A viral scandal that started out as the tale of one doctor’s extramarital affairs and medical malpractice has exploded into a wide-ranging societal discussion encompassing medical and personal ethics, research fraud, “returnee” students, intergenerational privilege, and unfair competition in the realms of academia, medicine, and scientific research.

The controversy entered the public eye in late April, courtesy of a leaked letter from the estranged wife of Dr. Xiao Fei, a thoracic surgeon at Beijing’s prestigious China-Japan Friendship Hospital, to the hospital disciplinary committee. The letter contained details of the doctor’s alleged affairs with several colleagues (including one Dong Xiying, a young resident at the hospital), and an allegation that Dr. Xiao left a patient anesthetized on the operating table for 40 minutes while he left the operating theatre to comfort Ms. Dong. After a brief investigation, Dr. Xiao was sacked by the hospital and expelled from the Chinese Communist Party.

But that was simply the first act in what would become a much larger controversy. Internet sleuths who dug into Ms. Dong’s background discovered that she was a “returnee” who had earned an economics degree at Barnard College in the U.S., was from a fairly influential family background, and had enjoyed an academic and career trajectory that may have been helped along by nepotism and string-pulling. Perhaps most controversial was Dong’s rapid rise via the “4+4” accelerated-degree pilot program at Peking Union Medical College (PUMC), which allows a small number of “elite” university graduates—even those with undergraduate degrees unrelated to medicine or biology—to attain a medical degree in only four years, a much shorter timeline than is typical for medical students in China. Netizens also raised questions about Ms. Dong’s publication history, including a graduate thesis that was suspiciously short, and author credits on research papers for projects she didn’t seem to have played much of a role in. (For more background on the multifaceted scandal, we recommend What’s On Weibo’s excellent account of the key protagonists and events.)

Discussion of the scandal proved so popular that at one point, it accounted for more than half of the top 50 “hot search” topics on Weibo, according to WeChat blogger “History Rhymes.” But just a few days later, as the blogger noted on May 5, they had disappeared from the list:

I checked Weibo’s “hot search” list today, and there are no longer any topics about Miss Dong, Peking Union Medical College, etc.

Keep in mind that just a couple of days ago, more than half of the top 50 “hot search” topics were about or related to her.

But just because it’s not trending, doesn’t mean that people aren’t discussing it. Netizens are still digging into the matter. [Chinese]

In addition to Weibo apparently muting the topic, there was also self-censorship on the part of PUMC, which removed content related to Ms. Dong from its website and edited her name out of a 2023 commencement speech given by the college president. Ms. Dong’s graduate thesis and other publications mysteriously disappeared from the academic database portal CNKI (China National Knowledge Infrastructure). After their removal was noticed, it briefly became the top trending search topic on Weibo.

CDT Chinese editors have archived 21 articles and essays related to the “4+4” scandal and its various corollaries; at least three of these have since been censored. The first of these deleted articles appeared on May 1, under the headline, “Could Miss Dong’s Family Be Considered Beijing Brahmins?” Written by journalist Wang Mingyuan, who runs the WeChat public account Fuchengmen Courtyard No. 6, the article argues that Ms. Dong’s family are simply upper middle class, not highly privileged cadres, suggesting that the kind of string-pulling behind her career could be even more pervasive and concerning. Wang’s article also includes a widely circulated (and now censored) meme poking fun at hospital corruption. In the now iconic cartoon, every doctor, nurse, patient, lamp, and piece of medical equipment in the operating theater claims to have gotten into the hospital by leveraging connections:

Patient on the operating table: I got in here through connections.
Doctor: Me, too.
Row of nurses: I did, too. Me too! Same here.
Various medicine cabinets and items of medical equipment: Me, too.
Overhead surgical lamp: Same here!
Another item of medical equipment, with a thought bubble: Hey, didn’t we all?
(source: Wang Mingyuan/WeChat)

