bommel, &
Spicer, 2017; Suddaby & Greenwood, 2005). Thanks to these distinctive advantages, the
justification/engagement approach is distinctively appropriate for studying the legitimacy
dynamics of the Chinese medical profession. As the profession is under formation,
transition and contestations, macro-level, ideological assessments may be misplaced, and
a stable institutional environment and logics are yet to be found or established.
Scene Style of Civic Actions
The dissertation commits to reading controversy by expanding analytical
categories and illuminating legitimacy questions in instability. But the dissertation also
adds to these concepts, a more ethnographic approach that better captures local meanings
and emic categories. It aims to illuminate “user practices and particular histories of

7
Other approaches to studying institutional legitimacy includes (1) the view of legitimacy as a property
(which usually sees legitimacy as a matter of fit between organizations and its environment), and (2) the
view of legitimacy as perception (which is primarily interested in the psychological dynamics among
individuals that might lead to institutional results) (Suddaby, Bitektine and Haack, 2017). The
communicative approach to legitimacy is arguably marginalized in the institutional organizational studies.
29

speech cultures” as well as the variety and ambiguity of online expressions and strategies.
The ethnographic commitment exposes the limitations inherent to the
justification/engagement analyses. For instance, the justification approach presents a
view of “critical capacity” (Boltanski & Thévenot, 1999) or competency that is universal,
unbridled, relatively disembedded and selectively de-institutionalized (Cloutier &
Langley, 2013; Friedland, 2013; Thornton, Ocasio, & Lounsbury, 2015). While such a
competent view is in keeping with the tendency to highlight agency in the China-focused
political/public communication, it too falls short of understanding how agency interacts
with, and is bounded by institutions, organizations, or more specific and local contexts.
What are the boundaries and limitations of Chinese doctors’ agency and their
justifications as they campaign publicly? While there is no need to embrace fully the
state-society, control-freedom paradigm, one may quickly surmise the state’s force to be
an influential factor. The transitional institutions and the stresses they generate are
impactful. How do controversial confrontations among justifications that set scenes
manifest themselves in or exert influence upon the digital, public communicative
practices of medical professionals? This is a key communication question to be pursued
in reading the “scene style” produced by participants debating the standing of medical
practices in China.
To read and assess the exchange among agents of medical controversies, the
current study deploys a cultural interactionist approach (Eliasoph, 1998; Eliasoph &
Lichterman, 2003; Lichterman, 2006; Lichterman & Dasgupta, 2020; Lichterman &
Eliasoph, 2014). In particular, the concepts such as “group style” and “scene style” are
used to interpret each controversy. To some extent, group style or scene style resemble
30

institutional logics, that is, “bundled sets or ensembles of higher-order meanings, values,
norms, and/or rules that frame how individuals make sense of the world around them and
consequently know how to act.” (Cloutier & Langley, 2013, p. 361) Group style or scene
styles enjoins researchers to view the recurrent patterns of interactions that arise from a
collectivity’s taken-for-granted understanding about how to act (together) and relate to
one another in settings. While institutional logics “focused on formal organizational
‘myths’ or implicit ‘schema’ or ‘cultural models’ that shape action across whole
organizations or fields” (Lichterman, 2006, p. 52), group styles and scene styles are
uniquely useful for illuminating informal and implicit patterns that coordinate actions and
interactions in specific settings.” (ibid)
The emphasis on setting connects with Goffman’s (1986, pp. 8–10) insight about
“scenes”, which are constituted by actors’ implicit assumptions about “what is going on
here” in this “strip of action.” When participants’ shared assumptions about what is going
on have changed, then the scene has changed, even if they are still physically in the same
setting. “Style” describes the making of a scene (Blee, 2012). While “group style”
describes relatively simple organizations or assumes a consistent style denoting a group,
“scene style” facilitates descriptions of more complex and multifaceted organizations as
it acknowledges that there may be multiple “scenes” with multiple “styles” in any
organization (Lichterman & Eliasoph, 2014, p. 815). Specifically, styles could be
analyzed and presented through a tripart heuristic (p. 739): (1) map -- a collectivity’s
implicitly shared understanding of their relationships with the wider world in the setting;
(2) bond -- the collectivity’s shared assumptions about obligations between members in
the setting; and (3) speech norms -- the shared assumptions about the appropriate speech
31

genres and the appropriate emotional tones to display for a setting (Lichterman &
Eliasoph, 2014, p. 814).
To obtain an in-depth understanding of group scenes or scene styles, scholars
conducted extended ethnography (e.g., participant observation) to study how people
interact with one another and form collectivities over time face-to-face. Scholars also
conduct theoretical sampling of sites, take extensive field notes, undertake constant
comparison, and use theoretically oriented analytical induction (Dasgupta & Lichterman,
2016; Lichterman, 2002; Lichterman & Reed, 2015). Even though previous studies on
group styles and scene styles have been concerned with offline interactions and
organizations, the researcher sees no reason why this approach could not be extended to
online groupings and virtually coordinated actions. As Hine (2015, p. 34) argued, online
interactions “can form cohesive social entities that are readily describable in terms such
as community, or they can offer more diffuse social formations that still offer their
participants a sense that they are in a distinctive space which carries certain expectations
of their behavior and still have characteristic amendable to ethnographic exploration.”
The research methods and strategies for studying scene styles offline could be applied to
studying Chinese medical providers’ online interactions and campaigns, as they are also
re-occurring, meaningful, and more or less patterned and collective. By analyzing the
scene styles of Chinese medical professionals’ online advocacy and mobilizations, this
dissertation promises a much-needed understanding of the local meaning-making
processes and emic categories that energize medical controversies in the Chinese online
society. At the same time, by highlighting the situational shaping and patterning of
professional campaigns, this study also provides a less strategic understanding of
32

profession or profession-public communication, even when professional legitimacy is at
stake.
Assessing Compatibility, Combining Insights
While the above studies have introduced (1) justification/engagement and (2)
scene style respectively, a note is necessary to assess their compatibility and their
synergistic potential. There are obvious differences between these two approaches: first,
whereas justification/engagement analyses mainly examine how people instantiate
macro-level principles and orders in local situations or at a micro level, scene style
studies are mainly concerned with micro- and meso-level dynamics; second, whereas
justification/engagement analyses stress agency, scene style studies note much of the
confining effects of local cultures. Arguably, these differences could lead to
complementarity. At the same time, these two approaches are similar and highly
compatible: first, both approaches illuminate cultural repertoires (Lichterman &
Dasgupta, 2020; Lichterman & Eliasoph, 2014; Silber, 2003, 2016), i.e., a finite number
of relatively autonomous cultural structures that are widely shared in a given society.
Second, both approaches allow open and relatively flexible analyses. Neither approaches
start with presumptions about power, privilege, domination, civility or incivility,
democratic or authoritarian regime rule. Instead, the justification/engagement analyses
offer a wide array of justifiable orders of worth and acceptable forms of engagement;
while the scene style studies enable a more grounded, inductive view of local
understandings of appropriateness, together with a typology of known scene styles from
previous research (Lichterman & Eliasoph, 2014). Third, to address the normative and
political concern of China-focused political/public communication studies, both
33

approaches are connected to a broader literature about democracy, civil society, and
justice. The framework of justification and critiques provides an understanding about
which specific cultural forms are part of the democratic polity’s life and what impact they
have on it, by studying how aspirations to justice and justification are put to use (Eulriet,
2014, p. 415). It also provides a framework to understand how differences can co-exist
and resolve disputes peacefully in liberal democracy (Patriotta et al., 2011). Studies about
scene styles are also partially normatively motivated. They are concerned with
understanding the internal dynamics and dilemma in civil society, which may result in
differentiated communication patterns, resource obtainment, identities, organizations,
with further implication on the quality of the public sphere and democracy (Eliasoph,
1998; Eliasoph & Cefaï, 2020; Lichterman & Eliasoph, 2014). Putting these approaches
together, the current research approach, therefore, promises to illuminate the less
conspicuous political cultures and moral stakes that underlie and organize public
controversies and communication in contemporary China.
In sum, this dissertation is not to exhaust all empirics related to medical
controversies in China. Rather, by studying the justifications/engagement and scene
styles of the professional publics who advocate and mobilize, this dissertation seeks to
expand scopes for, and add nuance and depth to, China-focused political/public
communication studies. Additionally, it seeks to close the gaps on studying how mediated
profession-public communication relates to professional legitimacy in medicine – an
issue of increasing urgency as digital media practices have raised new challenges to
professional authority and control in many societies (Farnan et al., 2013; Lewis, 2012).
34

The proposed solutions to achieve research goals (justification/engagement analyses and
scene style studies) would prove themselves useful when the analyses they lead to
produce more nuanced understanding about the complexity and ambivalence in Chinese
public communication, and when they illuminate the richness and dynamics of mediated
profession-public communication as well as its implications on professional legitimacy in
China.
Operationalization, Positionality and Reflexivity
Since the processes to collect data and operationalize the justification/engagement
analyses and scene style studies are quite complex, they will be explicated in the
following empirical chapters. Importantly, this dissertation mainly uses textual analysis
and online ethnography to examine various found materials, conversations and
interactions on both legacy and digital media. To do so, the researcher has carefully
considered the ethics and practical challenges of studying mediated, online
communication (Buchanan & Ess, 2009; Ess, 2007; Ess & Jones, 2004). The dissertation
has received IRB approval from the University of Southern California.
Additionally, the researcher has also been informed by offline ethnography,
observations, face-to-face and remote interviews with medical professionals and health
journalists in other research projects, even though these additional projects and their data
do not appear in the current study. To note, the researcher comes from a family of
medical professionals in China, with her parents and many of her extended family
members working at different public hospitals. For many years, the researcher’s family
has resided in hospital dormitories. Since childhood, the researcher has frequented public
35

hospitals and stayed at her family’s workplace to hang out or kill time, with medical
professionals and their children – the so-called “hospital children” (yiyuan zidi). As many
Chinese public hospitals are public or semi-public, with clinical interactions open to
public visits and observations, the researcher has witnessed innumerable medical
encounters and habitually observed medical professionals over the years, long before the
familiar site become a research site. Over the dinner tables at home or at the hospitals’
canteens, the researcher has often heard discussions about medical professionals’ work-
related stresses and issues, including patient-initiated violence or sensationalist medical
scandals. It is family and friends’ complaints that have initially invited the researcher to
examine medical controversies in China.
Despite such personal connections with medical profession and institutions in
China, the researcher did not find herself entirely native to or in full identification with
the medical professionals. Nor was the current dissertation simply an attempt to “rectify
the names” for medical professionals. As a student of language, media and public
communication, the researcher often herself persuaded and moved by critical discussions
about medical professionals by journalists and the lay public rather than by doctors’
justifications. Personal proximity has allowed the researcher to see first-hand corruptions,
improper management, troubled communication, and many other problems in public
hospitals, as journalists and the lay public criticized. In fact, many medical professionals
are also in agreement with the critical journalists and lay public about themselves and
their institutions. In other words, the researcher’s social positionality – being a semi-
36

insider in the medical community through family connections – does not bind her to
natural or full identification with the perspectives and views of the medical professionals.
That being said, the researcher also finds it impossible and unethical to dismiss
doctors’ arguments and complaints. Growing up in a medical community and often
overhearing the discussions among medical professionals, the researcher has a more
intimate understanding about the work stress, life imbalance and financial constraints that
many Chinese medical professionals experience. The researcher therefore seeks to take
doctors’ complaints seriously. It is to this goal the ethnographic observations and
interviews conducted outside the dissertation project aid. For instance, in a
methodological course on qualitative research taken in 2016, the researcher interviewed
nine Chinese medical professionals who were visiting in the US. These medical
professionals come from different parts of China. Their age, trainings, work experiences
and understandings of medical profession vary. Nonetheless, all of these interviewees
brought to light some aspects of their work-related challenges, such as misunderstanding,
disrespect and even violence from patients, suppression from administrators, pressure to
research and publish, meager official payment, the inappropriateness of insurance policy
and malpractice law, etc. Such work challenges were often contrasted with the better
work terms and conditions for medical professionals in the US. With each interview
lasting for 60 - 90 minutes, the researcher better understood the prevalence and
implications of stress in China’s healthcare.
In another summer research project, the researcher shadowed six Chinese doctors
and nurses in a basic public hospital and observed medical encounters more
37

systematically. It was not until then the researcher gained a brief but deeper
understanding of the corporeal intensity and exhaustion that medical professionals have
to experience and take for granted on daily basis. Such intimate knowledge and exclusive
experience have made the researcher more sympathetic to the Chinese medical
professionals’ perspectives and voices. Yet the exclusivity of such experience also
hinders its communication in the public sphere. At the same time, ethnographic
observations, physical experience and casual conversations with medical professionals at
their workplace also confirmed and expanded the researcher’s understanding of the
problems in health organizations. Again, corruptions, aloofness, and inefficiencies were
witnessed, together with genuine care for the patients and devotion to the work. What is
developed in these processes is a complex view of the medical world that harbors various
internal contradictions.
In sum, the researcher often experience tension between the so-called doctors’
perspectives and those of their critics, even though the researcher does not fully or
exclusively identify with either. Eventually, the researcher decided that the dissertation
came neither to praise or bury Chinese medical professionals, or their critics. Instead, the
dissertation is to recognize and make sense of different voices and perspectives
analytically. It is these multiple and conflicting perspectives that continuously energize,
expand and interweave the conversations and disagreement around medicine in China.
Therefore, maintaining a tension-ridden dialectics between different perspectives and
categories (e.g., etic and emic) shall facilitate a richer understanding of medical
controversies.
38

Plan of the Dissertation
Chapter One introduces the topic of the dissertation -- medical controversies and
mobilizations in reform-era China. It explains how the novel empirics offers
opportunities to extend China-focused political/public communication studies as well as
communicative inquiries about the profession in transitional societies. To fulfill the
research promises, the chapter also introduces and assembles justification/engagement
and scene styles as analytical approaches. The result is a double inquiry that assembles
various methods and one set of empirical studies to address two sets of issues (see table
below).
Chapter Two illustrates the intersected socio-historical changes and institutional
background within which the Chinese medical profession is embedded, and from which
their contemporary grievances and controversies derive. The chapter also briefly
describes the status of medical controversies and mobilizations on the Chinese Internet.
Such contextualization prepares for a more embedded understanding of medical
controversies and mobilizations, and their more detailed analyses in the following
chapters. Chapter Three illustrates the methodology of the justification/engagement
approach in detail. It then adopts this approach to analyze a small corpus of media reports
on high-profile medical controversies that occurred in China between 2005 and 2016.
This chapter reveals the moral stakes and the “legitimacy stress points” of the medical
profession as articulated by China’s mainstream media. These media justification and
critiques also contextualize medical providers’ advocacies and campaigns later.
39

Chapter Four applies the justification/engagement framework to analyze a
textual corpus of doctors’ multiple campaigns between 2005 and 2014. The analyses
showcase that Chinese doctors mobilize various moral frameworks, not so much to
justify themselves vis-à-vis media criticism, but to problematize the state, the media, the
health care system, and medical institution, and to present their occupational challenges
as “social sufferings” (Kleinman, Das, Lock, & Lock, 1997) and public stakes. The
findings also showcase the moral multiplicity and ambivalence of medical professionals’
campaigns, which contain both public justifications drawing upon various orders of
worth, and arguments that convey “incomplete individualism” (Yan, 2011, 2018) and
manifest painful selves divided by the moral and amoral (Kleinman, 2011). The findings
also highlight a few often-neglected moral orders that are more salient in doctors’ public
communication, including “the industrial world” and “the world of fame.”
Chapter Five moves from analyzing textual content of mediated controversies to
studying the patterns of the doctors’ mobilizations that develop in specific online
situations and communities. The chapter noted “community of interest” as the dominant
scene style among medical providers as they interact online, preparing or developing
advocacies. It also noted dynamics that expand or contract the medical providers’ vision
and solidarity, leading to their occasional coordination through “social critic” and
“community of interest” styles. Still, possibly due to control, lack of institutional
progress, and other factors, the community-of-interest reigns. Therefore, Chinese doctors
are more likely to perceive themselves as a victimized minority in which discussions
about “medical ethics” and “self-reflection” are illegitimate and inappropriate.
40

Chapter Six – the concluding chapter – discusses the implication of the findings
as well as the current research framework. It considers the limitations of the current
dissertation as well as plausible, near-term remedies. The chapter also suggests two
general ways to advance scholarship: a political-cultural approach to studying China-
focused political/public communication, and more communicative studies about the
increasingly salient profession-in-public in transitional China.
Table 1. Plan of the Dissertation as a Double Inquiry
A Double Inquiry of “Professional Public” in Transitional China
Ways of Encasing China-focused political/public
communication
Professional communication,
legitimacy, and embeddedness
Research
gaps/questions/goals
How to study public controversies in a more
nuanced, complex manner?
How to study mediated profession-
public communication that implies
on professional legitimacy (in
transitional, developing societies
such as China)?
Proposed Solutions and the Questions They Lead To
Socio-historical
contextualization
(Chapter 2)
What are the socio-historical contexts in medicine and media that help shape
medical controversies and professional communications in China?
Media’s
justification/critiques
(Chapter 3)
How do media justify or critique medical
professionals during medical controversies,
and what are the perceived stakes?
What is the public opinion
environment in which doctors find
41

themselves and become
agitated/active?
Doctors’
justification/critiques
(Chapter 4)
How do doctors understand what are
civil/just/appropriate/just? What are the
stakes they articulate?
How do medical professionals
competently enact macro-
level/shared cultural structures in
micro/local situations to justify and
legitimate themselves? How do
these justifications/critiques relate
to/interact with the media’s?
Doctors’ scene styles
(Chapter 5)
How do doctors create publics and engage in
civic actions through interactions? How do
doctors understand what are
just/civil/appropriate in situations, and how
do they act upon these understandings?
How profession-public
communication might be
constrained by cultural patterns in
local contexts in which profession
coordinate their communicative
action?

42

Chapter Two: Embedding Professional Publics in Changing
China
How to contextualize the rise of professional publics, that is, the medical
professionals who engage in public controversies and mobilizations -- in reform-era
China?
In a general sense, this professional public is connected with widespread
grievances, increasing disparity, the growth of popular contention and conflicts (Gries &
Rosen, 2004), the emergence of civil society (G. Yang, 2003a, 2003b), the
commercialization, liberalization and digitalization of media (Y. Zhao, 1998, 2000a,
2008), the ascendance of law, the development of “the contentious public sphere” (Lei,
2019), and the synergistic ethos of multiple issue-specific publics (Yang, 2009) during
China’s Great Transformation (Polanyi, 1944). At the same time, this professional public
is embedded in a perennially conflicted relationship with the Chinese state, as well as the
state-led health and social governance in China. This relationship consists of control,
resistance, and competition, yet it also involves adherence, complicity, collaboration, and
internalization. This chapter first illustrates this tension-ridden relationship in the socialist
and post-socialist Chinese health care system. Then it turns to illustrate the rise and
mobilization of medical professionals on the Chinese Internet in recent years.
Medical Profession in Pre-Socialist and Socialist China
The modern medical profession was introduced to China in the late 19
th
century
by western missionaries and imperialists. During the Republican era (1912-1949),
medical professionals in major Chinese cities were common and privileged. They
43

practiced medicine privately and organized themselves freely through corporate
associations. Thanks to their corporate autonomy and power, these medical professionals
were able to negotiate with the state and persuasively influence the general public (Yao,
2016; Yin, 2007, 2013).
The establishment of the People’s Republic of China in 1949 led to dramatic
transformations to the organizations, ideologies, and training of medicine. In the early
1950s, the communist regime proposed four principles to direct healthcare affairs (Sidel
and Sidel 1973): (1) medicine had to serve gong-nong-bing (workers, peasants, and
soldiers); (2) preventive medicine had to be given priority over curative medicine; (3)
Traditional Chinese Medicine (TCM) practitioners had to be united with practitioners of
Western medicine; and (4) healthcare had to be integrated into mass movements. As the
first and fourth principle made clear, medical professionals in China were no longer free
and privileged. They were quickly incorporated into the new regime’s governance
machinery its waves of political movements.
Medical education was overhauled as a result. In order to better serve workers,
peasants, and soldiers, and to integrate medicine into mass movements, the Maoist state
mandated significant shortening, simplification, and politicization of medical training.
The medical professionals were also heavily impacted by various political mobilizations
and attacks, including the Patriotic Hygiene Movement that challenged medical authority
by assimilating it into mass movements; the bitter debates over “red versus expert” that
suspected the political loyalty of experts; the Great Leap Forward that promoted daring
research and practice agenda such as “Let Tumor Yield” and “Hypertension, Give Way”.
Most notably, in June 1969, Mao criticized the Ministry of Health as a “Ministry of
44

Urban Gentlemen’s Health”, thus setting the tone for medical professionals’ turmoil
during the decade-long Cultural Revolution: between 1966 and 1976, most medical
professionals, in urban areas, including senior authorities, were “sent down” to rural
areas; at the same time, barefoot doctors who had received preliminary training were
exchanged to serve the cities (C. Zhu & Zhang, 1990). It is these impacts that have led to
the arguable “deprofessionalization” of medicine in China.
Aside from the political turmoil, medicine during the Mao era was also
nationalized and bureaucratized. Almost all medical providers in urban areas were
absorbed into and made dependent upon their danwei (work unit). As Walder (1983)
argued, danwei provided its members exclusive opportunity to practice medicine, a set
career path, welfare, socio-cultural life, and identities. Perhaps unsurprisingly, all the
independent professional associations that used to organize and empower medical
professionals in the Republican era were either disbanded or transformed into semi-
official organizations. Therefore, even though medical authorities during the Mao era
have attempted to tactically resist socialist assimilation through discursive actions, their
resistance was to little avail due to their lack of power vis-à-vis the state (Lynteris, 2012;
Yao, 2016).
Institutional Transitions and Grievances
Starting from the late 1970s, the Chinese state and society entered a new era of
“reform and open up.” Like in as many other public sectors, the post-socialist Chinese
state implemented a dual-track system in its health care system, in order to facilitate the
latter’s “growing out of the plan” (Naughton, 1996) for a “reform without losers” (Lau,
45

