Let the language live 

By S. Michelle Ogunwole, MD, PhD, Johns Hopkins Medicine 

 

Author’s note 

I wrote this piece while struggling with the mandate that has been thrust upon many of us, but perhaps most especially health equity researchers: to change our words. To extract language that defines our work, not in the name of rigor or better science, but for a politicized filter that I not only don’t subscribe to but vehemently oppose. The ask has felt so misaligned with my values that my ethics feel at odds with my job. 

 

I struggle to reframe my work in a way that feels “fundable,” but not false. The tension between what I know to be true and what I’m being told to say (or not say) has been paralyzing. So, I attempted to write my way out. Out of the haze. Out of the distraction that’s kept me stuck. I offer this piece to others who may be feeling similarly stuck, not as instruction, but as companionship. This piece isn’t a roadmap or strategy guide. It’s not fully pragmatic. It’s just an offering. A note, a meditation, perhaps even a demonstration of the ways in which writing and language frees us. 

 

The process of writing it out reminded me that our words still matter—even when we’re asked to code them in ways that feel artificial to our true intent. It reminded me that the distortion and suppression of knowledge is an old tool of white supremacy. And that in the face of it, our predecessors fought back with strategy—and that strategy often looked like “working in the shadows, moving in ways that [were] illegible to the dominant gaze.” And that just may be what we are called to do in a time such as this. 

  

“This is precisely the time when artists go to work. There is no time for despair . . . no room for fear. We speak, we write, we do language. That is how civilizations heal.”—Toni Morrison 

 

In the U.S., we’re in a moment of immense instability and uncertainty. The landscape of National Institute of Health funding and biomedical research is shifting rapidly and has now become a landslide that will leave clinical research irreparably changed. For those of us committed to equity in medicine, these changes aren’t abstract. They’re deeply personal, and they challenge not only what we do, but how we speak about what we do. 

 

As the pressure mounts, we’re being asked—explicitly or implicitly—to dilute our language: to redact any words that signal an ethos of antiracism, that name those historically marginalized, that center at the margins, and that expose and confront systems of white supremacy.  

 

And what it feels like is that we’re being asked to make impossible choices. To prioritize strategy over truth, to swap integrity for self-preservation—all the while asking ourselves if our compliance makes us complicit.  

 

But words matter. And when language is stripped away, something vital is lost. 

 

“When a language dies,” wrote Toni Morrison, “out of carelessness, disuse, indifference and absence of esteem, or killed by fiat . . . all users and makers are accountable for its demise.” 

 

So how do we remain accountable—to our truths, our communities, and our missions—when the systems we operate within encourages reticence, if not our overt silence? 

 

We create parallel records. 

 

We speak, even if we must code our speech. We name, even if what we name is monitored. We write sideways if we cannot write straight.  

 

If the path ahead is untraversable, let us channel the spirit of those dazzling visionaries who built underground roads. Moving through the shadows, drawing on the traditions of  fugitive pedagogy—a refusal to let the truth be erased, even when it cannot be spoken openly or plainly.  

 

It will be challenging, and it will call for the very best of our imagination and creativity. It will ask for our nimbleness, ingenuity, and yes—like a broken record—our resilience. 

 

In my work to address maternal health disparities, particularly among Black women, I have felt the weight of this moment. Structural barriers to health aren’t new but are compounded now by shrinking resources and institutional silence. And yet, this is precisely the time when we must speak most clearly. 

 

Our research, whether in the form of clinical trials, community-based interventions, or qualitative inquiry—must be more than data collection. It must be recordkeeping. Documentation of what we dared to imagine and what systems tried to erase. We may not always be able to include our full truths in our grants, but we can put them in our talks, in our footnotes, in the margins of the peer review process. We can build something lasting in the space between the lines. It is small, like the break of a new day, but there is room enough, just enough, to let the language live. 

 

What healthcare professionals can do:  

Though I wrote this piece through the lens of a researcher, I’m a physician-scientist, and always a physician first. Ironically, I once chose the path of a clinical investigator—a physician whose work is rooted in research—because I believed, naively, that caring for patients one by one would never move the needle on systemic change. It took a global pandemic and a crisis in the foundation of our research infrastructure to realize how wrong I was. 

 

Clinical medicine holds a superpower—particularly potent in this time. We have the freedom to see our patients fully and to choose care rooted in justice. We can name racism. We can check our biases. We can listen. And we can love. 

 

If the government is demanding silence or obfuscation, clinical care becomes a place where we can still speak—clearly, honestly, and humanely. In a moment where our words are being narrowed, our scopes redefined, and our intentions questioned, the clinical encounter still offers a kind of agency. Not complete, but unique.  

 

We see people on their best and worst days. We’re trusted with their fears, their stories, their healing. And in a time when many of us are grasping for meaning—trying desperately to hold on to the purpose beneath the pressure—our patients remind us that it’s not only the words we write, but the ones we say—again and again, behind the closed doors of the exam room—that carry the power to heal, to name, and to see. That too is a form of resistance.  

 

Click here to read more about the author on her website.

 

 

“When a language dies out of carelessness, disuse, indifference and absence of esteem, or killed by fiat . . . all users and makers are accountable for its demise.”—Toni Morrison 

 

 

 

 

 

 

 

 

 

 

 

 

 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.