Lay expertise, therapeutic pluralism, and health science communication in the digital age: The case of Chinese cancer patients

This paper aims to address a lacuna in current scholarship by studying lay experts’ communicating health science and medical knowledge to other patients through on-line platforms. While science communication in the form of popular journalism is being studied within a diversity of disciplines (Lewenstein 1995; Friedman et al 1999; Moirand 2003; Bednarek/ Caple 2010; Molek-Kozakowska 2017), lay experts’ science communication, which constitute important routes in shaping patients’ perception and understanding of science, needs more scholarly attention. With its increasing digitization of medical information and services affecting a large population, wide-spread practices of therapeutic pluralism, including both Western Scientific Medicine (WSM) and Traditional Chinese Medicine (TCM), and its on-going project of promoting and popularizing science as a central task in the country’s modernization endeavours, China presents a particularly rich context for investigation of ethical and ideological dimensions in communicating health science and knowledge to the lay patients. Increasingly, a discursive outlook on expertise and expertise discourse, which shifts from the traditional, role-based appraisal of expertise to an understanding of expertise as locally-observable, emergent from interactions has been applied (see Candlin/Candlin 2002; Buttny 2009; Sprain 2015). Also various discourse moves have been identified as marking a general form of expertise discourse. Following this constructionist line of thought and analysis, in this paper I will, in particular, highlight the use of emotion discourses (Edwards 1999) and appraisal language (Martin and White 2005) in construing lay expertise.

My data are blogs collected from a major on-line cancer support group (Sina Cancer Patient-Friend Group) during a two-year ethnographical study. It is observed that in this closely-knit support group, the lay expert, who is perceived as a knowledgeable patient, performs the role of educator in facilitating its members’ understanding of cancer, interpreting of their experiences, learning to tell true information from the false, and most importantly, to adopt a critical attitude towards various sources of information. Drawing on one lay expert’s 100 blog articles, I examine and analyse the discursive and rhetorical strategies employed in ‘translating’ and ‘transforming’ medical knowledge on cancer, which is often based on western sources, to other group members. Based on detailed data analysis, I will demonstrate that emotion discourse and appraisal language constitute an important form of discursive resources that lay experts utilize in constructing their special form of expertise and identity, which encompasses a variety of positionings (a carer, an educator, a scientist, and a fellow patient). In addition, these discursive resources also contribute to the moral positioning of promoting science as ‘just’ and spreading non-science as ‘immoral’, with regard to cancer treatment.

Furthermore, other members’ comments on the blog articles and the lay expert’s responses will be analysed with a view to capturing how different parties discursively position themselves in negotiating the relevance of ‘science’ to cancer treatment, the right attitude towards science and their individual social identities. Finally, contextualizing science communication and knowledge dissemination in China within its cultural, political and historical circumstances, I will discuss the ideological implications of promoting western medical science in China, in particular concerning the case of cancer.