Qian, & Roland, 2000). The market side of the dual-track health system reform included
the state pushing public hospitals to the market: before 1978, state subsidies accounted
for 50% of public hospitals’ revenue. This number dropped to 30% in 1980 (World
Health Organization, 2015) and 10% and even less between the 1990s and 2010s (World
Bank, 2010, p. 8). At the same time, the state loosened direct management, allowing
public hospitals to seek ways to make profits, including earning 15%-20% markup when
dispensing pharmaceuticals and medical treatments. Private facilities and practice were
also allowed with limitations. By 2012, about 42% of the Chinese health facilities had
become private (Eggleston, 2010, p. 15).
On the other hand, the state still maintains its ownership of key medical resources
and larger hospitals in China--despite changing ownership structures. With the intention
to better accommodate patients’ interests, in the public hospitals, the state also
consistently suppresses the salary for medical providers and the prices of basic
pharmaceuticals and services (Yao, 2018). In 2014, the average monthly salary among
medical providers in public hospitals was only 3667 RMB (about 524 USD), only 10%
higher than the national average salary.
The dual-track health reform, combined with various systemic flaws, has
engineered perverse effects that gravely afflicted medical professionals and patients—
however well-intended it might have been. For instance, Chinese patients pay for specific
items or services rather than their health performance. Also, under-funded public
hospitals and medical professionals have been allowed to receive markups through
prescriptions. As a result, medical professionals in public hospitals were systematically
incentivized to overprescribe or induce patients to overconsume medical products.
46

Starting from the 1990s, 90% of public hospitals’ revenue comes from “selling” medical
products and services. Practicing over-prescription was necessary for individual and
institutional survival as well as ethically troubling for many medical professionals. Still,
in a 2014 survey of 700 medical providers in 17 public hospitals, 86.6% of medical
providers believed they were underpaid at work (Y. Wang & Gao, 2014). Senior medical
authorities in Beijing complained that their official income for operating a multi-hour-
long operation is lower than what a barber would charge for a simple haircut in the same
area (Yao, 2018). Additionally, defined as “personnel” of public institutions (shiye
danwei), doctors appear legally ambivalent subjects who have been historically outside
the protection of the Labor Law of the People’s Republic China (Zhou, Yan, & Huang,
2016). This is because the Labor Law focuses on protecting laborers who sign an
employment contract with a private enterprise, not public institutions. Therefore, doctors
who experience labor abuse are unlikely to go to the courts or take to the streets.
Doctors are not a unified group. Stratification and disparity among medical
professionals in public hospitals grew drastically in the reform era. Senior professionals
in certain departments in secondary and tertiary, urban hospitals are likely to be avidly
courted by patients and pharmaceutical sales representatives. Some receive or request
handsome “grey income” and are rewarded with bribes such as red envelope or kick-back
money for under-the-table deals (Blumenthal & Hsiao, 2005; Hsiao, 2008; Hsiao & Hu,
2010; Yao, 2016, 2017; Yip, Hsiao, Meng, Chen, & Sun, 2010). By contrast, junior
providers in other departments in lower-tier hospitals or rural health facilities are unlikely
to receive much unofficial income and often complain about their meager payments.
Medical professionals in larger urban hospitals are often overworked, lacking time to
47

properly communicate with patients. Many experience burnouts at an early stage of their
career. Meanwhile, rural health facilities were often under-visited.
The system generates widespread discontent (Blumenthal & Hsiao, 2005). Partial
marketization led to a significant increase in out-of-pocket health expenses for many and
health disparities and grievances grow among the Chinese public. China’s population also
experienced a precipitous decline in effective health insurance coverage. Agricultural de-
collectivization and the break-down of the “iron rice bowl” policy for many urban formal
sector employees (Eggleston et al. 2007) have generated more individual costs and less
security. Eggleston (2010) identified a whole generation of rural population deprived of
health insurance, when the Cooperative Medical System collapsed in the 1980s and
remained below 10% till 2003. With little government funding or insurance support,
average medical expense per inpatient grew from 29% of per capita GDP in 1990 to 33%
of per capita GDP in 2005. Unsurprisingly, then, affordability and accessibility of
healthcare ranked among Chinese citizen’s top concerns (S. Hu, 2006; Ru et al., 2006),
and complaints about “seeing doctors is expensive and difficult” (kan bing gui, kan bing
nan) and “becoming poor because of illness” (yin bing zhi ping) abound and resonate
widely (Eggleston, 2010; p. 13-4). It is against this background that provider-patient
relationships in reform-era China have become severely challenged, with widespread
perceptions of injustice in public hospitals and medical system (Ru et al., 2006; Tucker et
al., 2015), mutual distrust between providers and patients (Nie et al., 2018), and a rapid
increase of patient-initiated attacks against medical providers: In 2006, China’s Ministry
of Health reported 9831 “major disturbances” involving physical violence in Chinese
health facilities. By 2010 this number had increased to 17, 243 (Zhong, 2012). Between
48

2005 and 2015, at least 101 incidents of serious medical violence have occurred, in which
24 doctors or nurses died (Pan et al., 2015). Increasing violence feeds into a vicious cycle
of mistrust between medical professionals and patients, even if they are always mutually
dependent.
Despite persistent overall lack of financial investment in health care, the reform-
era state appeared over-responsive to individual patients’ grievances and paradoxically
“encouraged” doctor-patient confrontations and violence (Liebman, 2013). Between from
April 2002 and June 2010, the state regulation demanded reverse onus in medical
disputes, that is, shifting the burden of proof onto medical providers to disprove charges
during medical disputes. The regulation significantly increased the number of medical
disputes, leading to more medical providers’ complaints over their work conditions.
Local states and hospital administrators hungry for stability and harmony often rushed to
settle complaints with money rather than law or regulation, thus the development of
organized, for-profit disputants commonly known as “malpractice mobs” (yi nao) were
born. The latter actively threatens medical providers with violence for profit.
Despite various work-related grievances at public hospitals, Chinese medical
providers were given few viable options to resist, leave, or change. The danwei system
that cultivated strong dependency during the Mao era is still powerful in the health sector
after 1978. Most medical doctors in public hospitals hold shiye bianzhi (employment of
staffing quota in the public institutions), which guaranteed life-long career security and
welfare (Yao, 2017, p. 11-12). Even in highly mobile and developed metropolises in the
late 2000s, Chinese medical professionals still tend to cluster in the same residential areas
and socialize with other “danwei people.” This way they build, maintain and reinforce
49

exclusive communities and identities (Mason, 2016) that rest upon their profession and
state affiliations. Medical providers interested in better career development also tend to
stay at public hospitals for their near monopoly and bureaucratic privileges in China’s
health delivery market. In 2012, it is the state-owned hospitals that held nearly 85% of all
beds, over 85% of all health personnel, nearly 90% of all outpatients’ services as well as
nearly 90% of all inpatient services (Ministry of Health of PRC 2012). Private hospitals
have also been restricted by numerous policies in taxation, medical device equipment,
medical research, and occupational opportunities for doctors. As public hospitals
dominate the market, fairly or unfairly, medical practitioners were given few alternatives
(Zhou, 2008; Yao 2016). Finally, just like their predecessors in the Mao era, medical
providers in today’s China still lack an independent, powerful association that may
represent or empower them to negotiate collectively with the state over work terms and
conditions (Yao, 2016, p. 13). To some extent, medical providers in reform-era China
have been trapped in a malfunctioning system that makes them simultaneously privileged
and threatened, dominant and disempowered.
Mediation of Medical Problematics in the Reform Era
The rise of medical controversies and mobilizations partly stem from the socio-
historical trajectories of medical institution in China. Additionally, they are results of a
more expansive, vibrant, and contentious media landscape. Roger Silverstone’s (2005)
idea of “mediation” partially illuminate the dialectics between media and society: on the
one hand, “processes of communication change the social and cultural environments that
support them as well as the relationships that participants, both individual and
50

institutional, have to that environment and to each other.” (p. 189) On the other hand, the
social in turn acts as a mediator: “institutions and technologies as well as the meanings
that are delivered by them are mediated in the social processes of reception and
consumption.” (ibid.)
Yet, the entanglement and intricacy between media and medicine in China are
more large-scale, organized, and complicated. It is beyond the scope of this dissertation
to fully account for this intertwined history. What is offered here is a preliminary attempt
to map some of the intersections and interactions. In brief, the post-socialist reform in
China simultaneously pushed the media and medicine to the market, forcing them to
grow out of the plan (Naughton, 1996). As health care problematics accumulate and
become manifest, the commercialized and liberalized media took note and published
reports. Media reports touched the cord of widespread public grievances in transitional
China, leading to more and critical reports. These reports also triggered much
dissatisfaction among the medical communities, who were highly concerned with their
social standing. The medical professionals then took advantage of the digital media
technologies and popular social media, as to coalesce, develop campaigns, influence
public opinion, pressure media, and appeal to the state’s support. The following describes
these processes in more detail.
The Rise of Media Reports about Medicine
As the systematic issues of China’s healthcare accumulate and become manifest,
the rising and expanding media in reform-era China paid attention. To note, the dual-
track reform of China’s healthcare system was parallel to and intersecting with the
selective expansion, commercialization, liberalization, and digitalization of China’s
51

media landscape. As the state pushed public hospitals to the market in the 1980s, it also
cut subsidies to state-owned media, encouraging the latter to survive and profit on its
own. The forced commercialization of media, therefore, led to the rapid development of
metropolitan papers between the 1980s and early 2000s (Zhao, 2000). Newspapers
employed investigative reports and soft news, including those related to health and
medicine, to serve China’s rising urban middle class and earn unprecedented distribution
and advertising revenue (ibid). As reform-era China becomes richer, more urban, more
aged and more concerned with the quality of life (X. Wu, Yang, & Chen, 2017),
unsurprisingly, its demand for health information and medical news continued to
increase, which clearly expressed itself in the commercialized and digitalized media. As
the following graph from Baidu Index shows, the Chinese Internet users have been
frequently searching for health-and-medicine related information, including innocuous
topics such as “fitness”, “healthy lifestyle” or “wellness” (pink line), but also critical
issues such as “medical disputes”, “health reform” or “food safety” (purple line). These
health-related searches almost consistently and significantly surpass information demand
52

concerning “single child” (blue line), “migrant worker” (green line), or “China-US
relations” (orange line).
8

Figure 2. Demand for Health Information (compared with other topics) (June 2006- September 2020); source: Baidu
Index.
In response, Chinese news paper’s coverage of health skyrocketed, as the
following graph indicated. According to Duxiu Database, often known as the Chinese

8
Baidu is the largest search engine in China for websites, audio files, and images. Baidu Index indicates the
amount of searches a certain keyword or keyword combination has received by the Chinese Internet users.
The index is not to taken as an absolute account but a relative measure of the topic’s popularity. For
computer-based searches, Baidu Index results could go as back as September 17, 2007. The index score
Baidu attribute to “one-child” is 586, “migrant workers” 1041, “China-US relationship” 992, “fitness +
healthy lifestyle + wellbeing/health maintenance” 6368, and “health reform + medical disputes + food
safety” 2,647.

53

Google Scholars (UCSB Library, n.d.), between 1982 and 1999, there were only 145
health-related news articles that contain words related to “seeing doctor is expensive” or
“seeing doctor is difficult”, “health care reform” or “medical disputes”.
9
The number of
such health-related news articles produced between 2000 and 2005 has risen to 1,448. It
continued to grow to 36,781 between 2006 and 2010, and 41,079 between 2011 and
2015. In comparison, “poisonous milk powder” as an international food safety scandal in
2008 and “US-China relationship” as a long-term topic appear less salient on the
newspapers. The surge of health news between 2000 and 2010 is likely to driven by the
state-initiated health care policy changes and debates between 2003 and 2009.

Figure 3. Rise of Health News in China (Source: Duxiu).

9
The respective key words for news article searches on Duxiu are “seeing doctor is expensive OR seeing
doctor is difficult” ( 看病贵 OR 看病难), “health reform OR health care reform OR health care policy ( 医
改 OR 医疗改革 OR 医疗政策)”, “medical dispute OR provider-patient tension OR provider-patient
conflict ( 医闹 OR 医患矛盾 OR 医患冲突).

0
2000
4000
6000
8000
10000
12000
14000
Rise of Health News in China
Seeing Doctor Is Expensive or Difficult
Medical Disputes
Health Care Reform
Poisonous Milk Powder
Us-China Relationship
54

Meanwhile, with the rise of legal institution, digital technology, and liberal
journalism in China, the communicative landscape in reform-era China has also
witnessed the emergence of an ostensible “public sphere.” Despite obvious speech
limitations and control, the nascent Chinese public sphere has allowed relatively open
and free discussion. During its “golden age”, as the state is interested in using media and
public communication for intelligence and advice, the hybridized communicative space
has also mobilized and convened the publics to address significant social challenges that
could not be solved by the government (Dewey, 2012). It is this public sphere that has
enabled the critical mediatization of medical grievances as articulated by different actors.
During the Hu-Wen era, the state has openly acknowledged its governance
inadequacy and challenges in health care, thus opening the latter’s systemic woe to
critical media reports, expert debates, and public deliberation. In 2003, the SARS
epidemic forced the Chinese state and society to reflect with unprecedented candor over
the public health system ("[woguo yiliaogaige licheng huigu] Historical Review of
Medical Reform in China," 2013; "[Zhongguo yiliaogaige dashiji (1978-2011)] Major
Events in China's Health Care Reform (1978-2011)," 2012). In 2005, official media
Beijing Youth Daily cited an establishment expert and stated that “China’s health care
reform has been basically unsuccessful” (J. Wang, 2005). Such official cues suggested
health care problematics have become a “legitimate controversy” (Hallin, 1989) in China,
qualified for the state-led “public opinion supervision” (yulun jiandu)
10
(Repnikova,

10
That is, critical journalism that provides constructive criticism for governance without challenging the
regime.
55

2017). Quickly taking up these cues, the dynamic reform-era media has staged various
deliberations and performances, presenting voices of the general public, interest groups,
international organizations, research experts, as well as bureaucrats and officials (S. Balla
& Liao, 2013; S. J. Balla, 2014; S. Wang, 2004, 2009; S. Wang & Fan, 2011, 2013).
Unsurprisingly, an increase of critical reports and deliberations about medical institutions
and professionals were also salient in this contentious, communicative space.
While the liberal-minded usually appreciate the rise and development of critical
journalism in China, Chinese medical professionals in transitional distress tend to find
critical medical journalism frustrating, if not infuriating. Many providers have repeatedly
accused these critical reports of being unobjective, biased, sensationalist, pandering to
public anxiety and hostility by manufacturing “medical scandals” or “medical horror
stories.” They also criticized the media for allegedly creating broad and long-lasting
negative effects on public perceptions and provider-patient relationships. What is less
mentioned is that news media also consistently facilitate the construction and
maintenance of medical professionals’ authority, by seeking and displaying the latter’s
knowledge, opinions, and voices with reverence. Additionally, news media helped make
visible and agenda-set many medical professionals’ issues, particularly the rise of
medical disputes and violence.
56

Figure 4. Example of Online Deliberation around Health Care System Reform in China
(source: Sohu.com).
Professional Mobilization on the Chinese Internet
It is under these intersecting conditions that Chinese medical professionals turn to
the Internet to air grievances. Thanks to their urbanity, higher education, and income,
many Chinese medical professionals were among the early adopters of the internet.
11
A
1997 survey by China Internet Network Information Center (CNNIC) recorded fewer

11
As Yang (2009, p. 29) noted, China did not achieve full-function Internet connectivity until 1994, and
only after 1996 did the Internet begin to become available to the average urban consumers.

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than 1% of medical professionals were among all the surveyed Internet users across
China. The number rose to approximately 3.15% in 2004, even though medical
professionals represented fewer than 0.3% of the Chinese population then (Ministry of
Health of People's Republic of China, 2004). Like many other Chinese people, medical
professionals use the Internet for news, entertainment, hobbies, and casual discussions,
and socialization. Yet the doctors’ Internet use appeared to be driven primarily by
institutional tasks and motives. According to various surveys on Chinese doctors’ Internet
use between 2000 and 2020 (Health & DXY, 2016, 2017; Zhang, Xu, Mo, & Ji, 2003),
Chinese doctors use the internet mainly to exchange medical knowledge and information
and engage in other professional matters. Such a strong professional/instrumental motive
has energized the development of a niche, professional cyberspace connected with
broader societal discussions. In June 2000, Stanley Li, a graduate student at Ha’erbin
Medical University set up a personal website. “Nothing can stop human being from
sharing knowledge!” Li put such an impassionate message on the website’s front page.
Li’s website generously shared specialized tools, resources, and knowledge related to
medical research and scholarship for free. Quickly, Li’s website attracted more than 300
page views per day, mainly from other medical students and professionals. These visitors
left appreciative messages or made information requests, and Li responded to them
frequently and earnestly. As Li’s website continued to grow, it was increasingly linked to
other specialized websites in health and medicine, being integrated to a niche cyberspace
in China. At the same time, Li’s personal energy and his computer were pushed to their
limits. Li then had to purchase new equipment, recruit volunteers, ask for donations, and
expanded his personal website into a Bulletin Board System (BBS) with multiple sub-
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forums for different sub-disciplines and specialties in medicine and life science. By
August 1, 2003, the BBS, now named DXY, had nearly 30,000 registered users who have
created over 14,000 posts. Li eventually quit his graduate program for entrepreneurship.
In late 2005, he expanded the non-profit scholarly community into the largest specialized,
medical platform in China, serving over 5 million registered users, including over 2.1
million medical professionals.
In its earlier days, DXY BBS was decidedly professional and apolitical. An
administrative message posted on July 31, 2003 stated:
All pages at DXY BBS are to primarily serve academic exchange and
secondly personal discussions. Please do not post topics related to
politics, current affairs, or policies. Violating posts will be deleted, and
the poster will receive a warning. The repeated offenders will be
deducted points. DXY BBS is home to all members. To make this
scholarly community develop in a healthy and orderly direction, please
abide by DXY’s rules. Thank you.
The violators will be deducted points.
The reporters will be rewarded!
Yet as its user numbers increased, discussions about medical providers’
institutional stresses and conflicting conditions accumulated. The boundary
between the professional and the political became blurred. In March 2007, DXY
became visible to the general public for the first time due to its campaign around
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“green tea for urine test.” For the doctors, the campaign was a “scientific and
professional” response to a “false” media exposé. On March 19, 2013,
journalists paid covert visits to ten hospitals in Zhejiang Province, complaining
about painful urination and then used green tea for urine tests. The results were
astonishing: medical providers at six hospitals claimed to have found white
blood cells and red blood cells in the “urine” made of green tea. Believing that
such findings were impossible, the media concluded that these hospitals’ work
attitudes were by no means serious or rigorous. The exposé was soon widely
shared by multiple mainstream media. Inside DXY, however, many medical
providers, including those that tended to keep distance with sensitive topics,
were agitated. A call for “counterstrike” was proposed, and medical providers
from 92 tertiary/top-tier hospitals in China volunteered. Within 3 days, these
providers conducted urine tests with fresh green tea and then publicized their
aggregated test reports. As the results from 136 reports also showed surprising
findings including white blood cells and red blood cells in green tea, many
media changed their narratives, turning their critical scrutiny from doctors to
journalists. The “green tea mobilization” greatly encouraged Chinese medical
providers. A post created shortly after the campaign called for more and
continuous mobilizations: “Now, we have our own speech battleground, we
could speak freely in DXY, we could use DXY to air grievances!”
Indeed, one found increasing medical mobilizations on DXY. Many of these
mobilizations were responses to critical media reports where providers have identified
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technical flaws or biases. Other mobilizations occurred after violent medical disputes. On
June 23, 2009, more than 100 medical professionals demonstrated and sit-in at the
government headquarters in Nanping, Fujian, to protest against violence against doctors
as well as the failure of local government. After a patient died of kidney failure at a major
hospital in Nanping two days ago, angry family and others attacked medical providers
and vandalized the hospital while local police were present and watching. Later, to
resolve the conflicts, the local government decided that the hospital pay 210,000 RMB
(about 31,000 USD) to the family, even though five medical providers have been injured.
This decision prompted a rare case of street demonstration of the medical providers,
instantly attracting much media attention (China Daily, 2009). When people at DXY
learned about the protest, they quickly took actions: they asked for volunteers to visit
Nanping in person, contacted media, set up a website dedicated to provider-patient
(dis)harmony in China, collected signatures online for petitions, collected news reports
on medical disputes and violence, and created a Chinese map marked with occurrences
with “medical violence.” At the same time, DXY established a new program named “Yi
Bang Yi” or “Doctors Help Doctors”, offering solidarity and funding to support medical
providers who struggle with medical disputes or suffer from work-related violence.
However, due to heavy control and censorship, the Nanping website and its clones were
closed, related campaigns were halted, the “Yi Bang Yi” program was no longer active,
various social media groups set up for coordination were disbanded, and many doctors’
online posts were deleted. The killing of Wang Hao in Ha’erbin in 2012 led to another
outpouring of grief and anger on the Internet, including DXY’s rather restrained and
vague protest by changing its 404 Page Not Found to a digital memorial. Yet emotional
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expressions and online complaints also seemed to set the upper limit for what the medical
providers could do. Despite the frequent mentioning of strikes and street protests among
medical providers, rarely have such strikes or protests materialized. At the same time,
official media have turned from scrutinizing health institutions critically to being largely
sympathetic towards the medical providers, calling for zero violence, more public
understandings, and more positive media representations of the providers.

Figure 5. DXY 404 Page Not Found as an Online Memorial for Murdered Providers in China.
Between 2014 and 2016, the above pattern sustained with important variations.
During this time, the Chinese Medical Doctor Association, a semi-official association
affiliated with the Ministry of Health, filed an official complaint to the All China
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Journalist Association regarding the famed Southern Weekend journalists Chai Huiqun
and his critical reports about medical institutions. This complaint generated multiple
rounds of crossfires and legal trials among Chai, the Medical Association of Doctor,
another veteran journalist at CCTV, a few medical celebrities such as Burn Superhero
Abao, White Coat Mountain Cat, and many other medical providers on Weibo. As these
disputes ended with Chai’s defeat in courts and degradations in public, the medical
providers on Weibo expanded their attacks against numerous news media that produced
what the providers perceive to be false, misleading, or malicious. While these campaigns
mainly focused on media narratives and did not address many of doctors’ institutional
stresses, they seem to have created “collective effervescence” (Durkheim, 2008) among
the providers. Many doctors reported feeling vindicated, empowered, and more
appreciated by the public and the state as they campaigned on Weibo. Meanwhile, new
controversies about medical providers’ public incivility ascended.
Conclusion and Discussion
Through illustrating the continuity and disruption in the history of China’s
medical profession, this chapter sets a proper stage for carrying out the following
empirical analyses and making sense of their findings. Additionally, by embedding the
Chinese medical profession in their socio-historical and institutional contexts, this
chapter enables a better understanding of the rise of professional publics and their
controversies. It qualifies the de-contextualized discussions about medical providers’
mobilizations on the Internet. To be sure, the Chinese doctors indeed express opinions,
enhance visibility, construct solidarity, air grievances, and amplify influence through
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their online advocacies. Yet given the lack of changes in medical professionals’ work
terms and conditions, optimism and celebration of the Internet as “liberation technology”
(L. Chen, 2018) in the case of doctors’ mobilizations appear misplaced. At the same time,
lumping the vulgarity and vitriol expressed by medical providers with other online
trolling, hate speech is equally inappropriate. Such flattening dismisses the substances,
messages and meanings conveyed in medical providers’ campaigns. More importantly, it
exemplifies a thin assessment of public communication that neglects the socio-historical
background from which the offensive communication stem. Such thin assessments
resemble the confined impressions one gains by groping the elephant with their eyes
closed. Instead of aggregating multiple thin assessments, contextualization proves to be a
productive first step for furthering understanding. The following chapter provides the
next steps to deepen the inquiry. By analyzing the justification and critiques of the
medical profession in China’s mainstream media during the reform era, Chapter Three
illustrates the public opinion environment in which strained medical providers find
themselves and become agitated.

