President Trump's new pick for U.S. surgeon general could have a bumpy road to confirmation as she faces pushback on multiple fronts — not least from figures within the Make America Healthy Again, or MAHA, movement.
Dr. Casey Means has gained prominence in the wellness scene over the past year, with the publication of her book Good Energy and appearances on high-profile podcasts.
But her medical license is currently inactive, according to public records from Oregon, which could become an issue in her confirmation.
In announcing that Means would replace his initial choice, Trump said she had "impeccable 'MAHA' credentials." Her brother, Calley Means, is also an adviser to Health and Human Services Secretary Robert F. Kennedy Jr.
Much of her messaging around America's ailing health care system and chronic disease mirrors that of Kennedy, who has declared that she was "born to hold this job."
Not everyone in the MAHA ranks seems to agree, though.
Kennedy's former running mate during his presidential run, Nicole Shanahan, said on the social media platform X that she had "been promised" that neither of "these siblings would be working under HHS or in an appointment." Others who have been supporters of Trump and Kennedy have also voiced their displeasure with Means, in part because she's not been vocal enough against vaccines.
The backlash even inspired Kennedy to come to her defense.
On Thursday, he took to social media to call the attacks "absurd" and seemed to pin the blame on the industries he's targeting, rather than his own camp.
"The goal of MAHA is to reform the largest and most powerful industry in the United States," he wrote on X. "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," Kennedy wrote.
"She will be the best Surgeon General in American history."
Means has undergraduate and medical degrees from Stanford University, according to her website. In her book and public appearances, she has recounted how she left a surgical residency at Oregon Health & Science University because she'd become disillusioned with mainstream medicine.
Even though she didn't finish her residency, Means did enough postgraduate work to qualify for a medical license in Oregon. She opened a functional medicine practice — a branch of alternative medicine that focuses on treating the cause of disease rather than the symptoms — and founded a continuous glucose monitoring company, called Levels.
Former surgeon generals weigh in
Her resume is concerning to some who have held the position in the past.
"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," says Dr. Richard Carmona, who served as U.S. surgeon general under President George W. Bush.
"We don't see any of that here. So I think that our nation deserves better."
The role of surgeon general has changed dramatically since its inception when the position had significant regulatory powers to issue federal public health orders, says Lindsay Wiley, a professor of health law at UCLA.
"The modern position functions more like a health-communicator-in-chief," she says.
The surgeon general must be appointed from the Commissioned Corps of the U.S. Public Health Service and have "specialized training or significant experience in public health programs," according to the statute.
In response to the nomination, Dr. Jerome Adams, who held the position during Trump's first administration, pointed out that historically the surgeon general has been "required to be a licensed physician."
"As the Senate is considering confirmation, it is important that both historical precedent … and the law, are all taken into consideration," Adams wrote to NPR in an email.
Medical license issue
It's possible Means' inactive medical license may hold up her nomination.
The nominee can be appointed to the corps first and then to surgeon general, but being in the corps requires having an active license.
"As a Commissioned Corps officer of the U.S. Public Health Service, keeping professional licensure and certifications up-to-date is mandatory," the federal website states.
Means could get her license reactivated in Oregon, where she used to practice, or another state, though questions remain about whether that could be accomplished quickly.
"A medical license requires that the individual maintains her medical knowledge through mandatory continuing medical education," said Lawrence Gostin, professor of global health law at Georgetown University,
"She is not licensed and therefore should be ineligible to become surgeon general of the United States," he said.
However, Gostin and other legal experts contacted by NPR said the Trump administration may be able to change the policy or use some other administrative maneuver to allow Means to be eligible for the post.
Means is replacing nominee Dr. Janette Nesheiwat, a former Fox News contributor, following scrutiny over how she had represented her medical credentials, as first reported by independent journalist Tony Clark. Nesheiwat also faced criticism from the right for not being critical enough of vaccines.
Trump's original nominee to head the Centers for Disease Control and Prevention, Dr. David Weldon, was also pulled after it was clear he did not have enough votes in the Senate to clear the nomination process. Trump picked acting CDC Director Susan Monarez to replace Weldon as his nominee.
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