The new director of the Centers for Disease Control and Prevention reached out to alarmed agency staff over the weekend to tamp down fears incited by a report that the Trump administration has banned the CDC from using words like “fetus,” “evidence-based,” and “diversity” in its budget submissions.
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 defense 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.”
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 mischaracterization 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.”
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
A Health and Human Services official who asked not to be named told STAT 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.’”
It is not unknown for budget guidance on phrasing like this to be transmitted. STAT has been told a previous administration indicated to the CDC that it preferred the term “unborn child” to “fetus,” but that that was a suggestion, not an order.
The Post published its article late Friday and followed up Saturday with a report that a second HHS agency has been instructed not to use the words “entitlement,” “diversity,” and “vulnerable.”
The news touched off a firestorm. The Association of Schools and Programs 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 organization 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 U.S. 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 told STAT. “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 behavior of people who work there. And that’s much more damaging than any direct censorship.”
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.
This story has been updated to add reaction from a Health and Human Services official.