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The Trump administration versus “seven dirty words” at the CDC

On Saturday, The Washington Post broke a story that Trump administration will prohibit officials at the CDC from using a list of seven words or phrases — including “transgender,” “evidence-based,” and “science-based” — in official documents being prepared for next year’s budget. Although the Trump administration furiously backpedaled over the weekend and it now appears that HHS was the source of the edict, this an ominous indication that the Trump administration will attempt to impose ideology on the most important public health agency in the federal government.

[Orac note: There’s a grant deadline this week; so I’m sorry if you might have seen a version of this elsewhere in the recent past. And, yes, I do know that there are at least two stories out there that demand Insolence, and it pains me not to apply it today. Unfortunately, Trying to keep my lab funded must take precedence over my hobby. C’est la vie. No, actually, it’s killing me not to lay into them.]

Ever since Donald Trump’s unexpected victory in the Presidential election last year, many of us who advocate for the view that medicine and public policy should be based on the best evidence and science have been increasingly disturbed by just how little science and evidence mean to the Trump administration. Our concern began well before the actual election, based on the dangerous antivaccine politics on display in the Republican primary races, in which several of the candidates seemed to be competing over who could best pander to the antivaccine fringe. Trump himself, of course, has a long and sordid history of expressing a number of antivaccine views that he’s expressed on Twitter and in interviews many times dating back at least to 2007 and encompassing—of course!—the scientifically discredited view that vaccines cause autism. So when Donald Trump was nominated and then when he was elected, a number of physicians and a huge number of scientists were appalled—and rightly so, as it turns out.

George Carlin
Who knew that George Carlin’s immortal routine about the seven dirty words you can’t say on TV would become the basis for government policy, only substituting different “dirty words”?

Donald Trump bans “seven dirty words” at the CDC

I was reminded of that fear and what was likely to be the result of electing someone like President Trump on Saturday morning, when The Washington Post broke a story, “CDC gets list of forbidden words: Fetus, transgender, diversity“:

The Trump administration is prohibiting officials at the nation’s top public health agency from using a list of seven words or phrases — including “fetus” and “transgender” — in official documents being prepared for next year’s budget.

Policy analysts at the Centers for Disease Control and Prevention in Atlanta were told of the list of forbidden terms at a meeting Thursday with senior CDC officials who oversee the budget, according to an analyst who took part in the 90-minute briefing. The forbidden terms are “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.”

Here’s a brief video:

And more:

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, who spoke on the condition of anonymity because the person was not authorized to speak publicly. 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.

And still more:

The longtime 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?’”

Never put it past the Trump administration to leave an easy opening for ridicule. It had to pick a list of seven words to ban. Not six. Not eight. Seven. Seven allows me to channel George Carlin and refer to them as the “seven dirty words” that the CDC can’t say on TV (or anywhere else). I had thought of giving this post the title, “The Science-Based Vulnerable Entitlement of the Transgender Fetus for Evidence-Based Diversity,” but, damn if someone on Twitter hadn’t beaten me to it:

George Carlin is more appropriate for someone of my generation, anyway, given that I grew up with him and one of his classic routines, “The Seven Words You Can Never Say on Television,” more commonly referred to as the “seven dirty words.” Besides, as managing editor of this blog, in particular I was appalled that the terms “science-based” and “evidence-based” were on the list. After all, what the hell else is the CDC supposed to base its policy, research, and regulations upon? How can one request funds for scientific research on, for instance, transgender health issues without using the word “transgender”? Or, more pointedly, how does one request funds for research on microcephaly caused by the Zika virus without using the term “fetus”? Of course, the very idea of banning the word “fetus” is, quite obviously, to force the CDC to use the word “baby” or “developing baby” in its official budget requests, thus not-so-subtly influencing any health or scientific issue where abortion might be a relevant consideration.

I also fear for the “longtime CDC analyst,” as it is probably very obvious to the White House who leaked word of the ban to The Washington Post. I fear that that analyst is not long for the CDC. I also suspect that that analyst knew the consequences of leaking the information from the meeting but did it anyway. Good for him or her.

Mockery: The inevitable reaction to scientific censorship

Not surprisingly, the Internet exploded at this edict. Indeed, as I write this, I’m hoping that the outcry and mockery will cause the Trump administration to back down before this post even goes live. There are indications that it might be backing down in that the FDA has explicitly denied that it has been forbidden to use the seven dirty words. Also, the Department of Health and Human Services (HHS), while not exactly denying ban on the ban on the seven dirty words at the CDC, claims news stories have “mischaracterized” it, which is what bureaucrats always say when caught by the news media attempting to implement an obviously awful policy. (Censoring the words scientists can use in their funding requests is always bad policy.)

