Casey Means lacks the right stuff to be America's top doctor

Casey Means, a wellness influencer, entrepreneur, and physician, this week tried to convince the Senate Health Committee that she is up to the task of serving as the U.S. Surgeon General.

Her equivocating on basic health issues, particularly vaccines, did not inspire confidence that she is.

It might feel like a symbolic role — after all, the surgeon general doesn’t directly set policy. But the issues the nation’s top doctor chooses to focus on set the tone for health conversations around the country. We should want someone in the job whose views are grounded in science.The surgeon general’s advice to Americans on everyday health decisions has heft. For example, amid the "tripledemic" of flu, COVID and RSV that sent many Americans — particularly kids — to the hospital during the winter of 2022, former Surgeon General Vivek Murthy made sure to alert the public to the threat. He also unambiguously recommended vaccination. "I would urge parents to please get your children and get yourself vaccinated for COVID and the flu," he told Good Morning America.

If confirmed to the role and faced with an outbreak, would Means be similarly inclined? Virginia Sen. Tim Kaine got to the heart of the issue by asking her about comments made last month by Robert F. Kennedy Jr., the Health and Human Services secretary. He falsely claimed there is "no scientific evidence that the flu vaccine prevents serious illness, hospitalizations, or death in children."

Means repeatedly dodged the question, refusing to plainly state the truth: Decades of evidence show the flu vaccine is very good at keeping people out of the hospital and preventing death. After significant pressing from Kaine for a straight answer, Means finally conceded that it has benefits "at a population level."

Note the careful crafting of that reply. While Means allows that the flu vaccine might be good for the public at large, the implication is that it might not be good for you. It was one of many times during this week’s hearing when she equivocated on the subject of vaccines, including for measles and hepatitis B. She also left open the door to the disproven link between vaccines and autism by suggesting the issue merited further study. (It has already been extensively studied.)

Means justified her refusal to offer straightforward advice on vaccines by stressing the need for doctors to talk to their patients about the risks and benefits of any intervention. So-called "shared decision making" is the only way to restore public trust in health institutions, she said. She made a similar argument when pressed on her stance on birth control and on antidepressants during pregnancy, two topics about which she has made controversial comments.

Means was echoing an argument used by Kennedy and other health agency heads to upend vaccine policy in the US. Yet, as Louisiana Sen. Bill Cassidy pointed out, providers routinely talk to their patients about vaccines — it’s a fundamental part of their practice. Cassidy, who was a practicing physician before entering Congress, ought to know. (Means, meanwhile, did not complete her medical residency and does not have an active medical license.)

Means stressed that vaccines would not be a core part of her agenda if confirmed as surgeon general. Unfortunately, infectious diseases have a way of spreading no matter who is in office. Americans deserve a surgeon general who can offer the public a clear, evidence-backed message about how best to protect themselves. Vaccine shots are backed by decades of evidence across billions of people-and the nation’s top doctor shouldn’t hesitate to say so.

Her goal seemed to be to redirect the conversation to more politically palatable topics — namely, addressing chronic disease and improving the food system in the US. Yet, there, too, Means does not inspire confidence.

She has billed herself as fighting for safer, healthier food and against a health care system designed to profit from sickness, rather than address the root causes of disease. Means has frequently criticized researchers, doctors, and health agencies for taking money from the pharmaceutical industry.

That all sounds laudable, and certainly Means is hitting on issues that resonate with people of all political persuasions. But her motivations need closer examination.

As a wellness influencer, Means used her social media platform and widely-distributed newsletter to recommend products that she says she has personally vetted. However, an AP investigation found that Means had repeatedly failed to disclose that she was receiving compensation for promoting certain brands.

As an entrepreneur, Means tried to sell consumers on the concept of using continuous blood glucose monitors, devices more typically used for people with Type 2 diabetes, to better understand their metabolic health. The goal, she wrote on her company’s website, is to "alert us to early dysfunction, coach us on how to eat and live in a way that promotes Good Energy in our unique bodies, and promote accountability." But, as I’ve explained in the past, the concept of tracking blood sugar in healthy adults isn’t backed by evidence.

As Wisconsin Sen. Tammy Baldwin succinctly put it, "You’ve said the health care system is broken, but it seems like you’ve spent your career making money off the flaws in the system."

The job of the surgeon general, according to the Department of Health and Human Services, is to provide Americans "with the best scientific information available on how to improve their health." At her hearing, Means did not convince me that she will do that.

Like many others in the MAHA orbit, she has drawn the public in by focusing on a commonsense idea: Americans deserve healthier, safer food and a health care system centered on prevention. But her actions suggest she isn’t interested in offering real, evidence-backed solutions. Ultimately, that sounds a lot like we would be trading one flawed system for one that’s even worse.

This column reflects the personal views of the author and does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners. Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.