Only one part this Friday.
The president announced Casey Means, MD, would be his nominee for Surgeon General of the United States hearings in the middle of 2025. The US Senate began considering her nomination this week. The back and forth has been interesting. Where to begin? First we can start with the previous nine permanent Surgeons General, beginning with the Carter Administration. Each of these men and women were accomplished board-certified physicians with relevant and wide-ranging medical and/or administrative experience. [1]
Julius B. Richmond was the pediatrician instrumental in integrating psychiatry into pediatrics.
Everett Koop was Surgeon-in-Chief at Children’s Hospital of Philadelphia. From 1946 to 1981, Dr. Koop was the leading pediatric surgeon at one of the best children’s hospitals in the world.
Antonia Novello was a pediatric nephrologist and a Project Officer at the National Institutes of Health.
Jocelyn Elders was a pediatrician and Director of the Arkansas Department of Health
David Satcher was an academic physician who served as president of Meharry Medical College and as an administrator at the Centers for Disease Control and Prevention.
Richarda Carmona was a surgeon at the University of California-San Francisco and an experienced medical administrator.
Regina Benjamin was a family physician and accomplished administrator.
Jerome Adams was a noted anesthesiologist and Indiana State Health Commissioner.
Vivek Murthey was an internist at Brigham and Women’s Hospital, which is affiliated with Harvard Medical School.
Casey Means attended Stanford University School of Medicine. After graduation she began a residency in Otolaryngology (ENT) at Oregon Health & Science University in Portland. As recounted in her book Good Energy: The Surprising Connection Between Metabolism and Limitless Health (2024), she left her residency before finishing because she felt she was only treating disease rather than preventing it. She also reports that at Stanford she and her fellow students were not taught the causes of disease, only how to treat them. This is simply not believable. We have discussed this before, most extensively in Make America Healthy Again: Is MAHA a Trope or a Movement?
Casey Means has inevitably become a “thought leader” in the MAHA movement. After leaving her residency she opened a Functional Medicine practice for a while. She currently lacks a valid, active medical license. Means is also a principal behind the company Levels, which among other interventions recommends all people wear a continuous glucose monitor (CGM) despite little to no evidence that this is useful for a person without diabetes or other serious metabolic condition. It is expensive, though, and unlikely to be covered by health insurance. Thus, this intervention cannot be viewed as a serious solution to the chronic disease burden in the United States, despite the exhortations of the current Secretary of Health and Human Services.
So, does it matter that Casey Means never finished her graduate medical education that would have permitted her to become a practicing physician? This is a non-trivial question. From this account of her hearing from The Hill this past Wednesday (February 25th):
Means would be an unprecedented pick, not having completed her medical residency or having an active medical license. She is the sister of White House senior adviser Calley Means, one of Health Secretary Robert F. Kennedy Jr.’s top advisers, and a prominent “Make America Healthy Again” influencer in her own right.
Former surgeons general have spoken out against her nomination. Trump’s former Surgeon General Jerome Adams said of Means, “I feel strongly that the person who is leading America’s Public Health Service should be held to the same standard as the people he or she is leading.”
It is difficult to argue with Dr. Adams. One does not have to die to write an obituary, but it seems quite reasonable to expect the leader of American medicine have the same qualifications of those she is leading. In this case it apparently would be unprecedented, whatever her academic accomplishments.
Then there are a few other classic MAHA moments that come out of the Senate hearing, including vaccinations:
As with many of Trump’s health nominees, senators on both sides of the aisle zeroed in on Means’s views on vaccinations. Means sought to characterize her previous rhetoric about vaccines to be more about informed consent rather than questioning vaccine efficacy.
Sen. Bill Cassidy (R-La.), chair of the HELP Committee (and the Senator who clinched the approval of Robert F. Kennedy Jr. as Secretary of Health and Human Services), asked whether Means would encourage mothers to get their children vaccinated against measles, given the ongoing measles outbreaks across the country and the U.S. poised to lose its measles elimination status.
(From the nominee) “Like you, I’m a physician (probably not in California, where the law seems to say that only a licensed medical doctor can represent herself as a physician). I believe vaccines save lives. I believe that vaccines are a key part of… any infectious disease public health strategy,” Means said. “I’m supportive of vaccination. I do believe that each patient, mother or parent needs to have a conversation with their pediatrician about any medication they’re putting in their body and their children’s body.”
When pressed by Cassidy, however, Means declined to say if she’d encourage other mothers to get their children vaccinated against measles.