One meme created by Kevin Folta summed up the reaction quite well:

I’m half-tempted to rename this blog “Confirmicated Medicine,” because it’s so hilarious, but it would involve leaving Orac behind and getting rid of all the cheesy images from a 36-year-old obscure British science fiction TV show. So I won’t do it.

George Carlin
George Carlin knew.

“Science-based”: One of the “seven dirty words”?

Be that as it may, the Trump administration gave precious little guidance regarding replacement terms, other than for “science-based.” It sounds benign, but really isn’t, as you will see:

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,” the person said. In other cases, no replacement words were immediately offered.

I use the term “science-based medicine” because I recognize that medicine is not a science, at least not strictly. For instance, patient values can have a huge role in deciding which science-based treatments to use or whether to forego treatment altogether, among other examples. I do, however, argue that medical treatments should be based in science, because the best method for determining which medical interventions and tests are safe and effective and it is the best interest of everyone for health care to be heled to the best science available.

Now, some of you out there might be wondering: What’s the difference? “Evidence-based,” “science-based,” aren’t they basically the same thing as basing recommendations on “science in consideration with community standards and wishes.” The difference is one of emphasis. I view this as a Trojan horse designed to open the door to the CDC making non-science-based recommendations, as long as it’s considered the science. In other words, rather than science being the prime driver of health-based recommendations of the CDC, “community standards” and “community wishes” are now elevated to be equal to science in recommendations.

There are a number of situations where this sort of a wishy-washy “alternative” can be very problematic. Tara Smith points out:

Soak that up. This opens the door for official CDC documents to support, say, abstinence-based education in conservative areas as a “recommendation based on science in consideration with community standards and wishes.” In other words, not science-based at all, even though many communities support it *despite* the scientific evidence. Or anti-vaxxers in Oregon who believe vaccines are “toxic” to have that now become a CDC recommendation based “on science in consideration with community standards and wishes.”

It’s that latter example that came to my mind right away. For instance, “community wishes” might be that more funding is channeled to studying the scientifically discredited idea that vaccines cause autism. Science says that a link between vaccines and autism has never been demonstrated in well-designed epidemiological and scientific studies. Or what about nonmedical exemptions to school vaccine mandates. The science is very clear that easily obtained nonmedical exemptions are associated with lower vaccine uptake and greater likelihood of outbreaks of vaccine-preventable disease, while banning nonmedical exemptions or at least making them harder to obtain are associated with increased vaccine uptake. If “community standards and wishes” are taken into account, maybe my home state legislature’s boneheaded attempt to keep the Michigan Department of Health and Human Services from implementing science-based recommendations to increase vaccine uptake could be acceptable to the CDC.

Now consider the above “recommended replacement” terms in the context of what Donald Trump has done with respect to vaccines and the CDC. Right before the election, an antivaccine blogger couldn’t resist blurting out that Donald Trump had met with antivaccine activists in Florida in August 2016, including the patron saint of the antivaccine movement, discredited gastroenterologist Andrew Wakefield, the man whose fraudulent case series in 1998 gave birth to the most recent iteration of the antivaccine movement in history. During the presidential transition period, Trump also met with Robert F. Kennedy, Jr., one of the most active and famous antivaccine activists, a man who recently raised close to $50,000 to meet with every legislator to promote antivaccine pseudoscience. It’s not clear exactly what they discussed. RFK Jr. claimed that they discussed his chairing a “vaccine safety commission.” This claim was quickly denied by the Trump transition team, but that didn’t stop RFK Jr. from sending an e-mail to members of the Waterkeepers Alliance, which Kennedy leads, announcing that he would leave the environmental group if the commission actually comes to be. More recently, RFK, Jr. issued the most spectacularly dumb “vaccine challenge” since Jock Doubleday. Basically, like many antivaccine activists, RFK, Jr. dons the mantle of a “vaccine safety activist,” even though he’s anything but, his risible oft-repeated claim to be “fiercely pro-vaccine” notwithstanding. Worse, he met with government health officials as recently as August.

Do you see why I was concerned about threats to the CDC’s vaccine policy?

