Dec 18 2017

CDC Word “Ban”

I received a flood of e-mails over the weekend pointing me to reports that the CDC is banned from using seven words or phrases in their upcoming budget proposals. They are not George Carlin’s famous “seven dirty words” you can never say on television.  Rather they are: “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based,” according to the Washington Post, who broke the story.

First let’s discuss the status of these reports – they are not official public statements from the Centers for Disease Control (CDC), the HHS (department of Health and Human Services) or the Trump Administration. They are anonymous reports from CDC officials who were present during a meeting in which the seven unwanted terms were discussed. Apparently this report was confirmed with several people who were present.

CDC Director Brenda Fitzgerald has pushed back against these reports without straight-up denying them.

“I want to assure you there are no banned words at CDC. We will continue to talk about all our important public health programs,” CDC  said in a Facebook post. “I want to assure you that CDC remains committed to our public health mission as a science- and evidence-based institution. 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.”

Meanwhile the HHS stated the reports were a “mischaracterization.”

What I can best infer from the various reports and statements is that there is no official ban of any words or phrases. Rather, at a meaning where CDC officials were discussing their upcoming budget requests, it was recommended that certain phrases be avoided in order to have the best chance of approval from the Trump Administration. The seven dirty terms were a strategy, not a directive or outright ban. That is the “mischaracterization.”

It is telling, in my opinion, that no one is saying the reports are a lie, a fabrication, or completely wrong – just a “mischaracterization.”

The Post also reports:

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.

This fits the “strategy” interpretation – how to phrase things in the budget requests so as not to trigger any pushback from the conservatives who currently hold the purse strings.

What All This Means

While it seems clear there is no official “ban,” the implications of these reports remain disturbing. This is a manifestation of excessive politicization of science at government institutions. I say “excessive” because any scientific effort funded by the government with public money is by definition politicized. Politics is the mechanism by which public priorities are established.

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.

And of course, avoiding the term “science-based” caught my attention, given that I coined the term “science-based medicine.” In a way I am oddly flattered that they thought to include it and not just “evidence-based.” The alternate phrase, “CDC bases its recommendations on science in consideration with community standards and wishes,” I read as meaning that science won’t get in the way of ideology. If the community feels uncomfortable with a vaccine for a sexually transmitted virus, well their discomfort can take precedence over public health, no matter what the science says.

In case anyone is tempted to interpret all of this as benign and reports as an overreaction, we do have history to provide context. In 1997 congress added an amendment to an operations bill stating that the CDC is barred from research that “advocate or promote gun control.” The CDC was even threatened with having it’s budget cut. Since then the CDC has conducted no research into the health effects of gun ownership, gun control laws, or gun safety.   The congressional statement did not ban gun research itself, just advocacy, but the message was clear, and the CDC has listened. No gun research.

The bottom line is that the CDC has been properly cowed. They have to keep the powers that be happy by avoiding anything deemed controversial. Science and health are secondary to the prevailing ideology.

This is simply incompatible with the mission of a science-based organization. Science needs to be free, even a little rebellious. I don’t think that being horrified by these reports from the CDC is an overreaction. We need to be vigilant of even a whiff of ideology constraining science in our public institutions.

It is in everyone’s best interest that some agencies operate within a framework of professional standards, and that they are specifically cut off from political, ideological, or tribal agendas. A scientific organization charged with protecting the public health certainly qualifies.

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