For the past year, the United States has gone without its doctor. Ever since Vivek Murthy resigned as surgeon general last January, the role has remained empty despite President Trump’s attempts to fill it. He first nominated the physician Janette Nesheiwat but withdrew her nomination in May after reports that she completed her M.D. not in Arkansas, as she had claimed, but in St. Maarten. In her place, Trump nominated Casey Means, whose background is odd, to say the least.
Means is a Stanford Medicine graduate who dropped out of her surgical residency and has since made a career infusing spiritual beliefs into her wellness company, social-media accounts, and best-selling book. The exact nature of her spirituality is hard to parse: Means adopts an anti-institutionalist, salad-bar approach. She might share Kabbalah or Buddhist teachings, or quote Rumi or the movie Moana. She has written about speaking to trees and participating in full-moon ceremonies, both of which drew ridicule by the conservative activist and unofficial Trump adviser Laura Loomer. Her belief in “the divine feminine” (which she doesn’t quite explain) seems to have led her to renounce hormonal birth-control pills for halting the “cyclical life-giving nature of women.”
Although months have passed since her nomination, Means has still not appeared before Congress—in part because she went into labor with her first child hours before her confirmation hearing was scheduled to begin. (Means did not respond to questions for this story. A spokesperson for Bill Cassidy, who chairs the relevant Senate committee, told me that “the hearing will be rescheduled in the future when Dr. Means is ready” but did not offer a more detailed timeline.) The United States’ year without a surgeon general raises questions about how necessary the role really is. But the surgeon general still serves as the government’s leading spokesperson on public health, and if Means is eventually confirmed, her theology will become rather consequential because it is deeply tied to her beliefs about health. In 2024, she declared in a Senate roundtable on chronic disease that “what we are dealing with here is so much more than a physical health crisis. This is a spiritual crisis.” Part of her solution to both of these crises is to reject experts and institutions in favor of something far more alluring: intuition.
Means wrote in 2024 that she grew up in the Catholic faith, but left the Church in college. She grew fascinated by lectures at the Self-Realization Fellowship Lake Shrine, a spiritual center in Pacific Palisades, California. SRF, the religious organization behind it, was founded in 1920 by Paramahansa Yogananda, the “father of yoga in the West,” whose image graced the album cover of Sgt. Pepper’s Lonely Hearts Club Band. It accepts the teachings of Jesus and other spiritual masters and divinities, but nothing is seemingly as important as one’s personal relationship with God. Yogananda’s book, The Second Coming of Christ, posits that the Second Coming is not necessarily literal, but instead entails an awakening of the divine consciousness in ourselves.
SRF’s influence is apparent in Means’s advice that people follow their “heart intelligence” and “divine intuition” and avoid “blindly ‘trusting the science.’” In a newsletter sponsored by a probiotic-supplement company, she wrote that “applying the scientific method to health and disease has immense utility for helping us understand the natural world and live healthy, longer lives, but it feels increasingly like there is a campaign being enacted against our divine gifts of intuition and heart intelligence.” In another newsletter, she wrote about the role of divine intuition in deciding whether to drink raw milk: She wants to be free to look a local farmer in the eye, “pet his cow, and then decide if I feel safe to drink the milk from his farm.” (One could very well have a lovely experience with a farmer, Kevin Klatt, a registered dietitian and research scientist at UC Berkeley, told me, “but it isn’t going to change the fact that raw milk might give you listeria.”)
In the same newsletter championing bovine contact, Means laments a spiritual crisis of connection to nature. She frequently portrays nature as a force with humanity’s best interests at heart, nearly synonymous with God. In her book, she suggests that chronic stress and trauma can be treated by, among other things, spending time in nature and through “plant medicine”—specifically, psilocybin-assisted therapy. (Means has also written that psychedelics helped her be “one with the moon.”) In that sponsored newsletter, she warned of a prophecy she says was put forth by the Indigenous Kogi people of Colombia, in which humanity has only until 2026 to prove we want to right the wrongs we have foisted upon the Earth, or we will all die. “I use the Kogi prophecy metaphorically,” she wrote. “But I do feel we are on a road to disaster. I think we should take these messages seriously.” Natural disasters, she implied, are a “communication from God.”
Nature worship might be especially appealing at a time when trust in experts is declining and technology has become ever more inscrutable and overwhelming, Alan Levinovitz, a professor of religion at James Madison University and the author of Natural: How Faith in Nature’s Goodness Leads to Harmful Fads, Unjust Laws, and Flawed Science, told me. Means’s appeal to nature and intuition, he said, is empowering because it puts expertise back into everyday Americans’ hands.
