Abstract
We respond to calls for a greater focus on discursive arenas, their rules, and how these enable or constrain discursive legitimation. Our abductive study explores the case of a new cystic fibrosis drug, Orkambi, and the legitimation contests that surround the Irish government’s decision as to whether it should be funded by the public purse. Our dataset consists of tweets, newspaper articles, and parliamentary debate transcripts. We define a discursive arena, suggesting it is a location for micro-level discursive interactions that is bounded in time and place, observed by an audience, and underpinned by a set of rules that shape discursive positions and foundations. We identify three nonexhaustive and continuum-based characteristics of discursive arenas: one structural (how open it is) and two bases of legitimacy (whether it eclipses or evokes emotion, and whether it values lay or professional expertise). We build on this to suggest a typology of discursive arenas ranging from hot (where legitimacy commonly overflows into and out of other arenas) to cold (where such overflows are rare). We theorize a relationship between bases of legitimacy and arena type. In doing so, we focus attention on the nature of the arenas in which social issues are debated and how this affects the way that social issues travel from arena to arena. We believe that such a focus is vital in current climates where the rise of social media, the decline of traditional media, and the challenge of echo chambers all change the nature of democratic debate. How arenas shape and propagate or constrain such debate is vital to the design of a sustainable democratic society.
And then the improbable happened. At a price rumoured to be €100,000 per patient per annum, the State struck a deal ‘in principle’ with Vertex.
Introduction
The deal in question was for the Irish state to pay for a new cystic fibrosis drug, Orkambi. It had taken one candlelit vigil; two actual and one threatened demonstration outside the Dáil (Irish Parliament); 68 Dáil debates; hundreds of newspaper articles; and thousands of tweets. Finally, 17 months after its first submission to the Irish National Centre for Pharmacoeconomics, Orkambi reimbursement was approved. Politicians, patients, professionals, and pharma companies fought to legitimate themselves and their causes over those 17 months. This paper tells the story of the discursive arenas in which they met and made their cases. Our focus is on those socially constructed systems they chose as discursive arenas: the rules of play within each arena, and how arenas combined to legitimate some perspectives and actors over others.
Whether we see it as a state (at a given point in time) or as a process (over time), whether we are considering it from an evaluative (desirability) or a cognitive (taken for granted) perspective, legitimacy depends upon endorsement by ‘relevant social actors’ (Deephouse, 1996, p. 1025) and the ‘rules, laws, norms, values, and cognitive frameworks in a larger social system’ (Deephouse & Suchman, 2008, p. 54). Legitimacy is, therefore, completely bound up in the sociocultural context in which it is sought, contested, or taken for granted (Vaara et al., 2024). The ‘discursive spaces in which legitimacy is established and legitimation is thereby shaped’ have been described as discursive arenas (Vaara et al., 2024, p. 17). These arenas directly affect the discursive foundations and positions that shape, constrain, and enable discursive legitimation in that arena (Vaara et al., 2024). The contexts in which legitimation processes occur are crucial to understanding discursive legitimation (Snow, 2008). Put differently, the arena dictates the rules of the discursive legitimation games that it hosts, and these rules ‘matter for understanding how new practices emerge . . .’ (Furnari, 2014, p. 456). However, the role of interaction settings in relation to legitimacy is rarely theorized explicitly, creating a meso-level gap between our understandings of micro-level actor endorsements and macro-level social systems. This creates a twofold problem when it comes to modern understandings of legitimation processes.
First, we do not have a clear grasp on how rules change from arena to arena to enable or constrain discursive legitimation (Vaara et al., 2024). We know that the character of the medium may shape the types of authority that are accepted, as well as conceptions of value (McLuhan, 1964). But is the same true of arenas, and how do such bases of legitimacy change from arena to arena? This matters because different bases of legitimacy empower different actors and arguments. Those marginalized in one arena may be central and powerful in another. What, therefore, are those domain-specific conditions under which arena actors must seek or defend legitimation? Shifting focus from individuals or movements to the arenas in which they operate foregrounds historical differences in arenas. We ask, therefore, whether we can characterize different types of arenas to help us understand legitimation dynamics—from the more structured, actor-centric, formalized discourse that has typically characterized social movement-focused studies to the relatively unstructured and overflowing nature of discourse in social media?
Secondly, we don’t know how social issues travel from arena to arena. Understanding when and how actors can port their legitimacy through arena boundaries adds significantly to our understanding of social change. When discursive fields host moral legitimation contests, “arguments for one view can turn into emotion-filled criticism for those holding different views,” leading to isolation, entrenchment, and echo chambers (Jing et al., 2024, p. 1732). Are there connections between discursive arenas that can avoid the creation of echo chambers and facilitate the educational debate necessary around complex social issues? Or do different bases of legitimacy create boundaries that prevent or slow down the scaling of social issues?
Our paper aims to fill these two gaps through an abductive approach. We first marshal the discursive legitimation literature to define a discursive arena, suggesting it is a location for micro-level discursive interactions that is bounded in time and place, observed by an audience, and underpinned by a set of rules. We further rely on the literature to pay particular attention to the three arenas in our empirical case—newspapers, social media, and parliamentary debate. Having scoped the key attributes of the phenomenon under investigation—that is, the discursive arena—we link and interrelate these attributes to further explain the discursive arena (Furnari et al., 2021). We do this through a qualitative case study approach. Our focus throughout was on the arena rather than the actor—using the affordances and constraints experienced by actors to map the rules of the arena. We use both literature and empirical data to identify three non-exhaustive and continuum-based characteristics of discursive arenas, including how open it is, whether it eclipses or evokes emotion, and whether it values lay or professional expertise. Key to this is the overflowing of issues and actors between arenas. We suggest that the audience acts as a trailing anchor for debate—either traveling with the actor or remaining behind, thus determining the level of overflow. We sketch the foundations of a theory of discursive arenas that abductively combines our findings with the literature to suggest a typology of arenas from hot to cold, shaped by the role of emotion and the recognition of expertise. We also theorize inbound and outbound overflows between arenas. Organization theory has seen Weber’s (1947) structured, formal understandings of bureaucratic corporations embrace modern and post-modern views of the firm and its ecosystem. Our focus on arenas and their inter-connections takes us on a similar journey, building on formal conceptions of social movements-corporations-state interactions to understand how new arenas such as social media alter the wider ecosystem in which change agents must operate.
Theoretical Background
Actors engage in dynamic interactions that shape and reshape perceptions of legitimacy (Glozer et al., 2019). Phillips et al. argued in 2004 for due recognition of the fundamental role that language plays in relation to institutionalization processes (Phillips et al., 2004). This is captured in the term ‘discursive legitimation’ or ‘the use of language or communication to create a sense of what is positive, favorable, beneficial, understandable, necessary, or otherwise acceptable in a specific setting’ (Vaara et al., 2024, p. 2). Language, or rhetoric, is the route through which new legitimacy criteria are established that, in turn, justify the modification or displacement of incumbent institutional logics (Suddaby & Greenwood, 2005). Many theorists have conceptualized rhetorical or discursive strategies. Theorists such as Hardy, Phillips, Vaara, Suddaby, Greenwood, and their many colleagues have brought us to the point where we understand the importance of discourse to legitimation and institutional change (see, for example, Phillips et al., 2004; Suddaby & Greenwood, 2005; Vaara et al., 2006). They have focused academic attention on the discursive processes that maintain or dislodge dominant institutional logics and organizational forms at the field level. Our goal is to excavate the detail around one (relatively underexamined) element of these legitimation processes—the settings within which these strategies are selected and implemented. We believe that such detail is key to understanding and tracing legitimation dynamics in institutional discourse contests. We argue that these settings (or arenas) proliferate within contested discursive fields, forming discursive stepping stones from which motivated actors may launch challenges to dominant field-level logics while incumbents seek to avoid being knocked off balance into a river of institutional illegitimacy. We suggest that each arena lays down different conditions and legitimacy criteria; that these conditions change from setting to setting; and that legitimacy overflows occur between settings that can ultimately lead to the institutionalization of new logics at the field level.
