Brenda Fitzgerald, MD, director of the Centers for Disease Control and Prevention (CDC), again denied the agency has banned words such as “fetus,” “science-based” and “transgender” from official documents in a letter to Sen. Brian Schatz, D-Hawaii, but did reveal the style guide used by HHS recommends avoiding certain words and substituting others.

In her letter, Fitzgerald told Schatz the HHS style guide does instruct employees to avoid the words “vulnerable,” “diversity” and “entitlement,” which had been cited as banned words in the initial story from the Washington Post. Fitzgerald said no terms have been prohibited by the agency, but certain word usage may be recommended to “make the budgetary process as accessible and relatable to as many audience as possible.”

“These are merely suggestions of what terms to use and what often overused words should be avoided,” she wrote.

In an excerpt of the HHS budget guidance style guide, there was one notable change in word usage. The guide said to use “Obamacare,” instead of “Affordable Care Act” or “ACA.” In a press release, Schatz said those changes amount to using “politically charged language.”

“This is Orwellian anti-science partisanship that has no place in a government agency,” Schatz said. “HHS and the CDC have an obligation to carry out the law and protect public health. They should not be engaging in partisan politics that undermine scientific progress and public faith in our government.”

Sen. Ed Markey, D-Massachusetts, went further in his criticism, saying the administration of President Donald Trump is “turning our federal agencies into a flat earth society” with suggestions on what words not to use.

“These so-called alternative terms are as harmful as alternative facts, and we owe it to our health and science professionals to provide them with the best in policy guidance, not political rhetoric,” Markey said in a statement.