Trump nominates Casey Means as surgeon general, replacing Nesheiwat amid controversy

President Donald Trump’s decision to nominate Casey Means as the next U.S. surgeon general has sparked widespread discussion across political and health communities. Announced on May 7, 2025, the move comes after the abrupt withdrawal of Trump’s initial nominee, Janette Nesheiwat, just a day before her Senate confirmation hearing. Means, a wellness influencer and ally of Health and Human Services Secretary Robert F. Kennedy Jr., represents a shift toward the administration’s “Make America Healthy Again” (MAHA) initiative. This nomination underscores Trump’s focus on reshaping public health leadership with figures aligned with his policy priorities.

The announcement, made via Trump’s Truth Social platform, has drawn both praise and criticism. Supporters highlight Means’ unconventional approach to healthcare, emphasizing prevention and chronic disease management, while detractors question her qualifications for the prestigious role. The decision reflects broader tensions within the administration’s health policy agenda, particularly its skepticism of traditional medical establishments. As the Senate prepares to review Means’ nomination, her background and public statements are under intense scrutiny.

• Key aspects of the nomination:
  • Casey Means replaces Janette Nesheiwat, whose nomination was pulled amid questions about her credentials.
  • Means is a prominent figure in the MAHA movement, advocating for holistic health reforms.
  • The surgeon general oversees a 6,000-member public health workforce.
  • The nomination aligns with Trump’s broader health policy shifts under Kennedy’s leadership.

This development follows a pattern of high-profile personnel changes in Trump’s second term, with Means’ nomination signaling a bold direction for the nation’s top health advocate.

Shift in health leadership
The withdrawal of Janette Nesheiwat as Trump’s initial surgeon general nominee marked a significant pivot in the administration’s health strategy. Nesheiwat, a physician and Fox News contributor, faced criticism from influential conservative voices, including far-right activist Laura Loomer, who questioned her academic credentials and alleged ties to pro-vaccine advocacy. Loomer’s public campaign on social media platforms highlighted Nesheiwat’s medical degree from the American University of the Caribbean, framing it as insufficient for the role. The controversy culminated in Trump’s decision to replace her with Casey Means, announced hours after reports of Nesheiwat’s withdrawal surfaced.

Means, a Stanford-educated physician, has built a reputation as a health entrepreneur and advocate for addressing chronic diseases through lifestyle changes. Her alignment with Robert F. Kennedy Jr.’s MAHA initiative, which emphasizes reducing reliance on pharmaceutical interventions, has made her a polarizing figure. The surgeon general role, often described as the “nation’s doctor,” requires navigating complex public health challenges, from infectious disease outbreaks to mental health crises. Means’ lack of traditional public health experience has raised questions about her ability to lead the U.S. Public Health Service Commissioned Corps effectively.

Background of Casey Means
Casey Means brings a unique profile to the surgeon general nomination, blending medical training with a public persona as a wellness influencer. She earned her medical degree from Stanford University but chose not to complete a residency program, citing frustration with a healthcare system she viewed as overly focused on treating symptoms rather than preventing illness. Instead, Means co-founded Levels, a health technology company aimed at monitoring metabolic health, and has authored self-help books promoting nutrition-based remedies. Her social media presence, with a large following, has amplified her influence in wellness circles.

• Notable aspects of Means’ career:
  • Co-founded Levels, a company focused on real-time health data tracking.
  • Published works advocating for dietary and lifestyle interventions to combat chronic diseases.
  • Gained prominence through appearances on platforms like “Real Time With Bill Maher.”
  • Collaborated with her brother, Calley Means, on health policy advocacy tied to Kennedy’s initiatives.

Her unconventional path has drawn both admiration and skepticism. Supporters argue that her outsider perspective could bring fresh ideas to public health, while critics contend that her lack of clinical or administrative experience may hinder her effectiveness in a role requiring broad expertise.

Connection to MAHA movement
The “Make America Healthy Again” initiative, championed by Robert F. Kennedy Jr., has emerged as a cornerstone of Trump’s health policy agenda. Casey Means, alongside her brother Calley, has been a vocal proponent of MAHA, which seeks to address rising rates of chronic illnesses like obesity and diabetes through systemic changes. The movement critiques the pharmaceutical industry and conventional medical practices, advocating for policies that prioritize prevention and environmental health. Means’ nomination signals Trump’s commitment to embedding MAHA’s principles into federal health leadership.

During a 2024 interview with conservative commentator Tucker Carlson, Means criticized the healthcare system for prioritizing profit over patient outcomes. She argued that chronic diseases, which account for a significant portion of U.S. healthcare spending, could be mitigated through better nutrition and reduced exposure to environmental toxins. These views resonate with MAHA’s broader goals but have sparked debate about their feasibility at a national level. Means’ role as surgeon general would likely involve translating these ideas into actionable public health campaigns.

Public and political reactions
The announcement of Means’ nomination elicited a spectrum of responses from political figures, health experts, and the public. On social media platforms like X, supporters celebrated her as a “MAHA warrior” who could challenge entrenched interests in the medical establishment. Posts praised her critiques of Big Pharma and her focus on holistic health, framing her as a transformative figure for public health. Conversely, others expressed alarm, calling her “unqualified” and warning of potential risks to evidence-based health policy under her leadership.

• Key reactions to the nomination:
  • Conservative influencers lauded Means for her alignment with anti-establishment health views.
  • Critics, including some medical professionals, questioned her lack of public health experience.
  • Posts on X highlighted her past statements criticizing pharmaceutical companies.
  • Some Democrats signaled opposition, citing concerns about her ties to Kennedy’s controversial health stances.