Defining the Discursive Arena
Discursive arenas are the spaces in which this collective definition of reality happens—‘discursive spaces where legitimacy is established and legitimation is thereby shaped’ (Phillips et al., 2004; Vaara et al., 2024, p. 13.), 1 facilitating communication and providing a set of discursive, cultural-cognitive resources—for example, concepts, ideas, ‘truths,’ norms, and frameworks (Moisander et al., 2016). It is ‘a forum for a range of different actors affected by and interested in the subject of the inquiry’—to ‘deliberate on issues of consequence’ (Hardy & Maguire, 2010, p. 1384; Reinecke & Ansari, 2016, p. 319). Legitimation requires ‘a distinct normative space’ where boundaries define a perimeter of legitimacy (Cnossen & Bencherki, 2023). The discursive arena is similar to a relational space in that it offers a structure within which interaction and negotiation can take place but differs in that this is witnessed by defenders of the institutional status quo (Mair & Hehenberger, 2014). The notion of audience is key to our concept of discursive arena, and we therefore concern ourselves only with front-stage interactions in this paper. While backstage interactions deconstruct and reconstruct frames and models, it is front-stage interactions that make these models accessible (Mair & Hehenberger, 2014). Audiences may act ‘either as active contributors or as passive recipients of strategically relevant information’ (Dobusch et al., 2019, p. 348). As Ruef and Scott (1998) say, “the more the assessments of particular constituencies tap into the beliefs and values currently dominant in the institutional environment, the more salience we expect them to have . . .’ (p. 4). The discursive arena defines a ‘group in question’ and therefore facilitates the establishment of a new dominant institutional logic within that arena. McAdam and Scott (2005) describe the importance of preexisting social arrangements to early mobilizing as these provide a warming sunlight that feeds social capital development. 2 We view discursive arenas as such social arrangements that might provide either ‘warming sunlight’ or ‘cold light of day’ exposure for new logics that challenge incumbent dominance. Choosing a ‘warm’ or receptive constituency becomes important, therefore, for the accretion of social capital necessary for field-level change. This maximizes the likelihood of cultural alignment, normative support, and consonance with (or the absence of) rules and laws (Ruef & Scott, 1998). Viewing audiences only as ‘silent’ or ‘largely passive’ therefore risks underestimating their role in the shared evaluations necessary for discursive legitimation (Pozner & Hannigan, 2023). Those seeking legitimation for themselves or an object may choose discursive arenas with more favorable audiences (Cederström & Fleming, 2016).
Some of the statements above may seem close to previous conceptions of a discursive field. Both are ‘embedding’ concepts referring to ‘enveloping contexts in which discussions, decisions, and actions take place’ (Snow, 2004). The distinction is a matter of scale, purpose, and bounding (see Table 1 below). Discursive fields are broader than arenas—Rome versus the Colosseum, so to speak. Multiple discursive arenas may populate a particular discursive field. The concept of discursive field is derived from institutional theory’s organizational field: the set of actors that ‘constitute a recognized area of institutional life,’ (DiMaggio & Powell, 1983, p. 148). It offers a loosely bounded landscape for action upon which field-actors identify with, and commit to, a particular issue (Mountford & Geiger, 2021). Broadly, fields provide a ‘common meaning system’ (Croidieu & Kim, 2018, p. 4). Our discursive arena is more akin to an ‘interaction setting,’ specific in time and place (Furnari, 2014, p. 443). Unlike Furnari’s interstitial spaces, our arenas are not necessarily characterized by diversity. Our discursive arena has a specific purpose—to facilitate discourse between a subsection of field actors—and this ostensible purpose is apparent to most field actors. We see the discursive arena as a meso-level concept that connects the macro and the micro. Micro-level actors seek macro (field) level change. They cannot, however, reach the level of generalized ‘taken-for-grantedness’ required on their own. As McAdam and Scott (2005) say, ‘change occurs in many ways: the march that begins in the streets may transmigrate and begin to move through the institutions – legislatures, courts, agencies and firms’ (p. 39). The discursive arena conceptualizes a type of social structure with the facilitative and jurisdictional elements to enable or constrain such migration of change—they are the path to generalized perceptions.
Features of a discursive arena.
Discursive positions are allocations of discursive power and authority within discursive fields. Positions encode institutionalized power into incumbent field structures, including preexisting discursive arenas. New arenas allow actors to carve out new discursive positions, bringing with them unconventional political powers that can challenge institutionalized politics. This creates opportunities, challenges constraints, and in doing so, facilitates the collective framing processes that link opportunity to action (McAdam & Scott, 2005).
Diverse manifestations of discursive arenas: A focus on newspapers, parliaments, and social media
As far back as the first century, Roman emperor Constantine ‘experimented imaginatively with the construction of his own legitimacy’ using coin issues and triumphal marches to create arenas in which he could secure his legitimacy, highlighting his expertise as a leader and arousing emotions such as pride and fear (Humphries, 2008, p. 85). Two-way discourse was, however, largely confined to local and physical arenas such as the Senate or gatherings in houses. Porter et al.’s (2018) study of the Dutch parliament’s response to the UN Intergovernmental Panel on Climate Change (IPCC) errors shows how parliamentary arenas can, however, act to promote inclusive and transparent discourse around major social issues. Yet parliamentary architecture is often designed to reinforce dominance and control, making it a discursive arena that only a few may occupy (Connellan, 2013). Although regulators have authority, coercive power, and can offer important legitimacy cues (Suddaby et al., 2017), they themselves, their actions, and their decisions, like Constantine, may nevertheless be subject to delegitimating efforts. Despite this importance of regulators and governments, there is little within the discursive legitimation literature about the discursive arenas in which governments are arguably most embedded—the parliament.
The arrival of the printing press in the fifteenth century heralded change. It was now possible to convey complex messages to wider audiences and engage in controversies at a scale never before possible (Eisenstein, 2005). Arenas became less wedded to physicality and, for legitimation, the concepts of ‘source’ and ‘arena’ became more intertwined. These mass media became both a source of legitimate authority (see Deephouse et al., 2017) and an arena in which discursive legitimation contexts take place, as an indicator, propagator, or agenda setter (Vaara et al., 2024). Books, newspapers, magazines, radio, television, and the internet transmit the facts, opinions, and entertainment that ‘collectively create and sustain diverse communities of discourse’ where ‘members share knowledge, goals, values and principles’ (Haveman, 2015, pp. 2–4). Vaara et al. have long proposed the media as key in discursive legitimation processes (for example, Vaara et al., 2006). Other authors have treated media as an actor, with the ability to legitimate or delegitimate other actors (e.g., Barros, 2014). Both views recognize, however, that for discourse to matter in a legitimation process, it must materialize through talking or writing (Cnossen & Bencherki, 2023).
Newspapers are widely accepted as a valid arena within which to analyze and understand legitimation processes (Suddaby et al., 2017), perhaps because, for centuries, they have been arenas for social issue discourse (Raviola & Norback, 2013). For a comprehensive review of the use of newspaper data in studying collective action and social movements, see Earl et al.’s (2004) paper in the Annual Review of Sociology. Newspaper editors have, however, traditionally wielded ‘almost complete control over topic selection’ (Barros, 2014, p. 1214). Individual reporters are not only ‘deemed authoritative in their writings’ but also act as arena gatekeepers, deciding who ‘other than themselves, could have access to public discourse’ (Barros, 2014, p. 1214). Declining sales, changing audience preferences, and growing commercial priorities are, however, increasingly threatening the expertise of journalists, promoting (or reflecting?) audience desire for entertainment over information (Karreman & Alversson, 2001). Simultaneously, traditional media’s monopoly is challenged by the advent of new technology-facilitated arenas such as social media (Barros, 2014).
