Some scientific and medical journal editors vow to resist new government censorship. Will they stand strong?

“It will create a shit-ton of extra work for editors, regardless."

Getty Images / paci77

Yesterday, I interviewed the Executive Director of the American Public Health Association Dr. Georges C. Benjamin on Instagram for MedPage Today. You can watch our conversation on Instagram (I’ll post that here in the coming days as well.) During our conversation, Dr. Benjamin made some news when he said that the American Journal of Public Health (of which he is the publisher) will do all that it can to stand up to the Trump administration’s new regime of scientific censorship. In today’s Inside Medicine, I’ll summarize some of Dr. Benjamin’s comments and share insights from editors-in-chief at two other major medical journals. Plus, an update on the gag order that has suppressed CDC publications, communications, and alerts. We’ll find out why that matters and what to expect in the coming days. Lastly, some brief updates on OSHA, the RFK Jr.’s, HHS nomination, and USAID.

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Some major scientific and medical journals will not their change style guides in response to Trump administration censorship, editors say.

As I reported over the weekend, CDC researchers have been instructed to scrub all active and future manuscripts of language deemed by the Trump administration to be offensive.

Yesterday, during an interview with Dr. Georges C. Benjamin, the longtime Executive Director of the American Public Health Association, I asked how the organization’s scientific journal would handle any ensuing conflicts over banned language. Dr. Benjamin did not mince words.

“We at the American Journal of Public Health [AJPH] have no interest in following the president’s prohibitions on language. It’s a First Amendment issue for us. It’s a science issue for us. So, we will publish things under our guidelines and under our ethical principles.” He said he hoped that non-governmental scientists would take the administration to court on First Amendment violation claims.

Materially, this may mean that the AJPH will not receive submissions that include banned terms (such as gender-related language), including from private sector researchers who receive federal funding.

What if, I asked, CDC scientists insist on terms that deviate from the AJPH’s established style guide? “What will tragically happen is that these papers will not get accepted….It's a collaborative process to publish something, and they can choose not to. That's fine."

Other editors chime in, allowing for nuance.

I also spoke about the issue with two other prominent editors. Dr. Paul Sax, editor-in-chief of Clinical Infectious Diseases, said, “We do have a usage guide that we’ll stick to. We can modify language at their request up to a point—this has happened already, with what I consider symbolic language changes only.”

Sax’s added that “our primary responsibilities are to the quality of the research, and to the author experience. The latter is especially important given the stress they are under.”

A third editor-in-chief for a respected medical journal within one of the major publication networks (and who spoke anonymously to maintain job security) was unsure of where things stood. “No formal guidance has yet been put into place, but internal management discussions and high-level stakeholder meetings are happening this week. I suspect that larger editorial groups or families of journals will be very ginger about making any hard and fast policy responses until specific instances occur.”

An emergency meeting of the International Committee of Medical Journal Editors has apparently been called, but has not yet occurred.

This editor had concerns about logistics, primarily around the notion of authors removing themselves from mixed groups (e.g., a collaboration of CDC and academic researchers) deep into the submission and publication process.

“While that sounds relatively straightforward, in practice, that’s a tremendous amount of extra work for editors as procedurally, because removing an author from a list is not as simple as deleting them. It means verifying that all of the other authors on the manuscript have agreed to the change and then storing documentation of the change. Imagine a paper with 30 internationally distributed authors and having to obtain emails from each of them with explicit consent to remove a single CDC author.”

As a researcher who has wrangled co-authorship forms myself, just reading that quote gave me a headache. The process can be arduous.

“It will create a shit ton of extra work for editors, regardless,” the editor said.

I reached out to editors at several other major journals, and have not heard back. I’ll keep after them and report back.

CDC communications freeze remains, but is thawing. However, the line between censorship and pure propaganda begins to blur.

The gag order on public health communications was supposed to expire on February 1. Remember? That date came and went and the CDC, the NIH, and other agencies remain under a strict regime of Trump administration censorship. The reason is unclear, though one official I spoke to wondered whether the “pause” would remain in place until the Senate has confirms a Secretary of the Department of Health and Human Services.

I communicated with several CDC officials and an official in a major county public health system (who works collaboratively with the CDC on various issues) yesterday to find out what to expect in the coming days. Here’s what Inside Medicine has learned:

• The CDC scientific journal Morbidity and Mortality Weekly Report is expected to be published on Thursday, after a two-week hiatus, the first gap in its publication in decades. Whether the articles that were supposed to come out on January 23 and 30th will be released with a new tranche of papers is not known.

