
Uproar Over Purported Ban at C.D.C. Of Words Like ‘Evidence-Based’ - matt4077
https://www.nytimes.com/2017/12/16/health/cdc-trump-banned-words.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news
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tptacek
This has been covered extensively on HN already:
[https://news.ycombinator.com/item?id=15937017](https://news.ycombinator.com/item?id=15937017)

------
Rarebox
* science-based

* fetus

* transgender

* vulnerable

* entitlement

* diversity

* evidence-based

~~~
dmitrygr
I don't agree with this move. But I also am not outraged

* science-based

* evidence-based

Unnecessary. Anything the CDC produces better be science based already

* fetus

annoying, but synonymous words exist

* transgender

Are some diseases suddenly targeting people based on their identified sex? If
no, the CDC has no business discussing this anyways.

* vulnerable

Subjective words have no place in scientific discourse

* entitlement

* diversity

Political words also have no place in scientific discourse

~~~
butterfi
I am incredulous that the current administration wants to ban the use of the
words 'science-based' or 'evidence-based' because they are "unnecessary" or
redundant. It seems far more likely that this is the same kind of political
maneuvering that led Gov. Scott to instruct Florida officials to not use the
words "climate-change." It's a deliberate attempt to obscure facts from the
public.

~~~
smallnamespace
Please don't be fooled by the branding.

Evidence-Based Medicine[1] is a particular movement that makes particular
claims about _what_ sorts of evidence are better than other sorts of evidence,
and how we should (re-)structure clinical practice to revolve around these.

In other words, EBC != evidence-based medicine. It strongly emphasizes large-
scale studies at the expense of other types of empirical knowledge, namely the
direct clinical experience of the practitioners.

What might be the harm in doing so? Why shouldn't we all rely only on large-
scale meta-analyses to guide treatment?

1\. There are important clinical questions that are difficult to measure in a
double-blind clinical framework; the risk is that _we end up optimizing what
we can easily measure over what is truly important, the health of the
patient_.

2\. It increasingly risks turning doctors into assembly-line technicians that
are only there to take the indicated 'evidence-based' tests and treatments. It
takes agency and decisionmaking effectively from the hands of doctors and
transfers it to large research bureaucracies, which may or may not be asking
the right questions.

It increases the social and informational distance between the patient and the
point of decision-making -- which we've seen can have disastrous consequences
(for example, in planned economies), when that distance impeded the smooth
flow of information.

3\. It presupposes the the studies and meta-analyses in the research pipeline
are a good decomposition of the current state of medical knowledge. E.g. if
there's an analysis that says 'treat a person with diabetes with treatment X',
then that approach would work well, regardless of the specifics of the actual
patient at the clinical level. Patients don't come cleanly with a single
diagnositic label; most people with chronic conditions have more than one, for
example.

Note that the _methodology_ and _effectiveness_ of Evidence-Based Medicine has
itself not been subjected to rigorous large-scale scientific evaluation; we
are literally being asked to take on faith that this _particular_ 'EBC'
implementation of evidence-based medicine will be better.

[1] [https://en.wikipedia.org/wiki/Evidence-
based_medicine#Limita...](https://en.wikipedia.org/wiki/Evidence-
based_medicine#Limitations_and_criticism)

~~~
lern_too_spel
It provides a reasonable framework for testing its own efffectiveness. If you
don't think it works, just do the experiment and compute the statistics.

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mcculley
I've read articles now on three news sites about this. All of them cite "CDC
analysts" but provide no names or credible sources. If these analysts are
upset, why aren't they providing their names? Why do newspapers allow these
anonymous sources?

~~~
tehwebguy
They aren’t anonymous to the newspaper, the newspaper is protecting them.

~~~
mcculley
I understand that. What I don't understand is why. Without naming names, this
is just gossip, not journalism.

~~~
pasbesoin
Because these people are career government employees. If they are specifically
named, under this administration their career is likely ended.

And unlike the tech industry, people in these positions don't job-hop
constantly.

They want the public to know about this [I can think of many unfavorable
adjectives] behavior. But they don't want to lose their careers, put their
families at economic risk, etc.

Acting as (responsible) intermediary in such circumstances is a time-honored
and proven role of journalism, in the U.S. and other countries.

P.S. I'll add that the U.S. scientific community had a good, close look at
such behavior as a preview, in the neighboring country of Canada under the
Harper government.

To the point where they were collaborating with Canadian scientists to back up
data before the Harper government erased it.

They are not merely reacting emotionally. They've seen Conservatives' (on
either side of the border) play book for this for nigh on a decade, at least.

~~~
mcculley
I agree that journalists protecting sources is important for some matters
(e.g., Watergate, the Pentagon Papers). I think the allowance of anonymous
sources has swung too far in the other direction, allowing for gossip as news.
Journalists need to hold their sources to a higher standard and make clear
that they must accept some risk.

~~~
pasbesoin
In this case, there is no need for such risk taking.

As I understand it, the journalists have been supplied with copies of the
specific document(s).

They can then ask the relevant administration whether the document is genuine.

If the adminsitration does not deny the legitimacy of the document, there's
your proof. (These are not classified documents. There's no "we can't respond"
cover for them, in this case.)

This is also a common journalistic practice.

I'd also expect them to pursue multiple sourcing for the story. Although, with
the document(s) at hand, and the course I described possible, that's not
strictly necessary.

P.S. I'll add that, more broadly, document sharing is not without risk. The
government as well as private entities have taken to distributing "marked"
documents that can be tracked back to original recipients. Not in all nor
anything like the majority of cases. Just some specific ones.

That marking can be overt, or covert. The latter case can include slight
variations in content that, particularly if someone has only one exemplar, can
be difficult to detect and at best only suspected.

Anyway... speaking VERY generally, a central if sometimes unspoken role of ANY
organization is mitigating risk to its participants.

I would not expect anything different from journalism. I would not expect
people to take on unnecessary risk. When people name themselves in such
circumstances, it's to accomplish something additional. That doesn't seem to
be needed, here. I don't see much reasoned doubt of the story, and I've yet to
see a denial from "the government".

Ok, too much caffeine, here. Sorry for my runaway keyboard.

P.P.S. I can't yet reply to your reply, but I wanted to say, "fair enough".

With the caveat I already added, above -- apparently, while you were replying
-- that original documents sometimes have to be presented in an information-
retaining representation, where overt or covert marking may betray the source.

(For example, the woman in Georgia who landed in jail... this past year or so.
Win-something or other? The press didn't screen the documents she provided,
and they were readily traced back to her. Then apparently corroborated by FBI
using system access logs. Apparently, because at the time I last read about
it, methodologies were not being confirmed.)

~~~
mcculley
I didn't see a document. I would love to see one. I want to see the
administration held accountable.