Then there’s the new CDC Director, Dr. Brenda Fitzgerald. While her previous record as the Georgia Public Health Commissioner was reassuring for her vigorous pro-vaccine stance, she is not exactly the sort of doctor who is likely to stand up to political meddling in public health affairs. For one thing, she is not a scientist and hasn’t even done clinical or epidemiological research, two previously very desirable qualifications in any CDC Director. Worse, before she became Georgia Public Health Commissioner, she sold quack anti-aging treatments from her private practice and had even been a Fellow in Anti-Aging Medicine. As I noted before when I first discussed her peddling of anti-aging quackery, Dr. Fitzgerald’s case suggests that you can be pro-vaccine and still be a quack. More importantly in the case of the ban on seven dirty words, not being a researcher grounded in science, Dr. Fitzgerald is in danger of not being able to distinguish pseudoscience from science when antivaxers come calling (and they will come calling) to demand an “investigation” into issues relevant to vaccines. I also hoped that she would listen to CDC scientists, but, even if she does, I doubt she’ll have the spine or smarts to stand up for science and resist this ban on the seven dirty words.

It’s very clear that the Trump administration does not value science and wants to control the narrative and research about science as much as it can. It’s also clear that the administration favors extreme deregulation and free market fundamentalism, given that two of the names floated to head the FDA were cronies of über-Libertarian Peter Thiel, one of whom wanted to roll the FDA back to only requiring evidence of safety and not efficacy before approving drugs and another who wanted to substitute online reviews for science as evidence to be used in drug approval applications. Ultimately the Trump administration settled on the “least bad” option for the FDA, Scott Gottlieb, who is as close to a real, honest-to-goodness pharma shill as there is in existence. Then there was Tom Price, a Georgia Representative and orthopedic surgeon, who was appointed to head HHS but lasted only a few months before scandal consumed him. He belonged to the ultraconservative free market fundamentalist group of physicians masquerading as a medical professional society, the Association of American Physicians and Surgeons (AAPS). AAPS is rabidly antivaccine and antiscience in a number of ways, as well as very Ayn Randian in its view of medicine. While there is no good evidence that Price was antivaccine, one does not belong to such an organization without being sympathetic to its views.

These are the sorts of people the Trump administration has been appointing to posts involving science and medicine. Sure, Trump kept Francis Collins as NIH Director, but that’s about the only sound choice he’s made. Of course, the desire of the Trump administration to control the narrative with respect to science extends far beyond health. This is not even the first time that the administration has tried to censor scientific terminology. As Winston Smith was tasked with doing at the Ministry of Truth to news stories that no longer jibed with the version of history mandated by the totalitarian regime in which he lived in George Orwell’s novel Nineteen Eighty-Four, the administration has been throwing references to human-caused climate change down the old memory hole, even at NIH. Basically, any science that conflicts with the Trump administration ideology is being systematically purged from the government, as much as the administration can manage, while appointing people like Scott Pruitt, a man who made his name suing the agency and who opposes the agency’s mission, to head the Environmental Protection Agency.

What about the other words?

I can speculate about why the Trump administration might want to ban words like “entitlement” and “vulnerable.” First of all, it’s clear that the current administration is hostile to “entitlements,” although I am unsure why it would matter in terms of banning the word for budget requests, although I can guess that it might not want the CDC doing research on how “entitlements” (Social Security, Medicare, etc.) impact health.

Reasons for banning the word “vulnerable” are easier to see. In epidemiology and medicine, “vulnerable” populations are defined as populations more at risk for disease, poor health outcomes, and death because of age (children are considered a vulnerable population), sex, access to health care, and socioeconomic status, among other factors. In general, vulnerable populations can be described thusly:

Vulnerable populations include the economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, the elderly, the homeless, those with human immunodeficiency virus (HIV), and those with other chronic health conditions, including severe mental illness.2 It may also include rural residents, who often encounter barriers to accessing healthcare services.3 The vulnerability of these individuals is enhanced by race, ethnicity, age, sex, and factors such as income, insurance coverage (or lack thereof), and absence of a usual source of care.1,4-8 Their health and healthcare problems intersect with social factors, including housing, poverty, and inadequate education.2

Given the policies of the Trump administration, one can easily see why it would want to ban the CDC from using the word “vulnerable” in its budget requests.

