If Casey Means becomes Surgeon General, Expertise Is Officially Optional
The U.S. Government is ready to replace scientific expertise with wellness influencer raw milk nostalgia in one of our country's most important public health roles.
This newsletter is free, but consider supporting a biomedical scientist trying to combat the war on health by upgrading to a paid subscription.
The Surgeon General Is Supposed to Be the Nation’s Doctor, Not Its Wellness Influencer
Let’s start with a basic question:
What qualifications should the Surgeon General of the United States have?
Historically, the answer has been boring, which is a good thing. Practicing physicians and public health leaders with deep experience (think decades-long careers) in clinical medicine, epidemiology, or health system leadership. People trained to critically evaluate evidence, communicate nuance and uncertainty responsibly, and make recommendations that will impact hundreds of millions of people.
The Surgeon General’s job is simple but serious:
To translate robust, well-supported, and credible scientific evidence into clear, population-level guidance that protects millions of people all at once–that’s public health.
Casey Means’ nomination is incredibly alarming. The issue here isn’t just that she’s unqualified. It’s that the US government is willing to replace scientific expertise with influencer credibility when it comes to national health leadership. Casey Means’ sole public health contribution has been to tell healthy people to obsess over blood glucose and reject scientific innovations that objectively improve quality of life.
We haven’t just lost the plot: our Federal government has failed us.
Casey Means has Zero Credentials to Serve as Surgeon General.
Casey Means is routinely described as a “Stanford-trained physician,” a phrase doing a lot of work. Our media outlets and our ranking government officials should know better. What’s almost always omitted is that she didn’t finish medical residency and hasn’t practiced as a board-certified physician. Casey Means graduated medical school. That’s it. She has an MD, a degree conferred to everyone successfully completing 4 years of medical school.
Quick note: part of my PhD requirement was teaching clinical courses to medical students. I can tell you (as would all responsible MDs) that graduating medical school does not equip someone to practice medicine, much less make medical recommendations to over 330 million people.
Medical residency is not a bureaucratic technicality. It’s where newly-minted MDs learn clinical decision-making under uncertainty, evidence-based treatment standards for their specific narrow field of expertise, patient risk management, and real-world medicine in practice.
Casey started an ENT residency (ear, nose, and throat, or officially, otolaryngology), a 5-year surgical program focused on head, neck, and plastic surgeries. Casey dropped out of that program 4 years in, later claiming she was disillusioned with the failures of medicine. That, my friends, is utter bullshit. An ENT residency is far less exposed to the failures of our for-profit healthcare system than family, emergency, pediatrics, OB/GYN, or internal medicine. The point is:
Casey has never practiced medicine independently.
She is not Board-Certified in any medical field.
She is also not a scientist.
She has not conducted medical or scientific research.
She has not led any large-scale public health initiatives.
She has not demonstrated any expertise in public health.
Her residency program had nothing to do with metabolic health or endocrinology, yet she positions herself as an expert in that field.
Means was cynical about the for-profit healthcare industry, so she probably got involved in philanthropy and public health efforts, right? Wrong.
Means co-founded a for-profit wellness company called Levels.
Totally sounds like something someone would do if they wanted to better people’s health, right?
This pivot is important.
Casey Means is a Wellness Influencer, not a Public Health Leader
The deeper issue is that wellness entrepreneurship and public health are diametrically opposed.
Public health aims to minimize harm across all populations using infrastructure and systems that benefit the whole. Wellness businesses monetize perceived optimization gaps of an individual person by convincing you health is solely your responsibility.
Wellness businesses treat health as an individual optimization project that can be monetized: if you just track your “biomarkers,” have a perfect diet, buy recommended products and engage in certain behaviors, then you’ll have health perfection. It positions health as your responsibility, and if you’re unwell, well that’s your fault.
In Casey’s world, pull yourself up by your bootstraps, find an extra $300 a month, and buy what she’s selling you, literally.
Public health is opposite this: it focuses on systemic population-level measures that improve health outcomes regardless of an individuals “optimization” status. Clean water. Plumbing. Vaccinations. Food Safety. These things prevent illness and death whether someone got a full 8 hours of sleep or ate 30 grams of fiber every day.
