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BREAKING: Trump Ditches MAHA Surgeon General, Bashes GOP Senator, Nominates Fox Contributor
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Hey everyone, we got an emergency podcast here with my man Jonathan Cohn. Because just about 30 minutes ago, Donald Trump, through a series of bleeds, announced, I, I think he announced is sort of insinuated, if not outwardly announced that his surgeon general nominee, Casey Means, is no longer the surgeon general nominee. Where she's going, we don't know. He said something akin to she'll continue to serve the Maha movement, but made no indication of in what capacity. You could see it right there. And instead he is nominating Dr. Nicole B. Safire, who is a actual doctor, unlike Casey Means. I believe she works at Sloan Kettering, but I may be wrong about that. I'll get that in a second. But she's also a Fox News contributor. Has been since 2018. Yeah, she is a radiologist and director of breast imaging at Memorial Sloan Kettering. So she's an actual doctor, which is an upgrade. But for now, let's focus on Casey Means because, Jonathan, you've been doing extensive writing, reporting, analysis of the that nomination, and it was doomed pretty much from the start. Why did he pick her in the first place? Casey, that is?
- [01:55]
B
Well, I mean, you know, he picked her because she was very much in the spirit of the RFK junior Maha imperative. Right? I mean, she now she had gone to medical school, let's be clear, she had a, you know, a medical degree from Stanford, you know, smart, very knowledgeable, but she kind of taken a detour off the traditional medical path and basically become a wellness influencer. And she very much embodied what I think is the sort of the guiding principle of Robert F. Kennedy Jr. Is that the medical establishment is wrong. Whatever they say, do the opposite. And that was sort of, she was very Much a part of that. But she got into trouble right away. I think there was a lot of wariness about having somebody be the surgeon general. This is the nation's most important doctor, not a practicing doctor. I mean, that's. That's. You know, that. That really got people's attention. And then you remember her confirmation hearings. Yeah. You know, she was. She was kind of all over the place, and she wouldn't take, you know, wasn't clear what she said. She was dodging questions. And, you know, this all came at a moment, I think, when we've seen a backlash to Kennedy and his politics.
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A
Right.
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B
And they got caught up in that
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A
talk about the confirmation hearing. So she goes before Senate help Committee. She's asked about vaccinations. And I forget if it was specifically to the measles vaccine. Do you remember precisely what it was that tripped her up?
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B
Oh, gosh. What was the exact question? I mean, there were a couple of questions. The one that I remember most was. And we kind of pulled this just because we had pulled this out. Among other things, she got a question from Tim Kaine about whether she agreed with the science, you know, with the research showing that the flu vaccine, you know, was effective and reduced hospitalization, which is very well documented. This is, you know, we can argue about, you know, how effective it is, but, I mean, this is very well documented effect. And she wouldn't answer the question. She dodged and she weaved and she finally said she would agree with this statement. And it was sort of a shocking moment because it was. Wasn't even asking her whether to recommend the vaccine, which is, you know, you can get to the question of who should get it when and whatever. It gets slightly more complicated. I suppose this was. How do you read the research? Which is not ambiguous. And she wouldn't say, you know, answer that. And you didn't know. Is this because she has her views on it and she's afraid that those views will be politically toxic to the country? She has her views, and she's afraid they won't align with Kennedy's. But the point was, the surgeon general, if you want anything from the surgeon general, is you want someone who will at least tell you what the research shows. And if she's not willing to take that stand publicly, you know, how is she gonna. What's she gonna do inside the room and that. Moments like that. There were a bunch of moments like that, and she just.
- [04:43]
A
Well, let's. We actually have the video of it. I think it was Cassidy, actually, who asked her. It let's play this video because it's actually quite pertinent to what happened today, new season this year. Would you, as past surgeon generals have, encourage Americans to get vaccinated with the flu vaccine?
