The latest distraction for President Trump — and confusion for the American public — involves his administration’s advice to multiple agencies within the Department of Health and Human Services to avoid using certain words in official documents being prepared for next year’s budget. The forbidden words are vulnerable, entitlement, diversity, transgender, fetus, evidence-based, and science-based.

That directive reminds me of a chilling sentence from George Orwell’s classic book, “1984.” He wrote: “The Revolution will be complete when the language is perfect.” I hope we never have “perfect” language and will always have the freedom of thought and expression that comes with messy language.

I am a physician at Cambridge Health Alliance, a public health care facility that serves a diverse population, including some of our country’s sickest and most vulnerable individuals. I also teach medical ethics and human rights at Harvard Medical School. I am deeply troubled by the Trump administration’s subtle call to deny the existence of certain groups of individuals.


Soon after Trump was elected president, colleagues at Cambridge Health Alliance and I wrote an open letter. “From America’s Healers: A Letter to Our Patients in the Trump Era” contained eight statements of belief regarding health and human rights concerning issues that we feared would be imperiled by the Trump administration. It was ultimately co-signed by more than 6,000 health care personnel from across the country.

In that letter we stated, “We believe in evidence-based medicine and public health policy.” It is almost a truism that every medical student in the U.S. wants to practice evidence-based medicine. If we are not practicing such science-based treatment then we risk doing serious harm to our patients, including our pregnant patients who are carrying fetuses.

Outside the realm of medicine, everyone — including the president and those who support him — depends on science-based technologies in almost every aspect of their lives, from the cars and airplanes they ride in to the heating and cooling systems in their homes and businesses, the computers they use to access the internet, and on and on.

The letter reaffirmed our commitment to the principles of science. “In medicine, we strive to produce research that is non-partisan and free of personal bias in order to guide our practice as healers. We must continue to place our trust in scientific consensus and use facts to fight feelings when elected leaders raise doubts about long-settled debates, from vaccines to climate change,” we wrote. We also vowed “to defend the pursuit of scientific truth and free inquiry in America.” That vow is part of why propelled me to write this article.

The letter also stated that “we believe that all Americans, irrespective of their gender identity or sexual orientation, deserve to be treated with dignity and respect” and promised to “stand up against the violence, victimization, and health disparities affecting the LGBT population.”

The “T” in “LGBT,” of course, stands for transgender. Just because a small-minded administration wants to prevent the country’s federal health and human services agencies from using that word in budget requests, the rest of us need to stand firmly with all people, no matter their identity. Shame on the administration for trying to use language to deny anyone’s personhood.

By controlling the language used by people writing budget documents, the Trump administration might be trying to complete its revolution. I am determined that it will not have the last word on what language is acceptable. Americans need to speak out whenever the truth is challenged.

Across every stage of human life, from fetus to old age, we must protect the entitlement of those who are vulnerable, including transgender individuals and the poor, to equal and compassionate evidence- and science-based care that acknowledges the wonderful diversity of our country.

J. Wesley Boyd, M.D., is a staff psychiatrist at Cambridge Health Alliance and the founder and co-director of its Human Rights and Asylum Clinic. He is also an associate professor of psychiatry and a faculty member in the Bioethics Center at Harvard Medical School.

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  • Yes, language has power, foreshadows changes we may or may not want to embrace.
    Look at the miracles already reaped from: provider, prescriber, customer, marketplace and healthcare industry. A small shift in terms and now many doctors see they’re working assembly lines and patients see they or their health records are the products. Quite a contrast from 20 years ago when “paternalistic” medicine, disorganized as it was, could provide no assembly line. Patients had the freedom to stay with “their” doctors for years or choose to leave them for another.
    Trumps addition to our “trigger word” dictionary should be welcomed by the socially conscious. The author does not agree. To touch on the obvious, “fetus” is the word used when it’s “okay” to kill a baby. “Transgender” is the word used if it’s fine to have adolescent girls, some victims of sexual assault, be forced to go to the bathroom and change in front of biologic males. “Diversity” is the word used to discount and dismiss people who can’t claim any ethnicity at all, but plain vanilla. Perhaps they will graduate to a recognized minority, one day.
    I happen to like the list and think we are all smart enough to recognize the politically strategic and morally obfuscating power of these words. But I wish doctors would stop promoting their personal politics by exploiting their academic position, lofty sensibilities and “evidence-based studies.”
    Peggy Finston MD

  • Considering the serious lack of the ability of Trump to speak well in general, I find this highly hypocritical that he would demand such a lack of proper terminology. Quite baffling, and it is all about control, and frankly disrespect coming from him.

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