The United States has been operating without a Senate-confirmed Surgeon General for an unusually long stretch, relying on officials serving in an acting capacity since January 20, 2025. The last to receive full Senate confirmation was Dr. Vivek Murthy. Now, the nomination of Dr. Casey Means, put forward by the Trump/Kennedy administration, faces mounting challenges and appears increasingly likely to fail, raising questions about the future of public health leadership in the country. The confirmation process for the nation’s top doctor has been stalled for over a year, since May 2025, and recent developments suggest the nomination is in serious jeopardy.
The concerns surrounding Dr. Means extend beyond typical political maneuvering. While nominees often face scrutiny, the issues with Means’ candidacy are particularly unusual, centering on her professional background and public statements. She currently works as a “wellness influencer,” a role that has drawn criticism given the scientific rigor expected of the Surgeon General. Further complicating matters, Means has not completed a medical residency and does not hold a medical license in any state, raising questions about her qualifications to advise the nation on health matters. This nomination for the Surgeon General of the United States has become a focal point of debate.
Confirmation Hearing Raises Red Flags
Dr. Means recently appeared before the Senate Health Committee for her confirmation hearing, and by most accounts, it did not proceed well. Several Republican senators have publicly expressed doubts about her suitability for the role, with Senator Bill Cassidy (R-La.) emerging as a key figure in the growing opposition. According to reporting from Ars Technica, Senators Susan Collins (R-Maine), Lisa Murkowski (R-Alaska), and Thom Tillis (R-N.C.) as well voiced concerns during the hearing.
Senators Bill Cassidy (R-La.), Susan Collins (R-Maine), Lisa Murkowski (R-Alaska), and Thom Tillis (R-N.C.) all expressed concern in a confirmation hearing last month about her potential role and appear to remain doubtful. Just one of those senators may be enough to block her nomination from advancing beyond the Senate Health Committee.
Afterward, Senators Collins and Murkowski both said they still had questions. Murkowski also said she had “strong reservations” about Means’ nomination and that, as of last week, that opinion hadn’t changed, according to the Post.
The issues raised during the hearing were multifaceted. Senators pressed Means on her views regarding vaccines, but she largely avoided providing direct answers, leaving them uncertain about her position on a critical public health issue. Questions were also raised about her qualifications, given her lack of current clinical practice. Her career as a wellness influencer, where she has promoted dietary and lifestyle approaches to health—often echoing claims made by Robert F. Kennedy Jr.—and marketed supplements, also came under scrutiny.
Beyond Conventional Concerns: “Good Energy” and Alternative Practices
The criticism of Dr. Means extends beyond standard qualifications and policy positions. A book she co-authored with her brother, titled Good Energy, has been described by some as the “MAHA bible” (Making America Healthy Again, a slogan associated with Kennedy’s health policies). The book contains a chapter titled “Trust Yourself, Not Your Doctor,” a sentiment that clashes with the traditional role of a Surgeon General as a trusted medical authority. The Washington Post reports that Means has also faced questions about her past writings, which include discussions of taking psychedelic mushrooms, consulting a “spiritual medium,” and participating in “full moon ceremonies.”
While the use of psychedelics is a topic of growing scientific interest, the prospect of the nation’s top health advisor openly discussing such practices raises eyebrows for many. The situation highlights a broader tension between conventional medical approaches and alternative wellness philosophies.
A Pattern of Misrepresentation?
The difficulties surrounding Means’ nomination come amid growing scrutiny of Robert F. Kennedy Jr.’s own statements during his confirmation hearings as Secretary of Health and Human Services. Critics allege that Kennedy made misleading claims regarding his views on vaccines and other public health issues. The current situation with Means’ nomination has led some to believe that Kennedy may have misrepresented his intentions to key senators, such as Bill Cassidy, in order to secure his own confirmation. Now, Kennedy needs Cassidy’s support to confirm his chosen candidate for Surgeon General.
As one observer put it, Cassidy may be unwilling to be “fooled again,” suggesting a reluctance to support Means after feeling misled by Kennedy in the past. The dynamic underscores the political complexities surrounding the nomination and the potential for lingering distrust between the administration and key members of Congress.
The lack of a Senate-confirmed Surgeon General for an extended period has implications for the nation’s public health infrastructure. The office plays a crucial role in communicating health information, addressing public health crises, and providing guidance on important health issues. Without a permanent leader, the office’s ability to effectively fulfill these responsibilities is diminished.
The Senate Health Committee is expected to vote on Dr. Means’ nomination in the coming weeks. The outcome remains uncertain, but the growing opposition suggests that her confirmation is far from guaranteed. The committee’s decision will have significant implications for the future of public health leadership in the United States. Updates on the nomination process can be found on the Department of Health and Human Services website.
Disclaimer: This article provides information about a pending political nomination and does not offer medical or political advice.
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