Monday, December 18, 2017

In defense of forbidden words and evidence-based medicine

- Kenny Lin, MD, MPH

I was a federal employee in the Department of Health and Human Services (HHS) during the George W. Bush and Obama administrations. Although the current era of "fake news" and "alternative facts" lay in the future, some subjects were inherently more sensitive than others, depending on which party controlled Congress and the White House. For example, breast cancer screening with mammography made political waves when the U.S. Preventive Services Task Force released updated recommendations in 2009 (while Congress was debating the Affordable Care Act) and again in 2015 (as the House of Representatives repeatedly voted to repeal it).

Over the weekend, the Washington Post, STAT, and multiple other news outlets reported that the Centers for Disease Control and Prevention (CDC) and another unidentified HHS agency were recently provided with a list of seven "words to avoid" when writing budget proposals. These banned or forbidden words are: "vulnerable," "entitlement," "diversity," "transgender," "fetus," "evidence-based" and "science-based." Although CDC director Dr. Brenda Fitzgerald e-mailed agency staff and tweeted yesterday that "there are no banned words at CDC," neither she nor an HHS agency spokesperson denied the reports.

The unprecedented news created a firestorm on Twitter and elicited an immediate response from Dr. Michael Munger, President of the American Academy of Family Physicians (AAFP), who said in a statement:

The American Academy of Family Physicians, which represents 129,000 family physicians and medical students, is both surprised and concerned by the Administration’s clear disregard for the importance of science and evidence-based medicine. ... This action is an obvious attempt to politicize the most fundamental tenets of medicine and research, which will have a chilling effect on the CDC’s ability to rely on science to justify the work it does to protect public health.

American Family Physician is editorially independent from the AAFP, but the journal's editors stand with the organization in urging the Administration to "fully assess the broader implications of this purely political maneuver and reconsider its recent directive to the CDC." Further, we condemn censorship of science and public health in any form and will not allow it to infiltrate our content, which includes and will continue to include all of the seven forbidden words. Finally, we consider evidence-based medicine to be the essential foundation for ethical patient care, by distinguishing effective health care from tests and treatments that are unnecessary and harmful.