To culminate a year rife with political turmoil, one final wildfire swept the nation at the close of 2017. After initial reports from inside the Centers for Disease Control and Prevention (CDC) suggesting that it had received instruction to forbid the usage of seven words in its budget formulations, media outlets and the general public took en masse to declare a state of Orwellian emergency. Politicians and other state officials were quick to concur. Subsequent reports, however, elucidated a far blander story. Instead of a mandate explicitly calling for censorship of the CDC’s work, the purported seven dirty words actually arose as a funding strategy to help the CDC from inciting unnecessary controversy by using contentious language. Insipid as these facts are, the wildfire was quenched silently and uneventfully as with the passing of the year.
And yet, while the story lacks the flagrancy of its original misconception, it is not entirely benign. Its harm lies in a subtler form, a silent, creeping manipulation of public policy and popular opinion. My undergraduate degree is in linguistics, and even though I now spend more of my time mired in the intricacies of renal pathophysiology than the mysteries of human language, I still appreciate a foundational maxim of linguistic anthropology: language is a social tool, an instrument that conveys and contributes to the very fabric of our world. Possessing such a fundamental place in the human sociocultural experience, it can also be employed as a weapon, as a means to direct and manipulate thought. Sometimes this is beneficial, as in the psychological concept of cognitive reframing, which is a core principle of cognitive behavioral therapy. And sometimes it encompasses a more devious intent, one expressly intended to mislead and inform — or misinform — thought and opinion. It is often quite subtle, occurring at the level of the word. For example, if a conservative politician talks about tax relief, the juxtaposition of those words instills the thought process that taxes are necessarily wicked and, ergo, something from which necessitates relief. Similarly, if a progressive labels insurgents in a foreign nation as freedom fighters instead of rebels, the insurgents are to be supported. While linguistic tricks such as these do not control thought (as the movie Arrival may have us believe), they do inform thought and consequently policy.
Trump has taken the idea of cognitive framing one step further. He has begun — both surreptitiously and openly — a progression toward the banning of ideas, the erasure of opposition. Much has been written on Trump’s antagonistic relationship with the press, culminating in his unsettling Tweet: “It is frankly disgusting the way the press is able to write whatever they want to write and people should look into it.” He has even suggested on multiple occasions that the media — the “enemy of the American people” — ought to be stripped of content with which he disagrees. Similarly, Trump’s relationships with the EPA, Department of Energy and anti-vaccination organizations have led some to designate these actions a “War on Science.”
Trump’s latest drone strike in this war hit the medical community. Consider the CDC’s seven words considered potentially contentious: “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.” As has been made clear, the warning regarding these words was not intended as an act of bowdlerization, the very fact that these words raise concern in the first place is in and of itself problematic. These terms are not political terms, contrary to the terms used in the semantic games posed by tax relief and insurgents. Fetus is a medical term with a scientific definition. Yes, It is a term laden with political friction, but it describes objective, scientific realities. The inclusion of evidence-based and science-based is more than baffling; it is terrifying, and its implications are ominous. It does not exactly mean that we will revert to bloodletting and phrenology as first-line medical therapies. Instead, it portends a world where fact is no longer reality. A prime example comes from one of the recommended alternative phraseologies, specifically those for evidence- and science-based. The recommended terminology goes as such: “CDC bases its recommendations on science in consideration with community standards and wishes.” Let us dissect this. The first part, though more verbose than warranted, is innocuous: “CDC bases its recommendations on science….” What is problematic is the second half: “…in consideration with community standards and wishes.” This qualifier clearly states that recommendations are influenced by factors other than those derived through the rigorous scientific process, namely the “standards” and “wishes” of the “community.” Such sentiment is alarming because it violates the very principles of the scientific method. Who is this community? Who decides upon its standards and wishes? The fact that the CDC was advised to avoid those seven words implies that the ideas they represent are dangerous and threatening. Additionally, the words grant insight into the priorities and prejudices of the current administration as they pertain to scientific research. Irrespective of the origins of the recommendations, we should be alarmed that the CDC believes it will lose funding by using terms like evidence-based or fetus and more alarmed that the administration looks unfavorably upon these ideas.
As a future physician, I pride myself in my field’s unabashed embrace and foundation in all things evidence-based. Like anything, we are neither perfect nor immune to the influences of money, politics and status, but we have always regarded evidence-based medicine as our foundation to ground and propel us. It is and has always been one of the strengths of medicine. As medical professionals, it is imperative to push back against institutional efforts that attempt to undermine these ideals and harm the health and wellbeing of our patients. This is not just a political resistance. Health and the utilization of science as a means toward improvement cannot be used as pawns in this political chess match. This is a matter, quite literally, of life and death. Our discipline is one that puts patients above all, as they are the sick and — dare I invoke the forsaken — vulnerable. As I continue my training and enter my practice, I will strive to advocate for truth, for science, for fact and for evidence as a basis in forwarding our knowledge of health and disease. Because in the midst of political turmoil and international tension, disease shall always remain the great equalizer. We, physicians, thus are tasked with the sacred duty of serving as protectors and defenders of truth, as articulated in the Hippocratic canon: “science is the father of knowledge, but opinion breeds ignorance.”