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B
At the risk of sounding repetitive, I do think it's very important as a physician and to rebuild trust in public health to make sure that patients are encouraged to have informed consent with their doctor before getting any medication. I believe vaccines save lives. I believe they're an important part of public health. I also do not want to not encourage patients to have a conversation with their doctor. I think it's incredibly important. Informed consent is going to be part of building trust in public health.
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A
So you could see there, it's a classic two step, right? Have informed consent. Oh, by the way, I also believe vaccines are good, but never once saying, yes, you should get the flu vaccine. It's just a workaround. And that clearly bothered a lot of senators. Now I'm summarizing your piece on this. But you know, as much as it was problematic from a medical perspective, it was problematic from a political perspective too. Not just because it hurt her with the votes in the Senate, but because the, the whole crux of the Surgeon General position is that you have to be able to withstand political pressure to tell inconvenient truths to the public, whether it's about the flu vaccine, whether about aids, whether it's about smoking. You have to withstand political pressure as past surgeon generals have. And right there she failed the test, more or less.
- [06:18]
B
She did fail the test. She did. And it really misunderstands the role of the Surgeon General. As if, you know, is just there to kind of the Surgeon General. We don't have a Surgeon General to sort of instruct you to go on to, you know, Google health and figure out your own health information. The only reason we have a Surgeon
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A
general, one of the, that's why we have Claude and Chad. GPT. Yeah.
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B
Hey, you know, I mean that's, I mean. Dr. Claude laughing but, you know, that's might be where we're going. Yeah, I mean the Surgeon General has a number of duties, but a really important role historically, as you said, is, is to give guidance, is to give advice, say, look, I'm appointed by the government as a science, as a scientific officer of the government to make my best judgment based on what the evidence is. And here is what the evidence shows. Here's what I recommend that you do. I mean, the flu vaccine is a great example. It's not like anyone's mandating for forcing civilians to get the flu vaccine. I mean, we're saying, is the surgeon general going to urge people, say, hey, this is a good idea. I think you should do it. And the fact that she wasn't willing to do that is sort of shocking, but again, very much in line with Kennedy's sort of, you know, where Kennedy would like to see this go. I mean, you know, he presumably wants. No one's going to go.
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A
Yeah, we'll talk about the Kennedy element in a second. I will just note that, like, weeks after that exchange, Pete Hegseth did pull the mandatory flu vaccine from the U.S. armed forces. So we're.
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B
Well, you notice I said civilians very deliberately so.
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A
I did notice. That was my cue. I picked up what you dropped, Jonathan. Years of working together, I finally pick it up. All right. The senator asking that question was Bill Cassidy, Senator from Louisiana. Now, little political history for those who don't remember. Cassidy is in this kind of interesting position. He voted for Trump's impeachment after January six, one of painstakingly few Republicans who is still around who did so. And he's running for reelection this cycle now, in order to ingratiate himself with Trump, I suppose. But it's probably true. He voted for Robert F. Kennedy Jr's nomination to the Cabinet, to HHS secretary, even though it was very clear that he disagreed with Robert F. Kennedy Jr. On a host of fronts. And he insisted that RFK Jr. Had given him assurances that, among other things, major changes to the vaccine schedule would be passed by or screened by his office before they were announced or made, things like that. That hasn't happened. RFK Jr. Basically has given him the middle finger and just gone and decimated some of the main institutional vaccine structures at hhs. And Cassidy's been there holding the bag. And as we understand it, I mean, it seems pretty clear Cassidy was not a fan of. Of Casey Means. He was questioning her aggressively. And from all contemporaneous reporting, Cassidy was not going to vote for her nomination. But he wasn't the only one. There was a lot of Republican senators who were concerned about the nomination. Before I get into Trump's knock on Cassidy today, do you have any other reporting or insights to add on her on the politics of her nomination?
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B
Yeah, only that, you know, obviously he's the chairman of the HELP Committee, so he, you know, he's not just another Republican.
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A
Right?
