Casey Means Faces a Confirmation Test Over Vaccines, Credentials, and Conflicts
Trump’s surgeon general nominee defends her record as senators question her vaccine messaging, medical qualifications, and past business ties.
Guidance versus deflection: vaccine questions in a job built for clarity
Food, metabolic health, and prevention: where the room found common ground
From wellness entrepreneur to federal megaphone
Casey Means, President Donald Trump’s nominee for U.S. surgeon general, told senators on Feb. 25 that she believes “vaccines save lives,” then declined to say she would recommend routine measles and flu shots for children. The careful hedging, framed as deference to individual doctor-patient decision-making, turned a confirmation hearing into a test of something more basic than ideology: whether the nation’s next top public health voice will deliver clarity when the moment demands it.
Means, who earned her M.D. at Stanford but did not complete her residency and is neither board-certified nor currently licensed to practice, later reinvented herself as a wellness entrepreneur and MAHA-aligned influencer. She is now asking the Senate to entrust her with one of the federal government’s most symbolically powerful megaphones: the office responsible for issuing public health advisories and helping lead the U.S. Public Health Service Commissioned Corps.
Her confirmation hearing yesterday before the Senate Health, Education, Labor and Pensions Committee became a referendum on a central tension of the Trump administration’s health agenda under Health Secretary Robert F. Kennedy Jr.: the push to recast American health around chronic disease, food, and “root causes,” colliding with the unglamorous fundamentals of public health, especially clear, evidence-based vaccine messaging during outbreaks.
For supporters, Means’ appeal is obvious: she can speak about diet, ultra-processed food, and chronic disease in language that travels. She has the kind of reach traditional public health leaders can only envy. For critics, the worry is equally plain: a surgeon general who treats uncertainty as a brand aesthetic, and who has profited from wellness marketing, risks turning federal health communication into another affiliate funnel, or worse, could confuse public health messaging at the exact moment the job requires clarity.
Guidance versus deflection: vaccine questions in a job built for clarity
The sharpest exchanges involved not chronic disease, but immunization. The issue is politically radioactive in the MAHA ecosystem, and operationally unavoidable for the nation’s top public health messenger. As committee chair Sen. Bill Cassidy, a physician, warned at the outset, the surgeon general has a responsibility to counter rising vaccine skepticism.
Means repeatedly declined to make what senators were seeking: a clear, public-facing recommendation that Americans vaccinate against measles and flu amid outbreaks. When asked whether she would recommend measles shots for children, Means replied, “I’m not an individual’s doctor, and every individual needs to talk to their doctor before putting medication in their body.” She leaned on the language of informed consent and individualized decision-making, even as she said broadly that “vaccines save lives.”
The surgeon general’s job is to communicate clearly to the American public. And encouraging patients to talk with their doctors is appropriate. But a surgeon general can’t just punt to personal doctors. Many people don’t have primary care doctors. And even if you have a doctor you see regularly, you can’t make an appointment to talk to them every time you have a question, especially in a public health crisis. Answering those kinds of questions is literally the surgeon general’s job.
Then came autism, the topic that has become the moral litmus test of vaccine politics. Means refused to explicitly say vaccines do not cause autism. “We do not know as a medical community what causes autism,” she said. She told senators “no stones should be left unturned” in the search for causes, even as Cassidy pressed her to combat misinformation.
In November, Secretary Kennedy instructed the CDC to remove a long-settled conclusion from its website stating that vaccines do not cause autism. Senators explicitly tied Means’ nomination to the administration’s shifting approach to vaccine guidance, including hepatitis B. Means called the hepatitis B vaccine “very important,” while also aligning with the administration’s movement away from universal birth-dose recommendations. She said universal vaccination “at some point in childhood” was a “worthy goal.”
To critics, this pattern is the core risk: a communicator who sounds measured in isolation but, in practice, leaves discredited claims just open enough for misinformation to take root. To supporters, it is the opposite: a reset toward patient autonomy and skepticism of institutional overreach. Either way, it is exactly the sort of communication choice that can steer public behavior at scale, which is the surgeon general’s assignment.
The health risks of pregnancy versus contraception
Senators questioned Means about the safety of hormonal birth control, particularly the risk of stroke. That risk exists, but it is very low roughly 18 strokes per 100,000 women per year among women not on hormonal birth control versus about 39 per 100,000 among women on hormonal birth control in a large recent cohort study. Risk is higher among smokers, women over 35, and those with hypertension or migraine with aura, and lower with progestin-only methods or hormonal IUDs.
What often goes unstated is that pregnancy is dangerous.
In 2021, the U.S. pregnancy-related mortality rate reached 37 deaths per 100,000 births. Cardiovascular disease is a leading cause, and roughly 60% of these deaths are considered preventable. The stroke risk associated with pregnancy, about 30 per 100,000, exceeds that of most modern low-dose contraceptives.
If the concern is women’s health, the math is clear: unintended pregnancy poses a greater threat than contraception.
A conflict is a conflict: profit motives and public trust
Even if Means’ views satisfied every senator in the room, her business history raises a second kind of credibility question: not what she believes, but what she has profited from encouraging others to believe.
Means used affiliate links and “partner” coded links to promote a wide variety of products, including items sold via Amazon, from which she earned a small percentage. A product guide with “two dozen affiliate or partner links” had no disclosures. Means also promoted Function Health products without disclosing her investment or advisory relationship.
Influencers are required by the Federal Trade Commission to clearly disclose material relationships when promoting products, and disclosure must appear with the promotion.
Means’ business ties also intersect with policy in a more direct way. Levels, a company she co-founded that sells subscriptions linked to continuous glucose monitoring, could benefit from federal health guidance.
The surgeon general is supposed to persuade skeptics, not give them a reason to ask who is paying for the persuasion.
Means has promised guardrails. She pledged to resign from her Levels position and divest or forfeit certain holdings. She also pledged to stop working for Rupa, a specialty lab company, and not to promote her book, even as she may continue receiving royalties.
Still, the basic reputational dynamic is hard to reverse: once a health voice has spent years speaking inside a monetized ecosystem, every future message gets filtered through questions about conflicts of interest, fairly or not.
Food, metabolic health, and prevention: where the room found common ground
Means’ strongest case is the one she made in her opening statement: the United States is buckling under chronic disease, and the country’s health conversation has become reactive and fragmented. She called America “the most chronically ill high-income nation in the world,” argued that “today’s children are projected to live shorter lifespans than their parents,” and framed chronic illness as a public health crisis “robbing our children of possibility” while draining the federal budget.