The Surgeon General is not a podcast personality or a wellness profiteer. The Surgeon General’s job is not to promote unfounded personal biohacking measures. It’s to protect the health of our entire population through evidence-based policies.
The fact that Casey has zero relevant credentials for Surgeon General should have been immediately disqualifying. Yet, here we are.
Selling Medical Anxiety As Preventive Health
Casey and her brother Calley love to scream about the “overmedicalization” of Americans, yet are the ones directly contributing to it. As mentioned, Means founded a for-profit wellness company called Levels.
Levels sells continuous glucose monitors (CGMs) to non-diabetics, paired with an expensive app that requires a monthly subscription fee, plus a myriad of auxiliary services like meal plans, and supplement recommendations. Conveniently, you can buy all these products directly through Levels or through her brother Calley’s wellness company, TrueMed.
The premise of Levels? That tracking blood glucose when you don’t have diabetes will help you “optimize” your health and longevity.
The problem? Multiple studies have shown that tracking blood glucose via CGMs for those without diabetes doesn’t offer a health benefit. Unsurprisingly, continuous blood glucose monitoring in non-diabetics demonstrates that the overwhelming majority of readings fall within the normal physiological range (70-140 milligrams (mg) glucose per deciliter (dL) of blood). In other words? Those metabolic systems are functioning properly already.
That’s why actual medical experts, including all major medical and endocrine professional organizations, don’t recommend it.
When you eat (anything), your body senses and responds in a way that enables you to function optimally and maintain a relatively constant balance. That is called homeostasis. Non-diabetics have normal and expected fluctuations in blood glucose, or excursions, within a well-characterized range between 70 and 140 milligrams (mg) glucose per deciliter (dL) of blood. This is tightly regulated by your organ systems, especially the insulin-producing ꞵ-islet cells of your pancreas.
So if you’ve got a functioning pancreas, you don’t need to add stress to your life by trying to track and hack blood glucose. Yet the wellness industry messaging around CGMs tries to convince you that:
normal glucose fluctuations are harmful
common foods are metabolically dangerous and your diet must be constantly ‘optimized’
Constant biological surveillance is essential for health
In their world, normal physiology is pathology-adjacent. This is medicalization disguised as empowerment. Casey Means and her colleagues do this, not because they care about your health, but because they want to monetize your fear of worse health. Let’s not even mention that it’s difficult to “hack” your blood glucose and runs the risk of malnutrition or disordered eating.
Public health aims to reduce unnecessary medicalization. Wellness influencers do the opposite–they fabricate medical issues, convince you to medicalize essential bodily processes, and monetize it. The Surgeon General should be reducing health anxiety, not normalizing it, and certainly not profiting off of it.
Casey Means Doesn’t Know What “Root Cause” Means
A core theme of Means’ public messaging is that metabolic dysfunction underlies most chronic diseases. That’s the premise of her and her brother’s book, Good Energy. Ironically, neither of them have any expertise in endocrinology, cell biology, or physiology, but I digress. This concept sounds plausible, because metabolism is important. But it’s an egregious oversimplification they use to sell false promises.
This is a hallmark of pseudoscience: using oversimplified nuggets of truth to make claims sound credible. It’s reused and recycled: adrenal fatigue, leaky gut, food sensitivities, and toxic mold syndrome all leverage the same tactic (click the links to read more detail on those). Casey routinely legitimizes these other adjacent pseudoscience claims, too.
Let’s be absolutely clear:
Chronic disease is a huge catchall that includes conditions like cancers (hundreds of diseases themselves), lifestyle diseases, neurodegenerative disorders, autoimmunity, and more. Lumping chronic disease into a single bucket is flawed to begin with, but more than that, chronic disease is multifactorial and influenced by:
genetics
aging demographics
improved survival of premature infants
infectious disease history
healthcare access
socioeconomic factors
lived environment
public policy
medical innovation and technologies (including improved survival of vulnerable populations)
Much of these are under the umbrella of social determinants of health – yet that has never been a topic of discussion for Casey.