Barros (2014, p. 1212) shows how social media can provide an arena, charged with credibility-claiming opportunities, where actors can be transformed ‘into legitimate discourse producers.’ This arena may have implications for both parliamentary and newspaper arenas in terms of their own legitimacy and their ability to legitimate. While print newspapers cast an institutional shadow that guides traditional journalists in their online activities (Raviola & Norback, 2013), non-journalistic contributors create new rules for social media arenas. Knowledge creation and sharing are distributed, collective, and ongoing rather than the individualism associated with the traditional media (Scott & Orlikowski, 2009). Gone is traditional media gatekeeping as anyone can ‘have their words “heard”’ and communicative control is ceded (Barros, 2014, p. 1214; Glozer et al., 2019). Indeed, gatekeeping in the parliamentary arena is also threatened by the advent of social media. Reischauer and Ringel (2023) describe how the German Pirate Party breached parliamentary arena boundaries, disclosing information about the daily work of the parliament through live-streams, video recordings, and public documents.
Social media is therefore sometimes described as the ‘foundation of the new e-democracy discourse,’ offering an access point for citizens into government decision-making and connecting social media to parliamentary arenas (Barros, 2014, p. 1214). Social media arenas do, however, have their own rules. Despite their seeming openness, voices may still be ‘included or suppressed within the dialogue’ (Glozer et al., 2019, p. 644). In discursive legitimation contests, not only is the validity of the discourse questioned, but the discourse producer’s right to speak (Barros, 2014). Social media platforms such as Facebook prescribe and prevent particular types of discourse through ‘Like’ buttons and other interaction tools (Beverungen et al., 2015).
Comparing traditional and social media highlights that arenas may be more open or more closed in terms of ‘access to sensitive information as well as modes of participation and decision-making’ (Dobusch et al., 2019, p. 344). The rise of social media creates arenas that are community-focused and therefore perhaps open to more varied forms of expertise, characterized as they are by voluntary participation and more permeable boundaries (Dahlander & Friedericksen, 2012). The recognition of expertise, conferring ‘legitimate authority over formal knowledge . . . in a given domain’ (Croidieu & Kim, 2018) depends upon discourse, as expertise is coproduced within the discursive arena (Eyal, 2013). Discursive boundary work ‘establishes an adversarial in-group/out-group distinction between “us,” the group that shares a worldview, and “them,” who are responsible for the problem and/or promote counter-frames’ (Lefsrud & Meyer, 2012, p. 1480). Indeed, entering the social media discursive arena may bring with it risks to professional reputation that were less likely in more traditional arenas such as parliament or newspapers (Vaast, 2020).
Reason, emotion, and moral evaluation ‘entwine and interpenetrate’ discursive processes (Moisander et al., 2016, p. 964). Discursive arenas may, therefore, contain emotive rules that control the ‘discursive spaces’ and the ‘alternative stories’ that might be told within such spaces (Hardy & Maguire, 2010; Moisander et al., 2016). Emotions may be used to challenge the moral legitimacy of ‘formal economy meanings, values and institutions’ (Abid et al., 2023, p. 703). Lingo and Elmes (2019) describe how ‘highly charged emotional statements—ranging from deep despair, anxiety, and fear, to calls for strength, hope, gratitude, and triumph’ can amplify both positive and negative discourse on social media (p. 905). Social movement theory ably demonstrates that agentic actors may leverage emotion to enroll and mobilize support for their cause (Lok et al., 2017). Speaking about interstitial spaces or ‘situations of social interaction between fields,’ Furnari (2014) tells us that emotional energy is key for translating ideas into practices (p. 441). The emotion associated with social media discourse, while capable of supporting actual social engagement, can however amount to little more than cathartic emotional venting (Beverungen et al., 2015). The constant public engagement and vulnerability to criticism required to step into the social media arena can be exhausting for those who wish to engage (Vaast, 2020). What, though, are the differences in ‘emotion work’ allowed within social media as opposed to more traditional arenas?
Do the rules change from the parliamentary arena to the newspaper arena to the social media arena to constrain or enable legitimation? How do social issues travel from arena to arena—do the connections and spillovers between arenas construct a legitimation web along which social issues may travel, or not? Like other organizational forms, the discursive arena experiences periods of institutional stability and periods where the emergence of new forms require reconception of the genre. The arrival of social media as a discursive arena, with its relative lack of structure and new rules, makes understanding the discursive arena construct a timely endeavor.
Methodology
Case studies are particularly suited to the building of theory (Eisenhardt, 1989), and we therefore chose a case study of a real-life context (Yin, 2011) to theorize discursive arenas. Our qualitative approach allows us to situate and explore discursive legitimation activities between and within different discursive arenas.
Research context
Orphan drugs treat rare diseases (affecting fewer than five in 10,000 people). In Ireland, orphan drugs undergo the same assessment process as all other drugs to determine whether public funding should cover their cost. The Health (Pricing and Supply of Medical Goods) Act 2013 devolved responsibility for reimbursement decisions from the government to the health services executive, who should take into account advice from the National Centre for Pharmaco-Economics. Products with significant budget impact or value for money concerns undergo formal pharmacoeconomic assessment by the National Centre for Pharmacoeconomics (see Moran & Mountford, 2021, for more details on this approvals process). The limited market for orphan drugs, alongside high development costs, means that their manufacturers seek very high prices.
Our case centers on the debate surrounding the reimbursement of one orphan drug, Orkambi, used to treat cystic fibrosis (CF). CF is a life-shortening rare disease (average life expectancy of 45 years) resulting from a genetic mutation. A sticky mucus lines the walls of the lungs and digestive tract, causing infection, blockages, and lasting damage. 4 Currently, there is no cure for CF. Ireland has the highest per capita rates of CF in the world. 5 The importance of the issue to the country, the access to multiple discursive arena data, and the importance of legitimacy make this both an extreme and a revelatory case (Yin, 2011). The rarity of this type of decision being openly and widely dissected and ultimately overturned means that it offers a unique opportunity to study the multiple discursive arenas in which the discourse occurred.
In late 2015, Vertex Pharmaceuticals submitted Orkambi for reimbursement. Orkambi is a ‘game-changer’ treatment for CF as it is the first medication to treat the most severe genetic mutations, affecting up to 50% of patients. Vertex initially sought €159,000 per patient per year for Orkambi, a budgetary impact of €390 million over five years. The National Centre for Pharmacoeconomics recommended refusing Orkambi reimbursement at this price on cost-effectiveness grounds, describing Orkambi as minimally effective. 6 In the aftermath of this refusal, CF patients organized a sustained advocacy campaign under the moniker YesOrkambi to overturn this decision. Over 17 months, various stakeholders, including patients, government, Vertex, and the National Centre for Pharmacoeconomics, engaged in public debate and contestation across multiple discursive arenas. Orkambi was eventually approved for reimbursement in April 2017.
Data sources
We collated a trove of rich data to abductively observe, confirm, and evaluate the anomalous process of delegitimating, and overturning, this reimbursement decision in three key discursive arenas (Sætre & Van de Ven, 2021). Arenas were selected for their relevance to discursive legitimation as outlined in our theoretical background section: the Irish parliament (or Dáil), mainstream Irish newspapers, and social media platform X (formerly Twitter). We also obtained correspondence concerning commercial negotiations via Freedom of Information requests and conducted interviews with two patient representatives. These additional sources of information were used as background context only, given our definition of a discursive arena as requiring an audience. They are not included in the data analysis below but served to complement our understanding of the phenomenon. Data was obtained from the first reimbursement application (November 2015) through to final approval (April 2017). Figure 1 provides a timeline of key events.
