Why Casey Means' surgeon general nomination is in limbo

Wellness influencer Dr. Casey Means' nomination to be US surgeon general is stalled a month after senators of both major political parties grilled her on vaccines and other health topics during a tense confirmation hearing, deepening doubts about her ability to secure the votes she needs for the role. The nomination has languished despite ongoing efforts from the White House and Make America Healthy Again activists, revealing how intractable rifts over health policy can be even when Congress has shown deference to President Donald Trump. It's become the latest snag in Health Secretary Robert F. Kennedy Jr.'s agenda after two legal setbacks last week.

Means, a 38-year-old Stanford-educated physician who became disillusioned with traditional medicine and did not finish her surgical residency program, has faced scrutiny for her lack of experience and potential conflicts. Another sticking point has been her close alignment with Kennedy, whose efforts to dramatically pull back vaccine recommendations have been slammed by lawmakers and medical groups. To advance to a full Senate vote, Means likely needs every Republican on the Senate Health, Education, Labor and Pensions Committee to support her nomination. But after last month's hearing, two of them — Sens. Lisa Murkowski of Alaska and Susan Collins of Maine — told reporters they still had questions for her.

Murkowski told reporters Tuesday that "I'm just in the same spot" when it comes to those hesitations. Collins and Republican committee chairman Sen. Bill Cassidy, a physician from Louisiana who interrogated Means about vaccines during the hearing, didn't respond to multiple inquiries about the delay.

White House spokesman Kush Desai said in a statement that the Trump administration has been having "productive conversations with the Senate" to advance Means. He added that her "elite academic credentials, research background and advocacy on America's chronic disease epidemic will make her a critical asset for President Trump's push to Make America Healthy Again."

Kennedy spokesman Andrew Nixon reinforced the Republican administration's support for Means and praised her message calling for healthier lifestyle choices rather than "sick care." Means promotes ideas popular with the MAHA movement, including that Americans are overmedicalized and that diet and lifestyle changes should be at the center of efforts to end widespread chronic disease.

But she's been criticized for having an inactive medical license, for sometimes failing to disclose financial relationships with brands she promotes and for some of her past health-related comments. Senators asked her during her hearing about how she would speak to the public about vaccines.

Murkowski and Cassidy pressed Means about her past doubts about the birth dose of the hepatitis B vaccine, which the U.S. Centers for Disease Control and Prevention stopped recommending for all children late last year in a move later temporarily blocked by a federal judge. Means called the hepatitis B vaccine important and lifesaving but said parents should make their own decisions with their doctors.

Cassidy also asked Means whether she would advise Americans to vaccinate against the flu and measles amid outbreaks across the country. She didn't make that commitment, instead emphasizing the importance of informed consent.

Collins asked Means about her past advocacy for the therapeutic use of psychedelic mushrooms. Means, who has spoken positively of her own experience with the drugs, said she wouldn't recommend psychedelics for the American public.

Once it appeared Murkowski and Collins were undecided, MAHA activists orchestrated a push to support Means' bid by surging phone calls to the two senators. "Please call both of them. Call them time after time. Get your friends to call them," Tony Lyons, head of the Kennedy-aligned group MAHA Action, told supporters earlier this month.

Others have loudly opposed Means' nomination. Dr. Jerome Adams, Trump's first-term surgeon general, has repeatedly called her unqualified for her lack of an active medical license. He said in an interview that Republicans in Congress and in the Trump administration have told him they disapprove of the pick but see it as Kennedy's choice.

"What I keep hearing from folks is, 'This is what Bobby wants,'" he said. While surgeons general aren't mandated by law to have an active medical license, they are required to be part of the U.S. Public Health Service Commissioned Corps, a group of health professionals that says members should have up-to-date licenses.

Means said during her confirmation hearing that she had voluntarily made her Oregon medical license inactive, and that Adm. Brian Christine, who runs the Commissioned Corps, had testified that she was eligible to serve.

Even if Means advances out of committee, she might have difficulty securing confirmation by the full 100-member Senate. Republican Sen. Thom Tillis of North Carolina, who isn't seeking another term, told The Associated Press that he's leaning against voting for Means.

At nearly 300 days since her nomination in May, Means' confirmation process has taken almost twice as long as the average presidential pick in Trump's second term, according to data from the nonprofit Partnership for Public Service. The group found that in the first 400 days, the average time between nomination and confirmation for Trump's nominees was 157 days.

Sometimes the process has gone far more quickly. Markwayne Mullin, the new Department of Homeland Security secretary sworn in Tuesday, had his confirmation hearing, floor vote and swearing-in all within a weeklong period.

Associated Press