Surgeon general nominee faces sharp questions

NEW YORK (AP) — Wellness influencer, author and entrepreneur Dr. Casey Means on Wednesday shared a vision for addressing the root causes of chronic disease instead of feeding into "reactive sick care" during her confirmation hearing to become the nation's next surgeon general. "Our nation is angry, exhausted and hurting," the 38-year-old said in Washington before the Senate health committee Wednesday. "If we're addressing shared root causes, we're going to be able to stop the whack-a-mole medicine that's not working for us." It's a message that dovetails with that of Means' ally, Health Secretary Robert F. Kennedy Jr., and his "Make America Healthy Again" movement. It also has some bipartisan support, with many Democrats and Republicans agreeing that the rise in chronic disease is a problem that needs solving. But Means also faced tough questions from senators about topics that have become divisive in recent years, such as vaccines and hormonal birth control, as well as about her qualifications and potential conflicts. The Stanford-educated physician's disillusionment with traditional medicine drove her to a career in which she has promoted various products, at times without disclosing how she could benefit financially. She has no government experience, and her license to practice as a physician is not currently active. "I have very serious questions about the ability of Dr. Means to be the kind of surgeon general this country needs," Vermont independent Sen. Bernie Sanders, the ranking member of the Senate health committee, said Wednesday. Next, the committee will consider whether to advance Means' nomination, in which case it would go to a vote in the full Senate. Senators grill Means on vaccines As the nation's doctor, the surgeon general is a leader for Americans on public health issues. If confirmed, Means could issue advisories that warn of public health threats. She also would be tasked with promoting Kennedy's sprawling MAHA agenda, which calls for removing food additives, rooting out conflicts of interest and promoting healthier eating. Surgeons general also have sometimes used the office to advocate on issues related to vaccination — though the office has no role in creating vaccine policy. While Means has largely steered clear of Kennedy's debunked views on vaccines, senators from both parties grilled her on how she would approach the issue if confirmed. Sen. Bill Cassidy, the Louisiana Republican who chairs the Senate health committee, asked Means whether she would advise Americans to vaccinate against flu and measles amid outbreaks across the U.S. She didn't make that commitment, instead emphasizing the importance of informed consent between patients and doctors. Cassidy, a doctor himself, then asked Means whether she believes vaccines may contribute to autism, a claim that Kennedy has embraced despite overwhelming research to the contrary. "I do accept that evidence," she said, referring to the research. "I also think that science is never settled." Means said she looked forward to seeing the results of a federal effort to study environmental contributors to autism. The National Institutes of Health is funding such research, and it's not clear when those findings will be made public. Means also was asked about concerns she has raised about the birth dose of the hepatitis B vaccine, which the U.S. Centers for Disease Control and Prevention stopped recommending for all children in a move criticized by scientific and medical groups nationwide. She said she supports the CDC's approach to the birth dose, but that promoting universal vaccination against the disease "at some point in childhood" was worthwhile. Senators scrutinize Means' past comments on birth control, psychedelics Washington Democratic Sen. Patty Murray asked Means to address her past comments that birth control pills were being prescribed "like candy" and showed a "disrespect of things that create life." Means said she thinks oral contraceptives should be available to all women, but raised concerns about what she called "horrifying side effects" that can occur in certain populations. "Doctors do not have enough time for a thorough informed consent conversation," she said. According to the American College of Obstetricians & Gynecologists, hormonal birth control methods such as the pill, patch or ring are safe for most people but are associated with a small increased risk of deep vein thrombosis, heart attack and stroke. The risk is higher in some people, such as smokers older than 35 or those who have multiple cardiovascular disease risk factors. Sen. Susan Collins, a Republican from Maine, noted that Means had touted the therapeutic use of psychedelic mushrooms in her book and tried them herself. "What I would say as a private citizen is in many cases different than what I'd say as a public health official," Means replied, adding she wouldn't recommend psychedelics for the public. Means isn't a traditional candidate for the role During the hearing, Means said her goal is to "get more whole, healthy foods on American plates." It's a worldview she developed during her unconventional path in the medical field. After graduating from Stanford University with a doctor of medicine degree, Means dropped out of her surgical residency program at Oregon Health and Science University in 2018. She later cited her belief that the health care system was broken and exploitative as the reason for her withdrawal. Means then turned to alternative approaches to address what she has described as widespread metabolic dysfunction driven largely by poor nutrition and an overabundance of ultraprocessed foods. Because she had completed enough postgraduate training to obtain a medical license, she did so and started her own functional medicine practice in Oregon, which later closed. She co-founded Levels, a nutrition-, sleep- and exercise-tracking app that can give users insights from blood tests and continuous glucose monitoring. Financial disclosures show she made hundreds of thousands of dollars promoting wellness products, including specialty basil seed supplements, teas and elixirs, probiotic products and a prepared meal delivery service. An Associated Press investigation found that while recommending these products, she at times failed to disclose that she could profit or benefit from the sales. Senators on Wednesday questioned Means about some of those cases. She said the claims were incorrect, and that she takes conflicts of interest seriously. In an ethics filing, Means said that if she is confirmed, she will resign from her Levels position and forfeit or divest stock options and stock in the company. She also pledged to stop working for Rupa, a specialty lab work company for which she developed an online course. While she may continue receiving royalty payments from her book "Good Energy," she will not promote it, the filing said. The filing also noted she will "not acquire any direct financial interest in entities listed on the Food and Drug Administration's prohibited holdings list." At least two previous surgeons general have publicly suggested Means is not fit for the job. Last May, former Bush administration surgeon general Dr. Rich Carmona wrote that Means' professional qualifications "raise significant concerns." Later that month, President Donald Trump's first-term surgeon general, Dr. Jerome Adams, wrote on social media that the surgeon general's traditional leadership of the U.S. Public Health Service Commissioned Corps requires a medical license. Means is seeking to join an administration for which her brother, Calley Means, already works. As a senior adviser to the U.S. Department of Health and Human Services, he has helped promote the Republican administration's warnings about ultraprocessed foods.