Timeline of key events.
We searched the online database of the Irish Parliament’s (Dáil) debates for mentions of Orkambi, returning 68 debates. Next, we searched Proquest to identify newspaper articles that featured the term ‘Orkambi’ resulting in 137 articles. We included only articles in the top ten Irish newspapers by circulation to represent ‘mainstream media’ as identified by the Audit Bureau of Circulation, an independent, industry-owned auditor of media circulation figures. 7 On Twitter (X), we identified the patient-led YesOrkambi campaign as the locus of social media-based discussion. Hashtags and handles serve to group topics and support discoverability on sites such as Twitter while also documenting the temporal sequence of events as they unfold (Yang, 2016). In effect, hashtags and handles bound particular discursive arenas within social media platforms. We downloaded all tweets and retweets associated with the hashtag #yesorkambi and the handle @yesorkambi. These identifiers were widely adopted by stakeholders to tag contributions and thus represent the heart of this social media reimbursement discussion. Our search returned 3,337 tweets for #yesorkambi and 1,012 tweets for @yesorkambi.
Data analysis
All three data sets were downloaded and entered into the qualitative analysis software NVivo. Our overall approach was abductive in nature, ‘creatively inferencing and double-checking these inferences with more data’ while moving ‘back and forth between data and theory iteratively’ (Timmermans & Tavory, 2012, p. 168) resulting in three rounds of data coding. Initially, each data point was inductively coded by the authors and a research assistant based on grounded theory methodologies (Glaser & Strauss, 1967). We initially ‘scoped’ the data to identify, analyse and report patterns (themes) (Furnari et al., 2021), facilitating the identification of key actors (see Table 2 below), legitimation, and de-legitimation efforts at the arena level. Emerging from our inductive coding were four broad actors key to this legitimation debate and evident in all three discursive arenas –
Key actors in Orkambi debate.
In a second round of inductive coding we used word search and manual coding processes to follow these actors through the arenas to understand how each arena worked and to track the overlaps between them. The first author performed this coding in the newspaper and parliamentary arenas while the second author carried out this coding for the Twitter arena. Both authors collaboratively reviewed all data points and identified sequences of actor participation in the legitimation process. We explored and linked key instances of the overflow of discussion from arena to arena (i.e. where a conversation from one arena is cited in another). Finally, two research assistants conducted a third round of abductive coding of all three datasets to identify key arena characteristics, forming the basis of our discursive arena theorising, with an intercoder reliability of 89.72%. Using the interplay of dialogue from all three arenas, we demonstrate how legitimacy is established, defended, challenged, and contested within and between discursive arenas over the 17-month campaign for Orkambi reimbursement approval.
Findings
Our findings suggest that: 1) there are some characteristics of discursive arenas that are more important than others when it comes to legitimation; 2) that we can use those characteristics to understand what type of arena we are looking at; and 3) that legitimacy can flow between arenas but these ‘overflows’ are more or less likely between particular types of arenas. In this section we take you on the abductive journey we took through our empirical case and academic literature to arrive at these conclusions, starting with the characteristics of the discursive arenas.
We identify two different types of characteristic when it comes to discursive arenas. The first are more
Characteristics of discursive arenas.
Arena structure – degree of openness
We identify the openness of the arena as a key structural characteristic. We suggest that the degree of openness of a forum may range from participatory (most open) to restricted (least open) (Dahlander & Friedericksen, 2012; Dobusch et al., 2019).
Restricted: Epitomized by The Dáil (political arena)
In the Dáil, as in most parliamentary discursive arenas, participants are pre-qualified to participate, with speakers and topics being formally scheduled and timed. This restricts the nature of (spontaneous) open debate. From the beginning, and throughout our case, Government seeks to maintain a boundary between the Dáil and Orkambi decision-making through its reliance on scientific expertise and objective evaluation:
‘Decisions. . .are not political and not ministerial. They are made on objective, scientific and economic grounds by the HSE on the advice of the National Centre for Pharmacoeconomics, NCPE.’ (An Taoiseach, Dáil Debates, 16/12/2015).
It is, however, sometimes possible to work around openness rules. In defiance of the closed Dáil arena, CF patient advocate Jillian McNulty physically attends in the public gallery. Her words are verbally presented in the chamber via an opposition deputy acting as her mouthpiece:
‘There is a young lady in the Gallery today, Ms Jillian McNulty, who suffers with cystic fibrosis . . . is the Taoiseach in a position to update us on the progress being made to make Orkambi available to whose who would benefit from it?’ (Curran, Dáil debates, 05/04/2017).
Participatory: Epitomized by Social media (Twitter)
Participatory arenas, on the other hand, are more transparent in their sharing of information and invite contributions from all types of stakeholder. On social media, the patient-led YesOrkambi campaign creates a recognizable and hashtag-bounded arena with a singular focus on overturning this reimbursement refusal decision. The open access social media arena acts as a real-time soapbox for activists to engage with a wide public audience. Social media allows patients to virtually bring Government into their arena where they can denigrate An Taoiseach’s character and legitimacy:
‘@EndaKennyTD get up off your arse and do your job. Don’t put a price on people’s lives #YesOrkambi’ (Tweet, 06/2016).
Social media, being open and two-way, also allows the Minister for Health to reassure patients directly:
‘@orlatinsley people saying Ireland will not fund #YesOrkambi is simply not true. There is a process ongoing. Please do keep in touch 2/2’ (Harris, Tweet, 03/06/2016).
Bases of Legitimacy in Discursive Arenas – Expertise and Emotion
In order to sway minds within the arena, however, a speaker must ground their discourse in that arena’s accepted bases of legitimacy. We identify two characteristics of arenas that form such bases – the recognition of expertise; and the role of emotion.
The role of emotion: Eclipsed to evoked
It is important ‘to consider how cognitive and emotional systems interact to influence legitimacy judgements’ (Deephouse et al., 2017, p. 35). For those who engage in discursive debate within them, arenas ‘prime how they think and feel’ (Voronov & Yorks, 2015, p. 579). We argue that some arenas will be more open to discursive legitimation based on emotion, while others will seek to bracket emotion out.
Our case demonstrates a spectrum of emotion across different discursive arenas – from emotion eclipsed in the National Centre for Pharmacoeconomics website to emotion evoked on social media. When Orkambi is first refused reimbursement approval on June 1st, 2016, the National Centre for Pharmacoeconomics website simply states the decision and publishes a technical summary report. It is in the social media arena that we see patients’ raw emotions come to the fore in real-time as they dissect and react to the twists and turns of the approval process. Immediately, they lay blame for the refusal decision at the doorstep of the National Centre for Pharmacoeconomics (NCPE) and the Health Service Executive (HSE):
‘#NCPE and the @HSElive playing with fragile lives over costs. Disappointed doesn’t cover it. @VertexPharma @cf_ireland @CFAware’ (CF Tweet, 01/06/2016).
Social media provides a platform for CF advocates to magnify and legitimate the YesOrkambi issue. They adopt and continually tweet an emotive, ‘pricing life’ mantra from June 2016 right through until Orkambi is later approved:
‘@SimonHarrisTD @EndaKennyTD Don’t put a price on the lives of people with CF. Please work with @VertexPharma & make #YesOrkambi happen’ (CF Tweet, 06/2016).
In the parliamentary arena we see, however, a real and constant battle between government and opposition as to the role of emotion. Opposition spokespeople consistently introduce emotion throughout our case, accusing the government of ‘hiding behind the HSE and the NCPE’,
‘The Taoiseach is playing politics with CF patients again. . . He should speak to the issue and be a man and tell the people whether he is going to provide the money or not.’ (Martin, Dáil Debates, 16/12/2015).