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Chapter Three: Vexing News! Medical Controversies and
Media Critiques
This chapter studies media reports about medical controversies from the
perspective of justifications and engagements. To do so is to at once illuminate one way
of understanding civil/uncivil, just/unjust in the Chinese society, and to showcase the
public opinion environment in which Chinese medical professionals find themselves. In
some way, this chapter connects with an array of studies on “Chinese media’s
constructions and representations of medical providers,” which emerged as the media-
medicine relationship becomes and remains contested in China. This study, by
comparison, draws upon a broader range of analytical categories or “coding schemes”
drawn from the justification/engagement framework. It avoids reducing media discourses
to dichotomies such as “positive representations” versus “negative representations.” The
findings of this chapter are also to converse with later studies on medical professionals’
expressions and mobilizations.
To set the stage, the following section revisits the theory of justification and
engagement and considers in detail its methodological considerations and
operationalization. Then, the chapter examines Chinese media reports on health
controversies that impact medical professionals’ legitimacy during the reform era. It
analyzes media arguments through the lens of justification/engagement and makes
explicit the moral grounds to which the media appeal.
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Methodological Considerations and Empirical Operationalization
Empirical studies of mediated deliberations and justifications in public
controversies are challenging (Joutsenvirta & Vaara, 2015). Their methods are varied and
still maturing. Existing engagement and justification studies often use a large amount of
textual data, trying to represent public debates in a more or less comprehensive manner,
or to increase precision when comparing national cultures (Thévenot et al., 2000).
Recently, Ylä-Anttila & Luhtakallio’s (2016) attempts to systematize the methodology of
“Justifications analysis (JA).” Ylä-Anttila & Luhtakallio identified the unit of analysis of
JA to be a claim, that is, an act made in public (cf. Koopmans and Statham 1999). A
claim can be a statement to the reporter, but also, for instance, a speech, a published
report, a letter to the editor or a demonstration (p. 4). Coding a claim in justification
analysis should include “who: speaker,” “to whom: addressee,” “how: means,” “what:
content,” “why: justification.” Additionally, Ylä-Anttila & Luhtakallio compared JA with
frame analysis (FA) in social movement studies and media studies. According to Anttila
& Luhtakallio (2016), JA understands “the moral” much more broadly than FA, as the
former includes disputes over economic benefits or industrial efficiency as contention
with certain metaphysics or moral philosophies, while the latter does not (p. 2, 16). In
addition, while FA derives the codes inductively from the data, JA is based on a more or
less fixed set of justification principles. Such a difference enables JA to better articulate
“what are the meanings and values at stake or in conflict in the debate,” “what kind of
moral evaluations lay behind the frames,” and “what are the reasonings among various
actors, including the less dominant ones.” Specifically, the authors argue that JA
generates more nuanced analysis and does a better job attending to the power dynamics
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of public debates than FA (p. 9). Importantly, JA is better positioned to illuminate how
today’s disputes are related to a more general discussion about moral principles, be they
those repeated over time, or the more recent public debates about a similar topic (p. 10).
Finally, the authors caution that sensitivity is needed should one conduct justification
analysis of debates and culture in a non-Western context (p. 12).
While Ylä-Anttila & Luhtakallio’s clarifications through comparison with frame
analysis are welcome, one should note that they make few connections to the ideas of
“situated judgment”, “reality test”, “critique” and “compromise” in Boltanski &
Thévenot’s original work. The author shall address the risk of losing the theoretical
richness associated with such operationalization later. Additionally, neither Ylä-Anttila &
Luhtakallio nor others specify, justify or standardize a process for collecting and studying
a large amount of data related to public controversies. Such specifications are needed
because it is impossible to simply collect and analyze all the available data that relate to
public controversies in highly mediated societies. At the same time, the results of
engagement/justification analyses could be highly influenced by the nature of the data
collected (Eranti, 2018). As argumentation scholars noted, large-scale public
controversies in highly mediatized societies are likely to generate never-ending
conversations (Glozer, Caruana, & Hibbert, 2019) that involve multiple persons,
positions, and places that engage with one another in the form of complex networks
(Lewiński, 2016; Lewiński & Aakhus, 2014; Lewiński & Mohammed, 2015; Musi &
Aakhus, 2018). To address this operationalization challenge, the author turns to emulate
the methods established in the discursive legitimation studies without fully embracing the
latter’s agenda.
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Discursive legitimation studies are primarily interested in coming up with
analytical categories and theoretical insights. While they recognize the need to present
the controversy in a fair or even comprehensive manner, they are less concerned with
collecting and analyzing a large amount of data. Noting that “textual analysis is often
laborious and time-consuming” (Joutsenvirta & Vaara, 2009; Vaara et al., 2006), they
aim to “a lot about a little” (e.g., Potter and Wetherell, 1987; Silverman, 2001) instead. In
other words, these studies attempt to reveal significant information and insights through
analyzing small speech acts. Therefore, discursive legitimation studies often deploy and
report a sophisticated, multi-stage process of selecting and downsizing data. For instance,
in Joutsenvirta and Vaara’s research (Joutsenvirta & Vaara, 2009, 2015; Vaara, 2014;
Vaara et al., 2006), the authors (1) took note of the most important period of the
controversy, (2) sampled important media outlets and collected their reports as data, and
(3) analyzed the themes and their frequency to identify salient discursive strategies. Later,
in what they term the interdiscursive (e.g., Fairclough, 1995) phase of analysis, the
authors (4) focused on different kinds of linguistic means for constructing and contesting
the legitimacy of the organization of interest (Joutsenvirta & Vaara, 2015, p. 91).
Through these stages, the authors “carefully selected those articles that were built around
various parties’ opinions about the conflict” while disregarding those that focused on
reporting “hard facts.” (p. 90) Particularly, Joutsenvirta (2015) explicitly reported a
selection of texts that “represented the most ‘opinionated’ writings in the actors’
communication outlets: in the writings, sides were taken and rich – and often also
aggressive – arguments were presented to question or justify certain industry practices.”
(p. 60)
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Such specifications of the data selection and compilation process become more
helpful when scholars discuss their methods’ limitations. Joutsenvirta & Vaara (2015)
note that their analyses are based on interpretations and alternative interpretations are
possible for the texts. Second, with the goal to “develop new theoretical understanding
and analytical generalizations”, their work may not provide “accurate claims regarding
the relative frequency of different strategies.” Third, as the authors read textual data in
Finnish and Spanish and translate them into English, the problem of “translatability” of
meaning and expressions is present and may not have been well addressed.
Since justification/engagement analyses overlap with discursive legitimation
studies as both codify textual data to understand meanings and connections with broader
cultural systems, there is no reason why the former could not lend methodological and
operational insight from the latter. As mentioned earlier, public, mediated controversies
often materialize into an enormous and expanding amount of data that are impossible to
collect in its entirety. In these cases, researchers who prioritize detailed insights about
public arguments and who have various constraints may be better off following
Joutsenvirta and Vaara’s recommendation to “say a lot” about a relatively confined and
carefully composed corpus, rather than aiming to produce an accurate or comprehensive
representation. The current and the next study, therefore, follows Joutsenvirta and
Vaara’s suggestions to downsize data by carefully selecting and compiling two corpora.
Data Collection
This study underwent multiple stages to build a corpus of media reports on health
controversies in the past two decades. As widely noted, media play a significant role in
influencing, constructing, and contesting organizations’ legitimacy, identities, and
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relationships in contemporary societies. Therefore, mediated, medical controversies are
highly relevant for the current study on the profession-public relationship. At the same
time, the media themselves could act as a stakeholder in these controversies, and different
media incorporates different voices, have different moral or political stances, and
exercise their influence differently. Therefore, it is recommended to select a politically
balanced range of media to counter systematic bias (Patriotta et al., 2011). To construct a
feasible and appropriate media corpus, the author of this dissertation started with
searching for the important scandals and controversies centering around health
professionals in China in the past two decades. Fittingly, Jiankang Shibao (Health
Times), a major health newspaper has consistently nominated and compiled “Top Ten
Health News/Incidents of the Year” in China every year since 2002, while Jiangkang Bao
(Health News) has engaged in similar activities since 2005. While Health Times is
affiliated with People’s Daily, one of the most important party organs in China, and
Health News is directly supervised and funded by the Ministry of Health in China, both
newspapers’ lists have contained many controversial cases and critical reports and are not
confined to party propaganda. Drawing upon both health newspapers’ annual listings of
major health news from 2005 to 2016, the author produces a list of major “public
incidents,” or controversies related to the health and medical profession in mainland
China. To note, some of the health or medical “public incidents” are scandals about
medical institutions and professionals, while others involve violent attacks against
medical providers that result in severe injuries or death. Each incident was retrieved and
“pre-screened”, so that only those directly involving medical professionals or those
heavily implying on medical professionals’ legitimacies are included. In the end,
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seventeen medical controversies that occurred between 2005 and 2016 were collected
(see below).
With the list of major medical controversies, a small corpus of discourses was
constructed. Specifically, each incident on Google or Baidu was searched. For each
controversy, one media report was collected from a more official or party press and
another one from a more commercialized press. While news media studies tend to use
newspaper database for systematic searches, this study finds popular search engine
adequate for locating a small number of news articles that are likely to reach ordinary
people via the Internet during public controversies. The categorization of official and
commercialized media organizations stems from previous research on media in China
(Lee, 2000; Stockmann, 2013; Y. Zhao, 2000a, 2000b). For instance, Zhao (2000b)
identifies evening newspaper and metropolitan press as the spearheads of China’s media
commercialization, while most provincial daily newspapers, CCTV (China’s Central
Television), Xinhua News Agency, People’s Daily, China News Service and other news
organizations that are directly supervised by the party-state fall under the category of
“party organs.” That said, the distinction between party organs and the commercialized
press is not absolute or always clear. Since the 1990s, even the most important party
organs (such as CCTV and Xinhua News Agency) have gone through significant market
transformation, developing more commercial offshoots in various form (e.g., websites).
At the same time, the highly commercialized press are still within the reach of the
propaganda department and are nominally led and supervised by the party-state. Under
such circumstances, some popular party press such as The Beijing News, China Youth
Daily, and China News Weekly may straddle the boundary comfortably. Therefore, the
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categorization of “official vs. commercial” is not a fully accurate representation of the
media landscape in China. Rather, it is a heuristic that enables the author to collect media
reports with some sensitivity to the diversity and heterogeneity within the Chinese media
system while avoiding systematic political bias. Together, the author collects 34 news
articles on 17 public controversies. Following Joutsenvirta and Vaara’s (2009, 2015)
recommendation, the author prioritizes the reports that involve clear expressions of
arguments and opinions than press release or purely factual reports.

Figure 6. Major Medical Controversies in Mainstream Chinese Media (2005-2016)
The media corpus included twelve cases of “scandals involving medical
organizations or professionals,” four cases of “violence against medical providers,” and
one “patient’s story (with implication on health care system).” These labels apply
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exclusively to the initial report since many of these news stories were later re-cast or re-
told in different ways. To use a popular phrase in Chinese media and academic
discussions, many of these cases experience “news reversal” or “news flipping” (xinwen
fanzhuan) as their initial storylines were later flipped or significantly challenged, with the
“heroes” and “villains” reversed or heavily problematized.
Situated Judgment, Justification, and Critiques
The analyses draw upon Thévenot, Boltanski, and colleagues’ sociological studies
of engagement and justifications as the analytical framework. While justifications restrain
them to commonalities and generalizability, engagement forms based on private interest
and familiarities are less conventionalized and public. As mainstream media are likely to
find it imperative to make claims and arguments with more generalizable, public
justifications than private interest or intimacy, the following analyses draw more heavily
upon the work on justification. According to Boltanski and Thévenot (1999), “[a]
justification in this theoretical view is an attempt to move beyond stating a particular or
personal viewpoint toward proving that the statement is generalizable and relevant for a
common good, showing why or how this general claim is legitimate. Disputants involved
in debating the resolution of a public problem are charged with this task of justification
(p. 236).”
Justifications can involve positive “arguments,” claims, or position statements,
but might also be critiques of deficiencies of an arrangement or “denunciations” of
opposing views (p. 237). According to Boltanski & Thévenot (1999, 2006), criticism can
be internal to a world when flaws or faults are noticed, and beings are re-qualified or
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discovered as relevant; or they stand outside, relying on an alternative world and
becoming more radical (Boltanski & Thévenot, 1999, p. 373). The current study uses
“internal critique” and “external critique” to refer to these two types of critiques.
Internal critiques are those that do not involve challenging the principle of
equivalence in one situation and aiming to substitute it. This form of critique involves
pointing to unworthiness, deficiency, impurity in the current world or test. For instance,
the industrial world that values control and efficiency would find spontaneous acts with
low productivity inadequate; the market world finds a less competitive product or person
less worthy; the domestic world finds lack of interpersonal trust undesirable, and the
world of fame finds someone invisible, unheard-of uninteresting. Internal critique may
also take the form of “unveiling,” which seeks to attribute value to being of a different
nature whose intervention introduces worth that are foreign to the test, thus rendering the
test invalid. In other words, unveiling critiques a transportation of worth from one world
to another, be such transportation resulting in privilege, pollution or deficiency. As the
principle underlying the test is not challenged, the reparation process would then consist
in setting aside disturbing objects of a foreign nature, carrying out a new and purer test,
or restoring the conditions of a test on which judgments can converge (Boltanski &
Thévenot, 2010, 2016, p. 224-5). Still, the pointing to extraneous elements may invoke
another definition of the situation. Should that occur, unveiling leads to the recognition of
the “true” worth or tilts toward a different world that competes to define the situation
(often characterized by expressions such as “actually,” “in fact,” “turns out” (p. 217,
219). This brings us to the second type of critique.
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“Clash” (Boltanski & Thévenot, 2006) or external critique challenges the order of
worth applied to a given situation and aims to substitute for the current test another one
relevant in another world. According to Boltanski and Thévenot (2006, pp. 223-224),
clash involves
[A] reconsideration of the common good denounced as mere self-
satisfaction in opposition to other principles of justification: the worthy
are not producing the common good but their own happiness; their
wealth is not the condition of the well-being of all -- it serves only their
own well-being; the work they accomplish is not useful to the common
good, but is rather at the service of their vanity or their personal
ambition, and so forth. In clashes, the discord thus has to do not simply
with the worth of the beings present, but with the very identification of
the beings that matter and those that do not; it has to do, then, with the
true nature of the situation, with reality and the common good to which
reference may be made to reach an agreement. The goal is … to
demystify the test as such, in order to place things on their true ground
and to institute a different test that will be valid in a different world.
A clash, therefore, includes the possibility of several tests as plural, incompatible
principles of justice enter into a competition. The parties involved disagree about the
world in which the test must be carried out if it is to be legitimate. The clash is thereby a
necessarily unstable moment in a dispute. This study also examines whether and the
extent to which “clash” or “external critique” might manifest in the textual data.
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Findings
The following graphs provide a brief quantitative summary of the current data and
its analyses. Such analytical descriptions should be assessed with caution, since they are
the author’s individual -- albeit careful – interpretations of a relatively small corpus of
discourses. To better understand the insight that such a small corpus could generate, the
following section turns to more detailed, qualitative analyses.

Table 2. Distribution of Media Justifications and Engagement
Forms of
Engagement Regime of Justification
Individual
Interest
Familiarity
Others
Sub-types civic domestic fame industry market

basic
life/humanity bioethics
direct claims 26 15 1 59 3 5 1 3 3
internal
critique 26 3 11 101 1 1 2 0 13
total 52 18 12 159 4 6 3 3 16
percentage 19.0% 6.6% 4.4% 58.0% 1.5% 2.2% 1.1% 1.1% 5.8%

