The surgeon general, America’s doctor, is the public face of medicine in the United States. The job is more educational than it is technical. Vivek Murthy, who was appointed as surgeon general during both the Obama and Biden administrations, went on Sesame Street to stress the importance of vaccinations and put out a guidebook to hosting dinner parties as a cure for loneliness.
In many ways, Casey Means is the perfect person for that job. Donald Trump’s new nominee for surgeon general, announced yesterday, is a Stanford-trained doctor who is well-spoken and telegenic. Most important, she clearly knows how to draw attention to health issues. Good Energy, the book she published last year with her brother, Calley (who, by the way, is a special adviser in the Trump administration), is Amazon’s No. 1 best seller in its “nutrition” and “aging” categories. She regularly posts on Instagram, where she has more than 700,000 followers.
In many other ways, however, Means is far from perfect. A leading voice in Robert F. Kennedy Jr.’s “Make America healthy again” movement, she has a habit of trafficking in pseudoscience and at times can be hyperbolic, to put it lightly. Means has said that America’s diet-related health issues could lead to a “genocidal-level health collapse” and that “all of us are a little bit dead while we are alive” because of what she calls “metabolic dysfunction.” She has also written about taking part in full-moon ceremonies and about how talking to trees helped her find love—though she admitted that the rituals were “out there.” And Means (who didn’t respond to a request for comment) has used her platform to promote “mitochondrial health” gummies, algae-laden “energy bits,” and vitamins she described as her “immunity stack.”
Means was not Trump’s top choice for surgeon general. His first nominee, Janette Nesheiwat, was pulled out of contention yesterday amid allegations that she had misrepresented her medical training. Presuming the Senate confirms Means as the next surgeon general, she will be another one of RFK Jr.’s ideological compatriots who have joined him in the Trump administration. National Institutes of Health Director Jay Bhattacharya and FDA Commissioner Marty Makary are both also skeptics of the public-health establishment. Earlier this week, Vinay Prasad, another prominent medical contrarian, assumed a top job at the FDA. Now the “MAHA” takeover of the federal health agencies is all but complete. Earlier today, Trump told reporters that he tapped Means “because Bobby thought she was fantastic.”
Means fits right in with the Trump administration’s approach to health. She dropped out of her medical residency, citing her frustrations with the myopic focus of modern medicine. By her telling in Good Energy, she left her program in ear, nose, and throat surgery because “not once” was she taught what caused the inflammation in her patients’ sinuses. In the third chapter of her book, titled “Trust Yourself, Not Your Doctor,” Means writes that you should not trust physicians, because the medical establishment makes more money when you are sick and does not understand how to treat the root causes of chronic disease.
Alleviating chronic disease is also a passion of Kennedy’s, and the similarities between them run deep. Like the health secretary, Means believes that you should avoid seed oils and ultraprocessed foods. She is prone to musings about the crisis of American health care that lean more Goop than C. Everett Koop. She has proclaimed that Americans have “totally lost respect for the miraculousness of life.” She has said that the birth-control pill disrespects life because it is “shutting down the hormones in the female body that create this cyclical life-giving nature of women.” One of the latest editions of her weekly email newsletter was dedicated to the children’s movie Moana, which she called “a forgotten blueprint for how we lead, heal, and regenerate.” (For the record, Koop, America’s surgeon general during Ronald Reagan’s presidency, never implied that he’d done mushrooms to find love.)
Tucker Carlson, Joe Rogan, and Andrew Huberman have all hosted Means on their podcasts. Means’s rise is, in many ways, emblematic of modern internet wellness culture writ large: If you’re articulate and confident and can convincingly recite what seems like academic evidence, you can become famous—and perhaps even be named surgeon general. Her most dangerous inclination is to toe the line of her new boss, Kennedy, on the issue of vaccines. On Rogan’s show in October, she questioned whether the barrage of shots kids receive as infants might cause autism. And on Carlson’s podcast, she argued that perhaps certain shots given to infants should be given later in life to avoid overexposure to neurotoxins. There is no scientific evidence to back up those claims.
But at the same time, much of Means’s philosophy toward health doesn’t seem that objectionable. Whereas the books that RFK Jr. has written are crammed full of conspiracy theories, hers focuses on how America’s ills can be treated with whole foods, exercise, and good sleep. It even includes a recipe guide. (Her fennel-and-apple salad with lemon-dijon dressing and smoked salmon is delicious, I must admit.) If her book is any indication, her first move as surgeon general will be to urge parents to cut down on their kids’ sugar consumption. “If the surgeon general, the dean of Stanford Medical School, and the head of the NIH gave a press conference on the steps of Congress tomorrow saying we should have an urgent national effort to cut sugar consumption among children, I believe sugar consumption would go down,” she wrote.
If Means sticks to these issues—encouraging Americans to eat organic, go on a walk, and get some shut-eye—she could be a force for positive change in American health care. If she urges women to forgo birth control, plugs unproven supplements, or uses her bully pulpit to question the safety of childhood vaccines, she will go down as one of the most dangerous surgeons general in modern history. In this way, she is much like Kennedy and the rest of the MAHA universe. Their big-picture concerns sound reasonable and are resonating with lots of people. America does have a chronic-disease problem; food companies are selling junk that makes us sick; the public-health establishment hasn’t gotten everything right. But for every reasonable idea they proffer, there is a pseudoscientific belief that strains their credibility.