It’s even easier to see why the Trump administration would want to ban word like “transgender” as a sop to the conservative evangelicals who supported him. After all, there is no good substitute term, not even one as convoluted and unbalanced as the one proposed for “science-based.” The overall effect is to make it harder to discuss scientific research having anything to do with transgendered people through language. Human nature being what it is, any roadblock placed in the way of doing research on a subject will make it less likely that scientists will want to jump through the necessary hoops to do it. Also, banning “transgender” is a clear signal to the CDC and other government agencies, whether they have to hew to the same ban or not, that the administration will not be receptive to budget requests for research in this area.

But what about “fetus”? As I alluded to above, banning the word “fetus” forces the CDC to use words like “baby” or “developing baby,” and changes the framing of any discussion of abortion. Why not ban the word “abortion” too? Good question. My guess is like that of Emil Karlsson, namely that banning “fetus” can “serve to crack down more broadly about research related to pregnancy and other issues related to reproductive health for women.”

Finally, “diversity” is a strange word to ban, although not surprising given the Trump administration’s oft-expressed hostility towards policies intended to promote diversity and equality. However, one wonders about unintended consequences. In medical science, the word “diversity” is used to describe far more than just racial and sexual diversity in human populations, the usual use of the word in policy and social science. As Karlsson also notes, “diversity” is a scientific term frequently used in biology and medicine; e.g., diversity can refer to genetic diversity of pathogens or hosts, diversity of animal populations, and the like. Will the Trump administration allow these latter uses of the word but not uses of the word related to human racial and ethnic populations, for example, and will the censors be scientifically savvy enough to tell the difference?

The predictable non-denial denial

On Sunday, Dr. Brenda Fitzgerald, CDC Director, took to Facebook and Twitter to deny everything.

First Facebook:

Here she is on Twitter, saying basically the same thing:

I was not reassured. This is a non-denial denial.

Note that that HHS statement was nothing more than the same statement quoted by a STAT News article published on Saturday, specifically a statement issued by HHS spokesperson Matthew Lloyd. Also note that I remain unimpressed by Dr. Fitzgerald using the terms “evidence-based” and “science-based” in a Tweet. Remember, the news reports stated that use of these terms was to be banned in budget requests. I also note that even Dr. Fitzgerald doesn’t exactly deny it. Let’s look again at the key Tweets:

Notice how carefully Dr. Fitzgerald is not to deny that these words were banned in CDC budget requests. It’s very careful phrasing that denies nothing while appearing to deny the reports. If these words were not actually banned in budget requests, why not say explicitly that these words are not banned in budget requests? Yet Dr. Fitzgerald does not do so. Instead, she hides behind carefully crafted sentences.

I call BS. I am now more convinced than I was when I saw the first story that the Trump administration did indeed ban these words, particularly in light of a follow-up report describing how officials from other HHS agencies revealed that they, too, had been given similar lists of banned words, and then some. The reporters also checked in with the CDC analyst who provided them the original story:

At the CDC, the briefing was led by a senior career civil servant in the office that oversees formulation of the agency’s budget. She opened the meeting by telling participants not to use the words “vulnerable,” “entitlement” and “diversity” because documents containing those words were being “flagged” by others higher up the chain in the budget process, and documents were being sent back to CDC for corrections.

And:

The CDC analyst said it was clear to participants that they were to avoid those seven words but only in drafting budget documents.

“What would you call it when you’re told not to use those words?” the person said. “If that’s not a ban, maybe I need to improve my vocabulary.”

No, the analyst doesn’t need to improve his vocabulary, and it doesn’t matter that, this year, the ban only applies to budget requests. The chilling effect is the same. Administration officials might now be claiming that this is only about the budget and how to win funding from Congress, words matter, and using the correct words matters.

Meanwhile, bioethicist Art Caplan scoffed:

This is what is known by journalism pros as a non-denial denial. Lloyd did not say that the arbitrary comment to the CDC prohibiting the words had not been issued. Rather, he said that the whole thing had been “mischaracterized”—whatever the heck that means. I think you can hear his comments as “message successfully delivered, so prove us wrong.”

Yes, that sounds about right.

1984 has arrived 33 years later than Orwell predicted

In this case, invoking George Orwell’s dystopian novel is not inappropriate. Orwell understood what all totalitarian governments know, namely controlling language and narrative is an essential tool to controlling populations. That’s why in Nineteen Eighty-Four, Orwell portrayed unwanted news and history being thrown down the “memory hole” and inconvenient people becoming “unpersons” (i.e., erased from existence), the term in a language he called Newspeak for eliminating all references to them. The Trump administration policy is not quite a memory hole, but this attempt to ban “inconvenient” words at the CDC is uncomfortably close to Newspeak.

