Health Update: Health Update: Wellness in the White House: How Casey Means Wants to Address America’s Health as Surgeon General – What Experts Say– What Experts Say.
Casey Means, the current nominee for Surgeon General of the United States, stood before the US Senate for her confirmation hearing on February 25. If she is confirmed, it would make her the first surgeon general in US history to not hold an active medical license or be board-certified.1
Dr Means graduated from Stanford University in 2009 with a bachelor’s degree in human biology and remained there for medical school, graduating in 2014. After completing 4 years of surgical residency at Oregon Health & Science University with an otolaryngology-head and neck surgery specialty, she eventually dropped out. Dr Means attributes her departure to becoming disillusioned with the health care system, though the former department chair says it was due to stress.1,2
Despite not completing her residency, she obtained her medical license in Oregon in 2018, opening a functional medicine private practice there in 2019.1 However, about a year later, she phased out her practice to co-found Levels: a health technology company that provides data on blood glucose levels through continuous glucose monitoring to “improve metabolic health,” often for people without diabetes, with membership prices ranging from $288 to $1999 per year.3
Most recently, Dr Means and her brother Calley Means — who is a senior advisor for the US Department of Health and Human Services (HHS) — co-wrote a book published in 2024 entitled Good Energy: The Surprising Connection Between Metabolism and Limitless Health. Dr Means and her brother have been working with HHS Secretary Robert F Kennedy Jr since 2024. She says she stopped seeing patients in 2024 and therefore did not renew her medical license.1
Your obligation [as surgeon general] first and foremost is to protect the public and to protect the public over politics. With the testimony [Dr Means] provided, it was very disappointing that rather than advocating for what the vast majority of physicians in America advocate for, she equivocated and really could not support the merits of vaccines.
Platform and Wellness Background
The crux of Dr Means’ platform is that the US health care system is broken in many ways, which is largely due to financial interests of hospitals or physicians outweighing the priority of patient health, which leads clinicians to provide pharmaceutical or surgical solutions rather than addressing the root cause of a chronic illness.
Many clinicians are in agreement with Dr Means that our health care system has numerous flaws that prioritize financial interests over patient wellbeing, and that a healthy diet and regular exercise are important to personal health and should be promoted nationwide. However, critics of Dr Means argue her solutions to improve the health of Americans are misguided, misinformed, and misleading.
“We all can agree on the importance of healthy food, healthy diets, and having food safety as being protective, but [her Senate hearing] was riddled with hypocrisy. In terms of food safety, we’re actually seeing the number of pathogens that are being tested for by the [Centers for Diseases Control and Prevention] being winnowed down. We can talk about healthy diets and wanting children to eat healthier, but the farm to table program, where school systems would be able to have local produce, was eliminated,” said Dr Scott Rivkees, MD, pediatric endocrinologist, former Florida State Surgeon General and Secretary of Health, and researcher at Brown University’s School of Public Health. “We know that eating healthy is more expensive, but in terms of benefits that are provided to individuals through the [Supplemental Nutritional Assistance Program], they don’t really allow that to take place.”
Another issue Dr Means has with the health care industry is her belief that clinicians work too closely with pharmaceutical companies and allow their financial interests to take priority over patient care. Means is correct in her assertion that some clinicians receive money from pharmaceutical companies or other lobbying organizations. However, this information is often available to the public and is included in disclosure statements when research is published.
On the other hand, these disclosures are not required of people outside of the medical industry. Wellness influencers and people online who do not have active medical licenses do not have to abide by these official disclosure agreements in the same way. Though the Federal Trade Commission (FTC) has rules about disclosing what online content posted on social media is an advertisement or sponsored, influencers sometimes do not abide by these rules, since there are few means of enforcement.
“FTC compliance is still a part of federal law, but they’re typically not very specific about what it means to work within the law when you are doing sponsored content,” Mariah Wellman, PhD, MA, assistant professor at the College of Communication Arts and Sciences at Michigan State University who studies wellness influencers, said. “[Dr Means] was questioned over and over again about her lack of disclosure that equaled hundreds of thousands of dollars just in the last year of sponsorships that we know she has engaged in and has not disclosed appropriately, which is technically in violation of federal law. If you’re breaking federal law, you also should not be eligible for Surgeon General.”
