Why Don't We Have a Surgeon General?

Summary

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Maintenance Phase Episode Summary:

"Why Don't We Have a Surgeon General?"
Aired: July 27, 2026
Hosts: Aubrey Gordon & Michael Hobbes

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Episode Overview

Aubrey and Michael dig into the ongoing absence of a U.S. Surgeon General during Donald Trump’s second term, unpacking the chaotic nominations, political infighting, and the ever-loosening grasp on public health science. The episode offers a thorough, frequently humorous exploration of three failed (and one current) nominees—each an emblem of broader wellness industry grift, junk-science rhetoric, and MAGA/MAHA (Make America Healthy Again) political drama.

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Key Discussion Points & Insights

1. What Does the Surgeon General Actually Do?

• The office is “America’s top doctor,” meant to translate scientific evidence into public health guidance—but with limited direct power.
• The office also oversees 6,000+ uniformed officers in the U.S. Public Health Service, making leadership/healthcare experience crucial ([02:12]).
• The confirmation process runs through a narrowly Republican-controlled Senate HELP committee, with “mavericks” like Murkowski and Collins tipping the balance ([03:11]).

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2. Nominee #1: Dr. Jeanette Neshwat – The Resume Fictions & Nepotism Circuit

Background:

• Dr. Neshwat, former medical director at CityMD, nominated for her TV punditry and family connections—not her credentials ([03:27]).
• Deep ties to Trumpworld: Sibling is a former Homeland Security advisor; brother-in-law is former Rep. Mike Waltz; another sibling married to Scott Stapp of Creed ([04:42]).

Scandals:

• Neshwat “distorted key parts of her resume,” claiming an Arkansas med degree she didn’t have; her actual MD is from a for-profit Caribbean school owned by DeVry ([08:02]).
• Misrepresented her specialty: Only board-certified in family medicine, not ER ([09:50]).
• MAGA right found her insufficiently anti-vax; Laura Loomer called her a “pro COVID vaccine nepo appointee” ([12:09]; [12:44]).
• Trump withdrew her nomination after press exposes and right-wing backlash. She failed upwards—sent to work on “Havana Syndrome” at Walter Reed ([14:19]).

Memorable Moment:

“We could have had a Surgeon General who has Thanksgiving with Scott Stapp from Creed.”
—Aubrey ([05:46])

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3. Nominee #2: Dr. Casey Means – MAHA Grift & Wellness Woo

Background:

• Stanford MD who quit a surgical residency six months before completion to found a “functional medicine” clinic in wealthy Portland and co-found blood-sugar tech startup Levels ([16:04], [39:51]).
• Her conservative-family cred: Dad was a Nixon/Ford operative, architect of cutting food stamps; brother Callie Means is a right-wing influencer and wellness entrepreneur ([29:02], [29:47]).

Two “Origin Stories”:

• Burned out by “profit-driven healthcare,” quit surgical training ([17:33]).
• Cites her mother’s cancer death as awakening to profit motives in medicine—but uses emotional anecdotes to indict the system without offering real reform ([22:26], [25:09]).
  • Michael: “She’s an unreliable narrator...if this was your issue you’d move toward universal healthcare, not start selling people more shit for profit.” ([26:50])

Means Family Grifting:

• Callie Means fakes a “lobbyist for Big Food turning whistleblower” narrative—colleagues say he was only an executive assistant ([34:57], [36:51]).
  • “He walked around the office saying, ‘Cali Means business.’” ([37:04])
• Both collaborate with wellness app and supplement startups, working with the rich and advocating for expanding HSA loopholes for junk products ([31:37]).

Book & Public Persona:

• Released “Good Energy”—calls for root-causes, personal responsibility, and anti-vax coded takes ([41:43], [42:06]).
• Main solution: “Trust yourself, not your doctor.”
• Claims most COVID deaths were due to “poor metabolic health,” calls the pandemic a “Darwinian moment for America” ([43:52], [43:56]).
• Anti-vax, but dresses it up as moderation; personal responsibility frame ignores social determinants ([44:05]).

Poetic (and Poetic) Red Flags:

• Wrote an AI-assisted poem: “The Devil’s Wellness Plan”—conspiratorial rhymes about vaccines, food, and gender politics ([46:33]).
  • Michael on the poem: “I miss Creed. Aubrey, can we go back to Creed?” ([47:47]).

Confirmation Hearing Flop:

• Struggled to answer basic vaccine questions, tried to evade or muddle CDC science ([57:08]–[59:42]).
• Failed to disclose substantial paid relationships with supplement and wellness companies ([62:00]).
• Withdrew her nomination after pushback from both left and right; not anti-vax enough for the base, not credible for the rest ([64:26]).

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4. Nominee #3: Dr. Nicole Saphier – "At Least She's Only Grifting a Little"

Background:

• Radiologist (Sloan-Kettering), Fox News mainstay, podcast host, supplement company owner.
• Medical degree from Ross University, Barbados; unlike predecessors, holds a valid medical license and clinical position ([65:38], [66:32]).

