Does Trump Actually Control Which Words Scientists Use?

Did Donald Trump really suggest the Centers for Disease Control and Prevention avoid words like “fetus” and “vulnerable?” On Dec. 18, The Washington Post published a report asserting that the Trump administration “banned” officials at the CDC from using words and phrases like “evidence-based,” “diversity,” and “transgender” in budget documents. Is this another example of political hysteria, or did someone blow the whole thing out of proportion? We dug a little deeper to find out what’s fact, what’s fiction, and what the changes actually mean.

True or false: The Trump administration tells the CDC how to frame its requests.

False. But who sits in the Oval has a powerful effect

trump in the oval office surrounded by his cabinet

Trump with his cabinet in the Oval office. | Drew Angerer/Getty Images

Anonymous sources at the Department of Health and Human Services told the National Review that any language changes did not originate with political appointees. Instead, longtime officials choose how to frame their budget request based on who’s reading it. That means the Trump administration may not have told the CDC to avoid certain words, but it remains in the organization’s best interest to write the request using language the administration prefers.

True or false: The CDC must defend its funding every year.

True. These organizations rely on a complex budgetary process

budget proposal

Stacks of budget proposals. | Alex Wong/Getty Images

Slate explains that the CDC “word ban” comes in the middle of a complex budget process that involves multiple agencies. The Trump administration sends its 2019 fiscal request to Congress in February, and staffers at each Health and Human Services agency have likely already submitted their proposals for consideration. Those proposals must include explanations for why they need funding. The documents then make their way to the Office of Management and Budget at the White House, which combines all of the proposals into one big one for lawmakers to read.

True or false: The language used could determine whether grants get funded.

True. Agencies have always chosen their words carefully

A podium with the logo for the Centers for Disease Control and Prevention.

A podium with the logo for the Centers for Disease Control and Prevention. | Kevin C. Cox/Getty Images

Speaking on condition of anonymity, a former CDC official told Vox this practice did not originate with the Trump administration. “The CDC is facing real budget restriction in FY 2019,” the ex-official said. “And the budget office is in the position of having to get more funding. They’re going to do that by saying things that will resonate with their audience.”

It’s worth noting that avoiding sensitive issues happens during each administration. “We have always known that issues like contraception are touchy,” the ex-official said. For one, during the Zika outbreak, CDC officials exercised caution about recommending women avoid pregnancy or use contraception. “There are topic areas you know are sensitive, and that you dance around.”

True or false: Other agencies follow these same guidelines. 

True. Under Trump, many agencies have changed their tune

The United States Environmental Protection Agency logo on its glass door in cream lettering

The U.S. Environmental Protection Agency’s logo. | Justin Sullivan/Getty Images

The CDC does not stand alone in avoiding certain language. Staffers at the Environmental Protection Agency rebranded satellites that help keep track of climate change. Now, those same satellites study “weather” instead. Officials also elected to replace the phrase “climate change” with “climate resiliency” in documents. A director at the Department of Agriculture additionally advised her team that carbon-sequestration and greenhouse-gas reduction should become “building soil organic matter” and “increasing nutrient use efficiency.” “We won’t change the modeling,” the director told that department, “just how we talk about it.”

True or false: Changing the language means the agency isn’t addressing issues the same way.

False. The CDC changed its approach for a different reason

donald trump with mike pence and tom price in the oval office

Trump talks with Vice President Mike Pence (R) and Health and Human Services Secretary Tom Price (L) in the Oval Office. | Mandel Ngan/AFP/Getty Images

The Trump administration in October released a draft plan for Health and Human Services, of which the CDC is a part. It included language on the federal health agency’s focus on “protecting unborn Americans’ starting as early as ‘conception.’” HHS, according to the plan, also supports “strong family values” and “healthy marriages.” Those radical changes actually come from the people in key HHS positions, not simply a strategic linguistic adjustment.

True or false: Trump has staffed the agency with some like-minded folks.

True. Many of the new officials hold conservative views

a doctor carrying a stethoscope and electronic medical records wearing a labcoat

Many of the new health and human services appointees hold conservative views. | Christopher Furlong/Getty Images

New Trump appointees include Teresa Manning, who called access to the morning-after pill “medically irresponsible” and “anti-family.” She now stands in charge of Title X, HHS’s federal family planning program. Anti-abortion activist Katy Talento once claimed that side effects of hormonal birth control include cancer and miscarriages and now works as a health care adviser. Valerie Huber, former president of an abstinence-only education association, works as chief of staff to the assistant secretary for health at HHS. These people’s input may mean the new language is not just strategic — but part of a shift in policy, as a whole. While every administration appoints like-minded individuals, these represent a very drastic rightward shift.

True or false: Even unaffiliated officials decry changing the language.

True. How dangerous this is depends on who you ask

a little girl with a stethoscope in her ear and a doctor using it

A girl gets her ears checked. The risks of censorship in healthcare can trickle down. | Joe Raedle/Getty Images

Dr. Ashish Jha, director of the Harvard Global Health Institute, said avoiding certain words sends a dangerous message to the agency. “There’s as much of a risk of self-censorship that comes out of this than actual direct censorship,” he told STAT. While the director acknowledged the language really only directly affects the budget, he argues the censorship could trickle down.

“So of course the administration and its defenders are going to argue that this is only about what goes into the budget,” Jha noted. “But we know that the signal to the agency is much stronger than that. And it’s going to change behavior of people who work there. And that’s much more damaging than any direct censorship.”

True or false: Did the president really ban words like “vulnerable?”

False. There are no banned words at the CDC

Ann Schuchat, M.D., Acting Director, Centers for Disease Control and Prevention (CDC); Ron Klain, Former White House Ebola Response Coordinator; Executive Vice President, Revolution; Ambassador James Glassman, Former Under Secretary for Public Diplomacy, U.S. Department of State; Visiting Fellow, American Enterprise Institute; David Smith, M.D., Acting Assistant Secretary of Defense for Health Affairs, U.S. Department of Defense, and Judy Woodruff, Anchor and Managing Editor, PBS Newshour, participate in a panel discussion

Ann Schuchat, M.D., acting director for the Centers for Disease Control and Prevention, among others in a panel discussion | Paul Morigi/Getty Images

Dr. Brenda Fitzgerald, who has led the agency since July, sent an all-hands email to the agency’s staff after the “ban” came out. She assured them that the CDC’s mission remains unchanged. “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,” Fitzgerald wrote. She added that “there are no banned words at the CDC.”

As Slate notes, the language changes are far less disturbing than the policy ones. Issues like drastic paring back of environmental regulations; significant cuts to public-health and science funding; rampant conflicts of interest in science leadership; and a total disregard for scientific expertise. If actions speak louder than words, we should watch these much more carefully.

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