In 2024, before Trump was elected, Dr Means and her brother advocated to remove any United States Department of Agriculture panelists who received funding from food companies. However, her colleague RFK Jr released new dietary guidelines in January, in which 7 of the 9 authors had ties to the food or pharmaceutical industry. This included organizations and companies such as the National Cattlemen’s Beef Association, General Mills, the National Dairy Council, the National Pork Board, and Novo Nordisk.4
Dr Means runs a social media account and newsletter where she posts sponsored content or affiliate links to dietary supplements and other wellness products. According to her own financial disclosures, she has made hundreds of thousands of dollars from these partnerships. She has pledged to divest from these wellness interests if she is confirmed to the position of Surgeon General.5,6
However, Chris Murphy, US senator from Connecticut, questioned Dr Means at her confirmation hearing about a pending complaint to the FTC. According to Murphy, she violated the FTC’s policy to disclose financial conflicts with products from 5 different companies she promoted online.7
An investigation by Rolling Stone magazine found that at least 5 of her sponsors sold products accused of containing hazardous ingredients, unsafe levels of lead and cadmium, or traces of forever chemicals.8
A number of Senators were vocal about their disagreement with some of the ways that Dr Means has chosen to address the problem of profits over patient care.
“You’ve said that our health care system is broken, but it seems to me that you’ve spent your career making money off the flaws of the system, and I’m wondering how the American people are supposed to trust you to put their health and safety first, and not profits,” said Tammy Baldwin, US senator from Wisconsin.7
Addressing Chronic and Infectious Disease
A substantial part of Dr Means’ platform, largely laid out in her book, is the argument that many chronic illnesses — such as diabetes, autism, infertility, cancer, and obesity — can be attributed to “metabolic dysfunction,” or “this core foundational issue of how our bodies on the cellular level function, which is driven by our toxic food system and our toxic environment.”9
In an episode of Tucker Carlson’s podcast with her and her brother from August 2024, Dr Means attributed global pesticide use in our produce and food supply to rising breast cancer rates and early puberty. Though breast cancer risk has been associated with pesticides, this link is largely among populations who are chronically exposed to these chemicals in rural or farming settings, rather than as a byproduct of consuming fruits and vegetables that aren’t pesticide-free, like Dr Means suggests.9, 10
Similar to RFK Jr, she hesitated to question vaccines outright during her Senate confirmation hearing, despite doubting their efficacy online.
In August 2024, she wrote on X that the practice of vaccinating newborns against hepatitis B when their parents don’t have the disease was “absolute insanity” and that these interventions are “jammed down our throats.”11 A few months later, she wrote in one of her newsletters, “There is growing evidence that the total burden of the current extreme and growing vaccine schedule is causing health declines in vulnerable children.”12 In November of that year, she wrote on X, “I have said innumerable times publicly I think vaccine mandates are criminal.”13
When asked by Senator Tim Kaine from Virginia during her confirmation hearing, “Do you believe that there is evidence that the flu vaccine prevents serious disease and prevents hospitalization or deaths in children?”, she did not answer yes or no.7
Lifestyle-Based Solutions
Instead of routine vaccination, Dr Means has turned to optimizing metabolic health as a solution to treating chronic and infectious diseases. In May of 2020, she wrote in a now-deleted post on X that “Many (if not most) COVID-19 deaths could be prevented w optimal metabolic health.”14 She then co-authored an opinion piece in The Hill calling COVID-19 “a Darwinian moment for America,” writing that “Americans must build personal immunity defenses through radical changes in diet and exercise, or risk getting sick and dying.”15
Dr Means has stated the more prescription medicines Americans take, the sicker they get. She also said on Carlson’s podcast that birth control pills that are being prescribed “like candy” — in part because they are also used to treat conditions such as acne, premenstrual syndrome, endometriosis, polycystic ovary syndrome (PCOS), or perimenopause — are a “disrespect of life.”9 She later said in her Senate confirmation hearing that she thinks oral contraception should be widely accessible, but that patients need to have a conversation with their doctor.7
“[RFK Jr and Dr Means] are making an assumption that collective scientific agreement is the same as one expert’s opinion. One expert’s opinion does not equal scientific consensus. Scientific consensus is built from a group of medical experts who have done a ton of research in a particular space,” Dr Wellman commented. “If we can encourage people to distrust one expert, and if we tell them that one expert is equal to scientific consensus, it’s a very quick line to distrusting all of the scientific consensus.”