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B
I mean, he's the guy who schedules the vote, you know, wouldn't schedule the vote. And he made very clear, I mean, you know, he, it put this way, we Know, basically to, you know, certainty that if, if, if he had wanted her nomination to go forward, it would have happened. He was the guy, he was the, he was the sort of the choke point. And he was the choke point, you know, also in the sense that he is a physician and he's, he's recognized as if he's a legit, you know, someone who cares about public health, talks a lot about it. How he went on this was going to influence any Republicans on the fence. I mean, probably not Susan Collins, probably not Lisa Murkowski. You know, they were more likely to vote on their own, but pretty much everyone else in the caucus was right.
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A
But she's got to get out. So Means had to get out of the committee and that was the first step and she was stuck. Clearly, something came to a head. I don't know, today, maybe the day before, sometime recently, because out of nowhere today, Trump put up this bleep, going hard at Cassidy. Let's put it up. For months. Senator Bill Cassidy to the great state of Louisiana, a very disloyal person who, whose Trump endorsement got him elected but later voted to impeach Trump, who on what was now proven to be a total hoax and scam. Here we go. Has stood in the way of Robert F. Kennedy Jr's nominee, Casey Means, for the important position of the Surgeon General. I nominated Casey, a strong maha warrior, at the recommendation of Secretary Kennedy, who understands my movement better than anyone, with perhaps possible exception of me. Nevertheless, despite cy's trans ninj and political games, Casey will continue to fight for maha. Many important fronts, yada yada. There was a second one that he then issued later in the day. Here it is. Hopefully all the great Republican people of Louisiana, which I won big three times, will be voting Bill Cassidy out of office in the upcoming Republican primary. President Donald J. Trump. So there you go, Trump, clearly blaming Cassidy for this and a lesson learned that you can bend over backwards and put perhaps the most irresponsible man ever to hold HHS secretary post in that post. And it will do you no good with Trump if you cross him on one additional thing. And that's where we end up.
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B
Yeah, and, and what a devastating blow to Cassidy, who again, as you said, you know, who knows how dangerous Kennedy is, has had, you know, when he's had gotten chances to question Kennedy in testimony. He's made very clear he's not happy with changes that Kennedy made. Kennedy, I mean, you said raising, you know, doing the middle finger to, I mean, to me, the classic example of this Is there was supposedly a guarantee he wouldn't change, you know, language, you know, official CDC language about links between vaccine and autism. If you go today to the CDC website right now, it was last time I checked. There's language there that says there. You know, we don't know for sure if there's a link between vaccines and autism because scientists haven't thoroughly, you know, investigated it, which is not true. And it actually, it actually appears, you know, there's still the old language that says there is no link. And the technicality here is basically. Well, we didn't take down the old information. We just added this new one. Obviously, it's just, you know, it's such a middle finger, such a.
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A
Is that what they did?
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B
Yeah, I mean, the old language is still there. At least it was last time I checked. It's been, it's been lost. Maybe it's gone. Oh my God. No, but I mean, originally that's how it was. And you know, it's just, it's so clear that he just, you know, whatever guarantees were or were not made, and you know, you and I weren't in the room, who knows. Whatever guarantees were or were not made, Kennedy is, has not done what Cassidy said he was going to do. And Cassidy's just gotten to sit there and take it and you know, you know, now he's running Louisiana primary where he could lose. Anyway, congratulations.
