President Trump’s selection of Dr. Casey Means, a Stanford-educated wellness specialist and book author, as his next surgeon general provoked a vigorous debate on Thursday over whether someone who is not a practicing physician should serve as the nation’s top doctor.
Laura Loomer, the far-right activist who holds so much sway with Mr. Trump that more than a half-dozen national security officials were fired on her advice, emerged as a vocal critic. So did Nicole Shanahan, Health Secretary Robert F. Kennedy Jr.’s former running mate, who called the choice “very strange.”
Dr. Means, a close ally of Mr. Kennedy’s, trained as a surgeon in otolaryngology — ear, nose and throat medicine — but left her surgical residency after four years to practice “functional medicine,” which focuses on the root causes of disease. She has said she was disillusioned with the medical establishment, and had concluded it was failing patients.
Ms. Loomer ridiculed Dr. Means on social media Thursday, calling her a “total crack pot” who “USES SHROOMS AS ‘PLANT MEDICINE’ AND TALKS TO TREES!” and “DOESN’T EVEN HAVE AN ACTIVE MEDICAL LICENSE.” As evidence, Ms. Loomer posted excerpts of Dr. Means’s weekly newsletter, in which Dr. Means muses on recipes, product recommendations and other topics, including “mindset shifts and habits.”
Mr. Kennedy pushed back hard with a lengthy post on X, calling the criticism “absurd,” while Mr. Trump told reporters that he did not know Dr. Means, but picked her because “Bobby thought she was fantastic.”
Dr. Means’s brother, Calley Means, a White House adviser on health issues and former food industry lobbyist, defended his sister in an interview.
“Casey has inspired millions of Americans and is a threat to the status quo because she left the medical system, not in spite of it,” Mr. Means said.
He added that the family had been shocked when she left her residency, “but she had a clear moral insight that her patients were not getting better.”
Under federal law, the surgeon general oversees the Commissioned Corps of the U.S. Health Service, the uniformed service that works on the front lines of public health.
There are just two requirements for the job: the nominee must be a member of the Corps (usually the president simply appoints a candidate before he or she takes the job) and must have “specialized training or significant experience in public health programs.”
Dr. David A. Kessler, a former head of the Food and Drug Administration who also served as dean of the medical schools at Yale and the University of California, San Francisco, said in an interview that while there may be legitimate reasons to criticize Dr. Means, not having a current medical license was not among them.
The main question, Dr. Kessler said, is whether a surgeon general is “well-trained” in medicine. If Dr. Means finished four years of residency, he said, “she is very well-trained.”
Major medical groups were largely silent on the appointment. Neither the American Medical Association nor the American Public Health Association issued statements. But Arthur L. Caplan, a prominent medical ethicist at New York University, called the appointment “irresponsible.”
“Appointing Casey Means, a non-practicing doctor who has spent years peddling unproven ‘health interventions,’ means a surgeon general that will put a fringe practitioner of unproven functional medicine in charge of educating the American people about their health and disease challenges,” Dr. Caplan wrote in an email.
Noting that Mr. Kennedy has called for placebo-controlled trials of vaccines, Dr. Caplan said the health secretary should apply the same scientific rigor to the type of functional and alternative remedies Dr. Means favors. “Without data it is akin to having her run Newark airport without radar or radio,” he wrote.
The Means siblings are both media-savvy wellness entrepreneurs. Calley Means is the founder of Truemed, a startup that enables tax-free spending on supplements, exercise and healthy food. Casey Means is the founder of Levels, a company that offers subscribers wearable glucose monitors to track their health.
Her embrace of holistic therapies has drawn some eye rolls in the press. Rolling Stone called her a “woo-woo wellness influencer.”
Dr. Means rose to prominence last year after she and her brother appeared on Tucker Carlson’s show to promote their diet and self-help book, “Good Energy,” which argues that metabolic dysfunction is at the root of a chronic disease epidemic.
Mr. Kennedy said on X that Dr. Means’s ability to “inspire Americans to rethink our health care system” was “an existential threat to the status quo interests, which profit from sickness.” In an interview with Fox News, he said she had “galvanized” his “Make America Healthy Again” movement.
Like Mr. Kennedy, Dr. Means has repeatedly said that America is in the midst of a chronic disease crisis. She has pointed to rising rates of infertility, obesity, diabetes, depression and other conditions as proof. Also like Mr. Kennedy, she has suggested that environmental toxins and the food system are to blame.
Mr. Trump’s appointment of Dr. Means came as a surprise. He announced it on Wednesday after withdrawing the nomination of his previous choice, Dr. Janette Nesheiwat, who was to appear before the Senate health committee on Thursday.
Dr. Nesheiwat, an urgent care physician and former Fox News commentator, is the sister-in-law of Michael Waltz, who served as Mr. Trump’s national security adviser until last week. She had faced criticism that she was less than forthcoming about her credentials; Ms. Loomer complained that Dr. Nesheiwat was not “ideologically aligned” with the president.
The surgeon general has no real authority to set policy; the power of the job is in the platform and in the surgeon general’s reports. The landmark 1964 report on tobacco led to warning labels on cigarette packages. Dr. C. Everett Koop, one of the nation’s best-known surgeon generals, used the office to advocate for patients with AIDS at a time when his fellow Republicans were ignoring the disease.
Dr. Vivek Murthy, who served as surgeon general in the Obama and Biden administrations, spoke out about loneliness and mental health.
Dr. David Perlmutter, an ally of Dr. Means’s whose work focuses on the intersection of nutrition and neurological disorders, said the most important quality for any surgeon general is the ability to communicate science to the public.
Dr. Means, he said, “excels at that.”
