Surgeon general nominee Means: America’s ‘mental and physical health are unraveling,’ but can be fixed

A physician’s advice to a particular patient supersedes the surgeon general’s advocacy about medical decisions involving vaccines, birth control and other medical treatments, according to the nominee for surgeon general.

Casey Means, M.D., testified in a confirmation hearing before the Senate Committee on Health, Education, Labor and Pensions. In her comments, Means said she agreed that vaccines save lives, but stopped short of supporting use of the surgeon general’s pulpit to encourage vaccinations. More important is informed consent built on conversations between patients and doctors about the best courses of prevention or treatments for individuals, she said.

Means praised the agenda of the Make America Healthy Again movement that influenced the policies of the U.S. Department of Health and Human Services under Secretary Robert F. Kennedy Jr. The secretary and President Donald J. Trump “have invited a mature, candid, grand conversation about how our medical education and fixing perverse incentives can pull us back from the brink, and for this, I am profoundly grateful,” she said.

The nation’s next doctor

A graduate of Stanford University School of Medicine, Means touted her experience and training as preparation to serve as America’s doctor. She said she has worked as a clinician, researcher and instructor on biomedical research around blood sugar dysregulation, nutrition and health.

“Mental and physical health are unraveling from shared root causes that we can fix,” Means said. “Preventable heart disease, our number one killer in men and women, is emblematic of a nation with a broken heart. Diabetes, representing cellular energy collapse, is draining our human potential. Dementia, depression and neurodevelopmental decline reflects a society losing its mind. Our bodies are telling us this current path is totally unsustainable.

“There is another way, a path that unites rigorous science with reverence for our miraculous bodies and planet, and brings Americans and our medical institutions together around actual healing and prevention,” Means said. “This path is also economically sound, with the potential to save trillions of dollars annually.”

Family in the Senate

Means, a surgical otolaryngologist, is co-author of “Good Energy: The Surprising Connection Between Metabolism and Limitless Health.” Her brother, Calley Means, is co-author of the book and is an adviser to U.S. Department of Health and Human Services under Kennedy. Calley Means attended the hearing along with their parents, Means’ best friend, sister-in-law, and cousin, and Means introduced them during a brief break in questioning. When her nomination was made public last year, there was social media buzz about her relationship status, and Means also introduced “my incredible better half and husband,” Brian Nickerson.

Current issues: What are Means’ stances?

HELP Committee Chair Sen. Bill Cassidy, M.D. (R-La.), pressed Means about whether she would encourage mothers to vaccinate their children against measles.

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

Cassidy asked a similar question about patients getting inoculated against flu.

“At the risk of sounding repetitive, I do think it's very important as a physician and to rebuild trust in public health to make sure that patients are encouraged to have informed consent with their doctor before getting any medication,” Means said. “I believe vaccines save lives. I believe they're an important part of public health. I also do not want to not encourage patients to have a conversation with their doctor. I think it's incredibly important, and informed consent is going to be part of building trust in public health.”

Vaccines and autism?

Cassidy represents Louisiana, which is experiencing a whooping cough outbreak. He asked about Means’ position about vaccination and some patients’ reluctance “because they've been told incorrectly that vaccines cause autism.”

“Do you believe that vaccines, whether individually or collectively, contribute to autism?” he asked.

“The reality is that we have an autism crisis that's increasing, and this is devastating to many families, and we do not know as a medical community what causes autism,” Means said. “The administration has just committed a huge amount of funding to look at the exposome of all environmental factors that could be contributing to autism, and until we have a clear understanding of why kids are developing this at higher rates, I think we should not leave any stones unturned.”

Cassidy said, “There's been a lot of evidence showing that they're not implicated. Do you not accept that evidence?”

“I do accept that evidence,” Means said. “I also think that science is never settled, and … I think that the effort to look at comprehensive, cumulative exposures of our exposome into what is causing autism is important, and I look forward to seeing those results and sharing the best public health information with the American people.”

