Why Do Standards of “Good Science” Not Travel? Efficacy Capital and Medical Hierarchy in Mao’s China

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 16. The State, Legal System, and Healthcare Policy

Abstract

Studies of science production in totalitarian regimes often presume that state control reaches an extreme that leaves virtually no autonomy within science, treating “science” as an extension of state projects such as ideological inculcation or modernization. Yet scholarship on late-developmental states shows that technocrats and domain experts can wield substantial authority in designing policy agendas and shaping implementation, even while embedded in political power. This tension raises a broader question: how are standards of “good science” produced under authoritarian coordination, how do they travel across fields, and how does their movement(or failure to move)reshape hierarchies within the medical field? This article delves into this question through an extreme case from Mao’s China: the state program to integrate Traditional Chinese Medicine (TCM) and Western Medicine (WM) into a socialist healthcare system (1954–1976). The center recruited leading TCM and WM physicians nationwide into policy-making and institutional experimentation. Yet the program produced a durable misalignment: TCM acquired high political prestige while remaining marginalized in everyday clinical practice. Why could politically endorsed standards of “good science” fail to become enforceable clinical standards in medicine? Rather than attributing this outcome to a linear modernization narrative in which TCM is inherently backward and therefore destined to fail, this article offers a process-based explanation. Using archival meeting records, newspapers, and core medical journals, I show that the center treated TCM–WM integration less as an epistemic program than as a political principle. By design, it avoided adjudicating medical truth, allowing multiple models of “integration” to coexist without consolidation into a single operational standard. This non-adjudication functioned as governance: epistemic judgment over diagnosis, efficacy, failure, and risk was displaced to organizational and clinical sites. In the medical field, competition reorganized around “efficacy capital” (recognized claims to therapeutic effectiveness as a dominant stake) through which WM retained structural advantages despite TCM’s elevated symbolic standing in the political field. The resulting mismatch –symbolic elevation without clinical authority—reveals how that reproduce durable hierarchy.

Author

• Jinyang Lyu, University of California-San Diego