• A news release from the CDC Health Alert Network (HAN) is anticipated “sometime this week,” and is expected to provide information about viral hemorrhagic fever outbreaks (including an Ebola outbreak in Uganda). If I had to guess, the news release will fall into the “intermediate” category of HAN message types. CDC HAN messages are categorized as either “Alerts,” “Advisories,” or “Updates.” Alerts are reserved for matters of the highest level of importance. The most recent communiqué from CDC HAN was an “Update,” regarding genetic information related to H5N1 bird flu cases, published on January 16, during the Biden administration.

The county public health official I spoke to said that the absence of usual CDC communications has been disruptive. “One thing directly impacting my work is the inability to respond to the three separate viral hemorrhagic fever (VHF) outbreaks happening right now. My team does traveler monitoring operations during VHF outbreaks. We have no way to do that now with travelers from Uganda, Tanzania, and the DRC [Democratic Republic of the Congo]. To be fair, the CDC doesn’t always recommend traveler monitoring during VHF outbreaks depending on the location, size, and circumstances. But a nurse died of Ebola in Kampala, which is extremely concerning. [For the first time], we have no way to know who visited Kampala and is in the US right now.” That means that hospital systems have no idea who to screen. “Without a CDC HAN message about any of these outbreaks, most providers have no idea and aren’t screening for travel to outbreak areas.”

As a frontline clinician, I often see these travel-related flags. Our emergency department triage teams do a great job of implementing the recommendations from CDC HAN and other warning systems. For example, when someone shows up in the ER with a fever, the patient is asked during triage about recent travel. Right now, the implication of a patient answering that they just returned from Kampala instead of Karachi might not raise a flag, because of the Trump administration’s CDC gag order. Not exactly “Making America Safe Again,” is it?

The politics are not great.

It’s worth noting that some federal health agency communications have been permitted while others have remained gagged. Some of the troves of CDC data taken offline last week line is back, but not all of it. The rationale behind these choices has often been unclear, but it is known that all approvals must be made by a political appointee (again, there’s literally one at CDC).

I noticed that last week the FDA announced the approval of a new non-opioid painkiller. I couldn’t help but wonder, “what made this news worthy of an exception?” Liz Szabo connected the dots on Bluesky. What we were seeing was propaganda.

Meanwhile, the CDC announced that grant funding for what it calls “gender ideology program” has been permanently terminated.

News round-up…

Here are a few other shorter entries on stories I’m following. These are not comprehensive analyses, as it’s virtually impossible to keep up with the news. So, these entries merely scrape the surface of these stories…

Senator Bill Cassidy forgot the Hippocratic oath.

Louisiana Senator and physician Bill Cassidy voted in favor of RFK Jr., nomination to become the Secretary of the United States Department of Health and Human Services— a sentence I never thought I’d write. Cassidy apparently “struggled” with the decision, but claims to have been reassured by promises RFK Jr., made to him. As the parent of two girls, ages six and two, I’d really like to know that they’ll have access to the full vaccine series that has saved millions upon millions of lives. Senator Cassidy just called that into question and it’s scary to think about the implications.

Occupational Safety and Health Administration (OSHA) under fire.

Some Republicans are calling for OSHA to be dismantled. Today, a public health official shared an email to a list that I am on that, “all links to the OSHA Best Practices for Hospital First Receivers of victims from mass casualty incidents have been taken down.” I checked, and it’s true:

Just imagine if a mass casualty incident were to occur right now. Would our public servants be able to respond adequately?

USAID continues to be gutted. Real effects already felt, globally.

Almost all staffers at the United States Agency for International Development were placed on leave yesterday. This news is the latest development in President Trump’s sustained attack on America’s most successful foreign policy and humanitarian efforts.

In addition to uncertainty regarding HIV drug delivery under PEPFAR (the program had been halted, was resumed, but may not actually be functioning), the US program that has saved more than 25 million lives since George W. Bush unveiled it, nonprofits around the world have already been affected by the Trump administration’s draconian and cold-hearted attitude. Last week, the International Center for Diarrheal Disease Research in Bangladesh had to terminate over 1,000 workers. Other effects on lifesaving US-funded foreign programs, ranging from malaria to tuberculosis, have also been frozen, causing mass shutdowns.

Trump World claims that inefficiency and insubordination are behind its brazen moves. According to a post on Twitter/X by my colleague Dr. Atul Gawande, Elon Musk’s claim that USAID is so inefficient that only 10% of aid reaches recipients is “absurd.” Here’s the actual situation, according to Atul, who recently completed three years of service as the global health lead for USAID:

Posted on Twitter/X by Dr. Atul Gawande.

Currently, USAID has been abruptly taken over by Secretary of State Marco Rubio, with help from an associate known for allegedly being present at the insurrection at US Capitol on January 6, 2021.

For more about what USAID used to do (until the last couple of weeks), you can read here and here.

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That’s what we know for now. Thanks for reading, sharing, speaking out, and supporting Inside Medicine! Please ask your questions in the comments and if you can’t upgrade due to financial considerations, just email me.