The CDC's word ban list is harmful to the health of the American public

The CDC's word ban list is harmful to the health of the American public
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On Saturday morning the Washington Post announced the Trump administration’s naughty list – and it wasn’t the names of children deserving a lump of coal. Instead, the list consisted of seven words purportedly banned for use by government employees at the U.S. Centers for Disease Control and Prevention (CDC).

The source of the prohibition — possibly the Department of Health and Human Services, the White House Office of Management and Budget, or the Executive Branch — was unclear.

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What is clear is that the mandate to ban these seven words “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based” is an attempt at censorship, an affront to scientists, and harmful to the health of the American public.  

 

As the nation’s leading public health agency, CDC is responsible for population health in the US. In its Pledge to the American People, it vows to “base all public health decisions on the highest quality scientific data…and treat all persons with dignity, honesty and respect.”

But now, how can CDC research the effects of the Zika Virus without things like fetal ultrasound and discussion of fetal development? Or prevent HIV transmission among trans people without using the word transgender? How can CDC reduce health disparities without thinking about vulnerability and diversity? And how can CDC possibly succeed in making wise public health decisions if not basing them on science or evidence?   

Evidence-based and evidence-informed public health policies are precisely what the nation and its citizens expect from CDC. The newly imposed censorship is a direct attack on the First Amendment rights of federal employees; the speech restriction also violates the ethical principles that underpin public health practice — and CDC’s core values of accountability, respect, and integrity.

This isn’t the first time the agency’s freedom to speak on certain issues has been limited. Kim Nolte was a contractor at CDC between 2002 and 2006. During the second Bush administration, “we literally couldn't tell the public which programs were the most effective at preventing teen pregnancy.

We used words like "science-based" and "evidence-based" as code alternatives to abstinence-only program. I hope my friends at CDC are thinking about similar workarounds” said the current CEO of the Georgia Campaign for Adolescent Power & Potential.

Now it appears that rather than workarounds, CDC officials are admonished to compromise on the value of science itself. Suggested alternative language like, “CDC bases its recommendations on science in consideration with community standards and wishes” opens the door for community preferences to trump intervention effectiveness.

Abstinence-only education, for example, could be treated preferentially based on community desires despite scientific evidence that they are ineffective in delaying sexual debut. Such recommendations carry the high risk of reducing CDC’s credibility — and resulting in harmful health consequences for the American people.  

Accurate and objectively derived information is key to health decision-making. The ability of the American people to access our best knowledge about health topics is in jeopardy.

Current HUD Secretary Ben CarsonBenjamin (Ben) Solomon CarsonTrump walks a tightrope with comments on NATO Progressive politics have done nothing to help black America Is civility in America really dead? MORE has noted, “By remaining ignorant, we shrink our democratic duty and open ourselves to slick politicians who would usurp our rights. Some of the segments of our society who are most easily led astray are those with the poorest general education, which makes me wonder if those seeking political advantage are happy to maintain the status quo in order that the uneducated might be easily manipulated.”

Whether maintaining the status quo, or a more insidious attempt to undermine health equity, people who already are invisible, under-represented, and under-served are further entrenched by the forbidden vocabulary.

CDC Director Brenda Fitzgerald has issued a statement re-affirming CDC’s commitment to “decisions that are based on the best available science and data and for the benefit of all people.” Whether and how those decisions are actually made remains to be seen.

In a politically divisive time, carefully crafting language related to budget requests, while inefficient and perhaps misleading, is pragmatic; compromising core values: freedom of speech, access to information, and scientific integrity is not.

The congressional committees charged with reviewing CDC’s budget request must ensure that such limitations on language are thoroughly investigated and prevented in the future. The American public is counting on CDC to ensure that science prevails over semantics; and they are counting on Congress to ensure that CDC’s budget appropriation is grounded in free speech rather than limitations on it.  

Dabney P. Evans, PhD, MPH is an assistant professor of Global Health at Emory University. Kenneth G. Castro, MD is a professor of Global Health and Epidemiology at Emory University and was previously director of the Division of Tuberculosis (TB) Elimination and Acting Director, Division of HIV/AIDS Prevention in the National Center for HIV, STD, and TB Prevention at the US Centers for Disease Control and Prevention.