Officials at the Centers for Disease Control and Prevention (CDC) say that the Trump administration is forbidding them from using a list of seven words or phrases in documents being prepared for the president's 2019 budget, according to a report from The Washington Post published on Friday.
Policy analysts at the country's top health agency were told by senior CDC officials in a meeting on Thursday that they were not to use the words “fetus,” “transgender,” “diversity,” “entitlement,” “vulnerable,” “evidence-based,” and “science-based.” Barring the use of these phrases seemingly contradicts the CDC's pledge to the American people to use the highest quality scientific data and treat all people with dignity and respect.
Analysts were given alternative phrases to use in some cases, according to an anonymous analyst who was at the meeting but is not authorized to speak publicly. Rather than “science-based” or “evidence-based,” the suggested phrase is “CDC bases its recommendations on science in consideration with community standards and wishes.” The Post says no replacement words were offered in other instances. Still, in a recent draft strategic plan, the Department of Health and Human Services (HHS)—the parent agency of the CDC—used the phrase "unborn child" rather than "fetus" and stated that life begins at conception. (HHS also oversees the Title X family planning program and Medicaid, which provides health insurance to low-income women and the move was viewed by reproductive health providers as an attack on abortion, certain forms of contraception, and IVF.)
The CDC does work in areas to which these newly forbidden words exactly pertain, like investigating the effects of the Zika virus on a developing fetus and helping prevent HIV in transgender people. The CDC's own pledge to the American people says that it will "[b]ase all public health decisions on the highest quality scientific data that is derived openly and objectively" and "[t]reat all persons with dignity, honesty, and respect."
The anonymous analyst, whose job includes writing summaries of the agency's work for annual budget documents, told the Post that people in the meeting couldn't believe what they were hearing. The source said: “It was very much, ‘Are you serious? Are you kidding?’” The analyst added, “In my experience, we’ve never had any pushback from an ideological standpoint."
The meeting was led by Alison Kelly, a senior leader in the CDC's Office of Financial Services, who did not say why the words were now prohibited, just that she was relaying information. The Post cites other CDC officials confirmed that a list of forbidden words does exist. HHS spokesperson Matt Lloyd told the Post that “[HHS] will continue to use the best scientific evidence available to improve the health of all Americans. HHS also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions.” Lloyd told STAT News: "The assertion that HHS has ‘banned words’ is a complete mischaracterization of discussions regarding the budget formulation process.”
We've reached out to Lloyd for further comment and will update this post if we hear back. A phone call to CDC media relations wasn't immediately returned. CDC Director Brenda Fitzgerald wrote in a Facebook post on Sunday: "I want to assure you there are no banned words at CDC. We will continue to talk about all our important public health programs."
A male HHS official who asked not to be named told STAT on Sunday that no words were banned; rather, analysts were told that certain words and phrasing in the CDC budget would be more likely to earn support from Congress. "The meeting did take place, there was guidance provided—suggestions if you will,” he said. “There are different ways to say things without necessarily compromising or changing the true essence of what’s being said,” adding “it was very much ‘you may wish to do this or say this’. But there was nothing in the way of ‘forbidden words.’”
Still, there's concern that even "suggestions" could lead to censorship. Former Surgeon General Vivek Murthy told the New York Times on Saturday: “Whether this is a directive from above is not clear. But for CDC or any agency to be censored or passively made to feel they have to self-censor to avoid retribution—that’s dangerous and not acceptable. The purpose of science is to search for truth, and when science is censored the truth is censored.”
On Monday, James Madara, the CEO of the American Medical Association sent a letter to acting HHS secretary Eric Hargan saying that the group "strongly recommends that the HHS issue a more detailed clarification in response to these reports, to reassure the American people that the health care principles and objectives captured by these broadly used and accepted terms retain their central focus in its agencies’ work." Madara continued: "Political sensitivities must not be allowed to obfuscate the priorities and core purposes of government programs that are vital to protecting and improving the health of the nation."
Reaction to the story was swift. Here are responses to the story from medical groups, doctors, civil rights groups, and lawmakers. We've reached out the American College of Obstetricians and Gynecologists for comment and will update this post if we hear back. We'll update as more reactions and statements are released.
Dana Singiser, vice president of public policy and government affairs for Planned Parenthood Federation of America:
“It is unimaginably dangerous to forbid the Centers for Disease Control and Prevention from speaking about things essential to Americans’ health. This edict doesn’t just mean a change in vocabulary. It means the Trump-Pence administration is trying to make a radical change in the focus of the entire agency.
You cannot fight against the Zika virus, or improve women’s and fetal health, if you are unable to use the word ‘fetus.’ You must be able to talk about science and evidence if you are to research cures for infectious diseases such as Ebola. You must be able to acknowledge the humanity of transgender people in order to address their health care needs. You cannot erase health inequities faced by people of color simply by forbidding the use of the words ‘vulnerable’ or ‘diversity’.
“This move is reckless, and will put millions of lives in danger. The Trump-Pence administration should be ashamed, and must end this dictate immediately.”
NARAL Pro-Choice America:
The Association for the Advancement of Science:
The March for Science:
Lambda Legal, organization committed to achieving full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people and everyone living with HIV:
Harold Pollack, professor of biology and public health at the University of Chicago:
Eric Topol, founder and director of the Scripps Translational Science Institute, former chair of cardiovascular medicine at Cleveland Clinic:
Daniel Grossman, a reproductive health researcher and director of Advancing New Standards in Reproductive Health (ANSIRH):
Jen Gunter, a prominent OB-GYN:
Senator Richard Blumenthal of Connecticut, member of the Senate committee on commerce, science and transportation:
Senator Brian Schatz of Hawaii, member of the Senate committee on commerce, science and transportation:
Senator Kamala Harris of California:
Congresswoman Nancy Pelosi of California, House minority leader:
Congressman Don Beyer of Virginia, vice-ranking member of the House science, space, and technology committee:
Update 12/18/17: This story has been updated to include a statement from CDC Director Brenda Fitzgerald as well as comments from the American Medical Association, former Surgeon General Vivek Murthy, and an anonymous HHS spokesperson.
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