Forbidden words

TROUBLE ACROSS THE POND

In December 2017 the Washington Post reported that the US Centers for Disease Control and Prevention (CDC) had instructed its employees not to use certain words in official documents.¹ Clearly these must be obscene or lurid terms. Well, if you are of a nervous disposition then best to look away now. The banned words were ‘vulnerable, entitlement, diversity, transgender, fetus, evidence-based, and science-based’. There were also a few helpful pieces of advice, such as:

‘… instead of “science-based” or “evidence-based,” the suggested phrase is “CDC bases its recommendations on science in consideration with community standards and wishes”.’¹

Following the Washington Post report the CDC ‘clarified’ that really there were no forbidden words. No, these words were only forbidden if you wanted any money. So during the current presidency if you want grant funding then on no account say you want to research vulnerability. Say you want to research resilience.

It is easy to laugh, being safely this side of the pond. One thinks of George Orwell’s ‘newspeak’ in his book Nineteen Eighty-Four, which made it impossible to express thoughts contrary to the dogma of the ruling party. That is to say, the only party. And in time it would become impossible to think anything contrary to party dogma. Newspeak eliminated words that represent wrong concepts, such as freedom or independent thought, to restrict the possible range of actual thoughts and mental habits to those approved by the state.

THE POWER OF WORDS

But is this analogy an overreaction to the CDC instruction? The English language has over 200 000 words. Surely we could give up seven of them for Lent? But remember that words represent thoughts, and thoughts model our world. The implication of the CDC ‘advice’ is twofold. First, it implies that the current US administration is unlikely to fund research relating to issues of gender, diversity, or poverty. I think we can all agree that this matters. One could dwell on the specifics, but these will change with each administration. However, my longer-term concern is the way in which our language makes our world.

So we should not say ‘evidence based’, but we should say ‘science in consideration with community standards and wishes’. So presumably our policy on vaccination, on state funding for homeopathy, on whole-body MRI as a screening tool, on CT imaging for non-red-flag headaches, on antibiotics for URTIs, and on opioids for fibromyalgia should now be based on ‘science in consideration with community standards and wishes’ ? We can all see where this is going.

ACADEMIC FREEDOM IS A KEY FEATURE OF A FREE SOCIETY

I am not trying to marginalise the patient’s voice in the consulting room. The whole point of consulting is to create a dialogue — Tuckett’s ‘meetings between experts’.² But this is what is at risk — both sides should contribute their expertise. My patient, Mrs Smith, is the world expert on what it is to have the hopes, beliefs, life goals, priorities, and fears of Mrs Smith. And I am supposed to be an expert in medicine. We meet to negotiate what medicine might contribute to the lived experience of Mrs Smith. We meet to explore the ‘ideas, concerns, and expectations’ of Mrs Smith, but not necessarily to implement them. My expertise in medicine is in a large part reliant on empirical science. And science depends upon fruitful research (and remember that we only label research as fruitful in retrospect).

Academic freedom is a key feature of a free society.³ Regrettably, research funding will always be skewed by expedience, power, and political convenience; however, censoring academic discourses themselves cannot be a good sign. And bending therapeutic policy to populist demand threatens the very populace itself.

According to Plato, democracy tends to break down under the pressure of mob rule and thus prepare the way for demagogy and tyranny.⁴ What Plato would make of the CDC ruling I cannot say. However, if my right to professional expertise is to be hobbled by popular opinion this just replaces paternalism with populism. We have tried so long to champion the voice of the patient. It would be ironic if now we lose our own.