Dicktater Don’s surgeon general nominee doesn’t have a medical license. Or a completed residency. Or, apparently, a relationship with established science. But, she does have a newsletter!
The Surgeon General of the United States is, quite literally, the nation’s doctor. The position carries no regulatory authority, no power to pass laws, no budget to command. What it has — what it has always had — is the singular power of the bully pulpit, the moral weight of the white uniform, and the public’s trust that whoever wears it has earned the right to speak plainly, with authority, about what keeps Americans alive and what kills them.
C. Everett Koop wore that uniform and told a country, and Reagan, in denial that AIDS was a public health emergency, not a moral judgment. Joycelyn Elders wore it and forced conversations about sex education and drug policy that powerful people desperately did not want to have. Vivek Murthy wore it and named loneliness a public health crisis before most institutions had the courage to say it out loud. These were people who stared down political pressure, industry pressure, and public ridicule to say: here is the science, here is the evidence, here is what we know, and here is what you deserve to understand.
Donald Trump’s nominee to fill that chair is Dr. Casey Means, 38, Stanford medical school graduate, wellness influencer, entrepreneur, podcast circuit regular, newsletter writer, supplement marketer, RFK Jr. campaign adviser, and co-founder of a glucose-monitor-app company called Levels. She did not finish her medical residency. She left a surgical program at Oregon Health & Science University in 2018, just months before completing it. Her medical license lapsed in January 2024. When a senator asked her about that license, she said she has no plans to reactivate it, because she is “not going to be seeing patients in this role.”
That’s right. The candidate to be America’s top doctor does not have an active medical license, does not see patients, and sees no reason why that should change. Trump’s own first-term Surgeon General, Dr. Jerome Adams, wrote that the person leading the U.S. Public Health Service Commissioned Corps should be held to the same standards as the people they lead — and that requires a medical license. Former Bush administration Surgeon General Dr. Rich Carmona called Means’ qualifications a matter of “significant concern.” The nation’s doctor, in other words, would not be qualified to practice medicine in any of the fifty states she purports to protect.
This is not a technicality. This is the point.
The U.S. Public Health Service Commissioned Corps — the entity the Surgeon General commands — includes more than 6,000 physicians, nurses, scientists, and engineers who deploy in public health emergencies, disease outbreaks, and disasters. They are required to meet rigorous professional standards. Their commander would not. In the Trump regime, this passes for qualification.
What does Casey Means believe? This is where the story gets interesting, and then alarming, and then clarifying — because these things happen in sequence. Means built her public following championing healthy eating, limited pharmaceutical use, and alternative remedies. She and her brother Calley, who serves as a senior adviser to RFK Jr. at the Department of Health and Human Services, co-wrote a book called “Good Energy.” Some of her ideas — eat less ultra-processed food, exercise, care about metabolic health — are perfectly sensible and not remotely controversial among actual physicians. The ridiculous MAHA movement, which she helped architect, has identified some real problems: the American diet is terrible, chronic disease rates are genuinely alarming, the food and pharmaceutical industries wield enormous and often corrupting influence over public health guidance.
But a framework that starts with legitimate grievances can still be corrupted in its conclusions. And Means’ record makes clear that she has let that corruption happen, repeatedly, with the enthusiasm of someone who sees doubt as a brand.
On Fucker Carlson’s program in August 2024, Means said that widespread contraception use is a sign that “we have lost respect for life.” In her public writing, she called birth control pills a “disrespect of life,” said Americans “use birth control pills like candy,” and claimed, contrary to established science, that hormonal birth control has “horrifying health risks for women.” When Senator Patty Murray (D-WA) read those quotes back to her at Wednesday’s hearing, Means pivoted to informed consent — a concept she invokes so reflexively it has become a verbal tic, a way to gesture at science without committing to it.
On vaccines, the pattern is nearly identical. In her published writing, Means argued that the “total burden” of the vaccine schedule was “causing health declines in vulnerable children.” On social media and in a podcast with Fucker Carlson, she said the blanket use of the Hepatitis B vaccine for newborns was inappropriate, characterizing Hepatitis B as a disease contracted primarily through sexual transmission and drug use. This is factually false in ways that have life-and-death consequences, as Senator Lisa Murkowski (R-AK) made startlingly clear from the dais.
“In Western Alaska, where we see Hep B as endemic, we find that it’s being spread through mosquito bites where a child is itching an arm, ordinary household, community contact,” Murkowski told Means. “Whether it’s sharing food, toothbrushes, and minor injuries.” She was not describing an edge case. She was describing her constituents. Murkowski praised the vaccine’s track record in her state with the specificity of someone who has watched communities survive, and sometimes not survive, infectious disease. Means responded by invoking shared decision-making. Again. Democratic Senator Angela Alsobrooks of Maryland brought up a past tweet in which Means appeared to suggest vaccinating newborns with the Hepatitis B vaccine was a crime. Means said the tweet was taken “out of context.”
It is always out of context. It is never her fault. The words just somehow arranged themselves that way.