Government representatives scold opposition members for using emotion to political ends and ignoring the expertise-based process that the house voted into place. Each side is seeking to assemble the discursive field in a way that suits their ends to either eliminate and invalidate emotions, or conversely evoke and promote emotions (Moisander et al., 2016).
Mainstream media faces a similar battle. On the one hand, emotion is evoked as, for example, the family of a young victim who lost their CF battle describe the decision as ‘cruel’ and the same article quotes social media saying: ‘To put a price on life is so unfair.’’ (Irish Independent, 06/06/2016). On the other hand, Professor Barry (National Centre for Pharmacoeconomics) avoids emotion in his engagements with mainstream media, drawing criticism of his perceived callousness from CF advocates via social media:
‘Listened to NCPE’s Prof. Barry on @RadioRayRTE and @PatKennyNT. Could we have a patient on for a warm heart the next time?’ (CF Tweet, 11/2016). ‘Also, will Prof Barry not get into a studio with patients for a 2 way discussion? Blankly stating #Orkambi doesn’t improve quality of life?’ (YesOrkambi, Tweet, 28/11/2016).
‘Rule-compliant emotional performances’ (Lok et al., 2017, p. 595) may be more likely to further a legitimation or delegitimation effort, where the emotional rules form part of the discursive arena’s ‘rules of the game’. Emotive performances on social media garner legitimacy while emotive performances in the Dáil are labelled ‘political play”. On the other hand, breaking with emotional rules may shake incumbent arena members out of a passive and into an evaluative legitimating role (Tost, 2011). At times, government adopts emotion in the Dáil and in mainstream media to prompt re-evaluation of Vertex’s role in drug-pricing, accusing Vertex of ‘ripping off the taxpayer” in the Dáil and labelling opposition politicians as “spokespeople for Vertex”:
‘They [pharma companies] overcharge and use patients as pawns. . . pay themselves massive salaries, draw down massive profits and pay massive dividends. . . This is a case of greed incorporated’ (Varadkar, Dáil Debates, 17/12/2015).
We suggest, therefore, that the role of emotion in an arena may range on a continuum from ‘eclipsed’, where discursive legitimation efforts founded on emotion-based reasoning are stifled and incapacitated, to ‘evoked’ where emotional discourse is used to enrol actors and it is considered valid to base legitimacy evaluations on emotion and affective ties (Moisander et al., 2016).
The Recognition of expertise – Scientific/professional vs lay/lived experience
Our data supports the idea that discursive arenas vary in the type of expertise deemed authoritative in legitimation processes. Our case highlights the presumed primacy of professional expertise in certain discursive arenas, opening with a heavy reliance from all parties on scientific expertise. CF Ireland describe the ‘groundbreaking’ nature of the drug in the mainstream media and An Taoiseach outlines the science-led evaluation process in the Dáil. Professional arenas are officially separated from the public realm by the formalization of laws and rules to the point that, where nonprofessional activities are allowed, they may nevertheless be marginalized (Croidieu & Kim, 2018). The National Centre for Pharmacoeconomics website, for example, outlines a highly controlled ‘Patient Submission Process’ which involves the ‘Identification and Notification of the Patient Organisation, Submission of the Patient Organisation Submission of Evidence Template, and Notification of Outcome by the NCPE’. 9
Professional and lay experts may, however, become rivals where authority claims are contested and the type of expertise recognised may depend on whether the arena is private or public, restricted or unrestricted (Croidieu & Kim, 2018). In the Dáil, professional and lay expertise are pitted against one another as Deputy Boyd Barrett challenges the weight placed on cost-effectiveness measures over patient well-being:
‘. . . it is price which determines whether ill people will receive a drug that could make a real difference to their health and quality of life. . . . It is utterly obscene’ (Boyd Barrett, Dáil debates, 02/06/2016).
Deputy Martin orally brings patient advocate and long-time CF campaigner Jillian McNulty into the Dáil arena, legitimating her first-hand experience as a trial patient:
‘Anyone who listened to Ms Jillian McNulty, who has cystic fibrosis, being interviewed on “Morning Ireland” this morning would have heard her outline, in a very articulate way, the extraordinary impact the drug Orkambi has had on her quality of life.’ (Martin, Dáil debates, 02/06/2016).
This expertise is slow to be recognised within the Dáil arena as Government reiterates the science-based process and its expert clinician, Professor Barry, goes into the mainstream media to defend its legitimacy:
‘We don’t put a price on life, but we believe the manufacturers got the price wrong here.’ (Prof Barry, quoted in the Irish Independent, 03/06/2016).
The Government steadfastly shields its legitimacy in the Dáil arena with scientific expertise:
‘Every drug undergoes a scientific and evidence based assessment in line with the HSE’s statutory obligations. . . . I know that the Deputy is not suggesting the HSE should simply accept the first price proposed by manufacturers for their products, regardless of their clinical benefits or cost effectiveness. . . . Every additional euro paid to pharmaceutical companies is a euro less for investment in other critical health services.’ (McEntee, Dáil debates, 02/06/2016).
As the campaign wears on, we see lay expertise gaining legitimacy in this debate. This legitimacy is forged in the social media arena as McNulty uses it to organise a protest and highlight her appearances in mainstream media. On the back of this momentum, McNulty is invited to deliver a cross party briefing in parliament buildings, infiltrating this arena’s barrier. These three arenas form a virtuous triangle that builds and protects McNulty’s lay expertise. Opposition politicians quote from briefings and mainstream media articles while McNulty tweets about their bringing her ‘testimony’ into the parliamentary arena. Throughout this phase we see virtually no discourse produced by the National Centre for Pharmacoeconomics to defend their scientific expertise. Government expertise in managing the process is called into question repeatedly – from social media, to the Dáil, to mainstream media. They are accused of cowardice, leaking information, and delaying negotiations.
The Government continues, however, to champion professional, clinical expertise and the mainstream media relays this to a wider audience:
‘“. . .I. . . don’t think having cabinet making the decision [on reimbursement] is the best system”, he said. “I certainly would like if my family relative was ill that decisions would be made by the clinicians.”’ (Minister for Health Deputy Harris, quoted in the Irish Times, 07/07/2016).
Meanwhile, the primacy of scientific expertise comes into question within the Dáil when Deputy MacSharry points to government precedent in overruling the National Centre for Pharmacoeconomics’ reimbursement decisions (MacSharry, Dáil debates, 29/11/2016). Moreover, opposition leader Micheál Martin equates patients’ lived experience with the National Centre for Pharmacoeconomics’ scientific expertise:
‘It is worthwhile to meet her [McNulty] and hear first-hand of the dramatic and transformative impact Orkambi has had on her life. One can look at all the statistics and so forth, but one should also meet a person concerned.’ (Martin, Dáil debates, 30/11/2016).
Eyal describes how the parents of children with autism assembled ‘an alternative network of expertise’ that bypassed the clinician and ‘blurred the boundaries between parents, researchers, therapists, and activists’ (2013, p. 868). This type of activity can be facilitated, expedited and scaled through the use of social media. Public arenas such as social media allow ‘nonprofessional actors display their knowledge about activities freely and without the constraints of jurisdictional controls’ (Croidieu & Kim, 2018, p. 6). It is, however, where expertise is triangulated across arenas that the impact is greatest on the legitimation of both cause and actor. McNulty’s expertise as an Orkambi trial patient was legitimated across arenas with appearances in mainstream media, constant social media presence, and even Dáil arena appearances by proxy. In every one of these her expertise and lived experience are cited and built up over time.
