On October 30, 2025, what was set to be a historic Senate confirmation hearing for President Donald Trump’s nominee for surgeon general, Dr. Casey Means, took an unexpected turn. As lawmakers and journalists prepared for the first-ever virtual appearance by a nominee before the Senate Health, Education, Labor and Pensions (HELP) Committee, word came that Dr. Means had gone into labor with her first child, prompting an immediate postponement of the hearing. The committee, in a statement echoed by the Department of Health and Human Services (HHS), expressed joy for Dr. Means and her family. “Everyone is happy for Dr. Means and her family. This is one of the few times in life when it’s easy to ask to move a Senate hearing,” HHS spokesperson Emily Hilliard said, as reported by CBS News and NPR.
Dr. Means’s nomination, announced in May 2025 after the withdrawal of Dr. Janette Nesheiwat, had already drawn national attention for several reasons. Not only was she set to become the nation’s top public health spokesperson, but she would also have been the first nominee to appear virtually for her confirmation, a nod to her pregnancy and the unique circumstances surrounding her candidacy. The hearing had been scheduled just two days after her due date, according to sources familiar with the process, and the new date has not yet been determined.
At 38, Dr. Means has built a profile that blends medicine, entrepreneurship, wellness advocacy, and controversy. A graduate of Stanford Medical School, she completed nearly all her five-year surgical residency at Oregon Health and Science University before leaving the program, a decision she chronicled in her bestselling 2024 book, Good Energy. “I walked out of the hospital and embarked on a journey to understand the real reasons why people get sick,” she wrote, as highlighted by The Associated Press and NPR. Her pivot from traditional medicine to what she calls “root cause” and “functional” approaches has won her both acclaim and criticism.
Dr. Means co-founded Levels, a health technology company that connects users to continuous glucose monitors, and has amassed a substantial following online through her writings and public speaking. She’s championed holistic health, advocating for whole foods, exercise, reduced reliance on pharmaceuticals, and even the mental health benefits of psychedelics like psilocybin. She’s also been a vocal critic of pesticide use and the long-term use of hormonal birth control, warning of what she describes as “horrifying health risks”—a stance that diverges from the prevailing consensus in the medical community, which maintains that such risks are rare and outweighed by the benefits for most women.
Her outspoken views have not stopped there. Dr. Means has questioned the safety of the childhood vaccine schedule, linking to materials suggesting vaccines cause autism—a claim repeatedly debunked by scientific research. She’s described America as facing a “spiritual crisis” in addition to a health crisis, and has frequently criticized what she sees as corruption in the Food and Drug Administration. These positions, amplified through her newsletter, book, and social media, have placed her at the center of the “Make America Healthy Again” movement, closely aligned with Health and Human Services Secretary Robert F. Kennedy Jr.—a longtime critic of pharmaceutical and food industry influence and a figure who recommended her nomination to President Trump.
Dr. Means’s brother, Calley Means, has also played a significant role in her rise. A close adviser to Secretary Kennedy and a special government employee in the Trump administration, Calley coauthored Good Energy with his sister and has appeared alongside her in numerous media interviews. Both siblings have become prominent voices decrying the role of the food and drug industries in shaping American health outcomes, arguing that lifestyle and environmental factors are at the root of the nation’s chronic disease burden.
Yet, it is precisely these unconventional views and her lack of traditional medical credentials that have fueled opposition to her nomination. Dr. Means does not currently hold an active medical license—her Oregon license lapsed in January 2024—and she never completed her surgical residency, both departures from the backgrounds of previous surgeons general. As former Surgeon General Jerome Adams wrote in a statement to NPR, “The Senate’s likely confirmation of Casey Means as Surgeon General, an individual who never completed medical training, would mark a disastrous precedent for the nation’s top public health role.” Adams argued that many fully trained, licensed physicians could lead the U.S. Public Health Service “with distinction,” suggesting that Means’s nomination reflected political pressure more than merit.
Other public health experts have echoed these concerns. Dr. Dara Kass, former regional director at HHS during the Biden administration, stated, “Casey Means has built her career attacking contraception, vaccines, and women’s autonomy—all while profiting from misinformation and wellness fads. The Senate should reject this dangerous, unqualified nominee.” Critics point to her promotion of wellness products, dietary supplements, and teas on social media—sometimes without adequate disclosure of financial interests, as found by The Associated Press. In response, Dr. Means signed an ethics agreement in September, pledging to resign from her advisory role at Levels and to stop promoting her book, newsletter, and monetized social media posts if confirmed.
Despite the criticism, some experts have urged a more measured approach. Marion Nestle, professor emerita of nutrition and public health at New York University, told The Associated Press that Means should be judged by her actions if confirmed, not solely by her incomplete residency. “She could take up ultraprocessed foods. That would be terrific,” Nestle said, though she cautioned against promoting supplements without strong scientific evidence. “I’m in favor of wellness. I’m not in favor of wellness products, because I don’t think there’s much evidence that they work.”
Dr. Means’s supporters, including Secretary Kennedy, have been effusive in their praise. Kennedy has said she will be “the greatest surgeon general ever,” while the Department of Health and Human Services has emphasized her “credentials, research background, and experience in public life” as assets that could help “make sure America never again becomes the sickest nation on Earth.” Her advocates argue that her focus on lifestyle, nutrition, and prevention could inject much-needed energy and innovation into federal public health policy. They also note that renewed attention on healthy diets and lifestyle is warranted, given the high rates of chronic illness in the U.S.
The surgeon general’s office, which oversees more than 6,000 members of the U.S. Public Health Service Commissioned Corps, has been without a permanent leader since the previous nominee’s withdrawal. In the interim, Secretary Kennedy has taken on many of the role’s public-facing duties, issuing advisories and reports on issues ranging from loneliness to chronic disease. Still, the absence of a permanent surgeon general leaves a gap in the nation’s health leadership at a time when public trust in science and medicine is under strain—and the debate over who should fill that role reflects broader divisions over the future of American health policy.
For now, the spotlight remains on Dr. Casey Means—not for her ideas or her critics, but for a far more personal milestone. As Senate staffers prepare to reschedule her hearing, the nation waits to see whether her unconventional path and outspoken advocacy will ultimately earn her the title of America’s top doctor.
