Government Ban on Seven Words Creates Anger Among Physicians

Sandra Levy

Disclosures

January 19, 2018

Last year's reports in the Washington Post that the Trump Administration told the Centers for Disease Control and Prevention (CDC) to avoid using certain words in its budget formulation process—"vulnerable," "science-based," "fetus," "transgender," "diversity," "entitlement," and "evidence-based"—evoked outrage among the medical profession. Although the Department of Health and Human Services, which oversees the CDC, said that it will continue to use the best scientific evidence to improve the health of all Americans and that it strongly encourages the use of outcomes and evidence data in program evaluations and budget decisions, the outrage that the ban engendered was still powerful.

In a recent Medscape commentary, ethics expert Arthur L. Caplan, PhD, said, "Banning valid terminology from government reports is what might charitably be termed 'crazy.'... Once the government tells a key agency like the CDC not to use utterly legitimate words, does anyone really think that any more needs to be said?" His viewpoint sparked emotional responses from many physicians in the comments section.

The vast majority were outraged and felt that such a stance was an attack on the freedom of American physicians. Still, a significant minority posited that the ban on these words is intended to prevent the rejection of budgets for public health, and they therefore expressed moderate support for the effort. There were also physicians who believed the ban to be "fake news."

Several physicians expressed their concern that politics shouldn't interfere with or guide developments in science. "This attempt at censorship is disturbing at the least. It is essential that the medical community continues to speak fervently to oppose it and any other future attempts," said a healthcare provider. "There is a risk that we may tire of solidly supporting the need for unbiased scientific inquiry when faced with likely repetitions of this kind of behavior. I suspect that these 'misconstrued' conversations will continue in some form."

Another healthcare provider agreed. "The [government] shouldn't have the attitude that it alone has the sole authority to dictate the terms that are used in science (nor should any other government agency, for that matter) since that would be politically motivated. However, for too long that is precisely what has been going on in the current world of academia—too much political influence. Science should be motivated and guided by facts, not politics."

Several healthcare providers took up the issue of whether the term "evidence-based" need to be censored.

One reader commented, "'Evidence-based' simply means based on evidence—a concept intrinsic to science! Its politicization comes not from CDC scientists' 'bludgeoning' anyone with it, but from people (starting with the fossil fuel industry) who do in fact deny the veracity of climate science... . Aside from the politics surrounding the seven words themselves, however, is the larger issue of an administration's attempts to censor the language used by agency professionals. The history of governments' attacks on language, on the press, on scientists, writers, and other academics, are tactics with which citizens of both political parties need to be familiar—and to guard against—even when seemingly minor, if they value our democratic freedoms."

Support for banning the term "evidence-based" came from a physician who specializes in maternal-fetal medicine. "The term 'evidence-based' should be removed from all scientific discussions since it is frequently used without giving any supportive data. If the term 'evidence-based' is used, the author or speaker should be forced to describe their evidence or be ignored. Remember in 1980 that the authors of a five-sentence editorial in the New England Journal of Medicine used the evidence from their database of 39,946 medical patients to declare that addiction to narcotics was rare. Now this 'evidence-based' editorial is considered by some to be a major contributor to our current opiate crisis."

An anesthesiologist agreed with the physician above, saying, "Science cannot be denied. Bludgeoning people with terms like 'evidence-based medicine' does little to persuade people; only the science can do that. I recall evidence-based articles from the 1990s indicating that patients could not become addicted to opiates if they took them only while they were in pain. Turns out that was not the case... Politics and science don't mix; too much bias is entered into the mix. Stop the name-calling about deniers and dupes and let the science/truth speak for itself."

A Financial Motive?

Some healthcare providers believe that the ban is solely intended to prevent budgets for public health from being rejected.

A physician said, "Since it was in the context of budget documents, it seems likely that this is not the edict from a conservative administration trying to muzzle the CDC personnel. It is more likely that it is an attempt by politically savvy CDC administrators to avoid conflict with that administration and congressional conservatives who might find these cultural shibboleths red flags that would cause them to reject budgeting for certain areas of public health. In that sense, it may be that the effort is an attempt to protect funding for these legitimate CDC efforts in recognition that, among other issues, science itself has become subject to debate within the government."

A pathologist concurred, saying, "Apparently the reason for these 'banned words' in budget requests was based on recommendations from a while back originating during the previous administration. It was felt that the words might be triggering for Republicans in Congress who might then be less likely to turn down budget requests from the CDC. These recommendations were intended to help the CDC get budget requests approved."

Fake News?

There were also comments from healthcare professionals who don't believe that the Trump Administration banned these words. A pediatrician said, "This article is absolute fake news. These words were never banned from the CDC."

Another healthcare provider said, "Many comments on this issue invoke claims of Fake News. The term itself was first coined to describe tabloid, or sensational, news (stories of alien craft found in trash cans, etc.) but has recently been used by both liberal and conservative media to describe one another's news, without any common criteria as basis... . We need to be careful about this kind of name-calling, because accusations of Fake News are themselves often fake—lacking any basis for their claims and undermining the credibility of all news."

Finally, although the news of the ban sparked a vigorous debate on both sides of the fence, one physician said that there are more important problems for healthcare providers to be consumed with than the administration's censorship. "Perhaps we all ought to worry far less about what words a federal agency does or does not use to finesse its budget through Congress, and much more about the bigger issues we face, such as, the added paperwork burden imposed on doctors who now want to extend an opioid pain Rx, and an NSAID-abuse crisis that kills something like 10,000 people annually and hospitalizes over 100,000... . To my mind, any one of these has greater ramifications for patients than Washington word games in the annual budget boogie," said the physician.

A neurologist addressed this comment, saying, "Accurate, scientific terminology and free speech help bring the reforms you suggest, but censorship is never healthy in science."

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