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Figure 7. Distribution of engagement and justifications in media reports about medical controversies.
The Industrial World: Deficient, Polluted by Market and Domestic, or
Adequate?
As shown by the above graph, the regime of justification, particularly the
industrial world, the civic, and the domestic worlds, features most prominently in the
media reports about medical “public incidents” or controversies in China. The following
analyses therefore focus on these worlds rather than address all the justifications and
engagements that exist in the data. In particular, the industrial world is the most well-
established, as various media reports either directly appeal to its principle, or invoke it by
addressing its deficiency, inadequacy and pollution.
As Boltanski & Thévenot (2006, p. 204) describes, “the ordering of the industrial
world is based on the efficiency of beings, their performance, their productivity, and their
capacity to ensure normal operations and to respond usefully to needs (original
emphases).” Indeed, many medical controversies and scandals are internal critiques of the
0 20 40 60 80 100 120 140 160 180
civic
domestic
fame
industry
market
bioethics
familiarity
individual interest
common humanity
distribution of engagement and justifications (N=274)
direct claims internal critique
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industrial world, where patients raised questions about the appropriateness and
effectiveness of medical treatments, or they complained about the competence and ethics
of medical professionals and their organizations. A notable example of these complaints
could be seen in the case of the “astronomical medical bill” in 2005. This scandal started
as a businessman complained to a variety of media that he had spent 5.5 million RMB
(about 860,800 USD) for his father’s 67 days’ treatment at a major hospital in Ha’erbin
City, only to find that the treatment was not effective, and the hospital placed many
wrong prescriptions and made exorbitant charges. Following this lead, the CCTV News
Probe story cited the family’s complaints profusely and raised many questions about the
hospital’s management and the appropriateness of the treatment and charges. These
complaints, which serve as evidence of deficiency of the industrial world, include that the
hospital charged the patient for testing two days after the patient passed away. Moreover,
within the patient’s 67-day treatment, the hospital has prescribed 83 bags (over 16000 ml)
of blood transfusions with a charge of 22,197 RMB (3,474 USD) in one day, 106 bottles
of saline (about 53,000 ml), and 20 bottles of glucose (about 100,000 ml). The patient’s
family, therefore, asked rhetorically, “Can human bodies contain this much liquid?”
These critiques were later refuted by medical experts, who explained in detail hospitals’
managements, procedures, rationales, and the proper calculation of liquid and blood
transfusion. Similar internal critiques, articulated more or less explicitly, can be found in
the reports about “green tea for the urine test,” “woman dying out of amniotic fluid
embolism,” “Gauze Gate” and others. In the “green tea” cases, the investigative-
journalists-as-patients observed that doctors in multiple hospitals produced mistaken
diagnoses of the green tea sample. In the second case, the patient’s family found the
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patient left alone and dead in a surgery room while the medical professionals were
absent. In the third case, the patient experienced persistent discomfort and found that a
surgeon has “mistakenly” left in her belly. In other cases, the internal critiques of the
industrial world involve unveiling and denunciating extraneous and polluting elements,
particularly those from the market world. In the case of “astronomical medical bill”, the
patient’s family accused the attending doctor of inappropriately using a drug unfit for the
patient, only because the doctor had a private and illegal liaison with the pharmaceutical
company. In “Eighty-Cent Gate”, the patient’s father accused the Shenzhen Children’s
Hospital of exaggerating his son’s symptoms and illness, probably because the hospital
incentivizes doctors to over-prescribe and over-treat. In “Sown-anus Gate”, the patient’s
husband accused the midwife of private and physical retaliation when unhappy with the
bribery money received. In the latter set of examples, it is public hospitals’ and medical
professionals’ profit-seeking incentives and mechanisms that are often identified as
extraneous elements and beings in the industrial world.
In a less common case, media critique the domestic beings as extraneous and
counterproductive in the industrial world. The domestic world refers to interpersonal
relationships and connections. In the “astronomical medical bill” case, the patient’s
family demonstrates domestic worth as they demand to treat the patient at any cost.
However, such domestic devotion was challenged and implicitly criticized by medical
experts on the industrial ground, not only because they are not cost-effective as the
patient’s illness is beyond meaningful treatment, but also when the family introduces
hierarchy and authorities that are foreign to the industrial world. When the wealthy and
powerful son threatens to bring in state authorities to force a hospital to treat his dying
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father, a doctor complains, “Why would doctors need central government leaders’
approval for ordinary medical activities?”
Critiques of deficiency and the extraneous elements in the industrial world were
often responded with defenses and justifications that re-access or “purify” the industrial
worth. Some of these responses involved simple re-assessment and defenses of the
industrial issues under question. For instance, the hospital accused of leaving gauze in a
patient’s uterus by mistake reveals that what it performed was an efficient treatment to
stop uterus bleeding, and that such operation had been consented to by the patient. Other
defenses involve setting aside the market elements as irrelevant or non-interfering in the
industrial world. For instance, in the “Eighty-Cent Gate”, defense arrived for the
children’s hospital accused of over-medicalization, as the infant-patient’s symptoms
aggravated and crystalize as the hospital predicted, and when other medical authorities
confirmed the hospital’s diagnoses about the infant’s illness.
In some cases, industrial defenses for the doctors shore up even though the
critiques are obscure. In the aftermath of a patient-initiated violent incident that killed and
injured four medical professionals in 2012, media noted the patient took to violence
because he was dissatisfied with the doctors’ treatment decision. Without clarifying what
motivated such dissatisfaction, a cited online comment defended the doctors based on the
industrial worth:
Doctors were in full consideration of the patient, so they treated
tuberculosis first and then used Remicade to treat Ankylosing
spondylitis. This is because Remicade suppresses not only TNF-α but
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also the vitality of the lymphocyte. If patients use Remicade when their
tuberculosis infection was not under control, disastrous outcome will
happen.
Civic Justification, Civic-Industrial Critiques, and Market Pollution
Justifications based on civic equality or solidarity refer to collective welfare.
Within the civic world, people propose or oppose projects based on equal access and
protection of civil rights (Thévenot et al., 2000, p. 246). Media reports about violence
against medical providers find civic justifications or claims among the victimized
medical communities. Theoretically, violence is outside the regime of justification, and it
is possible to counter violence from any of the six or seven worlds in the regime of
justification. In the media reports, one finds more civic arguments than others to counter
violence. For instance, after a doctor was attacked in Tongren Hospital in Beijing, news
reports noted that many doctors protested and mourned on the internet, appealing that “it
is high time to protect the life rights of doctors!” Tongren Hospital set up banners in the
hospital’s lobby, publicly demanding “protection for a safe medical environment!”
Tongren Hospital also appealed to the news media that “the mobster’s violence was
enraging. We strongly demand severe punishment of the murderer, respect for medical
providers, and protection for medical providers’ lives and safety! We demand a good
medical environment!” After the killing of Wang Hao, an intern at a major hospital in
2012, the media also cited a doctor’s appeal to make March 23 “Chinese Medical
Students Day.” This proposition is grounded on a national or nationalistic sense of
civicness, stating that “China needs excellent young people to pursue medical career,
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China needs to provide confidence to the future medical talents, and Chinese people’s
health needs to rely upon medical providers who enjoy dignity!”
Additionally, accusations of malpractice and improper management can be easily
linked to discussions about hospitals’ and professionals’ legal responsibilities. Patients’
rights to health care are valued, too. In such a field, compromise between civic and the
industrial in the media reports must be constructed. This is obvious in CCTV’s critical
report about the “astronomical medical bill.” Linking the particular case to widespread
complaints about “seeing doctors is expensive and difficult” in China, and raising
questions about the hospitals’ questionable treatments, management, and fees, the
reporter asked, “how could an ordinary person afford this bill?” In response, the
interviewed medical professional invoked the socialist-civic rhetoric:
Our hospital is a people’s hospital, a peasant’s hospital. If we use the
rhetoric in the old days, it is a hospital for the poor and middle-class
peasants (a category of population defined and used by the Communist
party). We consider what the patients consider, and we do what the
patients need. We never use our privileges to gain any material benefits.
Our medical staff can do this.
While the response did not directly answer the interviewer’s question, it affirms
that health care in China should be equalitarian and civic, right-based and accessible to
all.
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The report about medical (mal)practice by unlicensed interns in Peking University
Hospital also explicitly raised questions about patients’ rights while questioning these
phenomenon’s procedural appropriateness and legal accountability:
A nationally renowned hospital does not follow state laws or respect
patients’ life rights. This is not only shocking but also bitterly
disappointing. Across the country, how many similar hospitals are there
that have no regard for human life? We expect to gain the answer as soon
as possible. Who on earth is protecting our rights to medical services?
Similar composite civic-industrial arguments could be found in many media
reports, including the one about the internal infection that led to eight babies’ death in
Xi’an, the discussion about the midwife’s legal responsibility when she crossed the
professional and legal boundary to sew up a patient’s anus without consent, the
questioning about the surgeon’s license and the absence of a post mortem when a
celebrity-patient died in the midst of plastic surgery, and the investigation about a
Sichuan hospital that possibly persisted in over-medicalization while corrupting charity
money after a major earthquake.
In addition to critiquing deficiencies and unworthiness on civic-industrial
principles, many medical controversies also involve unveiling and denunciating market
elements in the civic or civic-industrial world. These critiques often address the issue of
“generating profits” (chuangshou) in China’s health care system, which is state-owned-
and-managed but deprived of state funding: “Under this circumstance, some hospitals
focus on pursuing economic benefits and depart from the original intention of state-run
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hospitals: they regard patients as sources of profits, so that medical consultations grow in
expenses, while provider-patient relationships become increasingly strained.”A
politician’s comment during the controversy regarding infant deaths from internal
infection in Xi’an epitomizes this unveiling:
Many hospital managers lack awareness of and attention to the
importance of medical safety; they disregard people’s life and safety,
their professional ethics become distorted, as they put most of their mind
on generating profit from medicine, so that public hospitals become less
oriented to public service, safety management become lacking, rule-
based executions become relaxed, medical disputes and accidents
increase, and the public’s health rights were jeopardized and extremely
bad social influences were created.
Dr. Lan Yuefeng, a senior medical professional who was “exiled” to work at the
hallway after resisting and protesting against corruptions inside her hospital, made the
unveiling more personal: “I think over-medicalization and kick-back money is no
different from stealing money from people’s pockets. Worse still, you (the medical
professionals who over-prescribe) are not only stealing money, you are also jeopardizing
patients’ health, happiness and even life.” Removing the market’s polluting influences,
therefore, is necessary and important to bring public hospitals and medical professionals
back to its industrial-civic state.
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Discussion and Conclusion
This study provides a fresh perspective to examine media reports about medical
practices, cases, and the profession. Conventional studies about medical controversies in
reform-era China have examined media content to gather information about “medical
disputes and violence,” to assess the accuracy of health information, and to explore media
portrayals medical professionals and provider-patient relationships. The current study
connects with these “media portrayal” approach but goes further. While many Chinese-
language studies criticize media for negatively representing medical providers and
organizations, the current study noted both media criticism of “market pollution” in
medicine, and ample media justifications of medical providers as worthy beings in the
industrial world -- competent, reliable, and effective. In other words, media
representations about medical professionals in China are filled with internal
contradictions. Media discussions about medical controversies are also full of ambiguity,
as many justifications or critiques are often under-developed and under-elaborated. These
contradictions and ambiguity suggest the media’s ambivalence to make sense of and
report on complex, composite issues such as medical controversies during societal
transitions. They also suggest heterogeneity or a lack of coherence within media, which
may result from individual journalists’ differences, the availability of diverse journalistic
roles and styles, different media orientations, external forces such as state censorship,
directive, and guidance.
In addition, by focusing on the media’s justifications and critiques, this study
illuminates the moral universe mainstream Chinese media evokes and the stakes it
identifies in medical controversies and conflicts in reform-era China. Among various
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forms of justifications and engagement, it is the industrial and civic world from the
regime of justification that are most frequently articulated and elaborated, by the
mainstream media and their sources. The elaboration of the industrial and the civic
worlds often involves unveiling and denunciations of market and the domestic beings.
Market, particularly profit-making among medical professionals and public hospitals,
were considered as what undermine and pollute the medical institutions and their
industrial-civic nature. There are few justifications that endorse market or other worlds.
To put it differently, according to the media reports, the stakes of China’s health care
system are mainly industrial and pragmatic. Health organizations and personnel ought to
carry out medical diagnosis and treatment tasks efficiently, effectively, accurately, and
reliably so that patients’ needs are met. The mission is also civic: people are to be
accorded basic rights to health care, either under the socialist-bureaucratic conditions that
promise protection of and service to people, or under the contemporary conditions of civil
and legal aspirations. Such rights are mainly concerned with accessing affordable and
safe health care without exploitation. At the same time, medical professionals also have
the rights to practice medicine safely. What is under-specified are other dimensions of
health rights. For instance, there are no discussions concerning a doctor’s rights to act as
a free-market agent who prices and sells services voluntarily and flexibly. Neither are
there discussions about patients’ demand of more human-centered medical encounters
where they are treated not as vessels of illness, but as human beings with socio-
psychological needs that demand respect and empathy.
To some extent, the current inquiry resonates with Park (2019) who studied media
reports on the crisis of education in South Korea. Experimenting with the task to adapt
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Alexander’s (2006a, 2018) framework of civic repair, code-switching, and societalization
of problems to East Asian context, Park (2019) argued that the South Korean media
appealed more to “system repair” rather than civic repair. In other words, the mediated
debates of civil society mainly activate the binary codes around system functions and
efficiency to address a malfunctioning non-civil sphere (e.g., education) to surmount its
functional crisis, rather than mobilizing values from the civil sphere (e.g., equity) to
democratize the non-civil sphere in question. Such dominance of system repair over civic
repair suggests the incomplete (re)construction of boundary relations between the civil
and the non-civil sphere in East Asia, where civil society has a relatively short history of
institutionalization (Lo, 2020, p. 7). In the current study of health professionals and
organizations, one finds many internal critiques of medical practice in the context of the
industrial world. The system is criticized for its lack of efficiency, reliability, and control.
Nonetheless, the current study also points to the prominence of the “civil code”
(Alexander, 2000, 2006) or the “civic world” in China’s health care crisis, and the civic
world both stands alone and hybridize with the industrial world to enable various
critiques, including denunciations of the market elements that jeopardize public safety
and undermine easy and affordable access to quality health care. At least from the
media’s perspective, the Chinese medical professionals are both distinct from and closely
knit with the civic sphere. They need to establish both industrial and civic worth as the
specialized institution and the public life are connected.
Therefore, the media’s justification and critiques embed Chinese medical
professionals in a hybridized world with both system and civil codes, or with both
industrial and civic worth.
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Chapter Four: “Doctors, Unite!” Plural Justifications and
Incomplete Individualism among Medical Professionals
The previous chapter applies the framework of engagements and justifications to
examine media reports about medical controversies and conflicts in China. The findings
could be read as the media’s ambivalent representation and construction of medical
professionals as China’s transitional health care and society are stressed. This chapter
uses the same analytical apparatus to examine medical professionals’ campaigns, which
were often prompted by medical disputes and violence. How do Chinese medical
professionals articulate their understanding of justice and injustice, appropriateness and
inappropriateness? How do they evoke the macro-level, shared moral orders to legitimate
and justify themselves as their public reputations are contested? To answer these
questions, the study again conducts careful empirical studies, whose procedures are
explained below.
Developing A Corpus of Doctors’ Campaigns and Advocacy
Over the past two decades, China’s medical industry and institutions have
transformed and expanded. China’s media has commercialized, grown and digitalized as
well. Communication conditions liberalize and multiply existing dispersions of media to
new relationships with viewers, readers, and producers/users. So, as Chapter Two
suggested, an increasing number of Chinese medical professionals have connected with
the Internet, form and expand their online communities and networks. One of these
online communities for Chinese medical professionals – and the “oldest” and the largest
– is DXY BBS.
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As far as the current study is concerned, DXY BBS provided a prime site to
observe medical Chinese medical professionals’ discussions about health controversies
and conflicts. In fact, one can hardly find a reported medical controversy in China that
goes unnoticed or un-discussed at DXY BBS, and many BBS discussion threads around
“hot topics” might include hundreds of posts. Furthermore, before the introduction of
Sina Weibo in 2009 and the ascendance of WeChat in 2011, DXY BBS has hosted a
number of doctors’ campaigns and advocacies, mainly as responses to increasing
violence against medical professionals in China. The author, therefore, conducted
extended and extensive ethnographic observations on DXY BBS from 2017 to 2020,
reading past discussion threads and current, ongoing ones, in order to understand the
landscape and dynamics of doctors’ campaigns in reform-era China. For comparison and
for complements, the author also searched for major medical controversies on popular,
general-interest BBS such as Tianya and Baidu Tieba. These searches reveal that while
Chinese medical professionals also use non-specialized, popular forums to express and
advocate for themselves, their campaigns and advocacies prepared at or distributed
through DXY are more numerous, better organized, and more systematic.
During these ethnographic searches and observations, two three of data were
noted as particularly apt for research: (1) two special issues of Medical Garden (Yi Yuan)
online magazines published in 2011 that focus on medical scandals, and (2) a medical
professional’s campaign website in response to the violent “Nanping Incident” in 2009
(see Chapter Two for the incident’s description). Later, as Sina Weibo and Tencent
WeChat replaced DXY BBS as the most prominent social media for medical
professionals, the author attended to (3) two major medical celebrities and their blog
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posts. Together, these three sets of data constitute the corpus for the current study on
Chinese doctors’ campaigns and advocacy.
The following briefly describes these three datasets and their respective
contribution to the corpus.
DXY Medical Garden (Yi Yuan) Magazine
DXY Medical Garden (Yi Yuan) magazines were prepared, curated, edited, and
distributed digitally by Chinese medical professionals who were also DXY BBS users or
moderators. From the information available, one can assume that the online magazine’s
biweekly publications started in January 2011 and ceased before November 2011. On
their front pages, the Medical Garden online magazines claimed to “deliver health
information, promote provider-patient communication, let medical professionals shine
and cultivate their cultural character.” Some Medical Garden magazines focus on medical
knowledge and cases, others combine specialized, technical knowledge with discussions
on health policies, controversies, and entertainment produced by and for medical
professionals. Most of these magazines are around 45 pages long, containing posts from
DXY BBS as well as from other online sites or mainstream media. In September and
October 2011, DXY produced two special issues dedicated to discussing violence against
providers in health facilities and flawed media reports about health and medicine.
Together, these two magazine issues provide a list of 51 articles that are authored by
Chinese medical professionals (most of which are originally published on DXY BBS)
that address a number of health controversies and conflicts in China, occurring between
2007 and 2011.
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The Nanping Website
The second set of data comes from a doctors-found-and-managed website
12
that
claims to concern “provider-patient harmony” and the “Nanping Incident” -- a highly
publicized case in Nanping, Fujian in June 2009. To recap, the incident started with
violent conflicts between providers and patients in a major Nanping hospital and ended
with the hospital paying the patients and local medical professionals protesting offline
against violence and state authorities. To note, such street demonstrations among state-
employed medical professionals are tabooed, in China. The website invites people to
“remember June 21, 2009” (the date when medical professionals were violently attacked
in Nanping), and to keep in mind that “the voices of medical providers cannot be missing
when harmony is being built; a normal medical order is the basis of harmonious provider-
patient (relationship).” According to its own description and related discussions on DXY
BBS, the website was probably established shortly after the Nanping Incident, as a large
number of medical professionals went to the Internet to continue to air grievances and
protest. However, the website lacks maintenance or update, probably due to censorship.
The discussions curated and exhibited materials and discussions that developed at
a variety of venues, including DXY BBS, and popular websites and social media such as
Sohu, Sina Blog, and others. These materials are organized into several categories,
including (1) comments on the Nanping Incident, (2) general discussions about the
strained medical institutions and stressed provider-patient relationships in China; and (3)

12
The website’s original link is www.09721.cn. The website had multiple clones or mirror sites to circumvent
censorship. The current website is likely the only survivor of a batch thanks to its overseas location.

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comments on media reports of the Nanping Incident (especially reports from China Youth
Daily). The voices and perspectives they represent are mainly doctors’, state authorities’
and media’s. Some of these online discussions, when compiled in discrete articles, are
extremely lengthy. At the same time, many articles are redundant in their opinions and
expressions. The author removes the redundant articles and those that mainly report facts.
In the end, the author incorporates 36 articles into the corpus.
Blog Posts of Medical Celebrities
As mentioned earlier, Sina Weibo and WeChat challenged DXY BBS’s
dominance among medical professionals after 2009. In fact, starting from 2012, a number
of Chinese medical professionals have accumulated a significant following on these
social media platforms and become “medical influencers or celebrities” on the Internet.
Between 2014 and 2016, these medical celebrities spearheaded and organized a series of
high-profile online campaigns and advocacies. Therefore, the author attended to two
major medical celebrities, White Coat Mountain Cat and Burn Superhero Abao, who
acted as leaders and major participants in these campaigns, and whose blogs provided a
convenient collection of their advocacies and comments on medical controversies. Due to
the large number of blog posts available, the current study refrain from analyzing every
blog post written by these celebrities. Instead, a stratified, randomized sampling from
these medical professionals’ blog post libraries is performed. First, each medical
celebrity’s blog posts are characterized as one of the following: (1) discussions about
health news and media, (2) discussions about health policy, governance, and government,
(3) discussions about medical organizational relationships and arrangements, (4) health
science communication and (5) others. As the first three categories are most relevant for
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the current inquiry, the author randomly selects three from these three categories, that is,
nine articles from each medical celebrity and eighteen articles in total.
In the end, the author has drawn upon three datasets and compiled a corpus with
105 articles.

Table 3. Descriptions of Medical Celebrities' Blog Content
Categories of Content/Number of
Posts
Burn Superhero
Abao
White Coat
Mountain Cat
Media 24 30
Policy + government 26 16
Organizational relationships and
arrangements
25 72
Science popularization 32 267
Other 16 53
Total 123 438
Articles Selected 9 9

Analyses and Findings
The following graphs present a brief quantitative summary of the current data and
analysis. Interestingly, while the Chinese medical professionals appealed to the regime of
justification most frequently, unlike mainstream media, they also make a significant
portion of claims based on individual and group interest. Somewhat surprisingly, rarely
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have medical professionals made claims based on bioethics. Within the regime of
justifications, while the media mainly relies upon the industrial world to critique and
validate medical professionals, the medical professionals are more concerned with the
world of fame and the civic world. The following discussion addresses these findings in
more depth.

Table 4. Distribution of Doctors’ Justifications and Engagement
Forms of Engagement Claims Percentage
individual interest 96 26.3%
regime of familiarity 18 4.9%
regime of justification 238 65.2%
bioethics 13 3.6%
total (all claims) 365 100.0%

Table 5. Breakdown of Doctors’ Justifications
Breakdown of Justifications Claims Percentages
civic 87 23.8%
domestic 18 4.9%
fame 101 27.7%
market 11 3.0%
industrial 45 12.3%

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Doctors for Patients: Industrial + Civic + Domestic Compromise and Critique
Similar to the findings in the media studies, the industrial world – attentive to
procedure, effectiveness, function, and reliability -- is also salient in doctors’ campaigns,
invoked to critique or validate the worth of medical professionals and organizations. Like
mainstream media, doctors also debate about the appropriateness of medical treatment
and the competence of medical professionals, and they also tie the industrial matters to
collective stakes, i.e., patients’ safety, medical profession’s social standing, provider-
patient relationship and public’s health rights. Kenneth Burke’s terminology of the tragic
frame and the comic frame helps illustrate the distinctiveness of doctors’ advocacies:
Whereas the mainstream media scrutinizes and denunciates doctors’ practices and their
public consequences with a tragic frame, that is, emphasizing the collective harm any
incompetence or inadequacy results in, doctors tend to frame biomedical deficiency
comically, that is, they stress tolerance, correction, and the prospect of improvement
despite existing problems. For instance, when commenting on the controversy where a
deceased patient was misdiagnosed as alive, a doctor argued that:
The argument was mistaken -- Dr. Shi has not been proven to have
irrefutable responsibility of misdiagnosis. What’s also wrong, however,
is that doctors get labeled as “irresponsible” and “unethical” whenever
they make mistakes these days. This (kind of labeling) would inevitably
make doctors afraid to acknowledge their responsibility even if they
realize they have made mistakes. Doctors are also human; they also have
challenges that are beyond their ability and make various mistakes.
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In other words, while doctors’ technical mistakes could be discussed and critiqued
on the base of evidence, they also need to be tolerated so that errors could be corrected
and performance improved.
In addition to making space to tolerate doctors’ technical deficiency, doctors also
appeal to the industrial-civic principle to cleanse themselves from various accusations.
Medical celebrity Burn Superhero Abao justifies doctors’ detached or dispassionate style
when interacting with patients:
People are not grass or trees, how could they be emotionless? Yet
surgeons have to face bloody scenes every day, so they have to be stable
even if a mountain collapses in front of them, as to deal with patients and
their illness calmly. For surgeons, emotionless is the true connection and
the great love (for patients).
To counter denunciation of doctors’ corruptions (e.g., shady liaison with
pharmaceutical companies), a doctor maintains that “no doctor will ask about and
prioritize kickback money when they prescribe a drug, absolutely no! Regardless of a
doctor’s character, he [sic] always chooses drugs based on their treatment effect on the
patient.” The assertion insists on the purity of the industrial order in the medical process
and implicitly recognizes market beings as extraneous and problematic thereby.
Nonetheless, one may easily cast suspicion over such claims, as they do not link with any
objects or evidence to go through a “reality test.”
Like the previous comment that ties a provider’s technical performances with
“love” and care for the patients, doctors’ self-validation of their industrial worth are often
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accompanied with various invocations of civic and/or domestic framing of provider-
patient relationships: “providers and patients are supposed to be one family.” After
defending a midwife who sewed up a young mother’s hemorrhoids as proper treatment, a
medical authority argued that:
When the new mother holds the lovely baby, when the whole family was
extremely happy, they were supposed to thank the hardworking medical
providers in the obstetrics department. Whether it is that they (the young
parents) are young, ignorant, or for other reasons, they should not hurt a
responsible midwife who has been insulted and harmed (by media).
This argument suggested that medical providers should be thanked, trusted, and
respected in return for their technical services. It further implied that provider-patient
relationships should be harmonious and perhaps paternalistic.
Doctors Against Violence: A Laminated Civic World (Civic + Inspiration +
Domestic + Industry)
Civic justifications feature saliently in doctors’ campaigns and occupy both pure
and hybridized forms. In fact, as the following analyses show, the civic theme serves as
almost an all-encompassing and all-connecting one across a variety of worlds. It is in this
sense that one may speak of a multi-layered, laminated civic world in doctors’
campaigns. Instead of illustrating the civic principle invoked in every situation, this
section focuses on civic justification and its compromise with the inspired, domestic and
industrial worlds when Chinese doctors respond to and campaign against violence at their
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workplace. As the following discussion reveals, the Chinese doctors also invoke civic
principles when appealing to the world of fame and market.
A pure, inspired world values intense emotions and authentic experiences for
creativity, while a civic-inspired world transforms individual and perhaps individualistic
expressions into a civic expression of collective interest. In reactions to violence at health
facilities, many doctors display their deeply-felted frustration: “(I) feel like crying but
have no tears!!! Doctors don’t cry!!!” “Heart-broken! Furious! We doctors are absolutely
helpless.” Such personal grief and pain seek public outlets, motivating doctors to
organize themselves and do something for the collectivity:
We made appeals when violence occurred in Shanghai
We were shocked when violence hit Dongguan
We put up banners and petitioned after Shangrao doctors were attacked
We want to defend ourselves and fight back after conflicts occurred in
Nanchang
What should we do after a doctor was butchered in Beijing Tongren?
During the Nanping Incident, doctors made demands for medical professionals’
rights, safety and dignity as citizens and as human: “Protect medical providers’ lawful
rights, punish villains who deliberately harm people. Return to us a blue sky, give us just
evaluation, and maintain the normal medical order for ordinary people.” These demands
are civic and industrial in content and in nature. As the French sociologists noted, labor
union movements, workplace safety, strikes and other arrangements related to work or
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the welfare state (e.g., labor laws, welfare policies, work conditions, etc.) are ripe
contexts and issues for achieving civic-industrial comprise (Boltanski & Thévenot, 2006,
p. 326). What is at stake in these situations, including the current one, is the dignity of
workers, the ability of experts to deliver reliable services, as well as the fulfillment of the
public’s health rights. The following quote makes the stakes explicit: “If medical disputes
continue to be neglected, hospitals would no longer be hospitals, doctors do not dare to
practice medicine, and it would be in vain to talk about improving medical skills. When
diseases become more complicated, where can your children and offspring seek medical
help?”
Yet doctors’ industrial demands, fueled by strong civic conviction and intense
emotions, often encounter the “strategic” and “self-interested” rejoinders of state rules
and bureaucrats. Strong frustrations result. Professional, institutional frictions were hard
to avoid during the Hu-Wen administration (2003-2013), as the then administration
pursued “harmonious society” as an overall goal for societal governance. The regimes
demanded that local officials reduce the number of conflicts. Instead of addressing the
deep roots of social conflicts and contention, local states tended to cover up or turn a
blind eye to incidents of conflicts (Weller, 2012). Documentation was avoided, as well as
punishment from those with authority. Indeed surface-level “harmony” was announced
while undercurrents of conflicts grew ever more turbulent.
During the Nanping Incident, doctors complained that patients’ violence was
encouraged when local police and state turned a blind eye and failed to intervene in time.
To make matters worse, the Nanping state tried to “harmonize” (he xie) the provider-
patient conflicts, downplayed patients’ aggressions, and censored doctors’ expressions
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and petitions. Still, doctors in Nanping and elsewhere participated in and experienced a
collective outpour of indignation over patients’ violence:
Insulted, abused, the medical providers are angry and crying, and the
criminals are yet to be caught and punished. However, Nanping
government issued a document to “strengthen education and
management of medical providers,” asking to “properly regulate medical
providers and ensure that they do not petition again,” and demanding to
“strengthen education and constructions in medical ethics.” Yet the
government did not discuss the medical providers’ lawful rights and
benefits, their safety and integrity.
“Education or construction of medical ethics” is an important component of the
(post)socialist health care governance in China, through which the state regulates and
ensures that the medical providers serve the state and people, not themselves (Lynteris,
2012). Unsurprisingly, Chinese doctors critiqued such governance through “medical
ethics” as high-sounding rhetoric, disconnected with reality at best and deliberatively
distractive and suppressive at worst: “We need to fight back. This is not an issue of
medical ethics; it is about defending our rights!” Another argued, “We are not asking for
any special treatment. When our safety as citizens cannot be guaranteed, how can we talk
about the lofty ideas of medical ethics?”
What the doctors’ civic-inspired critiques make manifest is the tension inherent in
the civic world, between sovereign of the people and representative politics of the state.
In a civic-inspired compromise, people prefer to “carry directly to the sovereign people
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the causes they care most about and in which they are often interested parties inasmuch
as they are victims.” (Boltanski & Thévenot, 2006, p. 298) These sovereign people
directly represent the collectivities’ authentic emotions and experiences as victims, and
they often accuse the state apparatus and the judicial system of “betraying the duties of
their office to the benefit of the powerful.” (ibid) This is often the case in doctors’
campaigns. The doctor who authored the first quote in this paragraph continued:
Nanping government’s order is no different than saying, for “social
harmony,” medical providers need to have “medical ethics” and turn the
right cheek when hit on left one, they need to have “medical character”
and take pride in their being beaten and that they should not cry or
petition. Such “harmony” (he xie) from Nanping bureaucrats is turning
medical providers into “river crabs” (also pronounced as ‘he xie’ in
Chinese) in their boiling oil!
In other words, local officials single-mindedly pursue harmony on the surface
level, for their political career but at the expense of the doctors’ interest.
With such critiques, doctors advocate more political actions that represent their
will directly and authentically. “No more endurance! Comrades, it’s time to fight back!”
“Chinese medical workers, unite! Fight for the work environment and social status we
deserve!!!” “School mates, colleagues, faculty, go on a strike! We need to be united.
Let’s strike, not for long, just one day. One day with no doctors in China. Let’s see if they
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can survive????
13
” With these civic inspirations, some doctor projects politicization and
even revolutionary transformation of doctors: “this (Nanping) incident is a watershed.
From this incident on, the doctor-collectivity marches towards the political stage.
Following the steps of Lu Xu and Sun Yat-sen, they are to transform the society.”
Not all the doctors who were frustrated with the state abandon the state apparatus.
Instead, they may hold high civic-domestic expectations of the state. As several long
posts in the Nanping website made clear, many doctors expected the central government
or leadership in China to be more caring about people than local bureaucrats: “Imagine: if
we have parent-officials (fumu guan) like Premier Wen who frequently get close to our
circumstances and understand us, who can help us create a good and harmonious medical
environment, how could things get so bad.” Critiques of the state were also made on the
civic-domestic ground:
What is the government doing?! Why does the government not do
anything?! Aren’t medical professionals also the state’s subjects
(ziming)? When the government is protecting the interests of the so-
called “marginalized group” (patients), has it ever considered the
interests and integrity of the medical providers?!
To bring the benevolent state into being and to hold it accountable, doctors
advocate in making direct appeals to Premier Wen, various central government offices
(e.g., Organization Department of the Communist Party Central Committee), and major