Wednesday’s hearing before the Senate Health, Education, Labor, and Pensions Committee was two hours of compressed national reckoning. The committee is chaired by Senator Bill Cassidy (R-LA), himself a physician, who inexplicably cast a pivotal vote to confirm RFK Jr. as HHS Secretary after extracting promises from Kennedy about protecting vaccine programs. Many of those promises have since been broken. Cassidy appeared to arrive at this hearing with the energy of a man who has been burned before and is not entirely sure he should not have known better. He asked Means directly: “Do you believe that vaccines, whether individually or collectively, contribute to autism?” Her answer: “Until we have a clear understanding of why kids are developing this at higher rates, I think we should not leave any stones unturned.” Cassidy pushed back. “A lot of evidence is showing that they’re not implicated. Do you not accept that evidence?” “I do accept that evidence,” Means said. “I also think that science is never settled.”
“Science is never settled.” Read that again. The nominee for Surgeon General of the United States, in the middle of a measles outbreak that is on track to be the largest since the disease was declared eliminated in this country, told a sitting physician-senator that the science linking vaccines to autism — a claim that has been investigated exhaustively, that has been debunked across dozens of large-scale studies across multiple countries and multiple decades — is still an open question because, you know, science is never settled. By the same logic, she should be open to the possibility that the earth is round “at the population level” but perhaps we should not leave any stones unturned.
This is not a philosophical position. This is a rhetorical technique. It is precisely the kind of soft-focus uncertainty that sounds humble and measured in the abstract and functions, in practice, as permission for parents to skip their children’s vaccines during an active outbreak. The Surgeon General’s singular power is communication. Words from that office move behavior at scale. The core risk critics identified is a communicator who sounds measured in isolation but, in practice, leaves discredited claims just open enough for misinformation to take root. That is not a bug in Means’ brand. That is the brand.
Bernie Sanders, the independent from Vermont serving as ranking member, put it plainly: “Secretary Kennedy and the Trump administration continue to spread dangerous conspiracy theories about vaccines, making it harder for Americans to protect their children from deadly diseases.” When Means tried to distance herself — “I don’t mention the word ‘vaccine’ in my book,” she said, as if that were a credential — Sanders responded with the directness of someone who has been doing this long enough to be done with the theater: her answers, he said, were “political and not to the point.” He wasn’t wrong. Senator Tim Kaine (D-VA) pressed Means specifically on whether the flu vaccine reduces hospitalizations and deaths in children. She ultimately agreed that at the “population level” the flu shot works. The population level. As if children live at an abstraction. As if the parents of a child hospitalized with influenza complications would find comfort in the knowledge that, statistically, their doctor’s recommendation checked out. Senator Chris Murphy (D-CT) raised a pending complaint that Means violated FTC rules by failing to disclose financial relationships to products she has promoted. Means, who runs a glucose-monitoring app company and a supplement and wellness products business, pledged to divest if confirmed. The FTC complaint was not resolved at the hearing. Senators also asked about her use of psychedelic mushrooms. She had taken them therapeutically, years ago. This is perhaps the least alarming thing anyone disclosed all morning, and certainly less alarming than snorting coke from a toilet seat.
Let us be precise about what a surgeon general is supposed to do. The position has no regulatory power over the FDA, the CDC, or drug manufacturers. It cannot ban a pesticide or mandate a vaccine. What it can do — what it has historically done at its best moments — is cut through the noise of a billion-dollar wellness industry, a profit-driven food system, a pharmaceutical complex with deeply compromised incentive structures, and an information ecosystem designed to confuse, and say: here is what the evidence shows, here is what your children need, here is what is killing you, here is what to do. That clarity is the whole job. Past surgeons general most famously led the push to add warning labels to cigarettes — a campaign that took moral courage, institutional credibility, and a willingness to say clearly, publicly, and without equivocation that an industry that had spent decades manufacturing doubt was wrong. The doubt-manufacturing was the weapon. The clarity was the antidote.
Casey Means is a doubt manufacturer. That is her professional practice, carefully wrapped in the language of wellness and patient autonomy and informed consent and “I just want families to have the conversation.” She has a million social media followers, a book deal, a supplement company, a newsletter, and a brother inside the HHS building. As Senator Sanders noted, she would be walking into a role that demands public health leadership at the exact moment the measles outbreak is threatening to erase American elimination status, Kennedy is cutting vaccine programs, and 50,000 Americans a year may lose their lives due to Medicaid cuts. She is prepared for none of it. Or rather — she is prepared for a different job entirely. She would be a very capable influencer. She is a genuinely compelling communicator about metabolic health and ultra-processed food, and some of that matters. Even Sanders said he wouldn’t be frustrated if she talked about ultra-processed foods. He’d be delighted. But the surgeon general is not a wellness podcast. It is a command post. And you cannot run a command post on vibes, newsletter subscriptions, and a principled refusal to say that the flu vaccine works.
All the Democrats, including Sanders, said they would not support the nomination. But with Republicans in control of the Senate, and most Republicans apparently willing to confirm anyone the administration sends up the hill so long as they perform sufficient vagueness about vaccines, Casey Means will almost certainly become the next Surgeon General of the United States. A nation in the middle of a measles outbreak will have, as its top doctor, a woman who will not say whether you should vaccinate your children against measles. A country where 15 million people may lose health care access will have, as its public health voice, someone whose medical license lapsed two years ago and who has no plans to renew it. An American public that deserves clarity will get a woman whose entire professional brand is calibrated ambiguity, dressed up in the language of healing.
Casey Means said in her opening statement that she has always been inspired by the etymology of healing — that the word means “to return to wholeness.”
The country’s public health infrastructure, right now, is bleeding out.
Wholeness is not a newsletter.
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