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A
And I'm curious what you talked about guarantees. I am curious if Cassidy got any guarantees like for instance, from the White House. Hey, if I support RFK Jr will he at least like sit out? Because you have to imagine that was a calculus. After all, these are politicians. Look, we're going to get into the new Surgeon General nominee in the state of the Maha movement itself. But first we have actual sponsors for our program because people like our program and want to advertise on it. If you're an advertiser out there looking to reach a really well informed populace and a growing one, think about advertising on a show. Here is an ad from one of my favorite gifts for my mother in law I gave to her last Mother's Day. Or frames. Let's play it. Where you want to get caught flat footed. Trust me, I've been there. It got ugly, thankfully. Or frames, digital picture frames are a complete layup of a gift because you can give your mom more of her favorite thing. And what is that? It's you and your grandkids in pixel form. Whether you're reliving that trip to Disney or you're just Reliving moments from your childhood. I love my aura frame. I gave it to my mother in law last year. We put up all the pictures of her grandkids and her she loves it. She displays it right out there in her living room. These digital frames allow you to share your photos and videos effortlessly. Download the free Aura app or text photo straight to your frame and with free unlimited storage, you can add as many photos and videos as you want. You can even preload photos before it ships and then you can keep adding them at any time or anywhere. Every frame comes packaged in a premium gift box with no price tag. Their top rated App reached number one in the App Store on Christmas Day in 2025. Named number one by Wirecutter, you can save on the gifts moms love by visiting auraframes.com for a limited time. Listeners can get 25 off their best selling Carver mat frame with code Bull work takes. That's A R A frames.com promo code bulwark takes. Support the show by mentioning us at checkout and terms and conditions do apply. All right, how I do as a pitch man? Did you hear?
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I got a future as a pitchman. All right, let's talk about Nicole Sapphire. Let me just say we mentioned that she's a doctor, she's a FOX News contributor, she is an author. She is of the Maha movement. I mean, she's very much of that mind. She wrote a book, I believe, on the Maha movement. You've done all of about, you know, 30 minutes of research, more or less. What'd you find?
- [16:04]
B
So she is legit. You know, she's at Sloan Kettering and she does, it looks like imaging MD does, you know, among, you know, oncology imaging, it's lung kettering, which, you know, first of all, number one, she's a practicing physician. So right off the bat, right. Something, you know, we couldn't have said, you know, about means. So, you know, that roots her in medical practice, which, you know is the first box you want to check on surgeon general, her, you know, she did write a book called, you know, make America or Making America Healthy Again or Make America Healthy Again. Yeah, the original, I don't know if that's the original original, but you know, one of the original uses of that acronym and you can see, you know, you know, she's got on the one hand she's of this World. I mean, she definitely is sort of a promoter of individual behavior, can make you much healthier. This is the secret, you know, of that. And her second book is A Panic Attack. Is that the name of it? Yeah, Panic Attack, which is very critical of the public health establishment's reaction in Covid. And if you watch some of her segments on Fox News over the years, I mean, she's got the tone, she's got the attack. You know, Fauci is terrible. You know, there was this tremendous overreaction that did all this damage. Now, what's not clear to me at this point, I'd have to really sit down. I imagine we'll all be sitting down and looking at what she's written and said. I mean, obviously, there's a. There's a. There's a very wide range of opinion on. When you look back at, like, you know, the COVID reaction, you know, and there's a very. I think lots of very serious people have a very. There's a lot, you know, reasonable debate here about, you know, what was too much, what mistakes were made, you know, without sort of tipping over into the sort of far, you know. Right. Conspiracy land. And, you know, where on that spectrum she is. I don't know. I mean, look, there's lots of, I think, important debate to have about, you know, everything from schools to, you know, the early reaction, you know, all of that. So where is she? No, she has the tone down. It's not clear to me how much of it is. That's how she sounds because she's on Fox News and what, you know, how much where she really believes. And kind of the same with vaccines. I mean, we'll have to, you know, I'm sure we'll all combing over her statements on vaccines. She's definitely talked about, you know, some of the COVID shot, you know, recommendations went too far. She's against mandates. But, you know, where in the spectrum she is, you know, there's a kind of what I would consider a reasonable version of some of those. You know, is she, you know, where in that spectrum? I don't know. It's hard to tell right now.
- [18:36]
A
Well, it's like there's like a line of demarcation somewhere in the Maha movement between people who care about eating healthier, exercise, who, you know, may be critical of the medical establishment, may be a little bit contrarian about things, maybe anti lockdown and may have real criticisms of what happened around Covid and those who, like, believe in Wiccans and want to drink unpasteurized milk. Right. Like that. I feel like there's, you know, one has more science based than the other one is like really just vibes and like they want to go back to like the 1840s because they think, you know, when we just ate protein all the time and you know, ate what we shot and, you know, that, that, you know, that was great. So, yes, we need to distill a little bit here on what she has said and we don't really have much yet. I mean, we're going to have a lot that she's going to be combed over. But I will say, like, you know, people like Jerome Adams, who is Trump's first Surgeon General nominee, I mean, they were out there and they wanted, they were very adamant that it was important that an actual practicing doctor be in this role. Now. Why? Why? Why? Because you want to have someone with authority, with gravitas, who's actually treated patients and understands that it seems like she at least clears that bar from the get go.
