The Trump administration has handed the Centre for Disease Control (CDC) a list of seven ‘forbidden words’ that are not to be used in the organisation’s budgetry documentation and reports to Congress, an inside source told the Washington Post on Friday. The story has since been confirmed by several sources with the CDC. The words listed are ‘Transgender’, ‘Diversity’, ‘Entitlement’, ‘Foetus’, ‘vulnerable’, ‘Evidence-based’ and ‘Science-based.’ Clearly, the latter two terms reveal something of a contemptuous attitude towards the scientific method and evidence-based medical interventions, but the other words included on the list may well indicate a shift in attitudes towards minority groups and the most disadvantaged in American society as well as an attempt to placate the Republican’s fundamental Christian base.
The ‘ban’ was announced to the CDC in the form of a 90-minute briefing on Thursday, passed down from the Department of Health and Human Services (HHS) which also oversees several other agencies and health organisations, including but not limited to, the Food and Drugs (FDA), the Health Resources and Services Administration (HRSA) and the National Institutes for Health (NIH). It is currently not known whether these agencies have been told to remove these forbidden words from reports also, although given the fact that decision has been levied by their governing body it seems highly likely.
An attack on science
The removal of the terms ‘science-based’ and ‘evidence-based’ may initially not seem as worrying as the exclusion of other words on the list that imply discrimination but to scientists, the idea that an organisation that relies on science as heavily as the CDC should avoid mentioning these things is worrying even if it is only in relation to certain departments and reports. This is coupled with the fact that Trump and several members of his administration have publicly expressed doubts regarding the safety of childhood vaccination and intend to instigate a commission to investigate the safety of vaccines, which medical experts worry Trump will also stack with critics of vaccines. One of the key strengths that supporters of vaccination rely on is that this form of medical intervention is strongly supported by evidence and the scientific method. This is in stark contrast to the arguments used by the ‘anti-vaxxer’ movement, which relies heavily on anecdote.
Unlike the other terms on the ‘banned list’ handed to the CDC, the HHS has recommended that ‘science-based’ and ‘evidence-based’ are replaced with this rather vague and rambling statement “CDC bases its recommendations on science in consideration with community standards and wishes,”. Despite the early usage of the word ‘science’ in that statement, the worrying part is what follows. The mention of “community standards and wishes” strongly implies that if a community’s wishes disagree with scientific consensus the latter should be tempered with the former. How exactly will the wishes of a community be reflected? Likely by the Senators they elect. This marks a significant switch from an agency that uses science to inform policy to one that is forced to use policy to inform science. This is a dangerous and worrying change. Senators should not be determining what science is valid based on their own individual opinions and beliefs. The CDC is the primary agency responsible for the health of millions of US citizens as well as preventing outbreaks of diseases and the spread across much of the western world. Allowing policy-led science will endanger the health of millions.
The move to stop the CDC using certain terms strongly reflects the recent ‘scrubbing’ of the term ‘climate change’ from the Environmental Protection Agency’s website along with the removal of many resources designed to help local authorities deal with the effects of climate change.
Another issue is the hindrance of the CDC to adequately communicate its findings. One of the most significant effects of the Zika virus, spread by mosquitos and sexual intercourse, was the causation of microcephaly and other severe foetal brain defects when passed in-vitro from mother to foetus. The adequate communication of science relies on very precise terminology, the idea of non-scientists wishing to restrict this terminology based on political position and religious belief is extremely worrying.
Pandering to the base
At the time of writing, president Trump’s approval rating stands at a staggeringly low 32%, whilst the rate of Americans that actively disapprove of the job he is doing at 60% with only 8% undecided. This makes Trump the least popular first-year president since records began. This is coupled with the loss of Roy Moore in Alabama Senate race, to Doug Jones, the first Democrat to hold Alabama’s seat since 1992. Losing the Alabama Senate election was a major blow. It’s clear that the Republicans need to do everything in their power to hold on to their base, white conservative voters. An easy way to do this is to take strong, public stances on issues that white conservatives care about, especially those which they feel were particularly affected by the Obama administration.
