Surgeon General nominee Dr Casey Means, a confidante of HHS Secretary Robert F Kennedy, was grilled in a tense Senate confirmation hearing on Wednesday. She fielded questions on vaccines, her conflicts of interest, pesticides, and birth control, and reaffirmed her focus on America’s chronic disease epidemic, promising to use her platform to promote “whole healthy foods” and informed patient consent.

Despite her nomination by the Trump Administration to become the “nation’s doctor,” Means deflected questions on vaccination, instead focusing on nutrition, environmental health, and her commitment to the MAHA movement.

She repeated her belief that vaccination is personal – and not a message she would take up in her role. Means also reiterated her drive to reform America’s healthcare system to address the root causes of chronic diseases.

Means testified for over two hours in front of the Senate Health, Education, Labor, and Pensions (HELP) Committee. She is expected to be confirmed later this week. 

The US has been without a Surgeon General for over a year now. Past Surgeon Generals have used their position as the nation’s doctor to ring the alarm on smoking, nutrition, loneliness, and HIV/AIDS. 

Notably, it was Surgeon General Dr Luther Terry who, in 1964, published a landmark report establishing that smoking causes cancer, and Dr C Everett Koop who launched the issue into the mainstream. 

Means would lead a cadre of 6,000 Uniformed Public Health Service officers and be the Administration’s leading health spokesperson – though the question of how critical the role is has been raised given the length of the vacancy. 

Senators grill Means on vaccines

Both Republican and Democratic Senators thoroughly questioned the nominee on her stance on vaccines, which the Trump Administration has come under fire for casting doubt on a variety of vaccines – and for its response to a wave of measles cases in South Carolina and Texas.

Means fielded terse questions from the HELP committee chair, Senator Bill Cassidy (R-LA) saying she would not use her platform to urge parents to have their children vaccinated against life-threatening diseases.

“I’m not an individual’s doctor, and every individual needs to talk to their doctor before putting medication in their body,” Means said. “I absolutely am supportive of the measles vaccine, and I do believe vaccines save lives and are an important part of the public health strategy.”

At times, the senators appeared frustrated at Means’ response, with Committee Chair Cassidy, who is also a physician, repeatedly asking her if she supported universal Hepatitis B vaccination.

“I am a doctor, and I am very careful with my words,” she responded. “Broadly speaking, I want to reassure you that this is not an issue that I intend to complicate or bring an agenda on vaccines.”

Senator Lisa Murkowski (R-AK) also pushed back on Means’ comments, highlighting the fragile victory of fewer Hepatitis B cases in her home state of Alaska, especially for Native Americans. “The vaccine made a remarkable difference in Alaska,” the senator said. “Other states look to us as an example.”

“You have expressed skepticism about the Hep B vaccine for newborns, and I need to try to understand your thinking on that given the medical consensus that this vaccine prevents this serious liver disease and liver cancer,” Murkowski said.

Additionally, Means left the door open to the question of the connection between vaccines and autism, which leading medical and scientific institutions have roundly debunked.

“I also think that science has never settled…we should not leave any stones unturned,” Means said in response to questions from Cassidy. 

The Centers for Disease Control and Prevention (CDC) came under intense criticism for now saying that the scientific consensus that “vaccines do not cause autism” is not evidence-based.

Stance on birth control, pesticides

Questioning regarding her views on birth control and the pill used to induce abortions, mifepristone, was equally tense. 

Means, who historically is highly critical of birth control and the negative side effects it has for women with co-morbidities, said that oral contraceptives should be accessible – though patients should have extended and thorough informed consent conversations with their providers.

Similarly, she said, “I think that every medication has risks and benefits. All patients need to have a thorough conversation with their doctor and have true informed consent before taking any medication,” in response to questions about the abortion pill.

Senators on both sides of the aisle raised questions on Means’s focus on pesticides, with Republican Senator Jon Husted (R-OH) revealing a picture of an insect-ravaged ear of corn.

“This is the kind of thing that destroys our crops all across the country, corn, wheat, soybeans, fruit and vegetables –  if we fail to use proper pesticides, it will drive down crop yields,” Husted said.

Means walked a fine line between staying true to her belief that environmental factors, like pesticides, are contributing to chronic diseases, with the Trump Administration’s support of agrochemical companies.

President Trump recently unveiled an executive order boosting the production of glyphosate, the widely used herbicide in RoundUp.  

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“There are grave issues with these chemicals. I think that we are in a very complicated moment for agriculture and food. We cannot overturn the entire agriculture system overnight. That would hurt farmers. It would hurt food prices,” Means said.