This is all complete MAHA nonsense. The nominee is referring her to the concept of informed consent as a cover for her waffling on vaccines. This has been an effective trope of the MAHA movement for a long time, something like “talk to your doctor to see if the measles vaccine is right for your children.” While there are good and sufficient reasons that a very few people should not be vaccinated, the logic and consistency of Means’s position is belied by the story of young Ethan of Spartanburg, South Carolina, from The Independent:
Six weeks ago, Ethan was like most 7-year-olds — spending the weekend riding his new bike or playing Minecraft on his iPad on a rainy day.
“He just learned how to ride, he got the hang of it right away,” Ethan’s dad, Luis, said proudly. “He wanted to go outside because he wanted to jump on his bike…it was an amazing thing for him.”
Instead, since late January, the schoolboy has been confined to a hospital bed with measles encephalitis, a complication that causes swelling and inflammation in the brain. “He’s pretty much as if he was paralyzed,” his devastated father, 41, told The Independent in a phone interview from his son’s hospital bedside.
Ethan’s parents decided not to immunize him against measles as they did with his three brothers. Three out of four of them contracted measles. Still, despite Ethan’s ordeal, his mom stands by their decision. “We’re not blaming God for this,” said 35-year-old Kristina. “Yes, it hurts, of course, it hurts. But God has chosen Ethan for a reason. God is doing something, and we’re gonna glorify his name regardless.
This is where the anti-vax nonsense of Robert F. Kennedy Jr. and MAHA leads. And it is simply impossible to believe that Casey Means doesn’t fully understand this. Measles injures permanently and sometimes kills. But another trope of MAHA is that “only children who are already sick” will have Ethan’s outcome. So, I suppose this is Ethan’s fault, or his parents’. And no, God is not responsible for Ethan’s illness. That lies in other places, beginning with Andrew Wakefield (who begat RFKJr, the anti-vaxxer), and the measles virus took advantage of an opening, to anthropomorphize a very dangerous pathogen. By the way, Casey Means also hemmed and hawed about the Hepatitis B vaccine, knowing full well that there is no evidence this vaccine is harmful when given to infants. But she also knows that Hep B is easily transmissible in a daycare setting and that (1) there is no treatment for Hep B and (2) that those infected are likely to suffer severe liver disease by middle age, including liver cancer.
Jumping to another issue, Casey Means was asked about previous comments in which she has said that contraception is “disrespectful of life.” From Mediaite:
In the past, Means has criticized the dispensing of contraceptives “like candy” and hyped the risks of the pill, as well as repeated several variations on the “disrespect of life” theme.
Means faced a confirmation hearing on Wednesday before the Senate Committee on Health, Education, Labor, and Pensions. The controversial nominee faced several contentious exchanges, including with Sen. Murray.
The nominee replied that these comments are taken out of context. But she does have a valid point about doctor-patient conversation and understanding about this. Yes, oral contraceptives do have side effects as all women and their doctors know. But no, they are not “dispensed like candy. There is nothing new here from Casey Means except dissembling:
SENATOR PATTY MURRAY (D-WA): I’m curious if you are with the FDA that went through all of these and rigorously looked at them, or as Surgeon General, if you’re going to tell the truth to the American people.
CASEY MEANS: I absolutely believe these medications should be accessible to all women.
And also, all medications have risks and benefits, and in our current medical climate with the burden on doctors, we do not have, doctors do not enough time for thorough informed consent conversations.
Some of the horrifying side effects of birth control that I have mentioned include blood clots and stroke risks in women who have clotting disorders, who are smokers, who have obesity–.
This is perhaps a new MAHA trope to me. And it doesn’t take much political awareness to know where this is coming from. But the risks and benefits of oral contraceptives are not hidden.
From The New York Times:
Dr. Means also showed her unorthodox side. When Senator Susan Collins, Republican of Maine, pressed her on her past use of the hallucinogen psilocybin, also known as magic mushrooms, she said she was grieving her mother’s death, and looking for healing, when she took it.
“I do believe that Americans are ready to hear about spirituality when it pertains to medicine,” Dr. Means said. She said that as surgeon general, she would not advise Americans to take the drug, though she cited “exciting work” into its potential benefits. “The science is still emerging,” she said.
It is true that psychedelics may have their uses, and if this country were not so self-righteous this research would be part of the mainstream. If psilocybin helped Casey Means deal with the death of her mother, good for her.
But the nonserious side of MAHA is also illustrated here:
Wednesday’s hearing unfolded during a precarious time for the MAHA movement. The White House has made clear that it wants Mr. Kennedy to pivot away from discussing vaccines to focus on his healthy eating agenda going into the midterm elections.