Types of Discursive Arenas
We conceptualise discursive arenas as ranging from ‘hot’ to ‘cold’ borrowing from both Marshal McLuhan’s conception of hot and cold media and Michel Callon’s conception of hot and cold market situations (Callon, 1998; McLuhan, 1964). Callon (1998) draws on Goffman’s concept of framing – containing the overflows while not ignoring them. We suggest that our structural characteristics of discursive arenas described above might, in other language, be considered as attempts to frame discourse and manage overflows. Sometimes very successfully, as in the case of National Centre for Pharmacoeconomics website, and sometimes less successfully, as in the Dáil where patient testimony charged with emotional energy ‘leaks’ through the frame constructed. Indeed, this follows Callon’s belief that all framing is imperfect.
Callon terms markets in which all overflows are framed out as ‘cold’, often relying on uncontested and scientific or professional knowledge. Hot markets, on the other hand, are those in which everything is contested. These hot situations are characterized by interdependencies and uncertainties. Scientific experts find their knowledge called into question by lay people as facts and values take on equal weighting.
For McLuhan, intense experiences needed to be censored and cooled to avoid audiences becoming “nervous wrecks, doing double-takes and pressing panic buttons every minute” (p. 26). According to McLuhan, therefore, hot media are low and cool media are high in audience participation. There is, however, a sharp distinction between media as a source of legitimacy, and media as a discursive arena in which legitimation is sought. Our case shows a lack of censorship experiences in the social media arena and a reduction in censorship across parliamentary and even mainstream media arenas. We now experience arenas underpinned by media that “do not leave so much to be filled in by the audience” (McLuhan’s definition of hot media, pp. 24, 25) and yet are high in audience participation (McLuhan’s definition of cool media). Social media epitomises this change, but traditional mainstream media is also experiencing far more audience participation with online comments on articles and social media posts being woven into news reporting.
We suggest that arena type can be better understood by examining the combination of recognition of expertise and role of emotion within that arena (see Figure 2 below). Where lay experience is privileged and there is a high evocation of emotion, the arena is likely to be ‘hot’. Where professional experience is prioritised and emotion is eclipsed the arena can likely fall into the ‘cold’ category. In between we have warm arenas where lay experience has an edge over professional experience and emotion is eclipsed; and cool arenas where professional experience is slightly more prominent and emotion is evoked. We do not claim hard boundaries between arena types. Our conceptions of expertise and emotion are spectral in nature and likely to bleed and blur at the boundaries of arena types.
Typifying discursive arenas based on recognition of expertise and the role of emotion.
We now discuss each of the four ideal-types of discursive arena, illustrating each with reference to our case.
Cold discursive arenas
Cold discursive arenas are those which are carefully framed and most overflows have been successfully bracketed out. They privilege professional or scientific knowledge and leave little room for lay knowledge that is not mediated and interpreted by the professional. Audiences receive edited versions of the discourse and are offered limited and highly structured opportunities to engage. The National Centre for Pharmacoeconomics website constitutes one such arena. The website offers limited and edited information about the drug reimbursement decision-making process including submission and decision dates and a final report. It also offers limited structured methods for lay knowledge to be routed into the process through time-limited and formatted opportunities to input. Patients describe Professor Michael Barry, who leads the National Centre for Pharmacoeconomics process as lacking ‘a warm heart’ and not offering two-way debate. Professor Barry consistently emphasises the National Centre for Pharmacoeconomics’ focus on the wider problem of drug reimbursement for all Ireland, rather than this particular cohort of patients. In the Dáil, An Taoiseach consistently refers to the scientific expertise that supports the National Centre for Pharmacoeconomics process of review. We suggest, therefore, that cold arenas maintain a problem focus, even in the face of consistent pressure to focus on the people affected by that problem. We also suggest that the bases of legitimacy in a cold arena stem from professional expertise while emotion plays a minor role. Because it is the profession, rather than the person, from which legitimation stems, there is a strong focus on the process as key to legitimation efforts and attacks. Patients and opposition politicians largely challenge the process rather than the people involved, describing it as too slow and heartless. Government and Professor Barry defend the process as being fair, scientific, and free of political play.
Cool discursive arenas
Cool discursive arenas are framed, but the frame is more porous than that of a cold arena. This porosity is valve-like - while legitimation within other arenas consistently overflows into a cool arena, legitimation or de-legitimation rarely overflows from the cool arena to other arenas. The parliamentary arena is a cool arena. Legitimation attempts within the Dáil stay mostly within the Dáil. We see the odd overflow where a politician quotes themselves from that day’s debate on social media; or where a journalist cites Dáil debate in the mainstream media, but for the most part legitimation in other arenas stays relatively unaffected by what is discussed in the Dáil. This is not to say that decisions made in the Dáil have no effect in other aspects of life. Our focus is on legitimation rather than decision-making or policymaking. It is attacks on, or attempts to shore up the legitimacy of an individual or a process that we are interested in. Our data consistently show, however, overflows from other discursive arenas into the Dáil. Mainstream media appearances are quoted within the Dáil to legitimate the lay expertise of patients such as McNulty. Opposition politicians carry discourse from Vertex and patients into the Dáil to delegitimise the National Centre for Pharmacoeconomics process. Parliamentary debate concerning the reimbursement of Orkambi is characterised by a constant fight for legitimacy between actors (such as McNulty, Minister for Health, An Taoiseach, Prof Barry) and the scientific, profession-led National Centre for Pharmacoeconomics decision-making process. Every time opposition spokespeople seek to turn attention to the people affected, government redirects discourse towards the problem of finding a sustainable price. Problem and person are equally prevalent in discourse although there is some suggestion that the problem aspect may be less politically motivated than the person emphasis. The emotions raised in legitimising a focus on individuals rather than price may convince constituents that their political representatives have a heart and should get their vote, but the National Centre for Pharmacoeconomics process was set up to avoid such scenarios and was voted into place by the Dáil itself.
Warm discursive arenas
Like cool discursive arenas, warm arenas are also framed by a permeable boundary. The overflow in this case is, however, largely in the opposite direction to that of cool arenas where legitimation overflows are mostly outbound with little incoming spillover. Traditional media in the form of newspapers best represents such warm arenas. We consistently see overflows where newspaper coverage is used to legitimate an actor in another arena. Jillian McNulty is legitimated in both Dáil and social media arenas partly through her appearances in mainstream media. Opposition leader, Martin, reads direct McNulty quotes from national newspapers into the Dáil record:
‘. . . Before Orkambi I was approximately eight months of the year in hospital, in the last three years I’ve spent just 12 weeks in hospital. Incredible.’ (Martin, citing McNulty in the Irish Independent, Dáil debates, 01/03/2017).
Her expertise as a witness with lived experience of Orkambi is cemented in mainstream media, amplifying her legitimacy as a CF spokesperson:
‘Tune into @RadioRayRTE I’ll be on in a few minutes talking about protest & Orkambi #mymiracle’ (McNulty, Tweet, 01/03/2017).
It is rare, however, that we see legitimation efforts in other arenas cited in mainstream media. In mainstream media a balance is struck between process and actors. People are profiled in-depth, their legitimacy built (as in McNulty’s case) or threatened (as for Vertex or Professor Barry). The problem features as a running undercurrent. Professor Barry is given time to explain the problem of balancing needs across all patients and journalists question the high prices charged by Vertex. This dual focus on problem and person means that in warm arenas actors and processes combine to legitimate or delegitimate another actor or process. Editorial review and the need for multiple sources involves a process that legitimates the featured content. Ultimately, however, it is lay experience rather than professional or scientific knowledge that carries outbound legitimation weight. It is McNulty’s lived experience, rather than Professor Barry’s clinical assessment, that travels from arena to arena. Emotion is felt at a remove in most of the newspaper coverage with the exception of Joe Brolly’s highly emotional opinion pieces:
‘. . . Vertex doesn’t give a f***. . . . It doesn’t care whether our loved ones live or die. So the only thing we can do is train our guns on the Government’ (Sunday Independent, 11/12/2016).
