At the height of the coronavirus pandemic, U.S. Surgeon General Jerome Adams stood with President Donald Trump at the White House, serving as a prominent face of the president’s health agenda.
Now Adams has taken a far different stand: trying to stop Trump’s nominee to be his successor, Casey Means, from being confirmed as the nation’s top doctor.
Means’s nomination has stalled in the Senate, where several Republicans have questioned her stance on vaccines, her pushes against the medical establishment and her medical credentials. Some lawmakers and staff have noted that her medical license is currently inactive. Nearly 11 months after her nomination, it is not clear how it moves forward, with some lawmakers openly frustrated with health secretary Robert F. Kennedy Jr.’s moves to change vaccine policy and disinclined to confirm another one of his allies.
The fight over Means’s candidacy starkly illustrates the evolution from the first Trump administration — when the president surrounded himself with more traditional health care appointees such as Adams, who had served as a state health commissioner — to his second, in which he consistently has been at odds with public health leaders.
That backlash has ensnared Trump’s latest pick for surgeon general, a role that offers a significant bully pulpit but limited policy impact. Past surgeons general have described their goal of focusing on the bipartisan priority of improving health, and several said they built bonds with predecessors that transcended political party.
No past surgeon general has come forward to defend Means as she fights for Senate confirmation. Instead, Adams and others have spent the past year questioning her credentials, noting that she left her surgical residency in its final year and went on to decry the medical establishment and pursue functional medicine, which focuses on lifestyle interventions to tackle the root causes of chronic diseases.
“The role of surgeon general has centuries of precedent and requirements, and she doesn’t meet them,” Adams said in an interview, framing his disagreements as “operational, not personal.” He noted that if Means is confirmed by the Senate to serve as surgeon general — a role that involves overseeing the Public Health Commissioned Corps, a 6,000-person force of government health workers — she would not be appointed to the corps as a physician, but through a different category reserved for health-service workers.
“The irony would be the nation’s doctor wouldn’t even be in the corps as a doctor,” Adams said.
Means did not respond to requests for comment. In testimony to the Senate, she has defended her qualifications, citing her work as co-founder of a health care technology company, her roles speaking and teaching on chronic disease, and other experience. She is also the author of a best-selling book, “Good Energy,” that has become a key tome of Kennedy’s Make America Healthy Again movement.
She also has said she voluntarily placed her Oregon medical license in inactive status because she was not seeing patients over the past several years.
“My professional history has prepared me to meet these very complex times as an innovative, unifying and practical leader focused on reversing chronic disease,” Means wrote in a response to questions from senators that was shared with The Washington Post.
Asked about past surgeons general’s criticism, she questioned their record. “Notably, under the tenures of our recent past Surgeon Generals, America’s health and lifespans have worsened,” Means wrote.
The White House defended Means, with a spokesman calling her “an inspirational voice for millions of Americans looking to better their lives, wellbeing, and health” and criticizing Adams’s past support for health-equity programs. Administration officials also said Adams, who has frequently opposed Kennedy’s moves on vaccines, represents an outdated approach to public health.
“When Americans resoundingly re-elected President Trump, they voted to Make America Healthy Again — not for more asinine diversity, equity, and inclusion (DEI) nonsense by out-of-touch institutional elites who spend more time talking than actually helping deliver better health outcomes for Americans,” White House spokesman Kush Desai said in a statement.
Kennedy and senior members of the Department of Health and Human Services have also praised Means’s work and said she is qualified for the role.
“Dr. Means fulfills the statutory requirements to be the next Surgeon General of the United States, and I look forward to serving with her,” Brian Christine, the HHS assistant secretary for health, wrote to senators last year, explaining how she would be appointed to the commissioned corps. The letter was shared with The Post.
The rise of Means also shows how the paths toward a senior role in the Trump administration differ in his second term.
Adams, a licensed anesthesiologist with a master’s degree in public health, served as Indiana’s health commissioner under then-Gov. Mike Pence, who then helped install him in Washington — one of multiple Pence allies who took senior roles in the Trump administrations. As surgeon general under Trump, Adams focused on curbing the nation’s opioid epidemic, encouraging flu vaccinations and responding to the pandemic.
Trump first selected Janette Nesheiwat to be surgeon general last year before the White House withdrew her nomination and put Means forward. Nesheiwat, a physician who had been a Fox News contributor and had family ties to several Trump appointees, was pressed by Kennedy allies over her pro-vaccine comments before her nomination was withdrawn, according to two people who spoke on the condition of anonymity to discuss private conversations. She also faced questions over whether she had accurately represented her credentials.
“I thought [Nesheiwat] was sufficiently qualified for the role,” Adams said.
Means, who received her medical degree from Stanford University and pursued a residency in otolaryngology — head and neck surgery — at Oregon Health and Science University before leaving the program in 2018, connected with Kennedy after he mounted an insurgent campaign for the presidency. She also developed a significant social media following, aided by some high-profile media appearances; her interview with Tucker Carlson was the most shared podcast of 2024 on Apple Podcasts, the company has said.
Lawmakers, wary of how Kennedy has often questioned the value of vaccinations, pressed Means last month on whether she would offer a full-throated endorsement of vaccines if confirmed.
“Every individual needs to talk to their doctor before putting a medication in their body,” Means testified. “I absolutely am supportive of the measles vaccine, and I do believe vaccines save lives and are an important part of the public health strategy.”
Some past surgeons general served a four-year term that stretched across presidencies, including David Satcher, who served under Presidents Bill Clinton and George W. Bush. But the role has become more politically charged in recent years.
Vivek H. Murthy, whom then-President Barack Obama tapped to be surgeon general, spent more than a year and a half waiting for Senate confirmation in 2014 amid questions about his experience and his support of tighter gun control laws. Trump removed Murthy in 2017, nominating Adams in his place, before President Joe Biden pushed out Adams in 2021 and nominated Murthy again. The role has been filled by an acting surgeon general since January 2025.
Past surgeons general said they have often found common ground on matters of health.
“The thing that we answer is, ‘What is the best science to solve this problem or prevent this disease?’ That’s not an issue that’s partisan,” said Richard Carmona, who served as surgeon general under President George W. Bush.
Carmona praised Adams’s work as surgeon general and said he questioned Means’s suitability for the role.
“She doesn’t have the experience, she doesn’t have the background, she doesn’t have the credibility, she has no public health background,” he said.
Means’s defenders include fellow advocates of functional medicine, such as Mark Hyman, who have also called for a focus on the root causes of chronic disease. Some of her allies say the reaction against her nomination by medical leaders is because she threatens a status quo that has led America’s health system to underperform compared with peer countries. They also have sharply criticized Adams and others who have spoken out against her.
Calley Means, a White House official and Casey Means’s brother, has called Adams a “democratic activist.”
“You were a lightweight as surgeon general and aren’t in the same stratosphere as Casey in terms of intelligence, which is obvious to litterally [sic] everyone who knows both of you,” Calley Means wrote last month on X.
You’re not a Republican, you’re a democratic activist. You were a lightweight as surgeon general and aren’t in the same stratosphere as Casey in terms of intelligence, which is obvious to litterally everyone who knows both of you.
— Calley Means (@calleymeans) February 26, 2026
Calley Means did not respond to a request for comment.
Adams said he did not want to “engage” with Calley Means’s comments.
“We can and should have vigorous debates about how to improve America’s health,” Adams said. “But lowering the discourse to crass ad hominem attacks comes across as childish and defensive.”
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