WASHINGTON, D.C. – U.S. Sens. Sherrod Brown (D-OH), Patrick Leahy (D-VT), Tom Carper (D-DE), Debbie Stabenow (D-MI), Ben Cardin (D-MD), Jeanne Shaheen (D-NH), Al Franken (D-MN), Tammy Baldwin (D-WI), Mazie Hirono (D-HI) and Cory Booker (D-NJ) are calling for the reversal of reported internal policies across the Department of Health and Human Service (HHS) that ban the use of seven words, including “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based,” and “science-based.”
In a letter to HHS, the Centers for Disease Control and Prevention (CDC) and the Office of Management and Budget (OMB), the Senators, led by Brown, warned that this policy could result in censorship and unscientific language that is damaging to public health and the goals of the agencies, particularly in the areas of minority health and health equity.
“Words matter,” said Brown. “Highlighting certain words may result in self-censorship and imprecision by CDC employees conducting work on important public health issues like minority health and health equity.”
Full text of the Senators’ letter is below and a PDF is available here.
Dear Acting Secretary Hargan, Director Mulvaney, and Director Fitzgerald,
We write to seek clarification over internal policies regarding the use of public health terminology across the Department of Health and Human Services (HHS). On Friday, December 15th, The Washington Post reported that policy analysts at the Centers for Disease Control and Prevention (CDC) were verbally instructed to avoid using a list of seven prohibited words and phrases in official department budget documents, including “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based,” and “science-based.” Employees from other HHS agencies confirmed that similar lists of “forbidden” words were banned from use in official documents. If these allegations are indeed true, we respectfully request that you immediately reverse these policies. Additionally, we request that you follow up with a written response to Congress regarding your plans to mitigate the adverse effects from these reports on HHS’s commitment to science.
According to The Washington Post’s report, CDC analysts were told that the list of prohibited words should be applied to the budget and any supporting materials distributed to collaborators and members of Congress. Multiple HHS officials confirmed the existence of a list of discouraged words. According to the report, the announcement was met with alarm and incredulity from CDC staff members. Once published by the Post, the situation prompted outrage from the wider public health community, with groups such as the Association of Schools and Programs of Public Health, Association of Public and Land-grant Universities, and American Association for the Advancement of Science taking a public stance in opposition to the reported decision. We share their outrage.
Dr. Fitzgerald’s December 17th email to CDC staff, while not denying the existence of the seven banned words, asserted that “science is and will remain the foundation of [CDC’s] work.” It is cold comfort that the Director of one of the world’s leading public health organizations is committed to sound science. Yet, the American people demand more than that. They deserve a Director and an agency committed to the highest quality science not hindered by political interference. As such, we believe that this issue warrants further discussion and clarification.
Words matter. Experts in the field have noted that banning words from budget documents can send “a signal to people in the agency that this is not just about the budget process.” Highlighting certain words may result in self-censorship and imprecision by CDC employees conducting work on important public health issues like minority health and health equity. While HHS’s guidance recommended clunky phrases such as “CDC bases its recommendations on science in consideration with community standards and wishes” in lieu of “science-based” or “evidence-based,” such substitutions cannot be made for the word “fetus” when studying the in utero effects of Zika virus or for “transgender” when studying LGBT health. Particularly in light of additional media reports from December 18th, which revealed that HHS had withheld over 10,000 public comments about abortion and transgender health in the context of regulations for religious and faith-based groups, it is critically important that the agency rethink its policy decisions around censorship and transparency – both within the agency and when soliciting stakeholder feedback.
The CDC’s “Pledge to the American People” states that CDC will “[b]ase all public health decisions on the highest quality scientific data that is derived openly and objectively,” and “[p]lace the benefits to society above the benefits to our institution.” In order to carry out these promises, the agency must remain steadfast in its commitment to the best science and the best words to describe that science. It is essential that CDC rely on science-based and evidence-based decisions, and use specific and accurate language to promote its work. In short, there is no place for censorship within the CDC, or within HHS at large. Furthermore, if other HHS agencies have promoted similar censorship policies, these steps must be reversed. We kindly request your response in writing regarding the agency’s plans to reverse its budgetary language decision, as well as to address its broader implications.
Thank you for your prompt attention to this serious issue. We look forward to receiving your response.