Another now-deleted article, published on May 4 by WeChat account Elephant News, provides details about PUMC’s accelerated “4+4” doctoral degree program, and compares it to the usual "5+3+4" route for Chinese medical students: five years of undergraduate-level medical education, followed by three years of master’s-level medical coursework and four years of doctoral-level medical coursework. The author notes how unusual it was that Dong Xiying, whose undergraduate degree was in economics, was allowed to help perform surgery when she was only in her second year of medical school. The article also includes a screenshot showing angry comments left under a PUMC social media account, with netizens complaining that going to see a doctor now feels like “making a holy pilgrimage,” expressing concerns that their doctors might not be qualified if they graduated from the accelerated “4+4” program, and demanding that PUMC make the list of “4+4” program participants public.

On May 5, CDT Chinese editors archived a deleted WeChat article by Sina Finance, which reproduced the answer given by Tencent’s Yuanbao AI chatbot in response to a Sina editor’s query about what other individuals might be implicated in violating the regulations of PUMC’s “4+4” program. The chatbot gave a detailed answer organized into four headings, the first of which listed known participants in the “4+4” program. The second listed individuals who may have benefited from personal connections or affiliations. The third section, enumerating some characteristic examples of systemic privilege, claimed that “35% of the ‘4+4’ program participants have parents who are departmental-level or higher-level cadres, which far exceeds the proportion found among students in typical medical school programs (2.1%).” The chatbot also claimed to have found admission loopholes (“Some of the ‘4+4’ students did not meet the pre-med course requirements”) and possible academic fraud (“Some of the students’ thesis papers did not meet the required page length, with some only 12 pages long”). The fourth and final section in the AI’s answer discussed the broader public opinion controversy over the “4+4” scandal.

One WeChat essay, published on May 6 and still available online, provides an interesting personal and historical perspective on how socioeconomic privilege has evolved since the beginning of China’s Reform and Opening. In "Deteriorating Circumstances Have Given Rise to ‘Second-Generation Privilege,’” essayist and commentator Xipo (“Western Slope”) explores how slowing economic growth, fiercer competition, and fewer opportunities for social mobility in recent years have spurred those with privilege to resort to ever more extreme measures to pass on that privilege to their children:

After publishing my last article [“All that Remains of the ‘4+4’ Scandal Is the Meme About It”], a friend and I discussed the phenomenon of “second-generation privilege.” That discussion made me realize that the unchecked proliferation of second-generation privilege is actually the result of deteriorating [socioeconomic] circumstances. It took me a while to realize this, but now that I do, it makes a lot of sense.

This friend of mine works at a scientific research institute in southern China. He was at university around the year 2000, a critical juncture in time [for the purpose of our discussion]. I won’t mention his field of study, but let us call him “Professor A.”

Professor A recalls that when he was at university, few of his classmates were what we might call “second-generation scions.” While there were some who excelled at their studies and followed conventional paths mapped out for them by parents, most students pursued majors in different fields from those of their parents.

Back then, of course, the overall population was much less educated than it is today. Many university students had parents who were farmers or factory workers, which is something we should keep in mind.

Professor A observes that when he was a student, even the children of professors and department heads rarely followed in their parents’ footsteps. “In those years, there was an abundance of choice when it came to academic majors and career paths. The children of faculty members chose various majors, regardless of what their parents happened to be teaching.”

But there has been a palpable shift over the past six or seven years, he notes. Now an academic advisor to university students, Professor A has found that most of his colleagues’ children are pursuing the same fields of study as their parents.

Thinking back over the news and public discourse of the past few years, I found that many things instantly clicked into place. That oft-repeated term “involution” [内卷 nèijuǎn, a profound sense of burnout caused by cutthroat academic and socioeconomic competition], suddenly took on a concrete form.