- [19:59]
B
It does, it does. And again, you know, if you're at Sloan Kettering, I, I don't want to make a rule here, but if you're practicing, you're probably, probably within the boundaries of hope for Sloan Kettering mainstream. We hope so for everyone at Sloan Kettering State. And look, I mean, you know, we've said this all along. There was a version you could imagine if you could unwind the clock in an alternative universe where Robert F. Kennedy Jr. Comes in and he, you know, he really focuses on, let's, let's, you know, let's get some of the, you know, there's some of the unhealthy. You know, let's, let's, let's encourage people to eat healthier and colors of the Gatorade. Yeah. I mean, I don't know how much the food dyes really matter, but whatever, fine. You know, get rid of the artificial, artificial food dyes and exercise. I mean, that's great. And I, you know, I don't know anyone who studies public health who wouldn't say, number one, there's always good room question things and, and there's times when, you know, the mainstream medical consensus turns out to be wrong. So someone who's willing to kind of look at things from a different angle and say, hey, you know, maybe there are things we can do in healthy living that can help. That's all great.
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A
And that's secretary. That's not HHS secretary. That's the Michelle Obama role in Obama White House. Right?
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B
Yeah. I mean, you know, well, especially, you know, if you, you know, if it doesn't come with, you know, oh, and by the way, we're going to take away, you know, funding for the next generation vaccine and we're going to tell people there's, you know, that the vaccines are dangerous and we're going to prove, you know, we're going to push vitamin A as a sort of, you know, first line, you know, alternative to treating, you know, to preventing the measles, which are all things Kennedy has done, although he says he's not anti vaccination. I know. So, yeah, I mean, there's a version of that, you know, where does she fall on the spectrum? I don't know.
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A
We got, we got breaking news here from our producer, Matt Marshall. She does believe in the measles vaccine. I believe we have a video of that. So, hey, small victories. Let's play the video. She believes in the measles vaccine.
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C
Measles, unfortunately, is one of the most contagious viruses. And one infected individual likely infects anywhere to nine to 12 people, largely because it lingers in the air for a large amount of time. If one person in the household is infected, highly likely the entire household is going to be infected. And the best way to protect yourself against measles is by making sure that your community and your family are vaccinated. But the problem is this is a very emotionally charged topic and unless you acknowledge both sides of the argument, both sides here saying that, you know, the measles vaccine has, has caused some adverse effects that have harmed children. There have been children who have died from the MMR vaccine. You have to acknowledge that when you have the conversation, which is why it is so important that we talk about benefits and risks with vaccines.
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A
Okay. I mean, the last part, not, not great. I don't think you. She had to do that, I suppose, to be good to her Fox audience. But at least she likes the vaccine. At least she believes in it, right? Isn't that a progress?
- [22:54]
B
Yeah, I mean, that's kind of a low bar, but I suppose, I mean, look, I mean, there's a separate conversation to be had about how you win back trust in the public health establishment from people who have lost trust and, you know, that conversational.
- [23:10]
A
Yeah, but these are the people who caused us to lose trust, right?
