Oh, Give Me a Home: Medicine and Discouraged Words

Open science, daily medical practice, electronic medical records, public health, and medical and science journalism require clear use of language. Clear language is always a challenge in a multicultural country with limited educational achievements of many of its citizens, especially those for whom English is not their primary language. Adding government cautions and restrictions on use of certain words makes the endeavor even more difficult. The Trump administration is doing its best to XXX what, exactly? 

The United States has a centuries-old history of censorship, with its effects most often experienced by librarians. Of course, the First Amendment of the US Constitution states, in part: "Congress shall make no law... abridging the freedom of speech, or of the press …" Please take note that it does not say: “The President of the United States shall make no Executive Order abridging freedom of speech or of the press.”

Unfortunately, recent examples of political suppression of scientific findings are not difficult to find, especially during the tenure of George W. Bush. Embargoes on the press releasing information date from the Civil War. Their application to upcoming articles in medical journals has been likened to a form of censorship, which James Stacey wrote about in JAMA in 1985. 

In 2018 (Trump 1.0), the US Centers for Disease Control and Prevention issued a short list of words forbidden by the Office of Management and Budget when preparing budgets. 

I responded in a Medscape At Large column by asking:

Where are Lenny Bruce and George Carlin when we need them? In 1966, Lenny had nine words and in 1972 George had the "Seven Words You Can Never Say on Television." Uttering them in public got the two comics into deep s***— woops, that was one of the nine and seven words. The other six were p***, f***, c***, c*********, m***********, and t***. Lenny's nine also included a** and b****.

As I argued then, the administration had created its own list of verboten expressions: 

The new seven dirty words, as of December 17, 2017, widely reported as "not to be used" in any budget preparation by the CDC, are: "evidence-based," "science-based," "diversity," "entitlement," "fetus," "transgender," and "vulnerable.

So, I suppose we should not be surprised that in Trump 2.0, the new list of discouraged words numbers nearly 300. All federal agencies (not only CDC but also NIH, FDA, CMS, AHRQ) apparently are required by Executive Order 14151 to cleanse their written and spoken offerings (and thoughts?) of them retrospectively and prospectively. 

The New York Times perused the various agency information offerings and reported actions taken on this list on March 7, 2025. The words, according to the newspaper, include: 

• multicultural
• gender
• race
• person-centered care
• underserved
• sex
• confirmation bias
• Black
• disabilities

According to the Times: 

The above terms appeared in government memos, in official and unofficial agency guidance and in other documents … Some ordered the removal of these words from public-facing websites, or ordered the elimination of other materials (including school curricula) in which they might be included. In other cases, federal agency managers advised caution in the terms’ usage without instituting an outright ban. Additionally, the presence of some terms was used to automatically flag for review some grant proposals and contracts that could conflict with Mr. Trump’s executive orders. 

Help me understand. How exactly would a physician do a competent history, physical, and treatment plan, or write an intelligent clinical article, or perform any public health actions without the words "women," "sex," "gender," "race," "ethnicity," "transgender," "systemic," "female," "accessible," "bias," "Black," "historically," "mental health," "at risk," "barriers," "trauma"?

Is this Alice through the looking glass, George Orwell, or mass psychotic delusion? What it ain’t, I know for certain, is freedom.