We Should be Concerned About What Happened at the CDC
On February 1, 2025 the Inside Medicine Substack reported that the US Centers for Disease Control and Prevention (CDC) ordered agency scientists to withdraw research manuscripts under consideration for publication at medical or scientific journals. The directive, which was emailed to staff members on January 31, included a list of “forbidden terms” researchers must strip from their work.
Banned terms include gender, transgender, non-binary, LGBT, biologically male, biologically female, and more. Removal of these terms is meant to ensure the CDC’s compliance with 47’s executive order stating that the federal government will only recognize two sexes, male and female, and that these sexes are not changeable.
Requiring scientists to remove these terms from their manuscripts is a direct threat to their ability to conduct rigorous research and will have devastating effects.
Negative Impact on Research
When I worked as a scientific editor at a medical journal, we required our authors to report patient characteristics and demographic information in Table 1 of their manuscript. This is a common practice across medical journals.
One piece of information in this table is the number of males and females included in the study (which is unfortunately interchangeably labeled with “sex” or “gender” and often does not account for non-binary folks). If the study has an even balance, readers can be more assured that the study conclusions are applicable across biological sex variations, instead of centering male biology as was the case for the majority of clinical studies before 1993.
Information in Table 1 not only helps readers better judge and interpret study conclusions, it can also help healthcare providers develop policies.
Let’s consider a paper by Thronhill and colleagues published in the New England Journal of Medicine reporting on cases of mpox during the 2022 outbreak. In Table 1 the authors report the sex and sexual orientation of people included in the study. Of the 528 individuals with laboratory-confirmed mpox infections, over 99% were male and 96% identified as homosexual, suggesting this outbreak disproportionately affected gay men.
This knowledge can inform healthcare professionals about which populations may benefit from enhanced testing and education. Additionally, given the short supply of vaccines during the 2022 outbreak, this knowledge helped identify which groups should be prioritized for vaccination.
Present and Past Destruction of LGBTQI+ Research
While censoring terms in research manuscripts will negatively impact major studies in multiple disease areas, what is more insidious is that the banned terms target LGBTQI+-related research.
How can scientists communicate research on LGBTQI+ topics if they can’t use the clear and accepted language? The answer is they can’t.
And that’s exactly what this administration wants. They are actively trying to destroy LGBTQI+-related research in yet another attempt to erase LGBTQI+ people.
This directive is especially disturbing because destroying LGBTQI+ research is a play right out of the Nazi handbook.
When Adolf Hitler became chancellor in 1933 he established policies aimed at eliminating Lebensunwertes Leben (“lives unworthy of living”) from Germany. One result of such policies was the destruction of Berlin’s Institut für Sexualwissenschaft (Institute for Sexual Research).
Opened in 1919 by Magnus Hirschfeld, a gay doctor who recognized the existence of variations in sexuality and gender, the Institute for Sexual Research was meant to be a place of “research, teaching, healing, and refuge”. In 1930, the first modern gender-affirming surgery was performed there.
The institute also had a massive library on sexuality that included rare books and protocols documenting the surgical process for male-to-female transition. But when the Nazis pillaged the institute on May 6, 1933, they burned over 20,000 books from the library, erasing research and knowledge that benefited the LGBTQI+ community.
Hirschfield not only provided life-saving medical care for his patients, he also fought against the criminal code that made homosexuality illegal (Paragraph 175) in Germany and provided jobs for individuals he had helped transition who couldn’t find work.
His dedication to the LGBTQI+ community is what we scientists should emulate today and we can do that by fighting to protect LGBTQI+ research.
What Can the CDC Do?
47 is trying to instill fear and chaos.
Leaders at the CDC must speak candidly but privately to their employees about this. The legality (or lack of legality) of the directive should also be discussed and employees should know that the executive order the directive is based on could be challenged in court.
The Inside Medicine Substack quoted an official from the CDC saying “I’ve got colleagues pulling papers over Table 1 concerns.” This is preemptive obedience and should be discouraged.
I understand that employees may worry about losing their jobs if they refuse to comply, but if no one is prepared to fight then tyranny awaits.
Examples of resistance from other organizations may be a good source of inspiration for CDC employees.
A thread posted on Bluesky by librarian Jennifer Goodland talks about how the library she worked at weaponized bureaucracy in response to PATRIOT Act-mandated requests for patrons’ borrowing history.
The librarians at her branch banded together to delete and shred that information. They also stopped tracking patrons’ reading history, but that wasn’t all.
“We added a Patriot Act compliance officer to our org chart. This person was a real employee.
Well, WAS. The office of Patriot Act compliance would be assigned to whichever employee had just left our library. And gosh, it’s just such a mess around here, you know.”
Goodland’s library branch ultimately didn’t fulfill a single PATRIOT Act request.
Other creative strategies of resistance could be used too. The “Simple Sabotage Field Manual” may offer a good starting point.
The manual, written during World War II by the head of the Office of Strategic Services William Donovan, describes methods for normal people to resist decrees by being “particularly annoying.” Suggestions include pretending that instructions are hard to understand or being “as irritable and quarrelsome as possible without getting yourself into trouble.”
I hope CDC employees band together (or unionize if possible) and prepare to fight. There is power and protection in numbers, and scientists must show politicians we will absolutely not back down from our convictions.
What Can Medical and Scientific Journals Do?
Journals should come out with statements supporting LGBTQI+ research and the scientists conducting this research. On February 4, editors at the BMJ censured the CDC order and called on journals and editors to resist.
Journal editors must also come up with strategies to address this censorship of science. This could start with highlighting a common requirement of medical and scientific journals, that research manuscripts adhere to the American Medical Association (AMA) Manual of Style. This manual includes guidance on the correct and preferred language to use in scientific publications.
Using appropriate and consistent terminology helps make research more clear, more accurate, and less biased. Not only does this make research more rigorous, it also better serves the populations studied.
Alternative Approaches
Scientists at the CDC were ordered to withdraw manuscripts being considered for publication in journals, but what about preprint servers?
Research can be submitted for free and disseminated for free on sites like bioRxiv and medRxiv. While these preprint servers don’t offer traditional peer review, papers are still reviewed by bioRxiv and medRxiv staff and volunteers and can be commented on. Perhaps publishing a manuscript on one of these sites may fly under the federal government’s radar.
Or maybe we need to completely flip things on their head and come up with new terms. If we can’t use the term “transgender women” we could replace it with another term that is popular with some in the community, “the dolls”. If a scientist can call a COVID variant FLiRT it seems anything can go.
Final Thoughts
47’s executive order stating that there are only two sexes is not only medically inaccurate but seeks to erase LGBTQI+ people, their experiences, and any research that supports them. When science is censored, it becomes impossible for scientists to conduct and disseminate research that can improve our world. We scientists must fight for the accurate and ethical reporting of science and advocate for the people we intend to serve with our research.