More commonly, journalists pass on emotional statements from patients and their families in quotation marks to signal that this is not their own opinion. Warm arenas are warmed not by emotion, but by the weight of lived experience and the overflows triggered by a relatively large audience that carries legitimation outbound to other discursive arenas.
Hot discursive arenas
Hot discursive arenas have highly porous boundaries. They are characterized by almost constant two-way overflows both inbound and outbound. Social media exemplifies a hot discursive arena. Actors build legitimacy within the arena itself, but also import legitimacy from other arenas. McNulty leverages appearances and mentions in the Dáil, and previews and reviews mainstream media appearances on social media. Outbound legitimation spillovers from McNulty’s social media reputation as a patient spokesperson allow her access to other arenas where her expertise as a lay patient is recognised and legitimated. Overflows from social media into the other two arenas sometimes require physical assistance. The Dáil and newspapers both have a far more physical presence than social media. It is when McNulty organises a physical protest outside the Dáil, using social media to do so, that her legitimacy and the legitimacy of her cause really overflow into Dáil and newspaper arenas. We suggest that this transition from virtual to physical may sometimes be necessary to trigger the overflows from virtual to physical arenas. In social media the focus is always on the person. Any discussion of the problem is always in the context of the people affected.
‘@VertexPharma it is time for you as a company to allow Irish CF sufferers access to #yesorkambi Please put human life before profit’ (CF Tweets, 12/2016).
There is little mention of the wider problem of affordability of drugs for conditions beyond CF. Efforts on social media to raise this wider problem meet with emotional responses that often include accusations of heartlessness or cowardice. In social media, process is largely absent and so it is the person that legitimates another actor or perspective. Unlike newspapers there is no editorial or quality control process. Unlike the Dáil there is no barrier to entry. What signals quality is the perception of the author’s credibility, honesty, and good faith. It is the author of each tweet that therefore confers or removes legitimacy.
Legitimacy Overflows between Discursive Arenas
We also borrow from Callon’s (1998) concept of overflows. Callon defines overflows as situations where the decisions taken, based on the preferences of actors in situation X, have consequences for another set of actors in situation Y. We argue that there are similar legitimation overflows between discursive arenas where the bases of legitimacy in one arena are built upon to legitimate a person or process; and this legitimation then overflows into another arena where the bases of legitimacy may differ (see examples in Figure 3). Had the legitimation been sought in the second arena at the outset it may not have been achieved because of the differing bases of legitimacy. The concept of audience is key to these overflows between discursive arenas. The audience, or at least a section of it, must follow the discourse from arena to arena in order for the overflow to occur. This is because legitimation depends upon perception and perception requires a perceiver. Where the audiences remain distinct in different arenas the perception of legitimacy remains contained within each arena. We now discuss in detail one example from our case of legitimacy overflows between arenas - how the response to the second decision to refuse reimbursement played out among actors and across arenas.
Examples of arena overflows.
In late November, the National Centre for Pharmacoeconomics’s second decision to refuse Orkambi reimbursement is leaked to mainstream media. Philip Watt, CEO of CF Ireland, portrays patients’ emotional outrage:
‘The decision was leaked to a Sunday newspaper even before the Minister was informed, never mind patients. It’s a disgraceful and heartless form of communication.’ (Irish Independent, 28/11/2016).
Campaigners’ fury is also captured in mainstream media:
“‘This is utterly devastating news. How could they?”. . . “We are going to march on the Dáil on December 7 at lunchtime and we want as many people there as possible,”’(Irish Independent, 28/11/2016).
This march on the Dáil connects social media and parliamentary arenas via a physical gathering. The social media arena is used to issue a clear call to action:
‘I have organised an Orkambi Protest at the Dáil Wednesday Dec 7th 1.30pm Please come & support the CF community of Ireland #letsgetitdone’ (McNulty, Tweet, 25/11/2016).
Cross-pollinating her mainstream media interviews on social media, (e.g. ‘I’ll be on @RTEOne Six One News this evening. . .’ (Tweet, 27/11/2016) and ‘Tune in @Liveline_RTE today. . .’ (Tweet, 29/11/2016)), McNulty demonstrates her growing legitimacy as a patient advocate. Her informal expertise allows her to infiltrate the seemingly-restricted parliamentary arena, as she tweets that she will deliver:
‘a cross party briefing on Orkambi on Tuesday afternoon in Dáil Eireann’ (McNulty, Tweet, 30/11/2016).
New hashtags in the social media arena sustain pressure on the government as McNulty declares she is ‘#takingonthegovernment’ and publicizes Deputy Martin carrying her words into the closed Dáil chamber:
‘Leader questions yesterday where Micheal Martin gave my testimony to the house #orkambi #mymiracle’ (McNulty, Tweet, 02/12/2016).
CF advocates symbolically challenge the closed parliamentary arena by arriving at the steps of the Dáil on December 7th. They legitimate their fight via mainstream and social media arenas:
‘. . .the Irish CF community must go to war. . . We must fight against two sides who have put a price on our heads and nobody wants to yield.’ (Irish Daily Mail, 03/12/2016). ‘I don’t want to die, I don’t want to be without this drug, my parents don’t want to bury a third child @jilli09 on #yesorkambi on #CBLive’ (Claire Byrne Live, Tweet, 07/12/2016).
On the day of the protest, the emotionally-charged crowd undermines An Taoiseach’s legitimacy via Twitter:
‘@EndaKennyTD too cowardly to come and face us today. Shame on you #yesorkambi’ (CF Tweet, 12/2016).
Mainstream media use their social media and print channels for crossover reporting. Their words capture, but moderate, the emotionality of the protest:
‘The mood veered between anger and poignant sadness as placards with the photos of sons and daughters who have already died young were held up. “Enda come out and look me in the eye,” Ms McNulty, who addressed the emotionally charged gathering, said.’ (Irish Independent, 08/12/2016).
Opposition politicians further leverage social media to support the YesOrkambi campaign:
‘Very strong case made for #yesorkambi outside the Dáil by @cf_ireland & @jilli09 today. Urgent progress needed by @roinneireann’ (Chambers, Tweet, 07/12/2016).
Inside the Dáil chamber, a heated debate pits opposition politicians against the Government, alleging An Taoiseach is ‘spinning’ and ‘leaking’ (Martin, Dáil debates, 07/12/2016). In response, An Taoiseach targets the manufacturer, accusing it of ‘holding the country to ransom’ and ‘ripping off the taxpayer’ (An Taoiseach, Dáil debates, 07/12/2016). Vertex Pharmaceutical takes to mainstream media to temper the rhetoric and clarify its negotiating position:
‘Our proposal is now a long long way from the numbers being quoted publicly’ (Irish Times, 07/12/2016).
The Minister’s attack on ‘big bad pharma’ and his accusations of ‘price-gouging’ spill over from the Dáil debate into the mainstream media arena where Joe Brolly, media personality and CF ambassador, leverages his privileged access to launch an equally blistering and emotion-laden criticism of Vertex via an unmediated op-ed:
‘. . .they [Vertex] have priced this life saving drug at EUR 230,000 per patient per annum. . . The killer is that the Cystic Fibrosis foundation contributed $1 billion towards its development, but failed to do a deal that would give them some leverage over pricing. As usual, the good guys got screwed. When Orkambi won drug of the year at the Bio Pharma Oscars, Vertex CEO Dan Leiden was cheered to the rafters. . . As he was receiving his standing ovation, kids in Mayo and Dublin were suffocating to death.’ (Brolly, Irish Independent, 07/02/2016).
When Orkambi is approved for reimbursement on April 11th, 2017, it is McNulty and CF advocates who are recognised and congratulated in all discursive arenas – signalling a ‘warming up’ of cooler arenas as a result of the campaign:
‘I thank people like Jillian McNulty and Orla Tinsley. . . .They were all unified by the same desire. They did not want to get caught up in a big political debate. They simply wanted what was best for their loved ones.’ (Minister for Health, Dáil debates, 11/04/2017). ‘Jillian McNulty, whose life has been transformed since she started on Orkambi as part of a trial, said last night she was overwhelmed that the fight of more than two years was finally over.’ (Irish Independent, 12/04/2017).