Birth control questions

Cassidy also asked about mifepristone and other birth control drugs, and Means confirmed the importance of women talking to their physicians about those drugs, which may be prescribed for years without follow-up.

On ‘junk food,’ TV ads and Big Pharma

Means found common ground with Ranking Member Sen. Bernie Sanders (I-Vt.) in supporting bans on television advertisements for ultraprocessed foods and on pharmaceuticals. Means noted it is not in the surgeon general’s jurisdiction to control TV advertising.

“But you have a voice,” Sanders said.

“Absolutely, and that's a voice I would absolutely lend to talking about the dangers of ultra processed foods and getting these advertisements off TV. This has long been a part of my message,” Means said.

She elaborated and used a neologism to describe the foods fed to children: “About 65 to 70% of the calories that our children are eating are ultraprocessed Franken-foods made in factories that are so disconnected from their origin, source and nutritional value that, you know, we're putting just nutritionally devoid food in our children. And then we wonder why we have an obesity crisis in children, and why chronic diseases are rising as early as toddler years.”

Sanders said the nation gets people sick, then spends a fortune trying to keep them alive, and called those important areas of agreement with Means.

Seeking better health care

Means was less definitive when Sanders asked about a potential connection between vaccines and autism. She noted vaccine advocacy or antivaccine rhetoric has never been part of her public message.

When asked if health care is a human right, Means did not answer yes or no. The United States spends more on health care than any other nation, and has worse outcomes — a point Means and Sanders agreed on.

“But is health care a human right? Will you join meet in fighting for a national health care program?” Sanders asked.

“I will be by your side trying to get Americans access to the best health care in the world,” Means said.

A licensed physician

Means has a medical license in Oregon; its current status is “inactive,” but with status effective as of Jan. 1 through Dec. 31, 2027, according to the Oregon Medical Board as of Feb. 25. Sen. Andy Kim (D-N.J.) asked about Means’ professional qualifications, such as the ability to prescribe medicines to patients. Means noted she voluntarily placed her license in “inactive” status, and did not plan to reactivate her license because she would not see patients in the role.

Means would be leader of the U.S. Health Public Health Service (USPHS) Commissioned Corps, with more than 6,000 public health professionals. Kim said rules require that leader to keep licenses and certifications up to date. Means said USPHS Head Adm. Brian Christine, M.D., assistant secretary for health, has testified she is eligible to serve in the post. Kim said the signal being sent should be looked at.

Additional questions

Sen. Markwayne Mullin (R-Okla.) railed against Sanders, calling him part of the problem in the worsening of the U.S. health care system, due to Sanders’ and Democrats’ support of the Affordable Care Act

Murray asked about the availability of birth control; Means said she supports women’s access to it, but warned there are potential side effects from birth control or any medicine. Sen. Tommy Tuberville (R-Ala.) spoke about the importance of nutrition, and Means said that with shifting attitudes, now is the time to make a generational change in nutrition and education about it.

Sen. Tammy Baldwin (D-Wisc.) asked about Means’ business and promotional connections and affordability of healthy food, prescription drugs and housing. Sen. Jon Husted (R-Ohio) asked about Means’ views on pesticides, and had a poster showing earworms eating corn on the cob. Means said she has respect for America’s farmers, who are in an impossible situation because the U.S. agricultural system depends on toxic chemicals to have an affordable food supply. Overnight change is impossible, but human health dangers of herbicides and pesticides must be examined as part long-term change toward a more sustainable, healthy growing system, Means said.

A dream for the role

Sen. Roger Marshall, M.D. (R-Kan.), asked about Means’ passions and how those would influence her leadership. Means homed in on her “dream for this role.”

“My dream for this role is first and foremost to help nudge, push, inspire our health care system towards focusing on root causes and the reasons why we're getting sick, moving towards a real health care system, and not just a reactive sick care system, which is, of course, also going to lower costs monumentally and unburden, I think, American taxpayers and doctors,” Means said.

Americans should have affordable, real and nutritious food, and scientists must study the cumulative health burden of exposures to chemicals in food, water, air, soil and the products people put in and on their bodies, Means said.