13
The original expression contained random symbols (e.g. *%$#) between the two characters of ba gong
(strike), probably to circumvent machine censorship.
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party media (e.g., Xinhua News Agency, People’s Daily, CCTV). At the same time,
doctors’ demands incorporate civic-industrial proposals that accentuate strict control and
methodic measurements (Boltanski & Thévenot, 2006, p. 208, 211). The following quote
provides an example:
We hope that our professional peers in Nanping can make the following
reasonable demands to the Nanping government: 1. The Provincial
Department of Public Security collaborate with a provincial-level
medical university to carry out a postmortem; medical institutions and
health administrative departments at higher levels work together to
establish the deceased patient’s causes of death; identify as soon as
possible whether the Nanping hospital had any responsibility for the
patient’s death during the patient’s medical process, and if it did, what
responsibility it was. (Please caution that police and medical universities
work together to carry out the postmortem to avoid any improper
intervention). Once the cause of death is identified, the authorities need
to release information at once, just like what was done in Shishou.
In other words, the medical professionals demanded that the local state
perform the forensic functions that absolve the institution of guilt and thus
localize or absolve responsibility, which should put an end to retribution.
Doctors Against Misunderstanding: Fame + Civic + Industrial
The Chinese doctors expressed great concerns with the public opinion, but their
discussions follow rather narrow and predictable formula of justification. After
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occurrences of provider-patient violence, medical professionals complained about the
insufficiency or inadequacy of media reports. They also expressed anger and even despair
about the negative opinions towards doctors among the general public. After an incident
of extreme violence against medical professionals in 2012 (killing one and severely
injuring three), online opinion poll was widely circulated among the medical
professionals. According to this poll, 70% of over 4000 internet users reported being
“happy” about the violence and only 15% reported “sadness”. Doctors are also among the
most attentive audience of media reports over medical controversies, and their website
and digital magazines systematically collected, curated, and commented on media reports
that they deemed questionable. As Boltanski & Thévenot (2006) noted, the desire for
recognition and respect stems from self-love and human dignity, and “in the world of
public opinion, the relation of worth is a relation of identification.” (p. 179-180) In post-
socialist China, the individualized, self-loving doctors are understandably frustrated with
mainstream media, which tends to identify with the lay public and patients. While the
Chinese doctors usually think highly of themselves (as competent, ethical professionals
who bring value to society and out of goodwill), they have to experience the discomfort
that such self-perceptions are disconnected with the images many others attribute to
them. As a doctor noted, “we often read such reports in newspapers’ social news section:
patients’ lives are at stake, but doctors do not save them, as if doctors are all snobs who
only treat the rich but refuse to see the poor.” Therefore, many doctors accuse media of
routinely distributing false messages and working with negative frames, while the lay
public lacks independent thinking and remains receptive to misinformation and rumors.
Whenever provider-patient conflicts occur, one could easily find civic critiques of the
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media like the following: “media has too much impact on medical providers and their
environment. They are always producing negative medical reports, using specific
negative personalities to imply on medical providers all over the country. Media has
unshakable responsibilities in these regards.” Alternatively, doctors demand that media
“pay more attention to the work environment of medical providers”, given that “today’s
medical work is arguably very intense, stressful and high-risk.” After all, “good media
should discover and solve problems, rather than create problems and conflicts.”
Yet even positive media reports may frustrate the medical providers, if they
deviate from “objective reality” and have complicated implications on medical
professional work. Such is the case in doctors’ responses to the report about the “80-Cent
Pediatrician”, a nationally renowned medical authority in pediatrics who claimed to
rarely use the injection and often address patients’ health needs with inexpensive
prescriptions. The responses curated and publicized at DXY Medical Garden magazine
questioned the authority’s technical expertise associated with his title and reputation.
They also scorned the technical inaccuracy in the media making of a medical hero. “If the
journalist’s report is true, then Prof. Hu’s publications on severe infections in children are
fake; if Prof. Hu’s publications are true, then the journalist’s report is ***!”
14
More
importantly, many doctors suspect that such “hero-making” is another way to jeopardize
their work conditions and relationships with the patients. A doctor put it effectively:
How difficult is it to produce objective and impartial publicity? What era
is it now, and media is still making gods?! With the elevation of “gods,”

14
“***” is likely to denote some censored, negative comments about the journalistic report.
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many innocent and ordinary doctors are to be beaten to the ground and
trampled upon by the stick called “ethics”! Is it praising or attacking
doctors after all?
As these comments suggest, doctors’ media criticism closely ties to their
understanding of the role of media in society, as well as media’s effect and implication on
professionals’ social standing and relationships with the public. The identified stakes are
at once reputational (fame), industrial and civic, and so are doctors’ means to address
them: doctors organized various campaigns, clarifying technical issues, trying to change
public opinion, and mobilize changes. These efforts include organizing top-tier hospitals
across China to run large-scale testing (to refute media reports), curating and distributing
digital magazines, setting up thematic websites, running blogs and growing fans, writing
to editors and journalists, offering suggestions on “how media could better report on
health”, etc. For instance, in the midst of the “green tea for urine test” controversy, in
addition to pointing out the technical flaws in media reports, some senior medical
professionals suggest that media should have contacted medical institutions for proper
urine samples, and they should have contacted medical authorities in lab testing to better
understand the results – these are better ways for media to conduct covert investigations
to find out the truth, to fulfill its supervision mission, and to produce results that could be
accepted by medical organizations and the general public.
In addition to “getting the facts right”, doctors’ campaigns also actively seek
famous experts that represent collective interests – who supposedly best serve the
industrial-civic-fame mission. Therefore, sanctions from civic and professionals offices
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(e.g., from the Ministry of Health), public announcements from major hospitals, and
opinions expressed by renowned medical experts or social media celebrities with high
professional status (e.g., Burn Superhero Abao) are highly valued and heavily relied
upon. Importantly, as doctors are more able to impose their definitions of biomedical
realities than journalists, the former can effectively accuse the latter of getting the facts
wrong, causing civic disturbances, and spreading false information. In so doing, doctors
may successfully flip “medical scandals” into “media scandals.”
A Market-Civic World for Better Provider-Patient Relationship?
Arguments involving market justifications evaluate worth based on the price or
economic value of goods and services in a competitive market (Thévenot et al., 2000)
p.240). While market is often assumed to be individualistic, Adam Smith and others
argue that competition and moral sentiments such as impartial spectatorship and
sympathy (i.e., consideration to others) serve as market’s higher common principle to
coordinate actions towards a form of generality. In the market world, people are
individuals motivated by interests, and the worth of services or commodities are judged
by price. People are buyers, sellers, clients, and competitors, who relate to one another
and situation with emotional distance and control (Boltanski & Thévenot, 2006, pp. 193-
203): “Money is the measure of all things, and thus constitute the form of evidence.” (p,
202).
The previous study finds few claims that endorse the market world, as most media
stories frame health care as public service, and market entities are situated critically as
extraneous and polluting. By contrast, medical professionals frequently invoke the market
world positively. These market justifications can be found in doctors’ in-depth analyses
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of China’s health care policies and governance. For instance, a doctor-advocate wrote
that:
Only under market economy can the interests of providers, patients, and
other stakeholders be achieved: medical organizations abound in market
economy, doctors can easily find or switch jobs easily, they could
conveniently operate their own clinics and make a living on their skills.
Doctors can accomplish their value. Patients could also find high-quality,
low-cost services as medical organizations compete, and they could
enjoy high-quality medical services in their neighborhood. Eventually,
we will have provider-patient harmony.
Establishing such a market order was seen as a solution to some vexing problems
and dilemmas medical professionals experience at work. Another doctor reasoned:
Since (provider-patient relationships are) relationships of consumptions,
then when you (the patient) are painfully ill, when you (the patient) do
not have money for treatment, surely I (the medical professional) don’t
have any responsibility or obligation to cure and save lives, surely I do
not only have to sell my service, my skills. This is because relationships
of consumptions are relationships of selling and buying – they are equal
and voluntary. You cannot impose your purchase on me, can you? In
addition, thank you very much, you need to keep my floor clear.
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This justification objects to a scenario where a doctor does not only have to cure a
patient, but also pay for the patient’s medical bill while receiving no gratitude. Such
objections implicitly criticize the (post-)socialist equalitarianism in China, which
demands that public hospitals and their medical providers serve the patients/people,
regardless of costs and even against their own interests. Such expectations and demands
for the “selfless doctors/hospitals” are widely shared and naturalized in the Mao era
(Lynteris, 2012), partly because the health care system is almost fully covered by the
state, and partly because the then healthcare system, like many other socio-economic
sectors in Mao-era China, were extremely under-developed and involving low cost for
either the providers or the payers. As Chinese society marketizes, and as Chinese public
hospitals have to largely rely on their own operations to survive and develop, many
medical professionals find it more appropriate to treat medical consultations as business
rather than social security, and their relationships with the patients as transactional and
preference-based, rather than universal, mandatory, and equalitarian.
Additionally, Chinese doctors invoke the market world to criticize their labor
conditions, work terms and fend off “unreasonable” expectations from the public:
Why doctors have to work hard, get no reward, and even give money to
patients? On what ground? Can any patient tell me on what ground?
Physicians in other countries charge an equivalent of hundreds of yuan if
they provide a few minutes of consultation. In China, we are only paid
little money and we have to answer a lot of patients’ questions; and if we
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don’t smile, if our answers are short, we will even get complaints about
“bad attitudes.”
These arguments speculate that in a market world some existing practices and
expectation in Chinese medical organizations, such as paying rather than charging
patients after providing services, is inappropriate, insensible, and unjust. It is similarly
illegitimate and inappropriate for clients to expect premium services such as receiving in-
depth answers or even smiles from the doctors when they pay little. By contrast, a civic
world that recognizes contemporary bioethics may highlight the importance of “bedside
manners,” that is, doctors should interact with patients in socio-psychologically
appropriate manners, rather than treat the latter as containers of illness or diseases. In
addition, a world of authoritarian or socialist civility where the provider-patients
relationships must be harmonious, it is justified that the doctors serve the patients well
regardless of payments and that doctors pay patients when the latter complaints and even
makes disturbances and trouble (yi nao), especially when they are from lower socio-
economic stratum (i.e., “the marginalized group”) and when they complain about
injustice and inequality in the health care system. Therefore, the doctor’s market
justification implicitly rejects invocation of these civic worlds, and it blurs with
justifications based on private interests (see below for further discussions).
That said, some doctors also recognize the tension between the market world and
the medical profession’s civic aspirations and professional values. For instance, Burn
Superhero Abao commented that,
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[I]f we really pursue marketized health care, if we fully follow the rules
of the market, let the market decide on the appointment price of these top
medical experts, then by no means the price would be 300 yuan, let alone
less than 100 yuan or even a dozen yuan. It must be several thousand or
even over ten thousand yuan. China’s top hospitals and medical experts
will be entirely beyond the reach of ordinary people.
Such reflections and caution against the market, however, are relatively scant in
the current corpus of doctors’ campaigns.
Slippage between the Justification and Individual Interest
According to Eranti (2016, 2018), in the regime of individual interests, the
common good is not associated with universal principles, but rising out of the private
interests of relevant actors, who construct legitimate, opt-in communities of preferences.
This regime is based on the idea that the general will is a sum of individual wills, and all
individual positions can be legitimately expressed. “Whereas the grammar of public
justification requires a higher common principle to be used in the evaluation, in the
grammar of individual interests, small groups can present their positions, their individual
wills, and still be treated as individuals, not collective actors in the sense of the civic
worth.” (Eranti, 2018; p. 57)
Two qualifications appear necessary before the analyses engage with the
discussions about individual interests. As Yan (2009, 2010, 2018) observed, the ongoing
process of individualization has led to the rise of individualism and the pursuit of
individual interest in post-socialist China. Yet the newfound pursuit of individual interest
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in China appears different from what Eranti described in Finland. First, the pursuit of
individual interest in post-socialist China could be highly politicized and contentious, as
it is often tied to the individual pursuit of dignity and rights against suppression,
humiliation, inequality, and injustice. As a move to challenge fundamental power
relations and bring to life civil society, this pursuit is different from individual interest as
expressions of personal choice, option or preference. Second, lacking a long history and a
political reality of democracy, the pursuit of individual interest in China is often
incomplete and imbalanced. As Yan (2018, p. 13) put it, on their course to overcome
inequality and injustice, “the Chinese individuals … tend to overlook the fact that others
have the same entitlements to dignity, autonomy, and respect, and they tend to
overemphasize their own rights and needs while disregarding those of others.”
Because of these differences, the following analyses discuss the issue of
individual interest more flexibly, without binding it to either Thévenot’s or Eranti’s
definition. As far as the current study is concerned, slippages exist between market or
civic justifications and claims based on individual interest. Such slippages are probable as
everyday disputes and arguments are dynamic and complex, while analytical boundaries
among categories are not absolute. Multiple possibilities of slippage across worlds have
also been discussed by Boltanski and Thévenot (2006), together with various precarious
scenarios where justifications in one world tilt towards another.
Whereas one can hardly find any claims based on the individual interest in media
reports, such claims abound in the doctors’ campaigns. Many medical professionals noted
that their private interests, especially those gained from over-prescription and kick-back
money and briberies from pharmaceutical companies, are what motivates public criticism
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and tarnish the professionals’ reputations. Nonetheless, quite a few doctors defend and
express entitlements to these shady deals and “grey income.” A doctor argued that
“hidden rules” or “shady income” exist in every industry: “if you have to criticize doctors
for being polluted (by these hidden rules), then you have to note that you are not clear
either.”
Seeing themselves working too hard for too little pay, doctors often express bitter
denials and announce rejections of the medical profession and bioethics. A doctor told a
story about how his hospital has turned away three aggressive patients and left them to
die, not because their illnesses could not be cured, but because these patients, aggressive
in interpersonal exchanges, have been implicitly identified by the doctors as possible
medical disputants should they be unsatisfied with treatment results. Such stories about
doctors denying patients implicitly legitimize doctors’ pursuit of private interest (even at
the expense of patients’ lives) and their dominance vis-à-vis patients. Moreover, these
stories criticize the socio-political environment that forced doctors to choose between
medical professionalism and private interests rather than strike a balance between them.
In the aftermath of the Nanping Incident, an online comment expressed such a dilemma
and environmental critique:
You (a medical provider) have chosen a field that others cannot govern
but only to scapegoat. So, learn to protect yourself. Now here is the
lesson: under the current circumstance, my lovely people, always
remember to protect yourself first, and save people second, because no
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one has provided you an environment where you could save and cure
people first.
Another comment asked doctors to give up the medical career for their own good:
Those who are to take college entrance examination – don’t go to a
medical school; those who are in a medical school, study the basic, the
fundamental (not the clinical); those who are working as medical
professionals, get a different job. Senior doctors -- consider retiring
before your time; retired doctors – don’t get re-employed.
Such claims based on doctors’ private interests give away a sense of irony, deep
ambivalence, and even helplessness. They suggest the claims makers hold onto their
individual interests defensively instead of aggressively, and they may discontinue such a
self-centered, self-protective orientation should their general work conditions improve.
These claims therefore reveal the divided subjectivities of Chinese medical professionals,
torn between the publicly justifiable aspirations (e.g., fulfilling difficult operations,
saving and curing lives) and the less public and less justifiable motives, including earning
more money (including shady income), and avoiding conflicts, risks, and trouble. Indeed,
many doctors express their envy towards their professional peers in other countries, not
only because the latter enjoy high socioeconomic status, but also because they are not as
torn. As a doctor put it:
Look at the Korean doctors! They don’t have to be like us, many of
whom have to constantly worry about survival. We hope very much that
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we Chinese doctors could be like them, and then we could also fully and
seriously devote ourselves to our profession, focuses single-mindedly on
improving our skills.
Discussion and Conclusion
This study on doctors’ online discussions and campaigns reveal distinctive
justification and claims-making dynamics among the Chinese medical professional,
which could be seen as a distinctive kind of cultural repertoire (Silber, 2003; Thévenot et
al., 2000) for the issue public. One may also say this study describes the “(medical)
professional speak” that is often mobilized to justify the medical profession, as well as to
critique the state, journalism, and the general public from the professional/expert
standpoint. Somewhat like the “greenspeak” G. Yang and Calhoun (2007) analyzed in
their study about environmental activism in China, the “(medical) professional speak”
involves discursive elements that are non-issue-specific, that is, elements that are not
distinctively “medical” or “professional”, but domestic, civic, and fame-oriented.
Different from G. Yang and Calhoun (2007)’s study that presents the greenspeak as
findings, this study showcases how the “(medical) professional speak” could be
disaggregated and assembled, by differentiating and combining different orders of worth
and more.
In doing so, this chapter also provides a detailed understanding of the multiple
and conflicted moral worlds of the Chinese medical professionals, and their agentic
moves to become professionals, citizens, well-respected, well-off, and self-interested
individuals therein. China-focused political/public communication studies have described
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the Chinese public as civic-minded, deliberative, contentious, politically aloof, passive,
playful, affective, and nationalistic. This study presents a somewhat different landscape
of morality and subjectivities: while also highly concerned with the civic and the state-
politic, the Chinese medical professionals as the professional public also pursue
competence, efficiency, fame, market value, and individual interest. They are at once
rights-bearing citizens, civil contenders, and worshipers of benevolent emperors (Perry,
1989). They are competent, ethical professionals who aspire better development and
command respect, and they are just doing a job, selling services, getting by, and minding
their own interests. They are victims of public opinion; they are also to become active
shapers of public opinion. Often, it is the mixture of multiple stakes and subjectivities,
rather than any pure one, that energizes the professional public. Reducing the hybridity
and complexity to one dimension, be it politics or self-interest, misrepresent the actors
and their motives and are therefore inappropriate.
Additionally, the current study illustrates how (aspiring) professionals in
transitional societies mobilize various cultural and moral resources to address their
professional challenges and establish their worth. To note, doctors did not confine their
campaigns to answering the criticism from mainstream media. The professional public
has instantiated and combined multiple orders of worth, to critique misalignment and
injustices in diverse manners, as to “particularize the universal” (Alexander, 2006a) and
repair their worth. Specifically, they have evoked and hybridized the worlds of the civic,
the industrial, the domestic, fame, market, and the less public but no less social argument
about individual interest. These composite arguments are mobilized to protest against
violence, critique the state, criticize the media, call for more market valuation, and
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advocate for their self-interests. Such agentic enactment of orders of worth allows the
Chinese doctors to seek sympathy, alliance, and support on a variety of fronts.
This chapter presents the multiple, conflicted moralities of the professional public
and their agentic, creative pursuit of public and social worthiness – in ways that exceed
media agenda or the conventional understanding about legitimacy maintenance in
organizations. Yet, how would these moralities be enacted in interactions? What sets the
boundary of this creative agency? The following chapter turns to answer these questions.