As the old saying goes, “Pavilions situated closest to the water are the first to bask in the moonlight” [近水楼台先得月, jìnshuǐlóutái xiān dé yuè; in other words, proximity has its benefits]. But in order to benefit from structural proximity, there must first be a structure in place. If we examine the history of China’s gaokao [university entrance exam], the most illuminating example can be found in the large cohort of post-Cultural Revolution exam-takers. [This cohort encompassed individuals across an unusually diverse age range, from teens to thirty-somethings whose education had been interrupted by the chaos of the Cultural Revolution.] Back then, teachers and students alike were starting from scratch, and everyone was positioned at the same starting line.

As the educational system gradually returned to normal and became more standardized, a certain group of people (or more accurately, a certain group of families) came to occupy central positions in the hierarchy of academia, scientific research, and resource allocation. This is not to dismiss them entirely, of course, for their contributions were essential as China was starting again from scratch.

During the phase of socioeconomic expansion, this wasn’t too big a problem. Right around the year 2000, for example, socioeconomic conflict was still largely centered in rural areas, and the “three rural issues” (agricultural production, rural development, and rural income) commanded nationwide attention. Although this was only a couple of decades ago, it now feels like a distant memory.

Naturally, by then, some far-sighted types had already begun grooming their second-generation successors. But it was also a time in which emerging industries were booming, culture was vibrant, and society was suffused with ambition and optimism. Even privileged members of the “second generation” didn’t just want to ride their parents’ coattails: they wanted to outdo them, to leave them in the dust.

But as China began to transition from one phase to the next, from expansion to contraction, both the first and second generations came to realize that the most reliable path to success was for children to follow in their parents’ footsteps.

By the latter half of the 2010s, China’s period of breakneck urbanization and industrialization was drawing to a close, and [socioeconomic mobility] had begun to congeal. There were also harbingers that China’s integration into the international economic system had run its course.

Now that we’re as materially well-off as other countries, and are more or less able to compete at the same level, our once-blue oceans of opportunity have become churning red seas of competition.

This is the point at which the first generation advises their children to follow in their footsteps, the better to avail themselves of a wealth of parental first-hand experience and ready-made resources. If the children demur, the parents might say, “Fine, go out and try to make your own way in the world. See how you like competing with a mob of people, all fighting over the same lousy job.” And after taking a quick look around and sizing up the competition, the second generation might think to themselves, “Sure, I’ll take your advice. Work is work. What more could I want?”

Uncertainty about the future is spurring those who already occupy lofty positions to marshal all available resources to pass their competitive advantages on to the next generation. This type of survival strategy does not differ fundamentally from that seen in the animal and plant kingdoms.

Naturally, these sorts of collective choices can have extremely negative consequences. Amid deteriorating circumstances, second-generation scions may happily “settle” for enjoying their second-generation privilege, but today’s bona-fide “first generation,” those with no parental legacy to lean on, suffer a dual blow. There are fewer opportunities available to them, and increasingly unfair competition for the few opportunities that do remain.

With this in mind, I have even more empathy for young people today. The ones wailing in frustration are those who bear the brunt of this “dual blow.”

Yet I would still advise them not to conflate their own career development with critical analysis of the socioeconomic environment. As I’ve said before, we can’t wait for society to improve before we start living our own lives. Even in conditions of unfair competition, we must take the initiative and find our own ladder to success. But I now have a deeper understanding of the dejection that so many are feeling right now.

And to those privileged first and second generations, I would like to say: “Other people still exist, even if you don’t see them. Other voices still exist, even if you don’t hear them. They are not simply your competitors; they are emblematic of shared opportunity and a path forward for everyone.”

Although humans are part of the animal kingdom, too, we should be able to do better than simply adhere to the doctrine of “survival of the fittest.” Even beavers know how to shape the environment to their advantage by building dams. Human beings, especially those who consider themselves “elites,” must learn to take responsibility for the environment they shape and inhabit.

After all, someone needs to think about the long-term prospects and overall health of our society. [Chinese]