Casey claims we don’t focus on “root causes” in science and medicine, but since she’s an expert, she knows that ALL medical issues are related to metabolism–not even metabolism, but just blood glucose excursions. She’s got the solution too: buy her glucose monitor and app!
I guess she missed the fact that literally all of science and medicine is based on identifying and addressing root causes – it’s called etiology. Maybe she slept through that lecture in medical school.
Let’s talk about some root causes:
The root cause of over 90% of cervical, anal, penile, oropharyngeal, vulvar, and vaginal cancers are HPV viruses (yes, it ISN’T JUST causing cervical cancer).
The solution? The HPV vaccine. Yet Casey Means demonizes this incredibly effective and safe preventive medicine.
The root cause of dental caries is demineralization of dental enamel, which occurs when normal mouth bacteria acidify your mouth through metabolizing food molecules.
The solution? Fluoride. Fluoride integrates with dental enamel and enables it to tolerate a more acidic environment, not only strengthening enamel but expanding the protection range. Yet Casey Means demonizes public water fluoridation, held by legitimate experts as one of the top public health achievements of modern medicine.
The root cause of type 1 diabetes is an inappropriate immune response where immune cells destroyed those insulin-producing ꞵ-cells in your pancreas. That’s one of the ~90 currently identified autoimmune disorders. Ironically, the immune-mediated destruction creates a metabolic disorder where someone with T1D does actually need to track blood glucose to supply their body with the insulin their pancreas no longer produces, but this one isn’t gonna be fixed with Casey Means’ app, either. It needs actual medical intervention, not wellness vibes.
I could go on, but I already wrote a long piece on “root cause” as a topic. Casey Means doesn’t know anything about root cause, but she and the rest of the wellness industry has co-opted this fundamental of biomedical science to sell snakeoil.
Real root cause medicine is based on science, not wellness disinformation.
Investigating root causes is how we’ve discovered what causes countless diseases: acute and chronic, infectious and non-communicable.
Raw Milk and Romanticizing The Days Before Modern Medicine
Here’s another: The root cause of milk-borne illnesses are pathogenic microorganisms found in the feces (and digestive tracts) of cows.
The solution? Pasteurization. One of the most successful public health interventions merely involves heating milk to 161°F for 15 seconds to inactivate nearly all disease-causing bacteria, protozoa, and viruses found in milk. Yet Casey Means promotes consuming raw milk and legislation to relax sale of disease-ridden dairy products.
Encouraging people to consume raw milk isn’t a weird lifestyle habit—it’s about eschewing centuries of scientific innovation that enables humans to live longer and healthier lives.
Romanticizing “natural” food systems while minimizing well-documented risks ignores centuries of public health progress built on microbiology knowledge. This is the same microbiology that underlies all infectious disease prevention, from hand washing, food safety, water treatment, and vaccines. This behavior is not just anti-science, it puts people at risk for illnesses we shouldn’t be contending with, because we solved the root causes already.
The Surgeon General should be explaining why pasteurization works, not spreading dangerous narratives that food safety is optional.
Casey Means Hides Anti-Vaccine Rhetoric in Plain Sight
Casey Means does not brand herself as anti-vaccine, but don’t be fooled. Today, the modern anti-vaccine movement is framed as:
emphasizing metabolic health and lifestyle as superior immune protection over vaccination
amplifying “natural immunity” narratives without proportional discussion of risk of infectious disease
portraying chronic illness patterns as a failure of modern medical systems rather than a consequence of preventing infectious diseases
This messaging shifts people’s risk perception and erases the notion that health is a societal issue, and we should act with shared responsibility.
Population-level control of infectious diseases depends on vaccination rates, not personal wellness status. High vaccination coverage reduces the amount of spread of microorganisms at a population level, thereby reducing the number of people who will get sick, the number of severe outcomes, the number of deaths. These large-scale health impacts are irrelevant to whether someone eats perfectly, sleeps optimally, or tracks glucose fluctuations.
Measles isn’t back in the US because people aren’t eating as much spinach as they did in 2000. Measles is back because people aren’t getting vaccinated anymore.
