BREAKING NEWS: CDC orders mass retraction and revision of submitted research across all science and medicine journals. Banned terms must be scrubbed.

Any unpublished manuscript mentioning certain topics, including gender and "LGBT," must be pulled or revised.

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The CDC has instructed its scientists to retract or pause the publication of any research manuscript being considered by any medical or scientific journal, not merely its own internal periodicals, Inside Medicine has learned. The move aims to ensure that no “forbidden terms” appear in the work. The policy includes manuscripts that are in the revision stages at journal (but not officially accepted) and those already accepted for publication but not yet live.

In the order, CDC researchers were instructed to remove references to or mentions of a list of forbidden terms: “Gender, transgender, pregnant person, pregnant people, LGBT, transsexual, non-binary, nonbinary, assigned male at birth, assigned female at birth, biologically male, biologically female,” according to an email sent to CDC employees (see below).”

A screenshot of a CDC email shared with Inside Medicine of a list of terms that must be removed from any CDC-authored manuscript being seriously considered or “in press” (but not yet online or in print) at any medical or scientific journal.

An expansion of an emerging censorship regime at the CDC.

The policy goes beyond the previously reported pause of the CDC’s own publications, including Morbidity and Mortality Weekly Report (MMWR), which has seen two issues go unreleased since January 16, marking the first publication gap of any kind in approximately 60 years. Emerging infectious Diseases and Preventing Chronic Disease, the CDC’s other major publications, also remain under lock and key, but have not yet been affected because they are monthly releases and both were released as scheduled in January, prior to President Trump’s inauguration. The policy also goes beyond the general communications gag order that already prevents any CDC scientist from submitting any new scientific findings to the public.

The edict applies to both any previously submitted manuscript under consideration and those accepted but not yet published. For example, if CDC scientists previously submitted a manuscript to The New England Journal of Medicine, The Journal of the American Medical Association, or any other publication, the article must be stopped and reviewed. (These are hypothetical, but are examples of major journals where CDC officials often publish.)

Scale of policy unclear. Chaos, uncertainly, and fear prevail.

How many manuscripts are affected is unclear, but it could be many. Most manuscripts include simple demographic information about the populations or patients studied, which typically includes gender (and which is frequently used interchangeably with sex). That means just about any major study would fall under the censorship regime of the new policy, including studies on Covid-19, cancer, heart disease, or anything else, let alone anything that the administration considers to be “woke ideology.”

Meanwhile, chaos and fear are already guiding decisions. While the policy is only meant to apply to work that might be seen as conflicting with President Trump’s executive orders, CDC experts don’t know how to interpret that. Do papers that describe disparities in health outcomes fall into “woke ideology” or not? Nobody knows, and everyone is scared that they’ll be fired. This is leading to what Germans call “vorauseilender Gehorsam,” or “preemptive obedience,” as one non-CDC scientist commented.

“I’ve got colleagues pulling papers over Table 1 concerns,” an official told me. (Table 1 refers to basic demographic information about the study populations included in research papers, rather than actual results.) Indeed, many studies include demographic information about sexual orientation. For example, a study describing mpox outcomes would likely include basic statistics in tables summarizing the percentage of patients who were vaccinated and were lesbian, gay, transgender, or otherwise. This information can be highly impactful during an outbreak, as it helps clinicians develop policies on who to vaccinate (given limited doses, as is the case with mpox), and even to whom scarce and limited supplies of tests and treatments should be offered to maximize benefits.

It is not necessarily the case that researchers who have submitted articles but who have not yet received an official decision from a journal need to actively recall them, however. But if a journal sends an article back for revisions, the authors would at that point have to cleanse the document of any “problematic language.” Of course, at that point, the gag order already in place would halt any resubmission.

Efficiency is impossible.

What can and cannot go forward appears to require approval by a Trump political appointee, an explicit requirement for any public health communications under the Trump Administration’s gag order. That’s slowing many things down. At present, there is only one political appointee in the entire CDC, acting Director Susan Monarez (plus her personal assistant, who is not a scientist). It’s unclear if some decisions may be devolved to lower officials. For example, if a paper is pulled because it simply mentions gender, it is unknown if anyone other than Monarez possesses the authority to approve its resubmission.

“How can one person vet all of this?” another official asked, “especially one who, [like Monarez], came from an agency of, what, 130 people?”

And yet, that seems to be the theme of the new administration: a few privileged individuals have been handed enormous authority, creating a backlog of decisions that may end up being fairly arbitrarily determined.