A 2014 Gallup poll showed that the issue that unified Republican voters the most, was that of abortion; with over two-thirds adopting a pro-life stance. The elimination of the term foetus means the likelihood of ‘unborn child’ becoming the term of choice is quite high as it’s one of the only viable alternatives. This clearly makes the issue of abortion far more emotive, something science really shouldn’t ever be. Something it’s explicitly designed not to be.
Again, this isn’t the first attempt of the Trump administration to restrict the reproductive rights of women. The HHS strategic review for 2018-2022 clearly states that life begins “at conception” and states the agency’s intention to work with “faith-based organisations”. The stance reflects the opinion of the pro-life group, the National Right to Life Committee (NRLC) which claims that it is a scientific fact that life begins at conception.
A history of Transgender censorship
This pandering to the GOP base may well be behind the decision to remove the word ‘transgender’ from CDC reports, something that the HHR has done previously. In March, the HHR removed questions on two elderly surveys that related to LGBTQ issues as well as archiving their LGBT page on the ‘Children’s and Family services’ site. Which can now only be viewed using Google’s ‘wayback machine’. In a response to this, Mara Keisling, executive director of the National Centre for Transgender Equality, responded to this in a written statement “To pretend and insist that transgender people do not exist, and to allow this lie to infect public health research and prevention is irrational and very dangerous.”
This is coupled with Trump’s declaration that transgendered Americans should be excluded from the military, announced in a series of tweets before any consultation with military leaders or generals. The reason given for this ban was the cost of medical coverage for transgender soldiers, a justification that was ruled “does not appear to be supported by any facts” by a judge in October. Judge Kollar-Kotelly upheld the complaint of unnamed plaintiffs that the directive was “not genuinely based on legitimate concerns regarding military effectiveness or budget constraints, but are instead driven by a desire to express disapproval of transgender people generally”. The ban is currently held up by judges in several states.
This approach to the issue of transgender is an ignorant and potentially harmful one. Multiple studies have shown that transgender individuals are significantly more likely to suffer from a variety of mental health and substance abuse issues. What is less clear-cut is just how much of this phenomena is a result of discrimination and poor treatment by family members and society at large. A recent study published in the journal Jama Paediatrics showed that it is extremely difficult to isolate just how influential treatment in society is to the mental health of group studied. It’s vital that this minority group is recognised and destigmatised, the actions of the Trump administration thus far have done literally the opposite of this and leaves an already marginalised group with less recognition than before.
Further hints at a worrying agenda
The removal of the terms I’ve listed above further solidify the ongoing attitude of the Trump administration towards science, reproductive rights and minority groups, but the removal of ‘vulnerable’ and ‘entitlement’ may hint at equally worrying intents. Research conducted by the Pew research centre in 2016 and 2017 indicates a strong belief amongst Republicans that the rich are such because of hard-work and irrelevant of status, race and good fortune. Whilst they believe that those less fortunate are so because they haven’t “worked hard enough”.
This naturally predisposes Republicans to be less in favour of various state-entitlements, state-provided healthcare and benefits. They are also less likely to support initiatives that aim to help less advantaged groups. The removal of the word ‘diversity’ is hardly likely to quiet growing claims that much of Trump’s remaining support comes from hard-right, nationalistic and even white-supremacist groups who he refuses to condemn or reject. Perhaps more worrying than all of this, the censorship of a scientific organisation seems more than a little Orwellian from an administration that repeatedly attacked and villainised the press and its political opposition.
The HHC has issued a statement regarding the story stating “The assertion that HHS has ‘banned words’ is a complete mischaracterization of discussions regarding the budget formulation process. HHS will continue to use the best scientific evidence available to improve the health of all Americans” If even if these words have been ‘banned’ their use has certainly been restricted within the CDC.
“It’s a beautiful thing, the destruction of words.” ― George Orwell, 1984