- [23:13]
B
I mean, there's, it's complicated because it's like, how did we get here? And then how do you solve it? Like, you know, you know, these are the people who went, I mean, look, I mean, there's a lot of reasons why people lost trust. I do think, you know, what happened in Covid. Lots of people lost trust. Whether they should have or not is another story. But whatever, it's a complex story. And figuring out how to reach these people is a complex story. And there's a world. If I wanted to be an optimist, I'd say, hey, someone who comes from Fox News and maybe has a following and can maybe talk that language and get people's trust. You always want to be. You never want to. No doctor should ever judge patients or should ever go in and be chastising people. That's bad medicine. You want to meet people where they are and you want to hear them out. You want to make sure that you understand them and convey that this is certainly true. Any medical intervention from, I used to say taking a Tylenol, but now that always sounds tainted. So any medical taking ibuprofen or an antihezeron, whatever, there are side effects and very, very occasional more serious dangers. That's true for everything. And yes, you should acknowledge those also. These things work really well on the over overwhelming majority of cases. And you want to be urging that. And that first part, she was great. She sounded great. She was very convincing. I thought, loved it. To have somebody from the Trump administration, maybe that's what it'll take. Maybe there's a world where having a Trump administration surgeon general say that, which we didn't hear from means. She wouldn't say that in testimony.
- [24:49]
A
No, she wouldn't. You mentioned the value of having a Fox News person maybe preaching to their choir. Maybe they have a lot of Fox News people in the cabinet. I'm just gonna give you a list. Pete Hegseth, former Fox and Friends weekend host Sean Duffy, Transportation Secretary Terry, former Fox Business host Tulsi Gabbard, Dni, former Fox News contributor Tom Homan. Borders are former Fox News contributor Kimmy Guilfoyle, Mike Huckabee, Mike Waltz, Dan Bongino, Janine Pirro, Sebastian Gorka. Is he in the mystery Shine guest law bit? Tammy Bruce, they all had FOX News contributorship. So she is part of a lengthy line of X Fox News personalities or FOX News personalities who are now in the administration. We have two minutes left before we say goodbye. Quick state of the Maha movement. How do they feel? I mean, there was some backlash going on because of a bunch of things that Kennedy himself didn't do or did do. Now means gets the boot. We'll see if her brother sticks around. How are they feeling?
- [25:49]
B
Yeah, I mean, they've had A string of defeats. And they were all in on means. They were big fans of hers. And you know, when she testified, one of the really big leaders of the Maha movement was sitting in the food babe. If you just have people know her on the Internet, you know, was sitting in the, if I remember correctly, was actually there in the hearings. So I don't know how they're gonna take this. And it's been rough. You know, they've taken a series of setbacks. Now there was a meeting at the White House with a bunch of where I think Trump tried to make clear, hey, I'm with you. I'm curious if those tweets against Cassidy were partly to kind of keep the Maha people in the tent, say, hey, it's not my fault the guy who controls this Senate committee won't confirm her and don't you worry, I'm gonna go after him. So they had a string of setbacks. Now, at the end of the day, do they really do? A, do they abandon Trump and the Republicans? B, does it matter how big A before? So that those are unknowns, you know, and even within Maha, you have different groups and you have the hardcore anti vaccination activists and then as you said, you have a lot of people who really, this is about, you know, healthy food, healthy living. And they're not necessarily, you know, they necessarily say on board with the, say the anti vaccination part of it and maybe not that committed to the Trump camp in the first place.
- [27:07]
A
I have a prediction. She'll be given a special envoy status to the Shield of the Americas alongside Christine. Where they all go, it's like sending your dog upstate. It's like you get to be a special envoy to the Shield of America's if you get axed. I'm kidding, folks. All right, Con, thank you so much. Everyone should be subscribing to his newsletter. It's fantastic he covered this stuff. You get much more than that. It's the breakdown. It comes out Sundays, Tuesdays, occasionally, mostly regularly, if I can, if I have my way. And you should be subscribing to the Bulwark YouTube where you get great takes like this. By the way, before we leave you programming note, as we have noted multiple times, we are hitting the road. Sarah, myself, Tim Miller, we're going to be in San Diego and Los Angeles May 20, May 21. You got all the details to getting tickets for those events@the bulwark.com events. We will drop the link in the show notes as well. But if you are in and around the area. Come and see us. It's a great show. All right, folks. Jonathan, thank you so much. Take care, buddy. Talk to you soon.
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B
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