The polarized reactions underscore the contentious nature of Trump’s health appointments, with Means’ nomination likely to face rigorous scrutiny during Senate confirmation hearings.

Nesheiwat’s withdrawal
The decision to withdraw Janette Nesheiwat’s nomination was a rare public reversal for the Trump administration, which has faced challenges in securing confirmation for several high-profile appointees. Nesheiwat, who served as a physician and public health commentator, was initially praised for her media presence and conservative credentials. However, her nomination drew criticism after reports surfaced about her medical training and alleged involvement in a medical malpractice case. These claims, amplified by figures like Laura Loomer, prompted Trump to pivot to Means as a replacement.

The timing of the withdrawal, just before Nesheiwat’s scheduled Senate hearing, raised questions about the administration’s vetting process. This was not the first instance of a health nominee being pulled; earlier in 2025, Trump withdrew nominations for the Centers for Disease Control and Prevention and the Drug Enforcement Administration. The pattern suggests internal pressures and external lobbying are shaping the administration’s health leadership selections.

Role of the surgeon general
The U.S. surgeon general serves as the nation’s leading voice on public health, overseeing the U.S. Public Health Service Commissioned Corps and issuing guidance on issues ranging from smoking to mental health. The role requires balancing scientific expertise with public communication, often under intense political scrutiny. Past surgeons general, such as Vivek Murthy, have used the position to address pressing issues like opioid addiction and vaccine hesitancy, shaping national health priorities.

Means’ potential tenure would likely focus on MAHA-aligned goals, such as promoting lifestyle interventions and scrutinizing pharmaceutical practices. However, her ability to navigate complex public health crises, such as pandemics or environmental disasters, remains untested. The Senate confirmation process will likely probe her readiness to lead a 6,000-member workforce and influence health policy on a national scale.

Influence of Robert F. Kennedy Jr.
Robert F. Kennedy Jr.’s appointment as Health and Human Services Secretary has been a driving force behind Trump’s health policy overhaul. Kennedy, a longtime critic of vaccines and pharmaceutical companies, has pushed for a reorientation of federal health agencies toward prevention and alternative health strategies. Casey Means’ nomination aligns with Kennedy’s vision, as both share a skepticism of conventional medical frameworks and a focus on chronic disease prevention.

• Kennedy’s influence on the nomination:
  • Means and her brother Calley have been key allies in Kennedy’s MAHA campaign.
  • Kennedy has publicly endorsed Means, citing her “impeccable credentials.”
  • The nomination reflects Kennedy’s broader goal of reshaping federal health priorities.

Kennedy’s controversial stances, particularly on vaccines, have drawn criticism from mainstream medical organizations, and Means’ association with him may complicate her confirmation. Senators are likely to question how her alignment with Kennedy will influence her approach to public health policy.

Health policy priorities
The Trump administration’s health agenda, as articulated through MAHA, emphasizes reducing chronic disease prevalence and critiquing systemic issues in healthcare. Means’ nomination suggests a focus on policies that promote dietary changes, environmental protections, and reduced reliance on medications. Her past advocacy for metabolic health monitoring could translate into public health campaigns encouraging Americans to track biomarkers like blood sugar and insulin levels.

Public health experts have noted that chronic diseases, such as diabetes and heart disease, account for over 60% of U.S. healthcare costs. Means’ emphasis on prevention aligns with efforts to reduce these costs, but critics argue that her approach may oversimplify complex health challenges. The surgeon general’s ability to influence policy is limited by congressional and agency constraints, making Means’ success dependent on her ability to build coalitions and communicate effectively.

Senate confirmation outlook
The Senate confirmation process for Casey Means is expected to be contentious, given her unconventional background and the polarized political climate. Republican senators, particularly those aligned with Trump, may support her nomination as a bold challenge to the medical establishment. However, Democrats and moderate Republicans are likely to raise concerns about her qualifications and ties to Kennedy’s controversial health views.

• Factors influencing confirmation:
  • Means’ lack of traditional public health experience may be a focal point for critics.
  • Her social media presence and wellness advocacy could be scrutinized for scientific accuracy.
  • Support from MAHA-aligned senators could bolster her chances.
  • Opposition from medical associations may complicate her path to confirmation.

The confirmation hearings will provide a platform for Means to articulate her vision for the surgeon general role and address concerns about her readiness to lead.

Public health challenges ahead
The next surgeon general will face a range of pressing public health issues, from rising obesity rates to mental health crises among youth. Means’ focus on chronic disease prevention could resonate with Americans seeking solutions to these challenges, but her ability to implement effective policies will depend on collaboration with federal agencies and state governments. Her nomination comes at a time when public trust in health institutions remains fragile, necessitating clear and credible communication.

Means’ emphasis on lifestyle interventions may appeal to some, but critics warn that it risks downplaying the role of structural factors, such as healthcare access and socioeconomic disparities. The surgeon general’s bully pulpit offers an opportunity to shape public discourse, but it also requires navigating competing priorities and political pressures.

Historical parallels
The selection of Casey Means echoes past instances of unconventional surgeon general nominees, such as Jocelyn Elders under President Bill Clinton, who faced controversy for her outspoken views. Like Elders, Means’ nomination reflects a deliberate choice to elevate a figure with a distinct perspective on health. However, the surgeon general role has historically required balancing bold advocacy with scientific rigor, a challenge Means will need to address.

Past surgeons general have left lasting legacies, from C. Everett Koop’s campaigns against smoking to Regina Benjamin’s focus on health disparities. Means’ potential tenure could redefine the role, particularly if she leverages her platform to advance MAHA’s goals. Her success will hinge on her ability to translate her wellness advocacy into policies that resonate with a broad audience.