Casey Means, M.D., the White House’s nomination for surgeon general, faced questions on Capitol Hill today ranging from her stance on vaccine and birth control advocacy to her history within the wellness and metabolic health sphere.
Means, an entrepreneurial health and wellness influencer whose medical license was voluntarily placed on inactive status, was the administration’s second pick for the role and was initially set to appear before the Senate Health, Education, Labor and Pensions (HELP) committee in October. That confirmation hearing was postponed when she went into labor five hours before it began.
Now with a 17-week-old son, for whom a mid-hearing intermission was necessary, the prominent Make America Healthy Again figure brought to senators a plan to tackle chronic disease, increase the availability of healthy foods and restore trust in healthcare figures through transparency and informed consent.
“As surgeon general, I would call on every American and the public health service to join in a great national healing, one that halts preventable chronic disease, makes healthy living the easiest choice, honors the body’s connection to the environment and puts America back on the road towards wholeness and health,” she said at the close of her opening remarks.
Means noted that her broad vision is “economically sound, with the potential to save trillions of dollars annually.” She referenced a book she co-authored with her brother, lobbyist and Department of Health and Human Services (HHS) advisor Calley Means, in which she advocated reversing the country’s chronic disease burden “through personal empowerment, culture change, and policy reform.”
While lawmakers from both parties found substantial components of her message to be agreeable—restrictions on television advertisements for drugs or junk food, for instance—they pushed the nominee on her unusual background and whether she would stand by recommendations for vaccines. The latter comes amid federal agencies’ aggressive moves to curb immunization recommendations headed by HHS Secretary Robert F. Kennedy Jr.
When asked whether she would broadly recommend long-supported pediatric vaccines by several senators, including HELP's chairman and most likely swing vote Bill Cassidy, M.D., Means said she believes “vaccines are a key part of any infectious disease public health strategy” but repeatedly sidestepped a definitive response. Rather, she stressed that any parent should seek “informed consent with their doctor before getting any medication.”
Cassidy, later in the hearing, pushed back on Means’ repeated calls for “shared decision-making,” telling her that such discussions are already commonplace among pediatricians and asked whether she was advocating for something more, like formal informed consent for vaccines. Means responded that her greater concern is that physicians see too many patients and that such conversations aren’t occurring in a way that leaves parents confident, to which the senator appeared to remain skeptical.
Cassidy and Sen. Patty Murray, D-Wash., also questioned Means on her past comments regarding the availability of birth control, to which she again said she supports maintaining access as long as individuals have informed consent conversations with their doctors about potential side effects.
Means has previously critiqued the administration of hepatitis B vaccines to newborns and said that women are taking hormone-based birth control pills “like candy.”
On questions about whether she disagreed with substantial evidence that long-recommended vaccines such as DTaP for whooping cough are beneficial and do not cause autism, the nominee said she does “accept that evidence” while applauding the administration’s plans to launch new studies into vaccine-related adverse events and the causes of autism.
“We shouldn’t leave any stones unturned,” she responded to a question from Cassidy.
Sen. Bernie Sanders, I-Vt., the committee’s ranking member, told Means her responses on vaccines “were a little bit political and not to the point.”
“Just to be very clear … any anti-vaccine rhetoric has never been a part of my message,” she said in response to Sanders’ critique. “I don’t mention the word ‘vaccine’ in my book. This is not a part of my core message. I am not here to complicate the issue on vaccines. And also I, as a physician, am very careful with my words, and I don’t think it’s responsible to say that we’re not going to study when kids are getting many medications. I think it’s important to keep it on the table.”
Lawmakers said their questions on vaccine support are particularly relevant amid outbreaks of preventable diseases like measles and the promotion of vaccine skepticism.
The issues also play into the public’s trust in government as a health authority and are “especially important as HHS undergoes substantial personnel and policy changes,” Cassidy said. “Dr. Means, it should be your mission, and every HHS official, to restore stability and assure Americans that protecting health is the top priority.”
On that issue, Murray highlighted comments from Tracy Beth Høeg, M.D., Ph.D., now acting director of the Food and Drug Administration’s Center for Drug Evaluation and Research, that voiced skepticism about respiratory syncytial virus vaccines and other treatments. Høeg is also a leading figure on the reconfigured Centers for Disease Control and Prevention Advisory Committee on Immunization Practices who has authored presentations and reports that were recently used to pare back universal vaccine recommendations.
Means said she was unfamiliar with Høeg’s comments but would “certainly have absolutely no issue having very frank conversations with anyone in the administration if I believe their statements are misguided in some way or not fully informed. That’s not a conversation I would have publicly first—I would have a private and direct conversation with anyone in the administration if I felt that patients were at risk.”
Endorsements, disclosures questioned
Beyond her positions on public health issues and common medications, the nominee’s chief pushback came from senators who said her entrepreneurial background and product endorsements could sow doubt in the nation’s physician.
Means often promotes health and wellness practices and products via her substantial social media presence and is a co-founder of Levels, a tech company that tracks metabolic biomarkers via continuous glucose monitors paired with a consumer app.
Sen. Tammy Baldwin, D-Wis., pointed to Means’ disclosure that she had accepted $10,000 from Genova Diagnostics, asking her whether she was aware of the company’s $43 million settlement deal over allegations it had violated the False Claims Act when billing for medically unnecessary tests. Means said she was not aware of that settlement before promoting them online and that she did so because she found a nutrient quality test “very compelling.”
Baldwin said such a response “raises questions about your judgment and does not inspire confidence,” despite Means’ pledge to divest her relevant health and wellness holdings in coordination with the Office of Government Ethics. She went on to highlight disclosures of at least $325,000 from promoting supplements since 2024 and said a full, $1,500 annual membership fee at Means’ Levels is beyond many Americans’ means.
“You’ve said that our healthcare system is broken, but it seems to me that you’ve spent your career making money off the flaws of the system, and I’m wondering how the American people are supposed to trust you to put their health and safety first, and not profits,” Baldwin said.
Sen. Christopher Murphy, D-Conn., outlined Federal Trade Commission (FTC) guidelines that require online endorsements to disclose compensation. Murphy said the committee had verified Means “routinely violated” that policy in her social media posts for several products, including prenatal vitamin supplement WeNatal, lab testing company Function Health, subscription organic food service Daily Harvest and Genova Diagnostics.
“You seem to be in regular, willful violation of the FTC rules,” Murphy said. “That is concerning as someone who agrees with Senator Cassidy that our focus has to be on restoring trust in the medical profession. And yet over and over again, you seem to be, at scale, recommending products without telling your followers.”
“I don’t think that’s true, and if it … inadvertently has happened I would rectify that immediately,” she responded. “However, I would be interested to see how your staff gathered this data.”
Means requires a majority vote from the HELP committee before her nomination moves to the full Senate. Various committees have so far voted along party lines for health nominees from the current administration that made it to the panel, though Cassidy's vote for RFK Jr. (on the Senate Finance Committee) was contingent on vaccine-related promises the secretary has since broken. The physician-legislator has been more firm on his disagreement with RFK Jr. and his department's recent actions in that arena in recent months.