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Chapter Five: The Styles of Doctors’ Advocacy
The previous chapter uses the justification/engagement approach to understand
the ways through which Chinese doctors’ campaigns deliberating publicly and
competently, to defend and corroborate their social standing and public worthiness. At
the same time, the chapter provides a new approach to analyze public controversies and
mobilizations without being confined to the conventional narratives of “state” and
“society,” “control” and “resistance,” “civility” and “incivility.”
Yet the justification approach has left a few important issues undiscussed. First,
the justification framework focuses on the publicly justifiable arguments by definition.
Despite the extension to the logic of individual interest and other forms of engagement,
the approach still falls short of providing an account for the myriad identity performance
and discursive practices in online controversies. Second, the previous applications of the
justification/engagement approach have exclusively examined the discursive products of
media productions and doctors’ mobilizations, without considering the processes through
which, or the contexts in which, the discourses or deliberations were produced or shaped.
Such flattening of the discursive practices and processual dynamics requires remedies.
Third, the justification/engagement analyses mainly connect micro-level practices with
macro-level, moral, and cultural orders. How might the professional public’s
communications be patterned at a meso level? Relatedly, the justification approach
presents a view of competent agency that is relatively unbridled, disembedded, and
selectively de-institutionalized (Cloutier & Langley, 2013; Friedland, 2013; Thornton et
al., 2015). Therefore, it falls short of understanding how agency interacts with, and is
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bounded by, institutions, organizations, or more specific and local contexts. What are the
boundaries and limitations of the professional public’s agency during their mobilizations?
To address these issues, the current study turns to the cultural interactionist
approach (Eliasoph, 1998; Eliasoph & Lichterman, 2003; Lichterman, 2006; Lichterman
& Dasgupta, 2020; Lichterman & Eliasoph, 2014), particularly its concept such as “group
style” and “scene style”, to examine doctors’ campaigns as dynamic interactions and
cultural practices. As the introductory chapter has presented a theoretical discussion
about group style and scene style, the following section shall focus on describing a few
known scene styles that could readily inform the current study. It also introduces the
methods to study scene styles in online “communities” and environment empirically.
Then the chapter presents the analyses and findings, which provide rich and theoretically
informed descriptions of the cultural patterns that coordinate and shape the doctors’
campaigns in diverse settings. In the end, the study discusses the added value when
incorporating scene-style analyses to the double inquiry.
Scene Style
Scene styles could be discerned empirically through a tripart heuristic: (1) map –
a collectivity’s implicitly shared understanding of their relationships with the wider world
in the setting; (2) bond – the collectivity’s shared assumptions about obligations between
members in the setting; and (3) speech norms – the shared assumptions about the
appropriate speech genres and the appropriate emotional tones to display for a setting
(Lichterman & Eliasoph, 2014, p. 814). With these analytical tools, previous research has
successfully distinguished and illustrated plural scene styles through which organizations
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coordinate actions in public settings and for civil purposes. These scene styles could be
differentiated through their proclivity in a variety of dimensions, including “conflict,”
“vision,” “universalism,” “unison,” and “temporal horizon”
15
(Lichterman & Eliasoph,
2014, pp. 842-843). The following cites previous studies extensively to illustrate the
scene styles that are particularly relevant for the current study includes:
Community of identity: In this style, participants share a map that pictures them
with a distinctive social identity that is in conflict with their exploiters. For the
participants, affirming and protecting the local community was in tension with engaging
a broader public and was also more important than acting in relation to a broad vision of
social transformation. Good participants were supposed to work in unison for “the
community” rather than being wide open to individual expression. Good participants
were supposed to bond over the long haul rather than for short-term strategic gains.
Participants also maintain relatively high boundaries (Weare, Lichterman, and Esparza
2014) on their map, collaborating selectively rather than imagining an indefinitely
expanding circle of constituents. Organizations or populations beyond the community, on
this map, either are in solidarity with or else threaten the community. Group bonds
require participants to identify closely with the community and maintain tight solidarity

15
Conflict: whether participants are highlighting conflict on their maps of the wider world, or they are
downplaying their conflicts with other organizations and other entities on their implicit maps; Vision:
whether they are working to coordinate their everyday action to a vision of social transformation, or not
doing so; Universalism: whether they are trying to construct a distinct community or limited social category
that identifies strongly with the problem and casting any others’ allegiances as secondary or distant;
Unison: whether they are expected to cohere as one body, as if singing in unison, or are expected to
highlight each unique individual’s contributions, as if singing in complex harmony; Temporal horizon:
whether participants cultivate the expectation that bonds will be relatively long enduring or they expect
short-term and easily disconnected bonds (Lichterman & Eliasoph, 2014, pp. 842-843).
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over a long haul rather than coordinate for relatively short-term gains (Lichterman &
Dasgupta, 2020, p. 248; Lichterman & Eliasoph, 2014, pp. 844-845).
Community of interest: Like community of identity, people engaging in this
scene do not tightly connect their actions to abstract ideologies or socially transformative
vision. This scene offers a map that supposedly can be identified and related to by a
socially diverse public. Relationships do not have to be long-term, and they could end
when benefits diminished. Until such time, the coalition expects tight unity, not
individual expressions (Lichterman & Eliasoph, 2014, p. 814).
Social critic: The social critic style envisions a map that includes conflicts and
ties everyday actions to the broader, socio-structural transformation. Participants enacting
this scene attempts to appeal to a diverse, possibly universal public, and they engage
themselves in collective-minded, civic action for the long term. The social vision,
however, could be ideological diverse. Participants are expected to bond in long term,
and in unison rather than in a complex harmony of diversity (Lichterman & Eliasoph,
2014, p. 845).
While the above descriptions present different styles as if they are distinct and
discrete, researchers have noted much ethnographic nuance and dynamics of the styles in
practice. For instance, styles may blend, become demarcated, or switch, depending on the
practical situations. Importantly, researchers caution that the dimensions that differentiate
and describe the styles are on a spectrum rather than being binary, and the relative
weights of the dimensions for each style are not determined or prescribed in exact
manners. As the following analyses shall demonstrate, such ethnographic nuance and
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analytical un-determinedness facilitate the adaption of the scene-style approach for
studying online interactions and cultures.
Recently, Lichterman and Dasgupta (2020) connects scene styles with another
important cultural sociological concept –discursive field, and offers an explanation of
how scene styles shape discursive field. A discursive field is usually seen as an enabling
and constraining cultural context, as it consists of cultural work with “fundamental
categories” that both provides actors with basic building blocks for meaning-making and
sets “limits of discussion” (Spillman, 1995, p.140; Wuthnow, 1989, p.13). Cultural
interactionists add that some discursive fields are products of recurrent, situated
interactions. As people interact in specific settings, real or virtual, that often carry their
own expectations (Eliasoph, 1998; Goffman, 1961, 1974; Gusfield, 1981), over time,
scene styles – cultural patterns of interactions in settings – emerge and become
established, and act to “sideline” or privilege certain discourses in settings in repeated,
predictable manners. Specifically, the researchers note that (1) scene styles bound the
discursive field by making some symbolic categories illegitimate; (2) scene styles induce
participants to deem some claims or discourses inappropriate because they do not
comport well with the style for the scene at hand; and (3) scene styles induce participants
to make some claims or discourses subordinate or less salient than others (Lichterman &
Dasgupta, 2020, pp. 244-245). This recent development on the connection between scene
style and discursive field provides an appropriate framework for discussing the scene
styles and their roles in shaping the discursive dynamics of doctors’ online campaigns.
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Studying Scene Styles in Online Setting
In the introduction, the author affirms the applicability of a scene-style approach
to online communication. Still, important differences exist between the current study and
a typical cultural interactionist one conducted in offline settings in the US. The first
difference has to do with the socio-political context and its impact on organizations and
interactions. Unlike the relatively autonomous, civic organizations studied by the cultural
interactions in the US, Chinese doctors’ campaigns have received varying tolerance,
autonomy, and censorship depending on the time and situations. While some campaigns
left a rich digital trace that enabled the researcher to reconstruct and understand what
happened and how they happened through interactions, other campaigns might have been
interrupted, halted, or closed down abruptly, and their online interactions and
communications deleted or hidden by the state, the internet platforms, website
administers or the doctor-advocates themselves. The second difference speaks to a
general feature of online interactions. Unlike the civic organizations in previous studies,
doctors’ campaigns often lack clear or stable leadership or organizations. As the sites of
doctors’ campaigns – BBS, blogs, or microblogging platforms – are often open, public,
and more or less anonymous, allowing fluid participations by anyone who is present, the
online discussions and interactions often appear to contain multiple voices and scenes,
and they appear to host more confusion and exercise less discipline. This is not to say that
online interactions always lack organizations or patterns, yet the organizations of online
interactions tend to be more hybrid and elastic than the civic organizations in previous
studies. Third, unlike conventional ethnographic studies in offline settings that involve
extensive participant observations and direct communication with the participants, the
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current study heavily relies upon textual and visual materials in a few social networking
sites that make explicit doctors’ interactions and communications. In other words, this
study lacks direct contacts, communications, and interviews with the doctor-campaigners.
As many campaigns occurred 5-10 years ago, many doctor-campaigners have migrated to
new digital platforms from the ones where campaigns or mobilizations took place. Even
if the researcher was able to locate some of these participants, the tightened political
environment in China in recent years has made it politically sensitive and difficult for
individuals living in China to discuss with an unfamiliar researcher at an American
institution about past online contention and mobilizations. The current author was only
able to find and talk to three participants, with one of them barely willing to discuss his
participation in detail. Still, the analytical methods in conventional scene-style studies
were emulated, such as taking and archiving extensive “field” notes of online interactive,
code online “field” notes through analytical induction, conduct theoretical sampling of
sites, and carry out constant comparison, including comparing the empirical data with the
known types of scene styles in the literature. Because of the above constraints and
limitations in data collections, the current study presents its findings of the scene styles of
the doctors’ online campaigns as probable rather than definitive, a starting point of
inquiry rather than a finished space.
Online Sites of Data Collection and Internet Research Ethics
The current study mainly collects and analyzes data from two public online
venues: Sina Weibo and DXY BBS. Sina Weibo, established in August 2009, is the
largest microblogging service in China. Weibo asks its users to use settings, to confirm
and control the level of publicity and visibility of their own information while using
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Weibo (Weibo Service Usage Protocol, 2020), for instance, its users can choose among
four levels of publicity –“public”, “visible to oneself”, “visible to friends”, and “visible to
fans” for their posts. This study only observes and collects information that is made
public. To the researcher’s knowledge, most popular discussions and academic
publications on Chinese media have no significant ethical problems in accessing and
using these publicized Weibo posts.
Established in 2000, DXY BBS identifies itself as a major, specialized, online
forum and community mainly for academic and professional exchange among registered,
health professional users. At the same time, it allows registered, non-professionals to
observe, but not to publish or participate in discussions. According to DXY, by the end of
2016, DXY has tens of millions of public users in China, and more than 5.5 million
registered life science members, including 2 million physicians. The researcher has
registered a non-medical user account at DXY BBS and has obtained approvals from
DXY BBS administrators/moderators to conduct observations.
A note is needed about research ethics and anonymization. To emulate the
standard of care when studying internet (inter)actions, online platforms’ “terms and
conditions” or “user agreements” were observed, as well as “Ethical Decision-Making
and Internet Research: Recommendations From The AoIR Ethics Working Committee”
(Ess and the AoIR Ethics Working Committee, 2002) and Christine Hine’s (2015)
Ethnography for the Internet: Embedded, Embodied and Everyday.
The researcher differentiates different kinds of online data and anonymizes them
differently. For instance, the researcher may offer no or little anonymization to medical
celebrities (e.g., White Coat Mountain Cat), their postings, or discussions around them,
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since these actors and their postings/discussions have become salient subjects of public
discussions or media reports. In other words, no significant risk would the current study
entail for the sources given that they have been highly public. By contrast, if the sources
do not enjoy celebrity status and have not been widely identified in public, they would be
fully anonymized for their privacy. The originally Chinese quotes are translated into
English by the author, so that sources are not searchable. Finally, the study’s data
collection and analysis have been confined to research purposes and unnecessary
judgments about individuals were avoided.
Analyses and Findings
A brief glimpse of the Chinese doctors’ campaigns suggests the salience of the
community-of-identity style. Doctors’ campaigns often demand workplace safety and
improved work terms and conditions on the one hand, and better public standing and
more legitimacy on the other hand. Therefore, when making these demands, medical
professionals consistently talk about themselves as the exploited and the jeopardized in
reform-era China, afflicted by a variety of forces and agents. Both the DXY 404 page and
the Nanping Website sought to highlight the unique threat, stress, and loss expressed by
the Chinese medical professionals. A program called “Doctors Help Doctors” (Yi Bang
Yi) was co-founded by DXY and many medical professionals in 2012 to protect the
professional community. The program’s introduction goes:
“System, institution, health care reform” …critics used these words to
analyze “the root causes” (of medical problems), yet what should the
medical professionals do as they live in the present? How much more
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lives and cost should we pay? We cannot shake up changes in the
medical system, but we hope that we could use our platform to do some
small yet concrete things for medical professionals who suffer from
injustice and harm.
While distancing itself from broader social vision and structural transformation,
the program again underscores the costs and injustices that medical professionals have
endured.
Similarly, the series of Weibo campaigns led by medical celebrities between 2014
and 2016 sought to “make doctors’ voices heard,” implying that such voices were absent
or marginalized in the past. One of these medical celebrities, White Coat Mountain Cat,
claimed that he joined and used Weibo and other social media mainly to represent the
doctors’ perspectives. As his Weibo “popularizes science for the public, debunks
(medical) rumors for the society, protects the medical professionals’ rights and helps
providers and patients communicate,” Mountain Cat stated that he “naturally hold
doctors’ perspectives” and should not be expected to be a fair judge in health-related
public incidents. In a more combative and explicit manner, Burn Superhero Abao seeks
to be, and is widely recognized by many Chinese medical professionals as, “a falcon and
hound who protects the Chinese medical community in deep distress.” One of his articles
stated,
I need to speak up, because doctors have endured so many attacks and
tortures. I need to speak up, so that their enormous sacrifice and
contributions would no longer be ignored. I need to speak up, so that
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they would not receive humiliation and harm every day… I need to
speak up, because I don’t want the demons who harm the angels to
escape the law, unpunished. I need to speak up, in order to reduce
hostility and misunderstanding.
Such are the views of the relationships between Chinese medical professionals –
including advocates like Abao – and their environments. More tellingly, in a 2014
controversy where a few surgeons’ professional ethics was publicly scrutinized and
criticized, Abao proclaimed that he “always speak for the doctors on Weibo, whether
they are innocent or guilty.” While such a statement is likely to appear “unprofessional”
to many for its lack of neutrality, a great number of medical professionals and students
responded to Abao’s statement with supportive comments and avid tipping, thanking
Abao for his solidarity with the community.
Dramatizing Conflicts and Radicalizing Visions
When speaking up in relatively homogenous and “enclaved” space, doctors were
more likely to make bold and even radical criticism of the perceived exploiters, including
the state and the patients. The following comments are easy to find in online medical
forums, particularly after occurrences of violent medical disputes: “The chief culprit is
the government – it invested little in healthcare and made the patients to pay for the most
part. No wonder that the patients are angry. Don’t trust the government. We are better off
without it.” “We should have collective resistance. Let’s have a big collective ***
(censored content, possibly “strike”) and see how the society could operate without us.”
Another doctor called:
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If we don’t help and support Nanping doctors today, tomorrow their
knives will stab at our bodies. Don’t place any hope onto the highest
ruling class. We are not pitiful creatures. All medical workers in China,
unite for our last survival space!!! Starting from tomorrow, let’s
BAGONG (go on a strike, pinyin origin to avoid censorship) in the name
of sick leave. THIS IS OUR FIRST STEP (capitalized English in the
original text).
After the violent assaults against doctors in Nanping in 2009 and in Ha’erbin in
2012, doctors used and modified classic texts, war-time materials, and revolutionary
memories to air grievances and advocate self-protections. In so doing, they analogized
their occupational plight to major socio-political crises in Chinese history, thus
radicalizing and dramatizing the conflicts and urgency in their map and vision. During
the Nanping Incidents, doctors widely circulated on the internet an image called
“Nanping! Nanping! (Hospital of Live (sic) and Death)”. The image shows Nanping
doctors’ protests in a dramatic, black-and-white atmosphere, emulating the film poster of
Lu Chuan’s “Nanking! Nanking! (City of Life and Death),” a heart-wrenching depiction
of the Battle of Nanjing and the following massacre committed by the Japanese army
during the Second World War. Later, under the local government’s directives, Nanping
Hospital agreed to pay the patient’s family a substantial amount of money. This
compensation agreement occurred when many medical professionals believed the
hospital had not committed malpractice. At the same time, the deceased patient’s family
and clan had injured five medical professionals and vandalized the hospital.
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Consequently, many doctors called the agreement between Nanping Hospital and the
patient’s family an “unequal treaty” or “the New Treaty of Shimonoseki,” referring to the
“humiliating and sovereignty-forfeiting treaties” China had signed with its invaders
during its colonial past. A doctor asked, “Why aren’t there Chen Sheng and Wu
Guang!”
16
Another doctor changed the first line of the lyric of China’s national anthem to
advocate the establishment of “United Self-Rescue Association for Chinese Doctors”:
“Stand up, doctors who do not want to be stabbed! Let our flesh and bloody make up the
new Great Wall!”

16
Chen Sheng and Wu Guang are two widely known insurrectionists in ancient Chinese history that ended
up overthrowing the first imperial dynasty in China.
Figure 8. Image Widely Circulated during the Nanping Campaign (left) Emulated Nanking! Nanking! film poster (right)
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Under the authoritarian political conditions in China, these bold complaints can
hardly congeal into stable organizational patterns to mobilize or sustain collective
actions. Nonetheless, they may have spread a more dramatic, historical and revolutionary
vision among the doctors, which at times enable the community of identity to adopt a
social critic style in brief and selected moments. Again, during the Nanping Incident,
doctors’ online campaigns did not only seek immediate justice for local doctors but also
institutional, long-term means to protect all Chinese medical professionals’ safety and
interests. As part of the institutional efforts, a signing petition was launched to collect
100,000 signatures from the medical professionals, as to support collective appeals to the
state and the media for changes. When some participants expressed doubts and asked if
such a signing petition would work towards the institutional goals, a few participants and
organizers responded:
If it is useless, why can’t we access the signing website for some time? If
your movement is nothing in the other people’s eyes, would they censor
and suppress you? The reason you are suppressed is because you have
made someone feel pressure! We need to demonstrate our power!
Another commented:
If we don’t fight for our own interest, how could we expect others to
endow them to us? How much longer will this selfishness and servility
(zisi yu nuxing) last? Does it have to last till the day when a heavy knife
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is to chop our head (da dang xiang women doushang kan lai)? But no
one will call to arms (nahan) for us then.
Many Chinese people would recognize “selfishness and servility” and “call to
arms” as Lu Xun’s writings between the two world wars (early 20
th
– mid 20
th
century),
which have been part of the middle-school education and often lauded as the sharpest and
perennial critique of the socio-cultural ills of the Chinese society. Similarly, “a heavy
knife to chop one’s head” is an expression that evokes the collective memory of China’s
survival crisis and struggles during the same time period. Contextualized with these
cultural and historical references, doctors’ small act of signing petitions became
connected to changing power dynamics and the collective psyche in the bigger society.
While currently, power concentrates within the party-state, constraining and suppressing
civil actions and expressions, through modest acts such as signing a petition, the medical
professionals aspired to change themselves and build a future where they are more
empowered and better able to access rights. Through expanding their civic and national-
historical vision, doctors engage in the campaigns to simultaneously protect their own
unique community and to achieve justice and value in the civic and nationalistic world.
Contracting Bond, Sidelining Publicness and Civility
While the doctors’ campaigns often expand its vision civically or national-
historically, they may also contract its map and bond, leading to shrunken space for
collective solidarity, publicness, or civility. After reading a few influential yet misleading
reports that scandalize medical institutions, a doctor named himself Dreamer on the
Internet asked to activate the “Doctors Help Doctors” program, encouraging doctors to
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take up their public responsibility to propagate correct medical knowledge. While some
doctors echoed Dreamer’s call for public actions communication, others dismissed it and
turned to private practices instead:
What we lack is not mouth water, but practical actions. We need to take
care of each patient we have and let their word of mouth enhance
doctors’ reputation. If you want to gain help from the party’s
mouthpiece, then keep on dreaming.