Instead, Dr Means and her brother suggest major chronic diseases can be largely prevented or reversed through a healthy lifestyle.
Part of Dr Means’ strategy for optimizing metabolic health is through cutting out ultraprocessed and nonorganic foods.
On Carlson’s podcast, she said that she and her brother “have a list in the book of what you should not eat and it’s basically everything at the grocery store. There are 9000 farmers markets in the United States right now. People can make the effort and reprioritize their values to focus on getting nutritious food. We need to be eating organic, unprocessed foods for the vast majority of our calories.”9
Whole foods and fresh produce are beneficial to individual health, but these options are not accessible both cost-wise and geographically for large groups of the US population, as most farmers markets in the country are concentrated in larger cities along the coast.16
Role of Surgeon General
The surgeon general, often referred to as “The Nation’s Doctor,” is responsible for providing information to Americans about how to maintain their health. They usually do this through issuing advisories or reports on issues they deem particularly relevant or important.
“Your obligation [as surgeon general] first and foremost is to protect the public and to protect the public over politics,” Dr Rivkees said. “With the testimony [Dr Means] provided, it was very disappointing that rather than advocating for what the vast majority of physicians in America advocate for, she equivocated and really could not support the merits of vaccines.”
In the past, surgeons general have advised the American public on health issues such as smoking, HIV/AIDS, and mental health.
The surgeon general also oversees the US Public Health Service Commissioned Corps, which is a group of public health officers in the federal government who can be mobilized during crises such as national disasters or disease outbreaks.
“Her desire to leave conventional medicine tells me that she shouldn’t have any interest in being Surgeon General, because Surgeon General is rooted in conventional medicine. And she left conventional medicine,” Dr Wellman said.
The previous Surgeon General, Vivek Murthy, MD, MBA, served from 2015 to 2017 and from 2021 to 2015. He received both of his graduate degrees at Yale and completed his residency at Brigham and Women’s Hospital and Harvard Medical School. During his time serving, he focused on a culture of prevention by emphasizing things like physical activity, nutrition, and emotional well-being. He addressed issues such as e-cigarette use, climate change and its health effects, conversion therapy, COVID-19 misinformation, social media and mental health, the loneliness epidemic, the clean water crisis, and opioid/substance use and addiction.
Though Dr Murthy has not commented on Dr Means’ nomination, Dr Richard Carmona, who served as Surgeon General under President George W Bush, told The New York Times he thought Dr Means “lacked the credentials for the role.”17
Jerome Adams, the Surgeon General during Trump’s first term, wrote on X that “it is incomprehensible that the Senate is even considering a nominee for this role who lacks any active license and has never practiced unsupervised.”18
“Based upon the answers she provided, I would be very skeptical that she is going to really put forth a legitimate public health message and do things in the best interest of this country,” Dr Rivkees said.
Medical Mistrust and Moving Forward
Many Americans face economic, geographic, or societal barriers to accessing primary care, and health and wellness content on social media provides a much more accessible avenue to those who can’t afford health care or find time to visit a doctor.
“That sort of interpersonal relationship that used to exist when you had 1 family doctor over the course of 50 years just isn’t the case anymore,” Dr Wellman said. “When wellness influencers are seen as similar, have a specific kind of expertise, and they are seeing them on a consistent basis, that makes Americans think that they are authentic and real and transparent, and it’s really hard to compete with that.”
Dr Wellman advised physicians to continue to cultivate personal relationships with patients in an effort to reestablish trust in the health care system.
“Be careful not to dismiss people who come into your office with information they found online or on social media,” she said. “Validate what is accurate and then offer more suggestions.”
If patients are asking about health information they have seen online or on social media that is misleading, Dr Wellman suggests introducing some alternative evidence-based sources on social media rather than shutting them down completely, which may lead to a patient’s increased distrust or feelings of invalidation from the medical system.
Dr Rivkees recommends emphasizing to patients the importance of supporting the community around us, especially when it comes to vaccination.
“America is really being governed by pitting Americans against Americans. Public health has to do with us caring for each other,” he said. “We have to recognize the fact that we live in a society with 340 million of us, and living in a society comes with certain rights, but it also comes with responsibilities. Our responsibilities are to try to keep each other healthy.”