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December 19, 2017

The 7 words CDC analysts were warned to avoid—and why HHS is pushing back

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    HHS on Monday confirmed that the agency had issued recommendations to CDC policy analysts on terms to avoid using in fiscal year 2019 budget documents, but that it had not prohibited use of the terms outright, the Washington Post's "To Your Health" reports.

    HHS' clarification follows Post coverage on Friday that alleged President Trump's administration had banned policy analysts at CDC from using a list of seven words in budget documents. The Post story cited an analyst briefed on terms. HHS and CDC officials said at the time that the claims are "a complete mischaracterization."

    Details on reported phrasing ban

    According to the analyst, who spoke with the Post on the condition of anonymity, the list was shared with CDC policy analysts during a meeting Thursday at the agency's headquarters in Atlanta. The analyst said the banned words are:

    • "Diversity";
    • "Entitlement";
    • "Evidence-based";
    • "Fetus";
    • "Science-based";
    • "Transgender"; and
    • "Vulnerable."

      According to the Post, four of the words had been flagged verbally:

    • "Evidence-based";
    • "Fetus";
    • "Science-based";  and
    • "Transgender."

    Other CDC officials confirmed that such a list existed, the Post reports.

    The meeting was reportedly led by Alison Kelly, a senior leader in CDC's Office of Financial Services. During the meeting, Kelly informed attendees about the directive, which applies to CDC budget and related materials that the agency distributes to partners and to Congress, according to the analyst. 

    The analyst said Kelly did not provide a reason for the ban, but told the group she was relaying the information and that the words should be removed from documents related to the president's fiscal year 2019 budget proposal, which is expected to be released in early February.

    According to the analyst, meeting attendees were offered alternative phrasing for certain words. For instance, instead of "evidence-based" or "science-based," analysts could say, "CDC bases its recommendations on science in consideration with community standards and wishes."

    According to the analyst, the reaction among meeting attendees was "incredulous." The individual said, "It was very much, 'Are you serious? Are you kidding?'"

    HHS, CDC official push back

    At the time of the Post story's publication Friday, neither CDC nor the Office of Management and Budget (OMB) had responded to requests for comment, according to the Post. HHS spokesperson Matt Lloyd at the time said CDC "will continue to use the best scientific evidence available to improve the health of all Americans," adding, "HHS also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions."

    On Saturday, Lloyd called reports that a list of banned words was circulating HHS a "complete mischaracterization of discussions regarding the budget formulation process."

    CDC Director Brenda Fitzgerald in an email to the agency's staff this weekend reiterated HHS' statement that the report was "a complete mischaracterization of discussions regarding the budget formulation process." However, according to STAT News, Fitzgerald did not explicitly refute the Post's article that staff had been warned against seven words.

    According to STAT News, an HHS official who asked to remain anonymous also confirmed the meeting took place, but characterized the phrasing list as "guidance" or "suggestions," as opposed to an outright ban. The individual said, "There are different ways to say things without necessarily compromising or changing the true essence of what's being said," adding, "This was all about providing guidance to those who would be writing those budget proposals. ... But there was nothing in the way of 'forbidden words.'"

    STAT News reports that it is not "unknown" for an administration to offer phrasing guidance on budget proposals.

    According to the Times, at the time of the original reports, there also appeared to be confusion among public health agencies regarding where the ban originated. FDA spokesperson Jennifer Rodriguez said, "We haven't received, nor implemented, any directives with respect to the language used at FDA to describe our policy or budget issues."

    HHS clarifies stance

    HHS officials on Monday confirmed that the department had shared a style guide with recommendations that budget writers avoid three of the seven reported terms—"vulnerable," "diversity," and "entitlement"—except "when the terms are referenced within a legal citation of part of a title." According to "To Your Health," the document also encouraged staff to refer to the "'ACA' and 'Affordable Care Act'" as "'Obamacare' wherever those terms appear."

    But officials again pushed back against characterizations of the recommendations as a ban. According to "To Your Health," HHS officials provided "different accounts" of how the four remaining words—"fetus," "transgender," "evidence-based," and "science-based"—were communicated.

    Lloyd said, "HHS and its agencies have not banned, prohibited, or forbidden employees from using certain words," adding, "Recent media reports appear to be based on confusion that arose when employees misconstrued guidelines provided during routine discussions on the annual budget process. It was clearly stated to those involved in the discussions that the science should always drive the narrative."

    Lloyd also said the guidance originated within HHS, not OMB. "This budget guidance is not official administration policy and did not come from OMB," he said.

    However, according to the Post, some officials briefed at the meeting rejected Lloyd's characterization of the discussion. The guidance on the terms "was interpreted as 'you are not to use these words in the budget narrative,'" one individual who attended the meeting said. "The idea that it's all a misunderstanding is laughable."


    The Post's article, which was published Friday, prompted outrage among advocacy groups and public health officials, including Planned Parenthood Federation of America, the Association of Schools and Programs of Public Health, Harvard Global Health Institute Director Ashish Jha, and former Surgeon General Vivek Murthy.

    Several Democratic lawmakers voiced concerns about the list of terms. Sen. Jeff Merkley (D-Ore.) in a tweet compared the reported list to George Orwell's novel "1984." He wrote, "Banned words in [President] Trump's America apparently include 'evidence-based,' 'transgender,' and 'vulnerable.' Are you kidding me?!?!"

    In addition, Sen. Patty Murray (D-Wash.) and Rep. Frank Pallone (D-N.J.) in a letter on Monday requested HHS Acting Secretary Eric Hargan to share "information and documents regarding how and why the prohibition is being implemented across [HHS]." The lawmakers added, "The prohibition has the potential to freeze scientific advancement at the agency and across [HHS], and it sends a clear message that the Trump Administration is yet again prioritizing ideology over science."

    Meanwhile, Rep. Tom Cole (R-Okla.)—chair of the House Appropriations Subcommittee on Labor, HHS, Education, and Related Agencies—on Monday said while he was "alarmed" by news about the guidance, he believes that "what we're looking at is more silly than sinister." Noting that he still plans to speak with Fitzgerald about the issue, Cole explained, "I think this is more the bureaucracy trying to react to what they think the new administration wants to hear. … This is not any effort to impose … parameters on research or blinkers on science" (Sun/Eilperin, Washington Post, 12/15; Belluz, Vox, 12/16; Booker, NPR, 12/16; Branswell, STAT News, 12/17; Bowden, The Hill, 12/16; Kaplan/McNeil, New York Times, 12/16; Greenwood, The Hill, 12/16; Eilperin/Sun, "To Your Health," Washington Post, 12/18).

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