Don’t waste your time and energy on this. We can’t change the status
quo. Our society only allows for top-down reform, and bottom-up
struggles are all defined as anti-revolutionary. They are all to be
suppressed. We are just workers after all. We can’t decide our own
destiny – only the rulers in different classes can. These people are
directors, hospital presidents… In fact, provider-patient conflicts are but
an instrument! The ruling class’ non-action and acquiescence (perhaps
permission) have tolerated these irresponsible journalists who keep
blowing up the right of the patient and the wrong of doctors…Dreamer,
just live your life well. It is enough if we are conscientious when we treat
patients!
Like the doctors who expand and dramatize visions in the earlier examples, these
doctors also see a highly conflictual and problematic status quo, for which the state is
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responsible. Unlike the “agentic” and collectively oriented doctors in previous examples,
the doctors in this example saw themselves disempowered in the map, and their bond
does not go further than their obligations to the patients and themselves.
Such a cynical style may further suppress its map and shrink its bond so that it is
no longer justifiable, professional, or civil. A doctor put it,
Remember the risk of being a doctor, always put self-protection first. Do
not act, act less, then there will be fewer mistakes. Apply this at work. If
I am afraid of risk when treating patients, what should I do? Ask the
experts in big cities to deal with the patient. Do not consider helping the
patient save money in these situations. Or else, ask the patient to transfer
to another hospital.
“If you can do conservative treatment, don’t do surgery. Remember colleagues,
we are not angels or saviors!” As the doctors picture a map in which their relationships
with the patients are so conflictual, they recommend discounting medical professionalism
for self-preservation. Other statements are even more blatant: “Let SARS come back,
quickly. Let them see how medical professionals treat patients. Then they will say, ‘you
are the most lovable people in the new era.’ I feel sorry for these people.” In other words,
the public health crisis is viewed as an opportunity for medical professionals to enhance
their social standing, even though it is pitiful that doctors have no other choice but to rely
upon such cruel opportunities in the first place.
I hope that one day, all or at least most medical workers would leave
their positions… Let illness and harm leave indelible impressions upon
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everyone’s hearts…Then, most problems we are facing now will be
solved! Phoenix must be burned and destroyed before it can be reborn!
Let provider-patient relationship worsen! Revolution is made of blood!
The blood is not only medical workers’; most of it should be patients’,
even the innocent people’s!
Seeing themselves fully alienated from the general public and suppressed by an
unjust system, doctors encourage one another to resort to everyday, clinical resistance
(Scott, 1990, 2008) or professional dominance in clinical settings (Freidson, 1974, 1988).
For instance, they could quit their profession or selectively do clinical work, thus denying
the possibility or space for public justification, communication or coordination.
Crowding Out Self-Reflections and Patient-Centeredness
As Lichterman and Dasgupta (2020) noted, scene styles may shape the external
and internal patterns of discursive fields, thus influencing what counts as legitimate or
illegitimate, appropriate or inappropriate speech in situations of interactions. In cases
where the contracted community of identity tolerates strong antagonism against the state
and the general public, it also filters out demands for doctors’ self-protection and patient-
centeredness, as these demands strain the ingroup solidarity. Such dynamics are visible in
some of the above examples, yet it is particularly pronounced in moments of breaching
and mistakes. A less supportive response from a lay Internet user to doctors’ Nanping
campaigns in 2009 provided such an example. While the Internet user also criticized the
state for the failed health care reforms firstly and primarily, he or she also asked the
doctors to stay constrained and reflective as China’s intellectuals and elites: “if doctors
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know that medical disputes are unlawful, why have you met violence with violence? I
think if you doctors have taken more responsibility and showed more integrity, perhaps
some undue things would not have happened.” Such a comment induced many
emotionally intense pushbacks from the doctors. One of them goes:
Who should reflect exactly?! Society has put all their blame for the
medical problems onto the doctors. The doctors have been scapegoated
for the corrupted medical systems. Who is the real marginalized, weak
group? Although patients deserve sympathy, doctors too have been
marginalized…Doctors’ life safety has no protection; their integrity
could be easily trampled upon, and the media manipulates the public
opinion. The law shifted the burden of proof to the doctors (assuming
doctors guilty until proven innocent in medical disputes)! Doctors have
to receive medical ethics education even after they have been attacked
and abused? How can doctors not be marginalized!... Dear journalist
comrade, there is no one who is stronger between the providers and the
patients! Doctors and patients are all victims to the backward medical
system. Please do not manipulate public opinion and incite provider-
patient opposition anymore!
For doctors evoking the community-of-identity style, an outsider’s demand for
doctors’ reflection does nothing but trigger strong self-protection and further
denunciations of external pressure.
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Doctors mobilizing as a community of identity also pushed back against medical
ethics and self-reflections when these requests were articulated by ingroup members. In
these cases, new boundaries were created to demarcate and alienate the self-reflective
doctors as “inadequate”, “different”, or “betraying.” In December 2014, a public
controversy broke out around doctors’ “selfies” taken in a working operation room. In
some of these pictures, surgeons smiled at the camera with “V” gestures while the patient
was lying on the operating table, receiving treatment with his body and face partially
exposed. Such pictures quickly stirred public scrutiny and criticism over the surgeons’
practices. To respond, many medical professionals turned the table by accusing the media
and public of exaggerating the surgeon’s flaws, creating moral panics while ignoring the
surgeon’s medical achievement. It is under this context that Burn Superhero Abao
publicly proclaimed that he would “always defend the medical professionals on Weibo,”
to which many medical professionals and students responded with avid support and
appreciation.
By contrast, two other medical authorities with significant followings on Weibo
knowingly and unknowingly strained the expected solidarity and unison of the medical
community of identity. Instead of defending the surgeons in the selfies, one of these
medical authorities shared his experiences and methods for better protecting patients’
privacy when posting pictures online. The other doctor explicitly criticized the surgeons
for professional flaws. Soon these doctors’ Weibo accounts were flooded with criticism
from self-identified medical professionals and students. A comment stated:
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Yes you have become a senior doctor now. Even though what you said is
correct, it is a smug assertion from a privileged position. We small
doctors are starting to realize that it is a tradition for Chinese media to
frame Chinese doctors, and it is similarly customary for Chinese doctors
to add insult to their colleagues’ injuries. Next life I would not be a
doctor anymore.
Another asked, citing a classic Chinese poem “We are of the same roots, why
rush to slaughter me? (ben shi tong gen sheng, xiang jian he tai ji)?” A third one posted:
As a medical student, I am rather disappointed to see so many medical
celebrities disassociate themselves from this incident in public... It’s
disheartening to see medical authorities use such an instructive tone and
judge the surgeons to be wrong – it hurts many colleagues’ hearts. It is
not that we cannot take the criticism, but we have become frightened,
skittish birds.
These comments suggest that when engaging in the public sphere through the
community-of-identity style, medical professionals are more concerned with solidarity
and loyalty to the people than adherence to professional principles.
The evaporation (Eliasoph, 1998) or crowding out of professional reflection does
not only occur in public controversies when “the whole world is watching,” even though
the presence of outgroups might increase a community of identity’s pressure for ingroup
unison and solidarity. Still, doctors enacting the community-of-identity style could also
turn ingroup discussions about medical ethics controversial, by emplacing such
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discussions in a map of “us versus them” struggles and conflicts. A post entitled “If I
Could Choose Again, I Would Still Be A Doctor” was subject to unexpected controversy
in DXY BBS. Reviewing his career, the middle-aged doctor-author shared his love for
his profession and patients:
Some people say, “guard against fire, thieves and patients,” but I love
my patients. They are the value of my life; they are the source of my
happiness. Over and over again, I refuse heavy red envelopes from the
patient’s family, just because I never take advantage of the fallen. Over
and over again, I travelled across hospitals across the country, saying to
the afflicted patient and family, “Please stay assured, I would do my
best.” Over and over again, patients and family come to the hospital with
suspicion and caution, and yet when they leave, we have become friends.
Such emotionally saturated writings, with its call for “loving patients” and
“positive energy”, are not unfamiliar among Chinese medical professionals in public
hospitals. While some doctors responded to this self-sharing with agreement and
appreciations, others posted pushed backs, interpreting the post as “disconnected from
reality” or “showing off”:
You have a kind heart – I admire that! Your love for work is more than
average people. Maybe you are so-called the “white coat angels” (a
common praise for medical professionals in China). As far as I now,
most medical professionals are still struggling against poverty, most
people are still fighting for their everyday meals. When facing patients
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who make unreasonable disputes, who refuse to pay for their bills, and
when facing evil bosses and directors/superiors, I do not know how to
love my patients, my career.
Another doctor responded:
In the medical realities in today’s China, I don’t understand how come
doctors are still advocating love for patients here. To be sure, the author
has his right to love his patients, but he is wrong to advocate such love
publicly! Yes, his patients have high “suzhi” (quality). They are
relatively wealthy. Therefore, his patients are loveable, and deserving of
his love. But there are many doctors in DXY who have been verbally
abused or physically assaulted by the patients, even significantly! These
are not due to doctors’ faults. What is the author trying to say on earth
when he said, “I love my patients” in DXY under such circumstances?
Apparently, for some junior medical professionals working at the basic-level
hospital, discussing one’s love for the patients leads to internal differentiation and
alienation within the medical communities.
Similarly, another post entitled “Experience and Thoughts after Visiting
Scholarship in the US – How does the US pursue human-centeredness and patient-
centeredness?” attracted many complaints. While some Chinese doctors appreciate the
American example for Chinese professionals’ emulations and aspirations, many others
assert contrary feelings -- complaining that patient-centeredness is impossible, baseless
(as in the Marxist sense – “base determines the superstructure”) and undesirable in China:
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In this country where care for the doctors has been severely lacking, you
are expecting doctors and hospitals to genuinely care for the patients? Do
you think Chinese doctors and hospitals managers are selfless gods? It’s
often said that medicine is the science of strong nations. Without strong
political economic forces and abundant humanistic resources, how can
(Chinese) hospitals get to the American level? This is not something we
can transfer to China by some simple observations and learning!! I think
the whole point of this article is to evoke envy and jealousy among
Chinese doctors!!”
Another comment went:
Could the author talk about anesthesia instead? This post is full of craps.
Talking about strengthening professional ethics and human-centered
management all the time is absolutely ridiculous! Isn’t this as impossible
as asking a tiger for its skin (yu hu mou pi)? Doctors want to butcher
patients, and patients want to stab doctors. This is the medical realities
(in China).
Again, as the doctors picture a map where they are under-resourced and overly
suppressed. In this map, they conceive their obligations to the patients secondary rather
than unconditional, and the discussions about patient-centeredness itself alienating and
off-putting.
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Expanding Alliance and Toning Down Criticism
The above analyses illustrate different modes of the community-of-identity style,
which appears to be pervasive in doctors’ campaigns. Yet in some situations, doctors are
willing to lower their barrier and downplay their conflict with other social groups, as to
expand allies and mobilize resources for short-term, strategic goals. In these situations,
one observes the tilt towards, or the emergences of, a community of interest. Dr. Wind,
one of the Nanping campaign’s organizers, asked doctors not to treat the state as unitary
or homogenous, but to be like the “rightful resisters”(L. Li & O’Brien, 2006) who exploit
the discrepancy between the local state and central state. In other words, the doctors can
trust and appeal to the central state in order to attack and bring down the local state. Like
many others, Dr. Wind recognized that many public opinions expressed on the Internet
were hostile about medical professionals even after violence and killings. Instead of
complaining about such negativity, Dr. Wind asked the doctors to lower their expectation
and tolerate the public opinion – it is the reality that they have to work with for the
moment, rather than something they could change in a short time. Since no campaigns
could succeed without the public’s support, and because many lay people tend to identify
with the patients and family, Dr. Wind asked the doctors not to attack the violent patient
family too much. Another organizer, Julie, similarly asked the doctors to accept the
public as long as they did not oppose the doctors’ campaigns. While many doctors
suggested pressuring the Chinese state by exposing the violence as scandals to
international media such as the BBC, Voice of America (VOA) and CNN, Julie cautioned
against contacting foreign media for fear of escalating the campaign’s “political
sensitivity” in the eyes of the Chinese central government. Instead, the organizers asked
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the doctors to focus on targeting at one journalist’s reports published at China Youth
Daily, a popular official newspaper, to produce multiple critical articles from different
angles, and to pressure the journalist on both his personal blog and the newspaper’s
website. At the same time, the organizers actively contacted other mainstream media such
as China News Weekly, as to propagate the doctors’ voices and perspectives directly.
Together, these organizers asked doctors to carefully “identify the major enemies,” to
“bond with all the possible allies,” to focus all the energies on a few key pain points and
to seek breakthrough. They should not address all the possible sites and sources of
doctors’ complaints: “It’s better to break one finger than injure ten.”
The community-of-interest style thereby encourages more domestic appeals and
complaints to the party government for more and better paternalism. At the same time, it
encourages industrial and civic critiques of the local state, police and media in Nanping
within a politically safer and more bounded framework of accountability, legality and
performance. In other words, the doctors criticized the local state, police and news media
for failing their civil, bureaucratic or industrial/professional roles, while refraining from
the bolder or more dramatic criticism mentioned above. An article on the Nanping
Websites demonstrated this tactic:
(We) Thank the Constitution, thank the central party. Now we have the
freedom of speech, the rights to make petitions, and the mass Internet
communication. So medical workers have a space to make complaints
and air grievances. (We) Thank the attention and instructions from the
vice Provincial Governor, so that the Nanping government finally
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responded to the anger of medical professionals. Yet this response –
Nanping Government’s press release on June 25, confused right and
wrong, reversed black and white, and were full of lies!
The appeal simultaneously confirms the legitimacy of the higher, central
leadership and denounces that of the local government.
Another doctor-advocate also blended a community-of-identity style and a
community-of-interest style when mobilizing campaigns in 2010. The doctor first
affirmed and analyzed the unique plight of the medical community and asked medical
professionals to address it, not through complaining among themselves but through
public, online campaigns. Then the doctor provided a list of concrete things medical
professionals should do to change public opinion and improve their social standing.
Finally, the doctor listed thirteen tips for how to do such online campaigns, which
illustrated a community-of-interest orientation to expand bond through toning down or
filtering out radical, alienating remarks. These tips include: “avoid rhetoric that might
trigger confusion or public angst, such as ‘it is normal that people die in hospitals’,”
“provide explanations and argumentations even when you talk about the technical content
that could be taken-for-granted,” “when facing the lay public, provide well-intended
guidance, not scorch or criticism”; “avoid engaging in quarrels even when facing the real
enemy – winning over one enemy in quarrels might turn ten spectators into enemies”; “do
not mention the government in the article’s title or opening”; “point out the root source of
the problem, but do not advocate the public to overthrow that source”; “do not mention
sensitive historical events and time”; and “respect the editors and managers of online
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platforms. If they censor your posts, show understanding and repost the content after
some adjustment. They are also sandwiched workers like us…” The doctor sets the scene
of interest-based collaboration by advising on types of engagement.
Such strategic, alliance-expansion orientations are also visible, though possibly
compartmentalized or subordinate, in some previously discussed campaigns. For
instance, the “Doctors Help Doctors” program enlisted several journalists at prominent
media as its consultants, even though one of the journalists have been subject to doctors’
collective protest during the Nanping Incident. Similarly, while the doctors’ campaigns
between 2014 and 2016 have frequently denounced local governments, state policies, and
media reports, many of the campaigns’ participants (including Superhero Abao and
White Coat Mountain Cat) have also been in close contact and collaborations with state
departments and media. However, due to the lack of access to the decision-making
processes of these doctors’ campaigns, and because censorship has removed much
relevant internet data,
17
the current study falls short of further clarifying the community-
of-interest style. It could not determine the extent to which the community-of-interest
style was developed or institutionalized, and how and when it was the dominant style in
lieu of alternative ones.

17
For instance, the Nanping Website established by the doctors in July 2009 was closed down in August
2009, the “Doctor Help Doctor” signing petition in 2009 was also halted before it collected 8,000
signatures, the medical forum DXY BBS was put to “maintenance” around the same time, and many
discussions regarding campaigns on DXY BBS, Tianya BBS, Weibo and blogs have been deleted or hidden
from view.
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Discussion and Conclusion
As discussed earlier in this chapter, the scene style approach complements the
justification analysis and adds value to the inquiry of doctors’ campaigns as public
communication in China. Specifically, the analyses of the scene styles illustrate the
durable yet dynamic cultural patterns through Chinese doctors participate in online
campaigns and develop their advocacy discourses. These cultural patterns are meso-level
and local, and they constrain expressions and actions as much as they enable them.
Thusly, scene-style analyses make the competent, creative doctors in the previous chapter
look more predictable. In some examples, one also observes how discourses, including
justifications and critiques, are filtered (and at times fully filtered out), by interactional
patterns rather than strategic intentions. For instance, when campaigning as a community
of identity, doctors often object to demands for more self-reflections and medical ethics,
even when such demands are articulated within the order of the industrial and civic
worth, and even though complying with such demands may be more strategic and
effective for doctors’ legitimacy repair and enhancement in the public eye. Aligned with
Lichterman and Dasgupta (2020)’s argument on scene styles’ causal influence on
discursive fields, this study suggests that scene styles have an impact on the uneven
distribution of arguments and discourses within doctors’ campaigns, while also
modifying the flavors and modulating the tones of those discourses. In fact, the above
scene style analyses suggest that justifications themselves are products of particular scene
styles in the case of professional public’s mobilizations: while doctors enacting the
community-of-identity style often express themselves extra-rationally and without fully
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spelling out what they mean, doctors acting as a community of interest are more likely to
develop claims and critiques by instantiating orders of worth.
The pluralism of scene styles and their differentiated effects on public
communications also provide additional considerations to the current inquiry about
political/public communication and professional legitimacy in China. This study joins the
ongoing discussions about the civil or uncivil communication in China and beyond.
Together with De Seta (2018) and Pohjonen and Udupa (2017), this study using the scene
style perspective argues that digital, public communications are multi-faceted, ridden
with situational performances and are embedded in specific settings and contexts. They
also involve ambiguity, variety, and local richness that require unpacking and should not
be treated as a lump. For instance, doctors’ pushback against “medical ethics” on the
Chinese internet has been widely noted and frowned upon. Instead of labeling this
practice with “unethical”, “uncivil” or other “thick concepts” (Brubaker & Cooper,
2000), it is more fruitful to understand how practices develop within the online medical
communities, and how they tie to doctors’ changing perceptions of and relations to both
the “outside world” (including the state and the general public) and themselves. To some
extent, one may argue that doctors’ refusal of medical ethics is tied to their lack of
political self-efficacy in China. Should today’s professional publics be able to establish
autonomous and powerful associations like their Republican predecessors, should they be
able to not only air grievances but also to organize collectively and negotiate with the
state effectively, the doctors may coordinate more as a community of interest rather than
a community of identity. In so doing, the professional public might not filter (out)
medical ethics in the same way. Of course, such outcomes are only speculative. Yet it
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converges with Yao’s (2016) similarly speculative conclusion in his sociological study
about China’s medical profession: without corporate power, the Chinese doctors are
unlikely to become “professional” either in clinics or in public communication.
Therefore, this study shows that profession-public communication is embedded in
specific communicative settings, just as they are embedded in socio-historical processes
and political-institutional contexts. Even when professional legitimacy is at stake, even
when the general public has articulated a demand for more “professionalism” and
“ethicality”, professionals’ public communication -- at once enabled and constrained by
the cultural patterns developed at local settings -- may resist and result in interactions that
are far from strategic or optimal. At the same time, this study addresses the difficulty of
achieving Habermasian deliberation and consensus in public communication. In specific,
organizational scholars Palazzo and Scherer (2006) recommended a deliberative
democratic approach to maintaining organizations’ moral legitimacy, in which
organizations turn to civil society discourses to establish alignment with broader
community values in a politicized, unstable institutional environment. The current study
informed by scene styles suggests that such alignment is unlikely to occur unless
communicators have established interactional patterns that facilitate non-antagonistic
conversations with one another. In the example of Chinese doctors’ campaigns, doctors
enacting the community-of-identity style consistently turn away from discussing or
acknowledging self-reflections and patient-centeredness – while such discussions may be
highly demanded by the civil society, they were seen as straining doctors’ ingroup
solidarity.