It is the public nature of the debate that allows McNulty and her arguments to break through the arena frames. She brings the public with her, connecting them across arenas such as social media, mainstream media, and parliament – offering them a window into discourse in arenas they may otherwise have ignored or been unable to access. In doing so, she snowballs legitimacy across arenas for herself and her cause.
Discussion and conclusion
Our goal was to build on Vaara et al.’s (2024) concept of discursive arenas to address two important gaps in the legitimation and social movement literatures: (1) how rules change from arena to arena, and (2) how social issues travel across arenas. We identified different types of discursive arena—ranging from hot to cold—and specified the characteristics and rules of each, particularly the role of emotion and the kinds of expertise valued. We also showed how legitimacy can overflow from one arena to another when audiences partially overlap, and how the “type” of arena (hot, warm, cool, cold) shapes the likelihood and direction of such overflow.
We now discuss how these insights advance theoretical understanding of legitimacy more broadly. Legitimacy as a concept has undergone substantial transformation—from early regulatory conceptions in the 1960s and 1970s, through the neo institutional expansion to normative and cultural cognitive bases, culminating in Suchman’s now classic tripartite distinction between pragmatic, moral, and cognitive legitimacy. More recent work has emphasized how social media is changing the nature of ‘authority’, the rising importance of social movements and interest groups, and the multilevel nature of evaluations (Bitektine & Haack, 2015; Deephouse et al., 2017). We suggest that a focus on discursive arenas adds to this development of legitimacy theory in two key ways:
Discursive arenas bridge dispersed conceptions of legitimacy
We began with Suchman’s framework, but our analysis shows that legitimacy must increasingly be understood as a situated and arena-specific phenomenon. As stakeholders become more numerous and more vocal, legitimacy no longer emerges from a single, undifferentiated audience but is constructed within discursively bounded spaces that differ in rules, actors, norms, and epistemic standards. Social media arenas, for example, set out new rules about who can speak, what counts as evidence, and how emotional expression is treated as legitimate or illegitimate.
Suddaby et al. (2017) draw attention to precisely this issue when they ask: where does legitimacy occur? They outline three views—legitimacy as property (something an entity possesses), as process (something actors construct), and as perception (audience judgments). We suggest that discursive arenas help integrate these perspectives by providing the “where” that connects them.
Legitimacy as property: Within certain discursive arenas, legitimacy operates. as a possession. Actors either have or lack the recognized forms of expertise, status, or standing that confer voice. Our case shows this clearly. Activists initially lacked legitimacy in parliamentary and pharmacoeconomic arenas because those arenas presupposed scientific and economic expertise as preconditions for participation.
Legitimacy as process: Actors work to reshape arenas or build new ones when dominant beliefs and values disenfranchise them. Arena construction—creating new rules, audiences, and discursive norms—is a collective process of legitimation. Our findings illustrate how actors strategically convene arenas that are more likely to prioritize regulatory, moral, pragmatic, or cultural cognitive bases of legitimacy depending on their preferences.
Legitimacy as perception: Legitimacy accumulates across arenas as localized evaluations travel, collide, or cancel each other out. Arena boundaries vary in permeability, allowing legitimacy assessments to spill over. Discursive arenas thus function as intermediate sites where individual-level perceptions aggregate into meso-level evaluations that may, over time, become macro field-level ‘taken for grantedness’.
Seeing legitimacy as emerging across discursive arenas helps explain how localized judgments become generalized perceptions in the field—the process Suchman (1995) theorized but could not fully specify without a concept like discursive arenas.
Discursive arenas illuminate distinctions between the sources and bases of legitimacy
Thornton et al. (2012) identify societal-level “sources” of legitimacy tied to institutional logics, such as trust and reciprocity for community logics or expertise for professional logics. Deephouse et al. (2017), by contrast, describe “sources” as the actors and channels (e.g., media, investors, social movements) through which legitimation is conferred. Both views are valid, but they refer to two different levels of analysis—one about the bases on which legitimacy rests, the other about the mechanisms through which legitimacy is granted or withdrawn.
We suggest that a focus on discursive arenas helps to clarify this ambiguity. At the micro level, individuals are sources of legitimacy because legitimacy originates in their perceptions and judgments (Tost, 2011). At the meso level, the arena itself becomes a source of legitimacy because it aggregates individual judgments into a collective evaluation and operates with its own rules, routines, and legitimacy criteria. These criteria—the bases of legitimacy—vary across arenas: what becomes “taken for granted” in one arena (Deephouse et al., 2017) may not hold in another. Our typology captures how different arenas prioritize different subjects of evaluation—processes, people, small practices (e.g., speaking in the Dáil), organisations (e.g., Vertex, government), or groups (e.g., CF patients). As legitimacy criteria vary, so does the content of legitimacy itself. Future research could examine arena-specific routines for perceiving, processing, evaluating, and communicating legitimacy claims.
Conclusion
Taken together, our analysis positions discursive arenas as the meso-level infrastructure through which legitimacy as property, process, and perception becomes observable, contestable, and transferable. By specifying where legitimacy occurs, how arena rules differ, and when legitimacy overflows across arenas, we offer a theoretical synthesis that bridges decades of dispersed legitimacy thinking—from Suchman’s generalized audiences to contemporary multilevel and discursive understandings. We believe that this insight is important for the creators and users of discursive arenas – particularly new arenas. As algorithms and moderators shape the nature of content within arenas, they can choose to privilege particular types of expertise or expressions of emotion. In doing so they may well be defining the nature of legitimacy overflows into and out of that arena. We recognize that our case focuses on a small number of arenas and one debate. This, and the data sources we chose, limited the type of actor we could study. Further examination of the roles of regulators, arena providers, and those who moderate discussion within such arenas may help us as a society to understand and frame overflows to avoid drowning productive discourse in a particular arena.
It may never have been more important to understand how bases of legitimacy shift from arena to arena and how they prime feelings and thoughts within that arena. An actor might employ scientific logic in one arena and emotion in another to legitimate the same person, process, or point of view. As society seeks to find a balance between professional and lay expertise; between acknowledging and managing emotion; understanding how these characteristics of arenas can be used (and potentially abused) by actors such as governments, social movements, corporates and others becomes essential to an informed but open-minded society. Our study stayed very much within the arenas studied, without examining the impact on the wider field. Future research could examine how discursive arenas interact with broader field-level logics. Arenas may selectively amplify, reinterpret, or resist dominant logics, thereby serving as micro-sites of institutional maintenance or change. This avenue would connect discursive arenas to institutional logics, logics multiplicity, and field dynamics research.
We have made a start on this process, while cautioning that we looked at only three arenas, in one specific context. We hope, however, that we have established a strong foundation for future research in an area of organisation studies that we believe vital to democratic debate and decision making.
Footnotes
Acknowledgements
We would like to sincerely thank our senior editor, Professor Santi Furnari, and our three expert reviewers for their highly supportive and constructive engagement with our manuscript and their interactions with us throughout the review process. A special thank you to Kerstin Neumann, Yiannis Kyratsis, and the participants of Sub-theme 40: Grand Challenges and the Rhetoric of Collective Action at EGOS 2023 for their comments and suggestions on earlier versions of this paper. Our thanks to Dr Amir Azadnia; Dr Threase Kessie; James Dunne, and Mary Hayes as well as numerous colleagues in the School of Business, Maynooth University for their help in second-coding and making sense of various elements of our vast data sets!.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded under the Maynooth University School of Business Seed Funding Scheme, 2019.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.