The ambiguity of Means’s spiritual views strengthens her appeal—they can be interpreted to fit a wide array of belief systems. Her 2024 New York Times best seller, Good Energy, uses terms such as energy and life force, along with scientific-sounding descriptions of metabolic processes, to insinuate that the vibes are off in the American diet and lifestyle. (Means wrote Good Energy with her brother, Calley, who is now a close adviser to Robert F. Kennedy Jr., the secretary of Health and Human Services.) In her newsletter, she encourages her readers to “avoid conventionally grown foods at all costs,” and warns that buying nonorganic food is a vote to “diminish the life force on this planet” while the use of synthetic pesticides “is giving a poor signal to God (Source!) that we want this miracle to continue.” (Source insinuates a godlike or all-powerful entity.) “She’s drawing on lots of different ideas very freely and without much rigor in ways that feel good,” Joseph Baker, a sociologist specializing in religion at East Tennessee State University, told me. “That sort of allows her to seem like a visionary without having to specify anything.”
Emily Hilliard, a press secretary for the Department of Health and Human Services, wrote in an email that religious and spiritual beliefs should not be held against anyone who seeks a government job, and that Means’s “credentials, research background, and experience in public life give her the right insights to be the surgeon general who helps make sure America never again becomes the sickest nation on earth.” The surgeon general has little power to enforce policy, but can call on Congress to put warnings on products like the ones seen on cigarette packets, release guidelines and reports, and lend support to various initiatives. Means’s belief system—which Baker characterized as a “sacralization of the individual”—suggests that she will use that platform to invite Americans to master their own health. In Good Energy, Means writes of chronic conditions such as depression, anxiety, infertility, insomnia, heart disease, erectile dysfunction, and cancer, “The ability to prevent and reverse these conditions—and feel incredible today—is under your control and simpler than you think.”
That statement is one of many in which Means echoes elements of manifestation: the belief that thinking good thoughts and putting in effort begets good things, which Means says is real. She advocates “tapping into the abundance that is a sheer law of our universe” and calling on a higher power—“When was the last time you simply sat quietly and asked God/spirit/ancestors/nature to help show you the way and guide you to your highest purpose?” she wrote in her newsletter—but also putting in the hard, hard work.
Means goes beyond intuition and heart intelligence to offer concrete suggestions for labor (and spending) that will be divinely rewarded—essentially, a reimagined prosperity gospel. The nature of that work is detailed in the penultimate section of Good Energy. Means recommends eating minimally processed and mostly organic foods, and taking regular cold plunges or showers. (In her newsletter, she also advises Americans to grow the majority of their food; instead of pets, they could “raise chickens and goats and have abundant eggs and milk.”) She includes checklists upon checklists of habits and tests that “enable Good Energy” (and recommends getting a comprehensive lab panel from Function Health, of which she was an investor). She suggests buying a glucose monitor through her own company, Levels, and also recommends various personal-care apps, water filters, and trackers for sleep, food, and activity. Some of these items are sold by the wellness company True Medicine, which helps customers use their health savings account for a wide range of purchases, and in which Means has invested; her brother co-founded it. According to financial disclosures made public in September, Means has also received more than $275,000 from supplement companies. (Means has pledged to divest from True Medicine and other wellness interests if she is confirmed.)
Besides potentially boosting her own bottom line, Means’s embrace of individualism in health is wholly unrealistic. Americans work longer hours than people in many other developed nations, and many don’t have enough time to cook dinner, let alone raise goats. Many of the most important nutrition victories over the past century, such as the fortification of foods and the removal of trans fats, were communal and systemic, Klatt, the dietitian and UC Berkeley researcher, told me—the type of science-backed, population-level interventions that Means hasn’t demonstrated much interest in. A different prospective surgeon general might recommend repeated visits with a dietitian and fight for insurance to cover them, instead of “advocating for this kind of woo-woo stuff that has no data behind it,” Klatt said. Means, though, “is not an individual who seems to be wedded to the scientific process,” Timothy Caulfield, a professor and the research director at the Health Law Institute at the University of Alberta, told me. “This is someone who seems to pull things out of thin air and then look for sciencey-sounding rhetoric” to support them.
Perhaps Means’s eventual confirmation hearing will clarify what, exactly, she intends to do as the face of American public health. But even she may not be sure. “The future of medicine will be about light,” Means wrote to her newsletter subscribers last year, before admitting, “I don’t exactly know how yet.”
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