In 1946, George Orwell published the seminal essay “Politics and the English Language,” in which he described how convoluted language can be used to intentionally confuse or mislead people. “A mass of Latin words falls upon the facts like soft snow, blurring the outline and covering up all the details,” he wrote. “When the general atmosphere is bad, language must suffer.”

Language is undoubtedly suffering in the Trump era, particularly the language of health and science. “There have been too many instances and too many suspected instances of words or ideas being set out of bounds,” Rush Holt, chief executive officer of the American Association for the Advancement of Science, told Vox.

Some of these changes in language are top-down, and they’re meant to shake up priorities, rebrand old ideas, or obfuscate truths. But other moves are happening from the bottom up, as people working inside scientific agencies try to protect their programs from funding cuts and from their new ideological leaders.

Of course, massaging language for political ends is nothing new. Orwell was writing about it more than a half-century ago. But some of these new examples are particularly worrisome. The administration appears to be controlling terminology to suppress well-established truths in science and take language about health in a more ideological direction, in ways that could harm Americans. Here, we rounded up four of the most important examples.

1) The CDC asked employees to refrain from using words like “fetus” and “transgender” in budget documents

A troubling example of restrictions on scientific communication happened at the Centers for Disease Control and Prevention in December. According to the Washington Post, CDC policy analysts at headquarters in Atlanta were briefed about the “forbidden” words at a meeting with officials who oversee the budget. The words, which were not to be used in documents circulated in the administration and Congress ahead of the budget proposal for 2019, included “evidence-based,” “science-based,” “vulnerable,” “entitlement,” “diversity,” “transgender,” and “fetus.”

After the report came out, the agency denied the existence of a “banned words” list. But discussions about language sensitivities in budget talks did take place. A former CDC official told Vox it’s not uncommon for officials to avoid using language in budget discussions that might offend those holding the purse strings.

And it seems likely that words like “transgender” and “fetus” would indeed be frowned upon by Republicans now in power. Consider, for instance, the backgrounds of certain people now close to Trump and at the Department of Health and Human Services:

A top Trump adviser on health care is Katy Talento, an anti-abortion activist who has claimed that side effects of hormonal birth control include cancer and miscarriages.

Trump put Teresa Manning, an anti-abortion lawyer who once said giving people easy access to the morning-after pill was "medically irresponsible" and "anti-family,” in charge of Title X, HHS’s federal family planning program.

Charmaine Yoest, now assistant secretary at HHS, was the president and CEO of the anti-abortion group Americans United for Life.

Valerie Huber, the former president of an abstinence-only education association, is the chief of staff to the assistant secretary for health at HHS.

But even if the avoidance of certain words in budget talks is mainly just playing politics, it can lead to a slippery slope of suppression, said Holt. “[Encouraging people not to use certain words] will lead to a kind of self-censorship,” he told Vox. “It’s troubling if ideology is interfering with the use of certain words.”

These language sensitivities around gender identity also belie the work the administration has already been doing to undo many of the gains for LGBTQ rights that were made during the Obama era. As Vox’s German Lopez explained, despite Trump’s early promise to be a pro-LGBTQ Republican, the White House has actually been working against gay and transgender rights:

On Wednesday, Trump announced he will reinstate a ban on trans military service. [which a federal court later blocked]. On that same day, his Department of Justice also filed a legal brief at a federal appeals court arguing that anti-gay discrimination is legal under federal law. Before that, his administration pulled back an Obama-era guidance that protected trans kids from discrimination in public schools, he appointed a Supreme Court justice who opposes LGBTQ rights, and he even failed to recognize Pride Month.

In March, the administration even removed questions about gender identity and sexual orientation from the 2020 census — which was seen as a blow to the LGBTQ community, about which data is already hard to come by.

2) Federal agencies are striking “climate change” from websites

Since Trump took office, the phrase “climate change” has been disappearing from government websites. Agencies including the Department of Energy, the Environmental Protection Agency, the Department of Health and Human Services, and the Department of Transportation have all had websites or press releases scrubbed of references to humanity’s role in rising average temperatures.

HHS, for example, buried references to a document on climate change and human health from its website and removed “climate change” from navigation menus. The EPA, meanwhile, said it was removing “outdated language” from its sites as it deleted pages relating to regulations around climate change.

Scientists at the Interior Department reported that agency officials asked them to remove references to climate change and sea level rise from a press release about their work.

Government staffers even rebranded their offices to avoid the term, and federal grant applicants were told to omit such language as well. In some cases, the concerns were warranted when some members of the Trump administration demanded names of people working on climate change issues after landing at their agencies, while one federal employee reported retaliation from political appointees for his work on climate change.

The White House also removed references to risks from extreme weather and rising seas in its most recent National Security Strategy, only referencing climate change as a threat to sales of fossil fuels.

Words are not the only things being deleted. One researcher reported that some of the government’s Arctic and atmospheric data used by climate scientists has been delisted or removed.

