President Trump's latest nomination for the position of U.S. Surgeon General is Dr. Casey Means, a figure who may encounter significant challenges on her path to confirmation. This uncertainty stems from various sources, particularly from individuals within the Make America Healthy Again (MAHA) movement. Dr. Means has recently gained traction in the wellness community, thanks to her book, Good Energy, and frequent appearances on popular podcasts. However, a potential roadblock in her confirmation process is the fact that her medical license is currently inactive, as indicated by public records from Oregon.
In announcing Dr. Means as his new pick, Trump emphasized her strong MAHA credentials. Notably, her brother, Calley Means, serves as an adviser to Health and Human Services Secretary Robert F. Kennedy Jr.. The messaging that Dr. Means promotes regarding America's struggling health care system and chronic diseases aligns closely with Kennedy's perspective, who has publicly stated that she is "born to hold this job." However, not all members of the MAHA community share this sentiment. Nicole Shanahan, Kennedy's former running mate from his presidential campaign, expressed her discontent on social media platform X, asserting that she had been assured that neither of the Means siblings would hold a position under HHS or in an appointment.
Criticism of Dr. Means also comes from some Trump and Kennedy supporters who feel she has not been sufficiently vocal against vaccines. The backlash has prompted Kennedy to defend her, labeling the criticism as "absurd." He suggested that the attacks are fueled by vested interests in the industries he aims to challenge, stating, "I have little doubt that these companies and their conflicted media outlets will continue to pay bloggers and other social media influencers to weaponize innuendo to slander and vilify Casey." He further proclaimed that she would become "the best Surgeon General in American history."
Dr. Means possesses both undergraduate and medical degrees from Stanford University, according to information available on her website. In her book and public engagements, she discusses her decision to leave a surgical residency at Oregon Health & Science University, driven by disillusionment with conventional medicine. Although she did not complete her residency, her postgraduate work qualified her for a medical license in Oregon. Dr. Means subsequently established a functional medicine practice—an alternative medicine approach that aims to address the root causes of diseases—and founded a continuous glucose monitoring company named Levels.
The nomination of Dr. Means has raised concerns among some former Surgeons General. Dr. Richard Carmona, who served under President George W. Bush, commented, "In every previous surgeon general, they've got the license, they've gotten the residency, they have at least some leadership ability that's scalable. We don't see any of that here. So I think that our nation deserves better." The role of the Surgeon General has evolved significantly since its inception, transitioning from a position with substantial regulatory powers to one that serves primarily as a health communicator-in-chief, according to Lindsay Wiley, a health law professor at UCLA.
According to existing statutes, the Surgeon General must be appointed from the Commissioned Corps of the U.S. Public Health Service and must have specialized training or extensive experience in public health programs. In light of Dr. Means' nomination, Dr. Jerome Adams, who held the position during Trump's first administration, highlighted the historical requirement for Surgeons General to be licensed physicians. He emphasized to NPR that it is crucial for the Senate to consider both historical precedent and the law in the confirmation process.
The status of Dr. Means' inactive medical license could significantly impede her nomination. Although a nominee can first be appointed to the corps and subsequently to the role of Surgeon General, membership in the corps necessitates an active medical license. As a Commissioned Corps officer, maintaining professional licensure and certifications is mandatory, according to federal regulations. Dr. Means could potentially reactivate her license in Oregon or another state, but there remain concerns regarding the speed of this process. Lawrence Gostin, a professor of global health law at Georgetown University, stated, "She is not licensed and therefore should be ineligible to become Surgeon General of the United States." However, Gostin and other legal experts suggest that the Trump administration might explore policy changes or administrative tactics to make Means eligible for the position.
Dr. Means is taking over the nomination from Dr. Janette Nesheiwat, a former Fox News contributor, who faced scrutiny regarding her representation of her medical credentials. This change was first reported by independent journalist Tony Clark. Nesheiwat also encountered criticism from some factions on the right for not being sufficiently critical of vaccines.
