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 and appearances on high-profile podcasts.
But her medical license has been inactive since 2019, according to , which could become an issue in her confirmation.
In announcing that Means would replace his initial choice, had "impeccable 'MAHA' credentials." Her brother, Calley Means, is 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 mirror 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 X that she had "been promised" that neither of "these siblings would be working under HHS or in an appointment." Others who have of Trump and Kennedy have also 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 . "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, . 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 post-graduate work to qualify for. She opened a functional medicine practice — a branch of alternative medicine that focuses on treating the cause of disease rather than the symptoms. She also founded a continuous glucose monitoring company, called Levels.
Former surgeon generals weigh in
Her resume, and lack of an active medical license, are concerning to those who've 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 , 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 a professor of health law at UCLA.
"The modern position functions more like a health-communicator-in-chief," he 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, 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 prove to be an issue.
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 .
It's possible that 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 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. , a former Fox News contributor, how she had represented her medical credentials, as first reported by. 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 to replace Weldon as his nominee.
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