The intent is clear. The pretext might be about the budget process, but, no matter how much Trump administration officials claim it’s just about winning funding from Congress, it’s about more than that:

Dr. Ashish Jha, director of the Harvard Global Health Institute, worries about the ban’s broader impact.

“It sends a signal to people in the agency that this is not just about the budget process,” Jha told STAT. “There’s as much of a risk of self-censorship that comes out of this than actual direct censorship … 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 said. “But we know that the signal to the agency is much stronger than that. And it’s going to change behavior of people who work there. And that’s much more damaging than any direct censorship.”

Exactly.

Science and ideology often butt heads, and this tension is not infrequently apparent between Presidential administrations and government agencies devoted to science. However, the great strength of the US federal government’s science programs dating back many decades has traditionally been just how little political considerations can usually interfere with the scientific efforts of these agencies. Indeed, it has been impressive just how little difference changes in administrations have usually made in the day-to-day operations of federal agencies tasked with funding scientific research and using scientific findings to develop policy options. That’s not to say that previous administrations haven’t tried before to influence the scientific mission of agencies like the EPA (probably the most frequent target of political meddling), NIH, NSF, or CDC. However, as far as I can tell, the Trump administration’s edict to the CDC is unprecedented. Never before has a list of words, “seven dirty words” or others, been explicitly banned for use in budget requests.

This attempt at censoring scientific discourse, even limited as it is to one agency for 2019 budget requests, provides grave reason for concern, as it is not likely to be limited. Yes, right now HHS is denying that this is a policy for any agency other than CDC, and, yes, the FDA has stated that it “hasn’t yet received or implemented a policy to avoid certain words in budget or policy work.” The key word is “yet.” If this censorship of science isn’t nipped in the bud at the CDC, there’s no reason to expect that the CDC will be the only agency affected. As Tara Smith notes:

If this policy is allowed at the CDC, there’s no reason to think this will stay in that agency, either. Imagine all of HHS, NASA, NOAA, the Department of Education, and many others requiring similar definitions of science/evidence-based. It’s programmatic approval of the idea that facts are anything you want them to be.

It’s literally turning “truthiness” into Federal policy.

As Steve Novella notes, the hypocrisy is thick, as well:

But the government should not micromanage the scientific process itself. They should maintain a “light touch” on scientific organizations and let the experts do their job, and let the free market of scientific ideas and evidence sort out what works from what doesn’t.

My choice of terms here is very deliberate. If you have been reading anything about the net neutrality debate you will likely have heard these terms countless times from the FCC director, Ajit Pai. I don’t want to get distracted by this separate controversy – I just want to make the point that conservatives seem to understand the limits of government micromanagement when they want to, but then are free to micromanage science over social issues they care about.

Also, while an outright ban would be more egregious, the passive inhibition of free thought at government funded scientific and health organizations is perhaps more pernicious. You don’t have to “ban” ideas if you have made it clear they are unwanted and you should avoid them if you want funding.

Exactly. If this action by the Trump administration, whether properly referred to as a ban or, ahem, merely a “strong suggestion” that the CDC should not use these seven words while making budget requests, results in self-censorship at the CDC (which is highly likely), it will greatly damage the mission of that great organization. We should not buy the excuses of the administration and its sycophants, toadies and lackeys that this is not a “ban.” Even the most charitable view of this action—heavy-handed incompetence in advising CDC officials how to craft their budget requests—reveals an alarming propensity to censor scientists.

Dr. Fitzgerald and scientists at the CDC need to resist this obvious attempt to censor “inconvenient” scientific discussion. Scientists need to speak out and resist. You and I need to speak out to our elected officials. This new policy at the CDC is not normal. It is a violation of norms accepted by both parties over many decades. It must not stand. Fortunately, since Sunday, I get the distinct impression that the administration might have been shamed in to backing down. I hope so.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

21 replies on “The Trump administration versus “seven dirty words” at the CDC”

Welcome to science paranoia and belief based Gov’t. We had ten years of it in Canada but Harper and his Cabinet were not quite as mad as the Trump and his Administration.

Orac writes,

Scientists need to speak out and resist.