At the same time, Mr. Trump’s recent executive order promoting production of the weedkiller glyphosate — a possible carcinogen that has been the target of thousands of lawsuits — has infuriated the so-called MAHA moms who power Mr. Kennedy’s movement. (evidence that glyphosate is a carcinogen is strong)
Senator Ed Markey, Democrat of Massachusetts, pushed Dr. Means to disavow the president’s executive order. She spoke of her respect for American farmers and said that changing the agricultural landscape overnight would be devastating for both farmers and consumers. The Trump administration, she said, is making “good faith movement toward moving our system toward regenerative agriculture.”
She has previously called moving away from industrial agriculture practices that use toxic pesticides “the SINGLE most important strategy” for solving health and environmental issues, and called the use of pesticides a “slow-motion extinction event.”
No argument from me about industrial agriculture. And we certainly cannot wake up tomorrow and begin eating local again. Casey Means is right about that. However, it is impossible to see any “good faith movement toward moving our system toward regenerative agriculture” in the current administration. Talk is cheap. But this has been a problem with the Uniparty for the past sixty years, which we discussed earlier this week. Both sides do it, and the Trumpian reprieve for glyphosate is just another item in a long list. Good faith has nothing to do with it.
For those with the time and energy, Casey Means’s appearance on the Joe Rogan Experience with her brother Calley just about covers it all, especially her “going with the Rogan flow” on vaccines and the vaccine schedule (another major MAHA irritant that nevertheless has banished many infectious diseases from childhood). Their performances are very good.
Still, there is something more at work here, and this was covered here yesterday in From Fed Failures to Inflation and Stablecoins: America’s Trust is Cracking. It is not difficult to see how this applies to Casey Means as Surgeon General. Yes, she graduated from medical school, a very prestigious medical school at that. And yes, for a while she had a valid medical license to practice as an intern and ENT-in-training. The latter indicates she did well in medical school, because the competition for ENT residency positions is sharp. But she did not finish and she lacks a medical license now. There is scant evidence she has ever managed an organization of any appreciable size or had any extensive administrative experience. How is it that we should have trust in someone who has not demonstrated she has ever been a trustee of any organization, much less something as large and important as American medicine? Her waffling about vaccines certainly does not engender trust in her knowledge or judgment, except in the anti-vax MAHA universe.
The same is true of Jay Bhattacharya, who is the current Director of the National Institutes of Health. He, like Casey Means is a graduate of Stanford, including an MD and a PhD in economics. Dr. Bhattacharya (by way of his PhD) never completed his medical education, either. He apparently went straight from his MD to the PhD and has never treated patients except as a third- and fourth-year medical student under the direct supervision of a licensed physician. He has received NIH support for his work in the economics of healthcare and he has published papers in the field. But he has never been a physician or a scientist. Yet he is responsible for the largest and most productive biomedical research organization in the world. Nevertheless, he has apparently never done an experiment or managed a laboratory. [2]
A successful Assistant Professor of Biochemistry who has gotten grant support for his research and managed a laboratory consisting of several graduate students who have received their PhD, two technicians, and a gaggle of undergraduates has more relevant scientific and management experience than the economist Dr. Bhattacharya. Without going into the utterly spurious nature of the Great Barrington Declaration, why should we trust him to do his current job? But CDC staffers, where he is the current acting director may be enthusiastic because he may endorse the measles vaccine. But is this reason for trust? Or is it more a case of “hand, grasp straw”? And how does this square with the Surgeon General designee’s current view of the measles vaccine as a matter of an ill-considered version of informed consent?
Anyway, ‘tis a mess and the way forward seems to be a path of full of brambles with sharp thorns. But as the Rabbi said, while we as citizens are not required to finish the work, neither are we free to desist from it.
Notes
[1] To obtain a license to practice medicine independently in the United States, a medical school graduate with an MD (or DO) must complete a course of graduate medical education (internship plus residency in the specialty of choice). These include, among others, pediatrics, general surgery, family medicine, internal medicine, psychiatry, anesthesiology, obstetrics and gynecology. Specialists such as cardiologists, nephrologists, and medical oncologists complete a residency in internal medicine before completing their specialty graduate medical education. The ENT residency began but not finished by Casey Means-MD is a rigorous five years.
[2] Scientists of my acquaintance have complained that RFKJr is Secretary of Health and Human Services but has no scientific experience. They forget that most HHS Secretaries have been politicians. On the other hand, previous Directors of the National Institutes of Health have been physicians or physician-scientists and have presided over research that has led to at least 29 Nobel Prizes in Physiology or Medicine and several more in Chemistry, as we have discussed here before.
Source:
www.nakedcapitalism.com