Casey Means, the RFK Jr.-allied wellness influencer Trump wants for surgeon general, isn’t anti-vax enough for anti-vax right 

President Donald Trump stocked his first term with characters out of Republican central casting. There was Vice President Mike Pence, the evangelical; Chief of Staff John Kelly, a Marine general; and Health Secretary Alex Azar, a corporate pharmaceutical executive, among others. Many, like Kelly, who after leaving the administration said Trump met the definition of a fascist, parted with the president on bad terms.

By contrast, Trump’s new crew is heavy on loyalists or right-wing media stars. There’s Defense Secretary Pete Hegseth, who had no experience managing a large organization before Trump tapped him to lead the Pentagon but liked to praise Trump on Fox News. There’s Robert F. Kennedy Jr., whose famous family uses words like “predator” and “dangerous” to describe him and his actions. He spent the COVID pandemic attacking vaccines and public health, all the while morphing from Democratic scion to Trump-world star. Some of Trump’s picks didn’t make the final cut, like MAGA diehard Congressman Matt Gaetz, whom Trump initially chose for attorney general but whose appointment was torpedoed by allegations of sexual impropriety with a minor. Given Trump’s reputation for elevating people from the MAGA (or MAGA-adjacent) fringe, it’s no surprise then that on Thursday the president looked past doctors with public health experience and chose, instead, for surgeon general, a wellness influencer who hawks supplements and tests.

In picking Casey Means, Trump replaced his first choice, Janette Nesheiwat, a doctor and Fox News contributor, after she appeared to have suggested she had received a medical degree from the University of Arkansas. In fact, Nesheiwat completed her residency there, but did not get a degree, which she received elsewhere. Right wingers also attacked Nesheiwat for her support of COVID-19 vaccines, with far-right activist Laura Loomer, for example, calling Nesheiwat a “pro-COVID vaccine nepo appointee.”

Means won’t face such criticisms. Unlike Nesheiwat, Means never completed a medical residency, and though she completed medical school, she does not have a medical license. And on vaccines, Means certainly won’t be out of place alongside Kennedy and the people he’s installed in the Department of Health and Human Services. She’s called for ending liability protections for vaccine manufacturers, for example, a policy supported by anti-vaccine activists. And she’s repeated the debunked suggestion that there is a link between vaccines and autism, telling podcaster Joe Rogan, “I bet that one vaccine probably isn’t causing autism. But what about the 20 that they’re getting before 18 months?”

According to the Centers for Disease Control and Prevention (CDC), “To date, the studies continue to show that vaccines are not associated with [autism spectrum disorder].” (Emphasis by the CDC.)

Means is the best-selling author, along with her brother Calley Means, of Good Energy, which purports to show the connection between “metabolism and limitless health.” The book is in keeping with Casey Means’s work in so-called “functional medicine,” which involves a personalized approach in which health care providers strive find the root cause of illness. “I am a medical doctor, writer, tech entrepreneur, and aspiring regenerative gardener who lives in a state of awe for the miracle of existence and consciousness,” Means writes on her website. “During my training as a surgeon, I saw how broken and exploitative the healthcare system is and left surgery to focus on how to keep people out of the operating room.”

Trump told reporters that it was Kennedy who pushed for Means’s nomination. “Bobby really thought she was great,” Trump said. “I don’t know her. I listened to the recommendation of Bobby.” Like Kennedy, Means promotes diet as the key to good health. Her “wish list” for the new presidential administration, published before last year’s election, included points on removing chemicals and toxins from the food supply, nutritious meals in schools, and warning labels on ultra processed foods—all points in line with Kennedy’s so-called “Make America Healthy Again (MAHA)” agenda.

In a darker echo of Kennedy, though, Means included on her list the goal of reforming liability protection for vaccine makers. “It is unconscionable that any pharmaceutical company should have blanket legal immunity from harm they are causing to Americans for medications that are mandated by the government in order for kids to do basic activities (like attend school) in some states,” she wrote.

A special government court hears alleged vaccine injury cases and compensates those who make and substantiate claims. No drug is entirely risk free, including vaccines, but compared to the number of vaccines administered, a vanishingly small number of cases have gone before the vaccine court; even fewer have resulted in payments to the petitioner. Between 2006 and 2014, 2.5 billion vaccinations were conducted, but only about 3,000 cases of alleged vaccine injury were considered by the court. Just over half of these ended with the petitioner receiving compensation. This means that just .00006 percent of vaccinations led to compensation by the court during that period.

The program was created after a TV show in the 1980s alleged DTP (diphtheria, tetanus and pertussis) vaccines were causing brain damage. Though vaccine makers left the market in the face of lawsuits, studies later showed that the vaccine did not cause long-term brain damage, according to the Children’s Hospital of Philadelphia. Congress created the liability protection and compensation program in 1986 to maintain a stable supply of vaccines and compensate any injured. Despite overwhelming evidence that Food and Drug Administration-approved vaccines are safe and highly effective, greatly reducing the incidence of serious disease, anti-vaccine activists like Kennedy have targeted the vaccine liability program as unwarranted protection for pharmaceutical companies that produce vaccines.

Means has also advocated revisiting the efficacy and safety of childhood vaccines, something experts say is dangerous amid growing concern that diseases like measles could proliferate amid an under-vaccinated population.

Means’s stances apparently haven’t gone far enough for the anti-vaccine right, though, perhaps complicating her path toward confirmation. “[S]he’s an impostor, she’s a plant, airdropped into the movement to change the narrative so you don’t talk about vaccines,” Mike Adams, who manages the conspiratorial far-right site Natural News, said on a livestream. “Instead you talk about this other stuff—seed oils or whatever.”

Means would enter the job with much different background than that of Trump’s first-term surgeon general, Jerome Adams. Adams completed a residency in anesthesiology and is a licensed medical doctor. Before joining the first Trump administration, he led Indiana’s public health agency. During the COVID pandemic, he became a staunch advocate of vaccines and public health measures such as masking. In post on the X social media platform, Adams seemed to question Means’ qualifications to be surgeon general. He cited a US law saying that the surgeon general must be a member of the Regular Corps of the US Public Health Service, for which, Adams wrote, physicians must be licensed and have special training or significant experience in public health programs.

“I can only speak for me, but I was a licensed and practicing physician with a masters degree in public health, and had previously run the Indiana State Department of Health for 4 years,” Adams wrote. “As the Senate is considering confirmation, it is important that historical precedent, the ability to effectively lead the USPHS, and the law, are all taken into consideration.”

Means’s field of functional medicine has gained acceptance in some quarters of the medical establishment, including at the prestigious Cleveland Clinic, but some experts and critics deride it as pseudoscience and a vehicle to sell  unproven supplements. “’Functional medicine’ preaches the ‘biochemical individuality’ of each patient, which is why one of its key features is that its practitioners order reams of useless lab tests and then try to correct every abnormal level without considering (or even knowing) what these abnormalities mean, if anything,” wrote Wayne State University cancer biologist David Gorski, who edits the site Science-Based Medicine. “So they make up fake diagnoses and profit.”

Indeed, Means’s website provides links to buy a dizzying number of tests and supplements, including to one company that promises to “empower you to live 100 healthy years,” presumably by paying $499 a year for “100+ lab tests.“ That’s “5x more tests than an avg physical,” the company’s site proclaims.

Regardless of whether functional medicine is scientifically rigorous, and putting aside Means’s personal medical qualifications and views on vaccines, Means and Kennedy, both passionate about fighting chronic disease, may face obstacles ahead. The president’s recent budget proposal slashes funding for the prevention of diabetes, Alzheimer’s, and other chronic conditions that both talk so much about.