The Make America Healthy Again movement’s infiltration of federal health policy took another step forward last week when President Donald Trump nominated Dr. Casey Means, a “metabolic health evangelist” and an ally of Health Secretary Robert F. Kennedy, Jr. to be his surgeon general.
If confirmed by the Senate in the coming weeks, Means will hold one of the most visible public health roles in the country, and would be set to boost Kennedy’s vision for remaking the nation’s approach to health and wellness.
But who is Means? And where does she fit in the broader MAHA space?
Like Kennedy, she is an insider turned outsider: She graduated from Stanford Medical School but dropped out of her residency program in 2019 shortly before completing it because she came to view the health care system as “exploitative.” She’s since pivoted to focus on personal wellness, challenging the health care establishment along the way. In doing so, she’s found an eager audience, attracting hundreds of thousands of followers on social media.
In 2019, she started a health tech company called Levels that marketed at-home glucose monitors. Means herself has pitched the devices as a general health tool not only for people with diabetes, for whom they were originally developed, but for everyone — even though research studies have found no benefit for those without the condition. Perhaps coincidentally, last month, Kennedy floated having the federal government cover the costs of such devices for some patients, rather than cover new weight-loss drugs, as one way to arrest the country’s obesity crisis.
Last year, Means published a bestselling book called Good Energy, co-authored with her brother Calley Means, that cemented her place as a MAHA champion who would take on the health care industrial complex.
In their book, the Meanses advance a theory of “metabolic dysfunction” — that Americans’ bodies are bad at producing energy because of our poor diets and sedentary lifestyles, and which is the root cause of chronic diseases, including not only obesity and diabetes but even schizophrenia and depression. (Scientists have found that metabolism is central to the development of obesity and its associated diseases, but the underlying causes remain the subject of active research.)
Good Energy paints a grand conspiracy that the food and medical industries have little motivation to prevent diseases from occurring because once a person becomes ill, they start using medical services and making money for health care providers.
Experts say Means’s commentary on metabolism is often overly simplistic. She can also stray into sounding more like a spiritual guru than a medical doctor, prone to talking about “dark energy” and speculating that our brains may be more like receivers that tap into the divine. She appears to view people’s ill health as a matter of spiritual disorder as much as a physical phenomenon.
“Humans are out of alignment with the Earth and depleting its life force,” she wrote last year. “And human bodies are now exhibiting signs of blocking the flow of energy through them. This is insulin resistance. We are the Earth.”
To Means’s public health critics, she is both anti-science — she frequently criticizes vaccines in her weekly newsletter — and fundamentally unqualified to be, as the surgeon general is often known, America’s doctor. (Her medical license actually lapsed in 2019.)
“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,” Arthur Caplan, a medical ethicist at New York University, told the New York Times.
But Kennedy says Means is “the perfect choice” for surgeon general — her unorthodoxy a feature, not a bug.
“Casey articulates better than any American the North Star of a country where we have eliminated diabetes, heart disease, and obesity through prioritizing metabolic health,” Kennedy wrote on X. “Casey will help me ensure American children will be less medicated and better fed — and significantly healthier — during the next four years. She will be the best Surgeon General in American history.”
The surgeon general, though not a policy-making role, has the influence to drive the national conversation on health and can draw attention to important changes in the nation’s health. Vivek Murthy, President Joe Biden’s surgeon general, released a widely covered report on the loneliness epidemic and called for cancer warnings on alcohol packaging during his tenure. Already Means has outlined what she’d like to see: less corporate influence in health and food, less ultraprocessed foods in the American diet, a reformed meatpacking industry, and more.
Means’s priorities are consistent with Kennedy’s agenda, which is why it was so surprising when Means’s nomination sparked outrage among some in the MAHA universe.
But wait — is this the beginning of a MAHA civil war?
Not in the least. But before we get into why not, here’s what’s going on: Means’s critics have gotten a lot of attention recently by portraying her as insufficiently committed to MAHA’s various goals — particularly in her opposition to vaccines — and suggested that nebulous dark forces may be at work against the movement.
As journalist Helena Bottemiller Evich wrote in her newsletter Food Fix, some anti-vaccine activists have come to believe an emphasis on food wellness has overtaken vaccine safety as Kennedy’s primary focus, and Means’s nomination exacerbated those tensions. According to the Washington Post, one anti-vax influencer said Means’s appointment showed Kennedy was actually “powerless” within the Trump circle.
“I don’t know if RFK very clearly lied to me, or what is going on,” Nicole Shanahan, who was Kennedy’s vice-presidential candidate during his presidential run, posted on X. “It has been clear in recent conversations that he is reporting to someone regularly who is controlling his decisions (and it isn’t President Trump).”
Shanahan, after speculating that Kennedy had come under somebody else’s influence, called the Means siblings “aggressive and artificial.” Far-right commentator and internet personality Laura Loomer called Means “a Witch Doctor” and insisted Trump could not have selected her of his own accord.
But according to Trump, he picked Means because Kennedy recommended her for the position.
So while the rift is eye-catching, it is probably better understood as interpersonal rivalries spilling into the open rather than any meaningful change in direction for Kennedy or the MAHA agenda he is implementing at HHS. Kennedy has nurtured a movement in which conspiracy theories are commonplace and now that he’s disappointed some of his supporters by endorsing Means, they are seeing more conspiracies.
The MAHA movement encompasses everything from vaccine skepticism and elaborate theories of chronic disease to eliminating environmental toxins and eradicating corruption in the health system. Means may bring a particular focus on food and wellness to the surgeon general position, but if you look at his record so far, Kennedy has begun working aggressively across a wide range of issues.
In his first few months as health secretary, Kennedy has downplayed the efficacy of the measles shot in favor of alternative treatments amid the worst outbreak in decades. He has also ridiculed vaccine mRNA technology, calling into question a future Covid-19 vaccine for children. And he has launched a vaccine safety investigation and ordered a probe into autism’s causes.
At the same time, Kennedy has already sought voluntary commitments from food manufacturers to remove artificial dyes from their products and tried to crack down on more additives in ultraprocessed foods. Last week, the FDA and NIH launched yet another research initiative, this one on diet-related chronic disease, that aims to understand how certain foods affect metabolism, the cornerstone of Means’s theory of our modern health problems.
All of this drama over Means’s nomination does clarify some things about the MAHA movement: The coalition is reactive and conspiratorial, but its key figures are moving at stunning speed to remake the country’s approach to health care. Tapping Means is another step in that direction; her nomination isn’t a sign of MAHA fracturing — it’s a sign of Kennedy doubling down.
MAHA’s political potency, much like Trump’s MAGA movement, is aided by its malleability: Make America Healthy Again could mean a lot of different things to different people, from hardcore anti-vaxxers to the kind of crunchy conservative wellness influencer that Means typifies.
But while that ambiguity can be an asset in a campaign, it presents a challenge when governing. You have different constituencies who, while happy to be unified to win an election, are now pushing you to pick different personnel, to prioritize different issues, to frame issues in different terms.
Even if you largely stick to the agenda you laid out in a campaign — as Kennedy has done so far — some members of your coalition are bound to feel alienated and start airing grievances in public.
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