MJD says,

The evolution of mankind:

Spiritual-based ~ Religion-based ~ Science-based ~ AI-based ~ Microverse-based ~ Multiverse-based …

Of course scientists need to speak out, but, in my opinion, resistance to evolution is futile.

piritual-based ~ Religion-based ~ Science-based ~ AI-based ~ Microverse-based ~ Multiverse-based …

Of course scientists need to speak out, but, in my opinion, resistance to evolution is futile.

You’ve truly outdone yourself on the gbbering front. Who’s your book designer this time? Clippy?

This story appears to have been misunderstood by the Washington Post, and the truth is a little bit more complicated:

In other words, what happened regarding these other terms (“transgender,” “fetus,” “evidence-based,” and “science-based”) was not that retrograde Republicans ordered career CDC officials not to use these terms but that career CDC officials assumed retrograde Republicans would be triggered by such words and, in an effort to avoid having such Republicans cut their budgets, reasoned they might be best avoided. With regard to “evidence-based” and “science-based” in particular, I gather the reasoning was simpler than that, and that the group thought these terms are so overused in the CDC budget documents they were discussing as to become nearly meaningless and that their use should be limited to where it actually made a point.

Source: http://www.nationalreview.com/corner/454752/cdc-did-not-ban-words-yuval-levin

There are a number of issues here:

First, the vehemence of the reaction of CDC officials. I find it hard to believe they would have been so willing to risk retribution by running to the press if the explanation were as seemingly benign as you claim. These were career officials. they’ve been around the block and seen multiple administrations at work. They said this was unprecedented. Given the reporting, I’m guessing that it would not be difficult for the White House to figure out the identity of the main source, and probably several of the other sources.

A WaPo followup story does suggest that the guidance came from within HHS, not the White House, but some of the officials who were at the meeting are scoffing that this was a “misunderstanding”:

Officials who have been briefed on the budget guidance, however, said the message was clear. “It was interpreted as ‘you are not to use these words in the budget narrative,'” said one person who received a briefing last week. “The idea that it’s all a misunderstanding is laughable.”

As I said, there’ve been a lot of non-denial denials, and these are officials who’ve been around the block a few times.

Second, I tend to doubt that the terms “evidence-based” and “science-based” were used so much as to become meaningless, but even if they were the suggested replacement (“recommendation based on science in consideration with community standards and wishes”) gives away the gam, as I explained above. The game is to lower evidence standards and allow “community standards and wishes” to dilute or overrule the science. I find it hard to believe that actual scientists would come up with such a substitute phrase. If they did, they should not be scientists or HHS officials.

Third, even if events unwound as you describe, I find that disturbing as hell. It’s potentially even worse than a ban. The message is clear, and scientists will self-censor.

Fourth, the Trump administration does not have a history that lends itself to giving it the benefit of the doubt, having started to scrub government websites of information on climate change, transgender issues, and basically any other science it doesn’t like.

Finally, I was amused by one bit in the story:

Rep. Tom Cole (R-Okla.), who chairs the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies, said in a phone interview Monday that while he was “alarmed” by reports about the budget guidance, he speculated that “what we’re looking at is more silly than sinister.” HHS staffers may have crafted language aimed at courting favor with lawmakers, Cole said.

Tom Cole is one of the worst Republican offenders when it comes to trying to politicize science.

@Orac:

Regarding your first point, I may be wrong in that it was the Washington Post that misunderstood the story; maybe it was the low-level CDC officials who spoke to them who misunderstood!

That would explain the vehemence of those who spoke to the Post. After all, from their point of view, all they knew is they received an order at a meeting that said “you are not to use these words in the budget narrative”. They don’t know who ultimately issued the order: President Trump himself, or the direct superior who called the meeting, or any of the 625 people on the ladder between them. All they knew is that the order originated from somewhere above – and their natural assumption is that the order came from the Trump administration, and therefore that’s what they told the Post. One could therefore blame the Post for not making enough of an effort to find out exactly where the order came from, and ultimately making the same assumptions that the CDC officials did.

In short, the idea that this was a misunderstanding and the idea that the people who talked to the Post were genuinely pissed off at what they saw as an imposition of anti-science dogma on their work are not mutually exclusive.

That version of events would also explain your second point. If the order was issued by bureaucrats-who-are-not-scientists wishing to curry favor with Republicans so they can keep their budget, they might well add “community standards” bureaucratspeak to the replacement language even if the reason for the replacement ultimately had nothing to do with Republicans.

