On Friday night, the Washington Post published a report detailing how officials at the Centers of Disease Control and Prevention had been banned from using words and phrases like “evidence-based,” “fetus”, and “transgender” in budget documents.
The report caused an uproar. Sen. Jeff Merkley (D-OR) said the forbidden word list was reminiscent of George Orwell’s dystopian novel 1984. Others viewed the move as more evidence of President Trump’s authoritarian tendencies. Members of the science and public health communities worried on Twitter about what this type of censorship would mean for the research being done at the CDC, how it’s communicated to the public.
But by Sunday, the head of the CDC was pushing back, claiming that the Post had misinterpreted the directive.
Dr. Brenda Fitzgerald, who has acted as the CDC director since last July, said in an internal email and on Twitter, that “there are no banned words at CDC.”
I want to assure you there are no banned words at CDC. We will continue to talk about all our important public health programs.— Dr Brenda Fitzgerald (@CDCDirector) December 17, 2017
Matt Lloyd, a spokesperson for the Department of Health and Human Services, echoed her, saying the Post report was a “mischaracterization of discussions regarding the budget formulation process.”
The whole episode remains confusing — the agency has not provided any additional explanation about how its discussions were mischaracterized. (Neither the CDC nor HHS have responded to requests for comment, and it’s still not clear at which agency the directive originated.) And denying there are “banned words” is not the same as denying discussions about language sensitivities in budget talks.
To try to make sense of it all, we called up a former CDC official, who was privy to the budget processes during the Obama administration. (The former employee spoke to Vox on the condition of anonymity.) The ex-official felt the Post had overstated the significance of what are common political maneuvers during budget negotiations — and that the report confused those financial conversations with the science that’s happening at the agency.
But given that the report is seen as part of broader language restrictions at other government agencies under Trump, it’s still pretty worrying.
According to the Post, CDC policy analysts at headquarters in Atlanta were briefed about the “forbidden” words at a Thursday meeting with officials who oversee the budget. The words, which were not to be used in documents circulated in the administration and Congress ahead of the budget proposal for FY2019, included “evidence-based,” “science-based,” “vulnerable,” “entitlement,” “diversity,” “transgender,” and “fetus.”
But the New York Times later reported that “science-based” and “evidence-based” were not firmly on a watch list, as the Washington Post suggested. The ex-CDC official had spoken to former colleagues in the agency, who confirmed that those words “were discussed, but it wasn’t like they recommended not using” them.
The former CDC employee told Vox it’s not unusual for CDC officials in charge of the budget request to be cautious about sensitive language ahead of budget talks.
“The CDC is facing real budget restriction in FY 2019,” the ex-official said. “There’s going to be no budget line for global health security at this point, among many other likely cuts that are coming. And the budget office is in the position of having to get more funding. They’re going to do that by saying things that will resonate with their audience” — an audience of conservative Republicans.
Using more muted language to talk about certain politically sensitive health issues happened during the Obama administration, too. “We have always known that issues like contraception are touchy,” the ex-official said. For example, during the Zika outbreak, CDC officials were aware they had to be careful about recommending women avoid pregnancy or use contraception. “There are topic areas you know are sensitive, and that you dance around.”
“Yes it’s ridiculous,” that this has to happen, the ex-official added. “But is this the end of the world? No. CDC is going to continue to be one of the most trusted agencies in government because they are based in science. That’s not going to change.”
The language used in budget talks is a separate issue from the science being done and communicated through the agency, the former CDC official said. “I am confident you’ll see ‘fetus’ in an MMWR [the CDC’s epidemiological digest Morbidity and Mortality Weekly Report] about Zika. And ‘transgender’ in a report about HIV. Just because the budget office is trying to use more favorable language to acquire funds, doesn’t mean in any way this will affect the integrity of the agency.”
A science and public health outcry
This may not be comforting to people in the public health and scientific communities, some of whom have noted that any type of censorship could be dangerous, and might indirectly affect the CDC’s scientific practice.
“[Encouraging people not to use certain words] will lead to a kind of self-censorship,” Rush Holt, chief executive officer, American Association for the Advancement of Science, told Vox. “It’s troubling if ideology is interfering with the use of certain words.”
“The purpose of science is to search for truth, and when science is censored the truth is censored,” Dr. Vivek Murthy, a former surgeon general, told the New York Times.
Here’s Sandro Galea, an epidemiologist and dean of the Boston University School of Public Health, on Twitter:
Changing language like “fetus” and “transgender” is part of a broader trend at HHS
Even if it’s not banning words, CDC’s rhetorical tiptoeing can also be seen as part of a broader push by the Trump administration to control how science is discussed and embrace the language of the religious right.
The term “evidence-based” appeared 104 & 119 times in @BarackObama's FY16 & FY17 CDC budgets & only 33 times in @realDonaldTrump's FY18, including once on opioid abuse/overdose prevention. In FY19, guess he plans to address opioid epidemic based on feelings vs. actual evidence? pic.twitter.com/ILIQy8p5uO— Chelsea Polis, PhD (@cbpolis) December 16, 2017
The Trump administration in October released a draft plan for Health and Human Services, which suggested the federal health agency will now be focused on “protecting unborn Americans’ starting as early as ‘conception.’”
HHS, according to the plan, will also be in the business of supporting strong family values and “healthy marriages,” empowering faith-based groups that receive federal dollars with the freedom to exercise their morals and beliefs, and looking after American lives all the way to “natural death.”
That’s a radical departure from the tone of strategic plans in the previous administration. But the sensitivities around conception and the word “fetus” are less surprising when you consider the ideological views of many of the people now in important positions at HHS.
The list of former conservative activists at the agency includes:
- Matthew Bowman, a lawyer at the Department of Health and Human Services, is reportedly one of the architects behind the new birth control rules and previously worked for Alliance Defending Freedom, a Christian legal advocacy (and anti-choice) group.
- Another top Trump adviser on health care is Katy Talento, an anti-abortion activist who has claimed that side effects of hormonal birth control include cancer and miscarriages.
- Trump put Teresa Manning, an anti-abortion lawyer who once said giving people easy access to the morning-after pill was "medically irresponsible" and "anti-family,” in charge of Title X, HHS’s federal family planning program.
- Charmaine Yoest, now assistant secretary at HHS, was the president and CEO of the anti-abortion group Americans United for Life.
- Valerie Huber, the former president of an abstinence-only education association, is the chief of staff to the assistant secretary for health at HHS.
The Trump administration has also been removing the phrase “climate change” from some government websites, part of its rejection of the science of global warming.
“I don’t know exactly who said what to whom [in the CDC meeting]. But somehow, the word got to some employees that there are things that shouldn’t be written,” said the AAAS’ Holt.
“The reason [the CDC report] wasn’t just immediately dismissed as a ridiculous idea, was that there have been too many instances and too many suspected instances of words or ideas being set out of bounds.”