Yet, the Surgeon General nominee also said, “a key passion of mine is to understand how the cumulative burden of the exposures we have in our environment, across food, water, air, soil, the products we’re putting in and on our bodies, how these are affecting our health. We know that these diseases are going up rapidly. And of course, genetics have not changed over the past decades.”

“It’s environmental exposures that are making us sick, and we have not prioritized studying that.”

Despite her commitment to environmental health, the Trump Administration, through the National Institute of Environmental Health Sciences (NIEHS), which is the main funder of this research, has said that in response to federal research funding cuts, the institute would scale back investigator funding by 15%. 

Nutrition, junk food, social media, illicit drugs

Means remained true to her critique of ultra-processed foods and the poor state of nutrition in the US, which she said leads to blood sugar issues, infertility, and metabolic diseases. 

“Mental and physical health are unraveling from shared root causes that we can fix,” she said in her opening statement. Means promised to fight to ban ultra-processed food ads, though she declined to state that healthcare is a human right after being asked by Senator Bernie Sanders (I-VT).

Many of the senators agreed with Means and applauded her attention to the issues. Others, like Senators Halwey, Marshall, and Husted, questioned the nominee on her commitment to combatting the youth mental health crisis – including putting warning labels on social media and stricter age restrictions.

Senators also questioned Means on her views that fall outside the medical establishment, such as her discussion of the benefits of illicit drugs.

“Illicit drug use remains a huge problem in this country,” Senator Susan Collins (R-ME) said. “And your use didn’t happen in your teen years. According to your book, in 2021 you began using illicit psychedelic mushrooms,” Collins said to Means during the hearing. 

“What I say as a private citizen is in many cases different than what I would say as a public health official joining a team where the purpose of this role is to communicate absolutely the best evidence-based science to the American people to keep them safe, thriving, and healthy,” Means said in response.

Confronting America’s health system

Casey Means earned her medical degree from Stanford University in 2014 but resigned from her competitive residency in head and neck surgery to “focus on reforming the ‘sick care’ paradigm in American healthcare,” her website reads. 

She has spoken and written at length about the scale of issues plaguing America’s healthcare system, including healthcare worker burnout.

“I deeply respect doctors, but I want to be very clear on something: at every hospital in the United States, many doctors are doing the wrong things, pushing pills and interventions when an ultra-aggressive stance on diet and behavior would do far more for the patient in front of them,” Means wrote in her book, Good Energy.

“I think a contributor to this phenomenon is an insidious spiritual crisis about the efficacy of our work and a sense of being trapped in a system that is not working but seems too big to change or escape.”

Mean’s attention on functional medicine and metabolic health as an answer to the country’s health woes prompted her to help found the personalized continuous glucose monitoring and coaching company, Levels. The company offers an app subscription and glucose monitor for up to $1,500 a year.

Her books, podcast, and public appearances have pointed to processed foods, environmental exposures, and the US healthcare system’s reliance on pharmaceuticals as contributing to “widespread metabolic impairment,” according to her website. She also argued that “our human health is simply a reflection of the destroyed ecosystem of our globe.” 

But her work in the wellness space has prompted critics to label her an influencer – who would use her prominent role as surgeon general for profit. 

Ties to wellness companies, conflicts of interest

With over 800,000 Instagram followers and 2,000 newsletter subscribers, Means has been a prominent voice in the popular medical space.

Her following, along with the popularity of her book and podcast, points to the growing frustration at America’s healthcare system and food environment. 

In her posts on a wide variety of popular health topics, Means will often mention a sponsor in the wellness industry, including prenatal vitamins, supplements, and other products. Senators picked up on the fact that the nominee profited from these endorsements – though Means pledged to divest from any such companies should she be confirmed.

“It does not inspire confidence that you’re here to make Americans healthy when you accept money to promote a company who had to pay a settlement because of violating the False Claims Act,” said Senator Tammy Baldwin (D-WI), referring to the company Genova Diagnostics.

“You made at least $325,000 from promoting supplements since the beginning of 2024, according to information provided to this committee. This includes nearly $135,000 for a so-called ‘longevity supplement’ and $46,000 for wellness teas and elixirs, both of which can cost upwards of $100 a month for somebody consuming them,” Baldwin said.

To Baldwin, Means’s proffered solutions to metabolic dysfunctions and the root drivers were “unaffordable” to everyday Americans – and a conflict of interest. 

But Means reiterated that in her role as chief medical spokesperson, she would take on the systemic drivers of America’s ill health.

“I think that we have a monumental blood sugar problem in this country that underlies most of the leading causes of death in this country. Dementia, cancer, diabetes, heart disease, stroke are all connected by metabolic dysfunction, elevated blood sugar,” Means said.

Image Credits: HELP Committee, Vital Strategies.