The third point is definitely disturbing as hell, but I’m not sure we have quite the same reasoning as to why. There’s no indication that there was any sort of unspoken understanding from Congressional Republicans where they say nudge nudge wink wink we don’t want to hear about transgenderism. The decision was made entirely due to the assumptions of officials within HHS. Is it bad that Republicans have a history of being anti-science enough that the CDC would try to self-censor the budget requests that those Republicans are to read? Absolutely. But I think that this is actually worse than if somebody in Congress spoke to the HHS and told them what they don’t want to hear. In the latter scenario, that guy can get voted out of office or at least can be forced to stop meddling thanks to the scandal being revealed. But in the current scenario, we have no idea who specifically within the CDC issued the order, they’re not prominent enough to shame by name – and if they are named, the spotlight on them would be exceedingly fleeting and they can resume meddling once they’re no longer a figure of public interest. So this is a much worse situation in that it’s not as easily corrected.

After all, bias goes both ways. The Republicans are not alone in being anti-science. You’ve reported in the past on Hillary Clinton’s strong ties with various alternative medicine cranks. Jill Stein panders to WiFi conspiracy theorists. In a non-science-related example, the Obama administration censored terms like “Islamic terrorism”, because of fears that it might offend Muslims – even though certain terrorist groups are undeniably influenced by Islam. I’m not going to pretend any of these are on the same level as Republicans (especially under Trump), but how many times over the decades have such orders been issued, internal to the CDC or other government administrations and unaccountable to the public, without us knowing about it? Did the CDC play up the potential effects of climate change under Obama and downplay them under Bush? Would we have any way of finding out if they did? Do we need to constantly keep an eye on the scientific consensus whenever reading something output by HHS, are we no longer able to trust them implicitly now that we know that they’ve done this at least once? That’s what disturbs me.

Regarding the fourth point, just because the Trump Administration has no benefit of the doubt when it comes to science doesn’t mean we should relax our verification standards when it comes to reporting stories in which they appear to be to blame. If we do so, aren’t we just as guilty of truthiness and alternative facts as the MAGA crowd? How can we willingly adopt falsehoods – or dismissively ignore when we are unwittingly guilty of reporting a falsehoods – and claim to be fighting for the cause of truth? You can’t just say, “well, it’s true all the other times, so I have an excuse”. You can’t adopt a Dan Rather-like “fake but accurate” position. If we’re to convince people that Trump is a serial liar who is unfit for office, we have to adopt a no-tolerance policy for lies ourselves, even if they’re ones that make him look bad. Otherwise we give the MAGA crowd yet another excuse to shout #FakeNews, and the people in the middle won’t be able to tell the difference between us and them.

@sadmar:

How does that make you any better than the MAGA crowd that dismissed the Roy Moore allegations because “The MSM always lies”?

I’m not at all sorry if the people who review the CDC’s budgets are tired of the word fetus. That’s what happens when there’s lead in the water, not enough folate in the diet and Zika in the mosquitoes.

That explanation (overuse) does not hold any water at all for “fetus”, and I think it’s unlikely for the word “transgender” as well. So while it is a conceivable explanation for a few words, it doesn’t explain the rest. I know I should assume incompetence before malice, but in this instance, why not both?

The overuse explanation is rather explicitly just for the two words “evidence-based” and “science-based”. It doesn’t apply to any of the other words. Even if you didn’t bother to click through to the article, that was in the part I quoted.

May I humbly suggest “in utero Homo sapiens” for fetus? Yeah, it’s wordy, but it does get around the problem.

I counter with “product of conception.” They are looking for “unborn baby.” Give them something as close to an inanimate object as possible.

I saw an excellent argument on Twitter yesterday (sadly I can’t find it again or I would cite the original poster) about why the words used by places like the CDC matter. In the early days of the HIV/AIDS crisis the Regan administration insisted that health officials not use the word “blood” but rather use “bodily fluids”, which lead to a lot of confusion and many people who still believe that HIV can be spread through saliva. And that belief has had serious negative impacts on people who are HIV positive who have been shunned by their families out of fear for how contagious HIV might be.

Now I understand that “bodily fluids” is more technically correct when talking about HIV than “blood”, but at the same time HIV is a “bloodborne pathogen” that can also be spread by OPIM (other potentially infectious materials), not a “bodily fluid” pathogen.

Words matter.

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