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Chapter Six: Conclusion
Despite their public visibility and political relevance, medical controversies and
mobilizations in transitional China have yet to be carefully accounted for in
communication research. The few existing studies that examine medical mobilizations as
political/public communication have arrived at diametrical assessments – civil and
uncivil, while referring to overlapping empirics. These inadequacies express the limited
and limiting approaches in the current scholarship about political and public
communication in digital China.
This dissertation offers an alternative and a remedy. Instead of praising mediated
conflicts as either “emancipatory” or condemning disputes as “fragmenting” in reform-
era China, the dissertation assembles controversies to understand the multiple and
contradictory moralities and politics articulated by different actors and attributed
audiences. Setting aside conventional dichotomies such as “state versus society,” “civility
versus incivility,” the dissertation doubly encases the rising medical controversies and
mobilizations as (1) issues of political communication over the constraints of state
structures and market incentives and (2) matters of professional legitimacy, agency, and
embeddedness. The dissertation worked out this double re-encasing through socio-
historical contextualization, justification/engagement analyses, and scene-style studies.
The empirical studies, each in a different way, expand the empirical and analytical scope
of the China-focused communication scholarship. They foreground history, illuminate
less attended cultural structures, and yield nuanced insight into the stresses in
communication among doctors, media, the state, and the general public during societal
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transitions. At the same time, they fill the empirical gaps of studying professional
communications in public, which are organized both strategically and non-strategically.
The studies, therefore, reveal the cultural and communicative embeddedness of the
medical profession in a transitional society. China is a useful but not universal example.
The modern medical profession in contemporary China diverges from and competes with
traditional Chinese medicine (TCM). The former follows the trails of evidence-based
decision-making and transnational professional/scientific communities. Still, it does so
within the Chinese post-socialist contexts that juxtapose state authority (in place of
corporate autonomy), market incentives, social grievances, and mediated contention by
empowered individuals. These complex contexts put stress on the changing medical
profession and its daily operation in China. The dissertation focuses on the professionals’
public communication rather than their clinical practice or institutional realities. To be
sure, they are connected, and the former need to be contextualized by the latter to some
degree. Borrowing arguments from the strong program of cultural sociology (Alexander,
2006a, 2006b; Lichterman & Dasgupta, 2020) and ethnography of the Internet (Herold,
2011; Hine, 2015), the dissertation nonetheless argues that the professionals’ digital
communications enjoy relative autonomy and should be studied on their own, instead of
being reduced to their institutional or structural conditions.
The following section discusses in detail how the dissertation addresses research
questions and generates implications for China-focused political/public communication
studies, studies of the profession, and the interdisciplinary inquiry on media-and-
medicine, profession-and-public.
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For China-focused Political/Public Communication Studies
“Contention,” a concept originated in political science, has been an important
theme in the studies of communication and society in China as the society underwent the
Great Transformation. According to Tilly and Tarrow (2015, p. 236), contentious politics
is “interactions in which actors make claims that bear on someone else’s interests, leading
to coordinating efforts on behalf of shared interests or programs, in which governments
are as targets, the objects of claims, or third parties.” Later, with the China-focused
scholarship growing to grasp more complexity in the Chinese communication and
society, researchers such as Guobin Yang (2015) have become interested in a wider array
of contestations, which “encompass the politics of governance, censorship, and
resistance, the politics of recognition, desire, and leisure, as well as the politics of
representation, class, and the nation”, and which manifest “the multiple ways of doing
politics and being political” (p. 14).
Sharing Yang’s interest, this dissertation assembled methods to offer a “civil
society” approach (Lo, 2010, 2019) to studying important but under-appreciated
communication in China. This approach illuminates the diverse and conflicted political
cultures in Chinese public life, which include but are not limited to state politics and
societal empowerment. Specifically, justification/engagement analyses illuminate
multiple ways (including non-civic ways) through which people make issues public and
universal, together with the multiple kinds of common good that enable these
publicizations. In the dissertation, while the media and doctors have criticized state
governance and the undemocratic regime -- aspects often highlighted by conventional
political communications studies, it is the industrial critiques over safety, competence,
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accuracy, and reliability that have taken precedence in the public engagement and
expressions among both the media and the doctors.
The importance of “the industrial” should not be surprising, even though it is
rarely discussed in China-focused communication scholarship. Repeatedly, the surveys of
Chinese doctors’ internet use (Health & DXY, 2016, 2017), and the CNNIC reports of
Chinese internet users, have stressed the centrality of work and function among the top
motives of Chinese people’s mediated communications. As China transitioned out of
communism, competence, efficiency, and reliability in problem-solving have constituted
the new cornerstone of the state’s legitimacy – pragmatic legitimacy (Shue, 2004; H.
Yang & Zhao, 2015; D. Zhao, 2009; Y. Zhu, 2011). Additionally, one should not forget
the tradition of technocracy and meritocracy in China (Cheng & White, 1990; Guo,
2007), as well as the avid pursuit of scientific development in Chinese modernity (Hua,
1993; Kwok, 1971; H. Wang, 1997) – it was the simultaneous articulations for “Mr.
Democracy” and “Mr. Science” that marked the beginning of China’s enlightenment
movement in 1919. All of these suggest that the industrial, the professional, and the
scientific may indeed be widely shared moral principles in developing and transitioning
China. As Lo (2010, 2019) argued, societies without a long history of democracy may
draw upon alternative cultural resources along with the “civil code” (Alexander, 2006a)
to make public claims and pursue democracy. The current studies suggest that the
“industrial world” and the “system code” (Park, 2019) are also important cultural
resources for the Chinese society to develop justifications, articulate critiques, politicize
issues, and become public.
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Scene-style studies also advance political communication scholarship’s
discussions about civil society. Scene styles refer to local cultural patterns that derive
from people’s recurrent interactions in a specific setting. They enable, orient, and
constrain collective sensemaking and coordinated actions, thus shaping the specific ways
through which people see themselves (dis)connected with the broader world, build
solidarity and exclusion, and make their actions contributory to the public or civic as they
see fit (Lichterman & Eliasoph, 2014). In other words, scene-style studies avoid labeling
actions as “civil” or “uncivil,” “empowering” or “disempowering” from an external
perspective and in a lump. Instead, they seriously consider actors’ own words and
meanings about how their actions could be civil or empowering, while articulating the
trade-offs of such coordinated sensemaking. Through carrying out scene styles studies,
this dissertation arrives at an agreement with ethnographers of speech such as De Seta
(2018) and Pohjonen and Udupa (2017): as conflictual communications are ambivalent in
politics, ambiguous in meanings, and situated in specific communities, they need to be
understood through attention to local context and everyday practice. These insights could
be generally applied to many other controversies beyond the current study. For instance,
a scene-style/ethnography-of-communication perspective to the “voluntary fifty-cent
parties” may complicate existing arguments (Han, 2015, 2018). It may better illuminate
how online community dynamics cultivate situated performances of nationalistic
identities and antagonism against the liberals, while noting that such situated
performances may be dynamic and varied within the same community. Furthermore,
these performances may not translate into consistent expressions and actions across
contexts, let alone generating the broader political effects Han (2015, 2018) speculated.
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For Studies on Profession
For studies on profession, the dissertation brings forward the need to study
profession-public communication related to contests of professional, institutional
legitimacy. The media and medicine are complex, far-reaching institutions. Doctors
themselves are taking up the challenge of defending themselves and their practices while
attributing blames to state governance, the political regime, press coverage, and popular
vulgarity. Doctors act as experts, not mere specialists (Peters, 2008, 2013) when the
narratives of a case are played up. The cultural affordance of justifications/engagement
and the professionals’ cultural skills (G. Yang & Wang, 2016) engender passionate
advocacies in transitional, mediatized societies, with the Internet offering ample, albeit
politically contained, space for exchanges. The justification/engagement analyses,
therefore, enable a competent and public view of the medical professionals who
creatively employ an array of shared moral principles for effective self-legitimation and
external critiques.
The scene-style studies then qualify this agentic and optimistic view. Through
repeated interactions in online communities, the Chinese medical professionals developed
local cultures that often cast them as victimized minorities against external exploitations.
These cultures have elements and potentials to encourage transformative actions upon the
social and political problems in transitional China. Yet more often than not, they lead to
more local actions with smaller ambitions. Importantly, while the media and the public
opinion have clearly demanded more ethicality, civility, and reliability among the doctors
(as revealed in Chapter Three), the medical professionals tend to coordinate online as a
community of identity, and thereby act defensively and antagonistically vis-à-vis public
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demands. One may say that the Chinese medical professionals were not so strategic or
public after all. Combining insights from different studies, the dissertation stresses that
professionals in transitional societies are not secluded in their institutional environment;
they are not distant from the public either, nor are they fully political or publicly oriented.
Instead, the professionals are at once shaped by their institution’s socio-historical
trajectories, reliant upon shared cultural resources, and embedded in specific
communicative settings. To re-introduce a previous statement regarding the relative
autonomy of culture and the Internet, this dissertation argues that studies about
professional dynamics in transitional China should not neglect their digital, public
communications.
A Model Build-out for Studying Controversies
While the current dissertation encases medical controversies as (1)
political/public communication in transitional China and (2) professional communication
in public, it also implicitly builds out a model to study public controversies. In his
groundbreaking article, Goodnight (1991) noted a mystery: while controversy is
empirically ubiquitous, its theoretical reflection is practically non-existent; while there
are countless cases of controversies, one could hardly find a general model of
controversies that travel beyond the confines of local disputes. After reviewing the
limiting biases in modernist and post-modernist thoughts, Goodnight (1991) advocated a
new orientation: instead of being disappointment or failure, controversies may be “an
achievement of sustained and mindful opposition.” (p. 6) Instead of explaining
controversies away, scholars should recognize controversies as “places where
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communication and reason are put up and worked out through argumentative
engagements” – “When unspoken rules and tacit presumptions are put for discussion
through clashes among members of institutions, interest groups, fields, communities, and
publics, there are new opportunities and obligations to learn, to decide, to argue.” (ibid)
It is this dissertation’s intention to answer Goodnight’s (1991) call for “sustained
rethinking” over controversies. To be sure, significant advances have preceded this study:
Olson and Goodnight (1994) examined the debates over fur fashion and animal rights in
the US between 1980s and 1990s to develop theoretical discussions about social
controversy and oppositional arguments. Fritch, Palczewski, Farrell, and Short (2006)
examined the disingenuous controversy that closes off rather than expands argumentative
space. Keränen (2005) studied argumentative boundary-making that discounted public
deliberation in a science controversy concerning breast cancer research. Kelly and Hoerl
(2012) analyzed how religious fundamentalists manufactured scientific controversy to
advance their claims by appropriating the material and stylistic signifiers of expert
authority. Disconnecting “controversy” from the normative framework of “public
sphere,” Phillips (1999) highlighted the fluidity, multiplicity, and mobility of
controversies that emerged from the intersection of specific sites and momentary
opportunities. Dascal (2008); Van Eemeren and Garssen (2008, p. 22) theorized different
prototypes of argumentative activities, including informal argumentative exchange,
scientific discussion, controversy as polemic disputation, eristic debate and legal dispute.
More recently, in order to fully explore the interactive dynamics in public controversies
such as fracking in North America and Europe, Aakhus, Lewiński and colleagues
(Aakhus & Lewiński, 2017; Aakhus, Ziek, & Dadlani, 2016; Lewiński, 2016; Lewiński
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& Aakhus, 2014; Lewiński & Mohammed, 2015) have been developing a polylogical
approach to public controversies. According to the authors, the polylogical approach
differs from a static argument analysis, a dialogical approach that examines exchange
between two and only two parties, or a rhetorical analysis that turns controversy into
communication between the rhetor and the audience. Instead, polylogue is networked,
involving multiple players or parties advancing various positions at different places.
The current study joins the ongoing conversation by introducing a method that
includes both etic and emic perspectives to examine expressions and coordination in
controversies at different levels – justification/engagement looks at micro-level
instantiations of macro structures, and scene style illuminates micro-level practices and
meso-level cultural patterns. This assemblage of methods enables the dissertation to
illustrate the persistent tension among contradictory positions advanced by different
actors at different venues that continuously energize the controversies. At the same time,
the dialogue between the emic meaning and the etic categories keeps the researcher alert,
driving the researcher to constantly look for actors’ inventive communications as well as
necessary theoretical additions. It is with this open and flexible analytical model build-
out that the dissertation claims its contribution to the controversies studies: in lieu of
offering a summative account of medical controversies with three or four empirical
studies, this dissertation provides a model for reading and interpreting public
controversies that unfold and evolve over time.
There is a final note to studying public controversies. Controversies invite
analytical explorations of the complexities as well as regulative actions of the messiness.
If justifications and engagement are indeed cultural repertoires (Thévenot et al., 2000),
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they are then subject to flexible interpretations that inevitably conduce to divergence and
disagreement. In other words, even in societies with shared moral orders, conflicts may
be inevitable, and honorable civil repairs are always accompanied by questionable civil
pollutions (Alexander, 2006a, 2019). At the same time, divergence, disagreement,
critiques, and civil pollutions could be productive. Amid online cacophony (Y. Hu,
2008), by identifying the stakes and problems as articulated by different social sectors
and actors, scholarly work could invite and maintain focus on critical issues and facilitate
constructive deliberation and problem-solving. In the case of medical controversies and
mobilizations, the critical stakes that require sustained attention appear to be the
industrial and civic worth of medicine, media, and the state, as the dissertation’s analyses
reveal. Under this context, researchers may ask whether the formal and informal civil
institutions in China have been (and could be) effectively energized to address these
multiple key stakes and whether they have been put to selective and improper use that
hinders deliberation and problem-solving.
Towards an Inquiry of “Professional Publics”
Through advancing China-focused political/public communication studies and
studies about the profession, this dissertation also develops the inquiry of the
“professional public” to consider the relationship between media and medicine,
profession and the public in transitional China. This inquiry is different from many other
attempts to consider the similar connections in western societies. For instance, it differs
from a mediatization perspective to health or medicine. Prominent in Western and
Northern European academia, the mediatization perspective studies and highlights the
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role of media in the social and historical transformation. Despite its many insights, this
perspective often stresses or presumes increasing institutional autonomy of the media
institution and a distinctive media logic (Hepp, Hjarvard, & Lundby, 2015; Hjarvard,
2013, 2014). As (Hjarvard, 2008, p. 105) put it,
Mediatization is to be considered a double-sided process of high
modernity in which the media on the one hand, emerge as an
independent institution with a logic of its own that other social
institutions have to accommodate to. On the other hand, media
simultaneously become an integrated part of other institutions like
politics, work, family, and religion as more and more of these
institutional activities are performed through both interactive and mass
media.
The notion’s dialectics is appreciated but its stresses on media autonomy or one
media logic are to be rejected. In fact, the argument for a distinctive media logic has been
criticized in European contexts (Couldry & Hepp, 2013), but it is particularly ill-fitting
for studying media and communication in China. Avoiding these pitfalls, “professional
public” explores how the professionals engage with the multiple “logics,” orders or
patterns that have enabled and constrained public communication and mobilizations in
public life, and how such engagement might shape nascent and/or contested profession as
societies transition.
The “professional public” inquiry also partly diverges from “healthscapes”
(Clarke, 2010) – a critical examination of the role of health-related popular culture and
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media in American society as the latter witnessed rising and expanding medical and
biomedical power. Situated within the broader enterprise on “biomedicalization,”
Clarke’s (2010) study on healthscapes analyzes how media represents health and
medicine and establishes them as a cultural field from 1890 to the present. Rich,
historical, and insightful, Clarke’s (2010) study is however premised on a critical
understanding of the cultural influence of (bio)medicine in the US, which itself is based
on a unique history of biomedicine’s political economy in the country. Given that the
Chinese medical professionals have not yet achieved similar autonomy or hegemony as
their American counterparts, it is more appropriate to refrain from critique but to observe
how professionals pursue more authority and autonomy in public. With that being said,
this study on “professional public” could contribute to a future research project on the
changing cultural authority of medicine in modern China.
Finally, the “professional public” inquiry is both overlapping and distinct from the
more recent framework of “biomediatization” and “biocommunicabilities.” In their book
Making Health Public: How news coverage is remaking media, medicine, and
contemporary life, Briggs and Hallin (2016) introduced and employed these concepts to
discuss the intersection and interface between the health world and the public world.
According to the authors, biomediatization involves the discursive processes and
products of health media, narratives, and news on the one hand, and on the other hand,
the material productions of the medical subjects and objects through complex
entanglements between epistemologies, technologies, biologies, and political economies
(p. 5, 13, 207). Briggs and Hallin (2016) argued that biomediatization refers to “neither
the colonization of media by biomedicine, nor the other way around”, but is about “the
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creation of a complex field of boundary-objects and hybrid practices.” (p. 76) Relatedly,
“biocommunicabilities” are the relatively autonomous, higher-order cultural models that
both shape and are shaped by the practices that constitute, organize and hierarchize
biomediatization (p. 46). In specific, biocommunicabilities are the understandings or
assumptions about the nature of medical knowledge and how it is – and should be –
produced and circulated (Briggs & Hallin, 2010, p. 149). Briggs and Hallin’s studies
(2007, 2010, 2016) elucidate three models of biocommunicabilities in the US: (1)
biomedical authority, (2) active patient-consumers, and (3) public sphere.
Briggs and Hallin’s (2016) framework furthered an interdisciplinary inquiry that
connects media and medicine. Like Clarke’s (2010) study on healthscapes, their studies
are also concerned with medical knowledge, authority, and their implications on cultures
and socialities. Briggs and Hallin’s (2016) framework is potentially useful for
understanding medical controversies in China, yet its methodological operations are yet
to be fully clarified or systematized. Additionally, their “public sphere” model of
biocommunicabilities intersects health news analysis and knowledge of social
movements in the US, but it did not foreground the normative concerns over civil society
and the public sphere – unlike the “professional public” inquiry.
So far, the “professional public” inquiry appears quite China-focused in its
empirical concern, analytical consideration, and research design. But this inquiry could
speak to a broader array of contexts. Professionals, experts, scientists could speak and
participate as concerned citizens and the public. While such phenomenon has not been
extensively studied, in the US, due to the consistent politicization of science (Gauchat,
2012) and its rapid intensification during the Trump era, the American public life has
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witnessed a surge of public participation and demonstrations by the experts,
professionals, and scientists (Syfert, 2019). In fact, the socio-political challenges in the
US and in the globe have led to increasing interest in exploring how professional
institutions and the expert system could contribute to democratic life and sustained
governance. Seen in this regard, the current inquiry on professional public join an
ongoing discussion about “democratic professionalism” (Dzur, 2008), “advisory expert”
(Fischer, 2004, 2009), and “scientists as public experts” (Peters, 2008, 2013), and with a
non-western perspective.
Limitations and Future Studies
A strength and limit of the dissertation is the assembly of a set of evolving
controversies. The principle of the current inquiry is to let the availability of resources
and the controversy guide the selection and gathering of methods appropriate for a
society where institutions and professions are in rapid transition. The limits of the study,
then, are that controversies are multifaceted, expansive and dynamic, and the assembled
toolkit may not fully do justice to their development. For instance, the dissertation relies
almost exclusively on publicized materials, including policy documents, newspaper
articles, online discussions, e-magazines, websites, etc. Censorship and self-censorship,
however, have made many online discussions related to doctors’ mobilizations
unavailable. To better understand what has happened and how they have happened, future
studies should seek additional forms of data through conducting interviews and offline
observations. As mentioned earlier, the participants of many doctors’ campaigns studied
in this dissertation have been difficult to contact, establish rapport, or have an in-depth
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conversation about their advocacy. Still, the researcher shall continue seeking and
contacting these participants in the future. Insights and conclusions of this dissertation
invite review and reinterpretation.
Another limitation of the current study is its lack of an in-depth case study that
illustrates the interactions among multiple positions and parties making claims at
different places (Aakhus & Lewiński, 2017). The dissertation has provided only a short
and incomplete glimpse into the interactions between the journalists and the doctors. This
is insufficient. As noted at the beginning of the dissertation, between 2014 and 2016, the
professional public has initiated multiple highly visible anti-media campaigns on Sina
Weibo. These campaigns have solicited state support, attacked journalists and media,
developed flaming arguments and heated exchanges, and resulted in mixed receptions.
Unsurprisingly, these campaigns have received a variety of responses, including state
endorsement, public support, journalistic pushback, and lay criticism. These campaigns
invite an in-depth case study of the interactions among the professionals, the journalists,
the state, and the general public in detail. Such interactions are paramount for the
professionals’ legitimacy and reputation, and they co-shape professional mobilizations,
making them possibly different from the previous ones developed in the specialized
online community (e.g., DXY BBS) mainly frequented by like-minded professionals.
Additionally, while much data related to older professional campaigns such as
“green tea for urine test” and mobilizations around the Nanping Incident have been
censored or archived, the more recent mobilizations on Weibo, despite censorship, are
relatively more accessible. Such data availability, combined with the richness and
extremity of the campaign cases, provides a valuable learning opportunity. Studies of
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more or less extreme or extraordinary cases usually offer more depth to complement the
breadth provided by the larger-sample studies conducted in this dissertation (esp. the
justification/engagement analyses that examine discourses from multiple campaigns).
Additionally, as far as understanding complexity and ambivalence in Chinese
communication is concerned, a case study presented in narratives can better convey
phenomenological details and deliver context-dependent knowledge than abstract
categories that scaffold realities (Flyvbjerg, 2006). These unique advantages of case
study methods should be further exploited in future studies.
Future studies should extend the study empirically and analytically, from the most
well-known medical controversies and mobilizations to a wider range of meaningful
communicative endeavors by medical professionals. Such an expansion is necessitated by
the proliferation of medical professionals as public communicators on the Chinese
Internet. The wide availability of digital platforms such as Weibo and WeChat
18
have
felicitated this proliferation, so has the rapid commercialization of medical knowledge
and services on these digital platforms. As the Chinese state leaders promoted “Internet +
Health” and “Healthy China 2030” as national policies, Chinese medical professionals
were also encouraged to carry out “rumor dispelling” and “science popularizations” on
social media. The proliferation and increase of the “professional publics” in number also

18
Wechat is most popular social media app in today’s China. This super, all-in-one mobile app has
superseded Weibo in daily user number in 2012 (Luo, 2013). In 2019, WeChat reported over 1.15 billion
monthly active users (Beijing Daily, 2020). At the same time, WeChat's official accounts service allows
1.75 million organizational and individual accounts to actively publish content (Xiguaji, 2019) to reach
around 0.9 billion content consumers (QuestMobile, 2019). As far as this study is concerned, many
individual medical professionals, so-called medical celebrities, as well as medical service provider such as
DXY have established their WeChat official accounts and use them to engage in public communication.

164

led to diversity in kinds, or did it? Are there different types of “professional public” in
today’s mediated space in China? How might the doctors understand their public
communications and roles differently? What are their justifications and scene styles in
public? What are the democratic potentials or pitfalls of the different kinds of
professional publics in China? How do they facilitate or hinder the maintenance of
professional legitimacy and authority? Future studies should conduct interviews with the
medical professionals that are currently active in public communication, be their
engagement contentious or non-contentious, controversial or non-controversial. The
interview data shall add new information and insights to online observation and textual
data.
Finally, another future study may focus on the cases of the commercialized
“professional publics” in Chinese public life. Just like Doctor Oz and the more recent
YouTube physician celebrity Doctor Mike, Chinese medical personalities such as Burn
Superhero Abao and White Coat Mountain Cat have also been highly commercialized. In
fact, these celebrities’ followers in millions have often been transformed into consumers
of advertisement. At the same time, using various medical platforms, specialized
companies like DXY have also established themselves as successful online content
creators and distributors. Often, these well-known medical professionals and health-
related organizations have blurred the lines among civic engagement, journalism,
advertising and public relations in their online communications. How should research
account for the commercialized “professional public?” What are the important issues to
explore and address? How does commercialization imply on and impact the professional
public’s legitimacy dynamics as well as their civic or democratic potentials? Tracing
165

these rapid transformations of “professional publics” could be a taxing task, yet it is also
what make the inquiry exciting. Future studies should consider perspectives such as
(digital) journalism studies (Boczkowski & Anderson, 2017; Carlson & Usher, 2016;
Usher, 2017; Usher & Kammer, 2019) and the political economy of communication (Y.
Zhao, 1998, 2000a, 2008) to better account for the changing realities (see the following
table for a summary of possible future studies).
China’s health care system is vast, dispersed, and growing. China’s “public
sphere”, too, is undergoing rapid digital expansions of entertainment, news, and
information. The study envisions growing pains and further controversies as China’s
institutions grow and clash among others. Transformation from a socialist state to market
incentives features multiple points of clash. This study has offered a build-out model of
critical inquiry, one that creates a double-encasement, pursuing the dialectics of
cooperation and competition in struggles to advance the autonomy, power, and publicity
of the respective institutions. Ideally, media and medicine will find an equilibrium or set
of boundaries within which the interests of their combined publics are served well. Such
possibly constructive searches for new inter-institutional balance could be empirically
studied in the future study about diverse sub-types of “professional publics.” For the
meantime, this inquiry offers a mode for the productive site of contestation where
learning can occur from the challenges of controversy, even to the basic trustworthiness
and propriety of communication in a given scene. China is but one model, however
immense and varied are its disputes. The communication practices and scenes of dispute
across post-colonial developing worlds constitute ever greater challenges for inquiry.

166

Table 6. Future Research of Professional Publics
Extending the Double Inquiry of “Professional Public”
China-focused political/public
communication
Profession-public communication
and professional legitimacy
Socio-historical
contextualization
(Chapter 2)
What are the socio-historical contexts in medicine and media that help shape
medical controversies and professional communications in China?
Media’s
justification/critiques
(Chapter 3)
How do media justify or critique medical
professionals during medical controversies,
and what are the perceived stakes?
What is the public opinion
environment in which doctors find
themselves and become
agitated/active?
Doctors’
justification/critiques
(Chapter 4)
How do doctors understand what are
civil/just/appropriate/just? What are the
stakes they articulate?
How do medical professionals
competently enact macro-
level/shared cultural structures in
micro/local situations to justify and
legitimate themselves? How do
these justifications/critiques relate
to/interact with the media’s?
Doctors’ scene styles
(Chapter 5)
How do doctors create publics and engage in
civic actions through interactions? How do
doctors understand what are
How profession-public
communication might be
constrained by cultural patterns in
local contexts in which profession
167

just/civil/appropriate in situations, and how
do they act upon these understandings?
coordinate their communicative
action?
Future Study 1:
case study of
doctors’ anti-media
campaign and public
receptions on Weibo
between 2014 and
2016
How do doctors’ justifications and scene
styles interact with those of other actors and
groups? How do other stakeholders of the
health care system articulate justifications,
expectations and stakes? What are their
styles of actions and coordination?
How do interactions among multiple
parties and positions articulated at
different places shape professional
legitimacy and dynamics?
Future Study 2:
interview studies
with a variety of
“professional public”
Are there different kinds of “professional
publics”? If so, how do they consider their
public roles and communications? How do
they act and express differently in public?
How do these various performances inform
the discussions about the democratic
potentials of “professional public”?
Does “debunking rumor”,
“popularizing science” and
propagating “positive energy” help
Chinese medical professionals
maintain and defend their social
standing and legitimacy? Are there
ramifications and backlashes?
Future Study 3:
case study of DXY
media groups (esp.
WeChat operations)
What happens when the “professional
publics” organizes themselves as commercial
enterprises? How do commercialization
impact the democratic or civic potentials of
the “professional publics”?
How does media commercialization
imply on professional legitimacy
and authority in the public? Would
there be new kinds of contestations
and challenges? How are they
addressed?

168

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Creator Yang, Yue (author)

Core Title Professional publics in transitional/digital China: medical controversies, justifications, and mobilizations

School Annenberg School for Communication

Degree Doctor of Philosophy

Degree Program Communication

Publication Date 07/08/2023

Defense Date 06/16/2021

Tag China in transition,Chinese internet,digital culture,medical controversies,OAI-PMH Harvest,professional legitimacy,public communication

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Goodnight, Gerald Thomas (committee chair), Eliasoph, Nina (committee member), Scheer, Robert (committee member)

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