The new director of the US Centres for Disease Control and Prevention has reached out to alarmed agency staff to tamp down fears incited by a report that the Trump administration has banned the CDC from using words like ‘foetus’, ‘evidence-based’, and ‘diversity’ in its budget submissions.
STAT News reports that Dr Brenda Fitzgerald, who has led the agency since July, sent an all-hands email to the agency’s staff assuring them that the CDC is committed to its mission as a science- and evidence-based institution. She later posted it on Twitter. “As part of our commitment to provide for the common defence of the country against health threats, science is and will remain the foundation of our work,” Fitzgerald wrote.
“CDC has a long-standing history of making public health and budget decisions that are based on the best available science and data and for the benefit of all people – and we will continue to do so.”
The report says Fitzgerald’s email to staff did not refute the Washington Post’s article reporting that CDC staff had been given a list of seven banned words by CDC budget analysts. The other words on the list were “science-based,” “vulnerable,” “transgender,” and “entitlement.” She did, however, quote from an HHS statement calling the report “a complete mis-characterisation of discussions regarding the budget formulation process.” And Fitzgerald tweeted on Sunday — pinning the tweet to the top of her feed — that “there are no banned words at CDC.”
The report says a Health and Human Services official who asked not to be named, said it was not accurate to say that CDC had been ordered not to use the seven words. Instead, he said, agency budget analysts were told that some words and phrasing might be more likely to win support for the CDC’s budget in the current 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.”
“This was all about providing guidance to those who would be writing those budget proposals. And it was very much ‘you may wish to do this or say this’. But there was nothing in the way of ‘forbidden words.’”
The report says it is not unknown for budget guidance on phrasing like this to be transmitted – a previous administration indicated to the CDC that it preferred the term “unborn child” to “foetus,” but that that was a suggestion, not an order.
The Washington Post published its article late last week and followed up with a report that a second HHS agency has been instructed not to use the words “entitlement,” “diversity,” and “vulnerable.”
The report says the news touched off a firestorm. The Association of Schools and Programmes of Public Health said that if true, the edict was “an Orwellian attack on scientific integrity.” In a letter to Mick Mulvaney, director of the White House Office of Management and Budget, the organisation demanded that the policy be withdrawn.
“The reported policy flatly contravenes the mission of the agency, grossly violates the agency’s pledge to the American people, and represents an appalling act of censorship,” wrote Laura Magaña, president of the association. “Leaving this policy in place would disrupt the agency’s critical work and, as a result, threaten the health of US communities across the country.”
“Among the words forbidden to be used in CDC budget documents are ‘evidence-based’ and ‘science-based.’ I suppose one must not think those things either. Here’s a word that’s still allowed: ridiculous,” said CEO Rush Holt.
Dr Ashish Jha, director of the Harvard Global Health Institute, said discussion of words that are banned or to be avoided sends a dangerous message to the agency. “There’s as much of a risk of self-censorship that comes out of this than actual direct censorship,” he is quoted in the report as saying. “This is the part that’s much more pernicious than any direct pronouncement.”
“So of course, the administration and its defenders are going to argue that this is only about what goes into the budget,” Jha noted. “But we know that the signal to the agency is much stronger than that. And it’s going to change behaviour of people who work there. And that’s much more damaging than any direct censorship.”
The report says there is evidence that type of self-censorship is already underway at the agency. Earlier this year the CDC cancelled planned conferences on the health of transgender youth, and on the health effects of climate change.
The report noted that the Trump administration was prohibiting officials at the nation’s top public health agency from using a list of seven words or phrases in official documents being prepared for next year’s budget. Policy analysts at the CDC were told of the list of forbidden terms at a meeting with senior CDC officials who oversee the budget. The report says in some instances, the analysts were given alternative phrases. Instead of “science-based” or ¬“evidence-based,” the suggested phrase is “CDC bases its recommendations on science in consideration with community standards and wishes”. In other cases, no replacement words were immediately offered.
The report quoted the Department of Health and Human Services, which oversees the CDC, spokesperson Matt Lloyd as saying that it “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.”
The report says the question of how to address such issues as sexual orientation, gender identity and abortion rights – all of which received significant visibility under the Obama administration – has surfaced repeatedly in federal agencies since Trump took office. Several key departments – including HHS, as well as Justice, Education, and Housing and Urban Development – have changed some federal policies and how they collect government information about lesbian, gay, bisexual and transgender Americans.
In March, for example, HHS dropped questions about sexual orientation and gender identity in two surveys of elderly people.
The report says HHS has also removed information about LGBT Americans from its website. The department’s administration for children and families, for example, archived a page that outlined federal services that are available for LGBT people and their families, including how they can adopt and receive help if they are the victims of sex trafficking.
At the CDC, the meeting about the banned terms was led by Alison Kelly, a career civil servant who is a senior leader in the agency’s Office of Financial Services, according to the CDC analyst. Kelly did not say why the words are being banned, according to the analyst, and told the group that she was merely relaying the information. Other CDC officials confirmed the existence of a list of forbidden words. It’s likely that other parts of HHS are operating under the same guidelines regarding the use of these words, the analyst said.
The report says at the CDC, several offices have responsibility for work that uses some of these terms. The National Centre for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention is working on ways to prevent HIV among transgender people and reduce health disparities. The CDC’s work on birth defects caused by the Zika virus includes research on the developing foetus.
The ban is related to the budget and supporting materials that are to be given to the CDC’s partners and to Congress, the analyst said. The president’s budget for 2019 is expected to be released in early February. The budget blueprint is generally shaped to reflect an administration’s priorities.
Neither the OMB nor the CDC responded to requests for comment, the report said.
The long-time CDC analyst, whose job includes writing descriptions of the CDC’s work for the administration’s annual spending blueprint, could not recall a previous time when words were banned from budget documents because they were considered controversial.
The reaction of people in the meeting was “incredulous,” the analyst said. “It was very much, ‘Are you serious? Are you kidding?’ ”
“In my experience, we’ve never had any push-back from an ideological standpoint,” the analyst said.
News of the ban on certain words hasn’t yet spread to the broader group of scientists at the CDC, but it’s likely to provoke a backlash, the analyst said. “Our subject matter experts will not lay down quietly — this hasn’t trickled down to them yet.”
The report said the CDC has a budget of about $7bn and more than 12,000 employees working across the nation and around the globe on everything from food and water safety, to heart disease and cancer, to infectious disease outbreak prevention. Much of the CDC’s work has strong bipartisan support.