When influential figures in the public sphere claim individual optimization is the primary protection against infectious disease, the public then believes that vaccines are secondary and optional. This belief is directly linked to declining vaccine confidence and vaccination rates.
The Surgeon General must unequivocally strengthen confidence in vaccines, not discourage safe and effective measures that prevent premature disease and death. There is no ambiguity in the scientific evidence when it comes to vaccinations, and anyone who suggests there is is not equipped to have a health leadership role.
This Appointment Is About More Than Casey Means: It’s What Happens when Expertise is Replaced by Vibes
The Office of the Surgeon General led anti-smoking campaigns during immense cultural and political resistance. It normalized HIV prevention amidst fear and stigma. It shaped vaccination confidence across decades. These successes have saved millions of lives. But to get buy-in from Americans, they required credibility that was earned through expertise, backed by robust scientific evidence.
Now, if someone talks about health confidently enough and has a large enough social media following, they qualify as a national health authority, even if what they say is objectively wrong. Even if what they say already harms millions of people–and will harm even more if they are installed as a shaper of national health policy.
If our Senate confirms Casey Means as Surgeon General, the United States government will be signaling that scientific expertise is no longer required for scientific leadership. At that point, we are no longer debating health policy. We are redefining what counts as expertise.
When a country replaces evidence with wellness vibes, it doesn’t just lose good guidance. It has officially detached itself from reality.
The more our government normalizes influencer rhetoric, the less reversible the damage will be. Now, leadership roles that should demand the utmost experience, knowledge, and authority will be selected based on how viral their social media following is. Influence can substitute for experience. Narrative can substitute for evidence. Wellness ideology supersedes rigorous science.
We are seeing the consequences already.
Lower vaccine uptake, distrust of credible experts and healthcare professionals, endorsement of pseudoscience, delayed treatments for medical issues. This adds up to worse health outcomes, increased strain on an already flawed and strained healthcare infrastructure, and more preventable illness and death. You won’t see it happening on an individual level until it’s too late to put the horse back in the barn. We’ve been watching this unfold for the last several decades. Now that we are stacking our highest levels of public health leadership with conspiracists and contrarians, expect it to accelerate.
And importantly: real experts become easier to dismiss as just another opinion. Audience size is not the same as expertise. But public health dies when expertise stops mattering. And public health decisions impact millions who don’t get to opt out of the consequences.
Public health is not biohacking. It’s not metabolic optimization. It’s definitely not raw milk nostalgia. Public health is not a lifestyle brand. And the Surgeon General should not be a wellness influencer.
As usual, you're spot-on. Casey Means as Surgeon General would be a national health embarrassment. As with RFK Jr, both do not know how much they do not know. Their health and nutrition literacy are extremely poor -- more evidence of their lack of qualification for his post and her nomination. But in this administration, the ONLY qualification is that you be on board with whatever the HHS Secretary and DJT are promoting. And your willingness to submit to a polygraph and sign an NDA. Frankly, ANYONE willing to do all three should be automatically disqualified.
I would go a step further... experience is not only optional, it is a mark against you. RFK has no experience and in fact one might argue based on his rhetoric that he is unqualified. Means certainly has no experience and i would argue unqualified. Both work in a direction diametrically opposed to what the department is supposed to do. look no further than one of the biggest departments and budgets placed in the hands of a cameo Fox news host, no military experience, no budget, no experience in national defense or strategy.... now we can turn to homeland security where we replace the dog killer with a person who's qualifications were listed by the president as a good maga supporter and a MMA fighter... this is the hallmark of authoritarians... get rid of outside experts... the authoritarian becomes the expert... use Clorox, dewormer medications, and light to kill covid.. use nuclear weapons to break up hurricanes.. you cannot make this stuff up... we are putting the health of millions at risk with RFK and Means, putting the health of millions at risk by pulling out restrictions on air pollution, water pollution, mercury, glyphosate etc etc etc... i grow angrier by the day at the people who were so stupid to vote for trump, the people who did not vote for Harris (or even my cat for that matter) to try to prove some point, and those that stayed home and sat on their hands...