So why is the administration scrubbing climate language and science from government websites?

Well, for one, ideologues like EPA Administrator Scott Pruitt are now in charge and believe humanity isn’t driving rising temperatures and that the science behind climate change has been systematically tainted.

Emails obtained by the Environmental Defense Fund show that Pruitt was personally involved in removing websites and gaming search results for the Clean Power Plan, President Obama’s signature domestic climate change policy.

We also have an administration deeply devoted to protecting the fossil fuel industry, particularly the ailing coal sector. And as “climate change” vanishes from the executive branch’s vocabulary, Trump and his Cabinet have introduced a new term: energy dominance.

That’s why even at international climate change talks last year, White House representatives used their only public event to promote coal and nuclear power as solutions to climate change.

The Trump administration’s goal here is to fulfill a major campaign promise to save the coal industry, which has been hemorrhaging jobs due to automation and competition from cheap natural gas.

But that case is harder to make with embarrassing reminders that coal is more expensive than natural gas and, in some markets, renewables, and it still emits more heat-trapping gases.

One key example is the Department of Energy’s infamous grid reliability study, a fig leaf for subsidizing coal. A draft of the study reported that climate change was a threat to the power grid, but all of these references were removed in the final version.

3) HHS is now in the business of protecting “family values,” starting from conception

The Trump administration’s 2018-’22 draft plan for Health and Human Services, which was released in October, offered another insight into how language is being used to chart the priorities and guide policy from the White House.

For the first time, the plan suggested the federal health agency will now be “serving and protecting Americans at every stage of life, beginning at conception.”

Language about human life starting with conception (the fertilization of an egg) is usually reserved for religious groups and anti-abortion activists, not government documents that will guide federal policy. The notion that life starts at conception runs counter to federal law — as well as the medical community’s consensus — which recognizes pregnancy as beginning with the implantation of a fertilized egg in the uterus.

That language was also a radical departure from Barack Obama’s 2014-’18 plan, which focused on getting the health care markets stabilized and more people enrolled in health insurance.

The observers and stakeholders Vox spoke to when the document came out said the language about conception and unborn children signaled a shift at the agency toward faith-based decision-making in health care. They also viewed it as more evidence of the religious right’s growing influence at the highest levels of government, and Trump’s desire to fulfill campaign promises to expand religious freedom.

There were other examples of this new direction in the strategic plan. The document mentioned the word “faith” 46 times. It also said HHS will be in the business of supporting strong family values and “healthy marriages,” empowering faith-based groups that receive federal dollars with the freedom to exercise their morals and beliefs, and looking after American lives all the way to “natural death.”

This ideological language in health is worrisome because it’s already being reflected in policies that will harm people, and that are divorced from science, such as the rollback of the Obama-era birth control mandate.

The Affordable Care Act required employers to offer insurance that covered contraception for women, so that they could more easily access affordable contraception and better control their bodies. The Trump administration’s birth control change was justified by the false notion that giving women free birth control makes them more promiscuous.

4) “Abstinence only” is now called “sexual risk avoidance” in some government documents

In the Bush era, the US government invested heavily in “abstinence only” sexual education programs. Instead of helping people reduce their risk of pregnancy and STDs through education, these programs suggested people eliminate their risk ... by not having sex at all until marriage.

And they proved to be a failure — ineffective at preventing teen pregnancies and potentially even contributing to higher pregnancy rates in some states. The focus during the Obama administration was on science, which meant deemphasizing funding of abstinence programs, explained Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation.

Now they’re back — though you might not know it. The Trump administration is once again talking about abstinence-only education, but this time it’s rebranded as “sexual risk avoidance.”

The president’s 2018 budget was the first to include the phrase in support of a domestic abstinence-only-until-marriage grant program. Congressional funding bills have suggested “sexual risk avoidance” programs should be a primary form of sex education, according to the Washington Post.

The phrase has also emerged in fact sheets at the Family and Youth Services Bureau and the Office of the Assistant Secretary for Health and the Administration for Children and Families at HHS. And it’s appeared at the State Department, which oversees PEPFAR, America’s global health program to combat AIDS around the world.

So why not just call the programs “abstinence only”? According to Jesseca Boyer, a senior policy manager at the Guttmacher Institute who has been tracking this language change, “Facing the reality of evidence as well as the majority of public opinion in support of sex education and access to sexual health services, the language shifts are an effort to promote an ideologically motivated agenda to restrict access to sexual and reproductive health information and services.”

In other words, instead of shifting their policies to reflect new science, they’re just changing the language to continue doing things that didn’t work.

Whether the censorship is coming from above or below, the result is a chilling effect on discussions of controversial topics that could hamper advances or taint the policies that stem from science. But the scientific community is pushing back, out of fear that it will only get worse. One place you can see it is the Twitter hashtag #ScienceNotSilence.