Positions:

• Advocates standard “vaccines save lives” but wants pediatric schedule “less stringent,” opposes mandates, and publicly disses RFK Jr. ([67:35], [68:03]).
• Authored “Make America Healthy Again” pre-dating the MAHA movement; also wrote “Panic Attack” on COVID science politics.
• Momsplains to Trump over Tylenol, criticized him on Twitter (now deleted) ([68:33]).

Potential Conflicts:

• Sells questionable kava-infused tinctures in her “DropRx” supplement line, contra FDA/USDA advice ([69:09]–[70:25]).
• May need to divest due to Sloan-Kettering policies and confirmation spotlight ([69:53]).

Comparative Relief:

• “She’s a mono grifter. That’s the best we can do in America in 2026.”
  —Michael ([71:30])

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5. Public Health, Junk Science, and MAHA Schisms

• Infighting exposes the ungovernability of a coalition glued by wellness conspiracies: “You can’t have a stable coalition when it’s built on lies and misinformation...” ([51:08], [51:41]).
• RFK Jr., anti-vax hero, clashing with Trump, who is less willing to burn political capital on extreme MAHA priorities ([65:37]).
• Confirmation failures become a rare, faint "win"—delays, infighting, and lack of nominees limit damage ([71:52]).

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Notable Quotes & Moments

• On appointment grift:
  “The administration finds people for the Surgeon General the way my tiny, underfunded NGO found graphic designers for PDFs.” —Michael ([06:06])

• On the “MAHA” (Make America Healthy Again) coalition and political chaos:
  “It’s all power games.” —Aubrey ([51:39])

• On Means siblings’ wellness push:
  “My daily salad is actually a prescription. My dad did cut food stamps, but now my work lunch is healthcare.” —Aubrey ([32:16])

• On anti-vax doublespeak:
  "Vaccine hesitancy is a matter of personal freedom and liberty. It is not a global health threat. My body, my choice.” —Laura Loomer (quoted by Michael, [13:16])

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Key Timestamps for Important Segments

• [03:27] — Dr. Neshwat’s nomination, family ties, and resume distortions
• [08:02] — DeVry/for-profit med school background exposed
• [12:09–13:45] — Laura Loomer v. Dr. Neshwat, anti-vax infighting
• [16:13] — Dr. Casey Means’ “functional medicine” and wellness startup
• [17:33/22:26] — Two Means “origin stories” (residency burnout, mother’s cancer)
• [31:37] — HSA loophole grift and Means family wellness empire
• [41:43/42:06] — Good Energy book, MAHA media circuit, anti-expert narrative
• [57:08–59:42] — Casey Means’ disastrous confirmation hearing (vaccine questions)
• [62:00] — Non-disclosure of supplement company conflicts
• [65:38/66:32] — Dr. Nicole Saphier profile, new nomination
• [69:09–70:25] — Saphier’s supplement line and possible FDA issues
• [71:52] — Analysis: Why “no Surgeon General” is actually a harm reduction win

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Episode Mood & Tone

Aubrey and Michael blend biting satire with deep political cynicism, balancing the bleakness of American public health politics with absurd humor ("I miss Creed," "Mono grifter"). The ongoing theme: what happens when wellness woo, nepotism, and conservative culture war priorities collide in the machinery of government.

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Takeaway:

"We’ve got to accept the good news we get—with arms wide open."
—Aubrey ([72:44])

The current state? No Surgeon General—delays, chaos, and a series of failure-to-launch MAHA grifters. But for the hosts, that is, improbably, cause for just a smidge of hope.

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End of Summary

Transcript

[A]

Okay.

[B]

I actually. I actually have one. I'm on fire.

[C]

He came prepared. Maybe.

[B]

Welcome to Maintenance phase, the podcast that has nothing to say about the surgeon specific, but a lot to say about the Surgeon General.

[C]

Oh, I like that one so much.

[B]

I'm Michael Hobbs.

[C]

I'm Aubrey Gordon. If you would like to support the show, you can do [e-mail] maintenancephase you can also subscribe on Apple Podcast Premium. It's the same audio content. Michael, Aubrey. We are a year and a half into Donald Trump's second term and we still don't have a Surgeon General.

[B]

I have not been following this at all.

[C]

You and most people. There's been so much shock and awe in so many places that it's like, hard to keep track. We're all sort of like drinking from a fire hose in terms of the news cycles. Right.

[B]

I know whenever I hear about, like an out of work Fox News host, I'm like, yeah, they're probably the Surgeon General now. Who fucking cares?

[C]

Today we're gonna talk about the three sort of MAHA aligned doctors who have been nominated for Surgeon General, which.

[B]

They're all doctors. That's actually kind of surprising.

[C]

Well, hang on.

[B]

Okay.

[C]

Let's not get too crazy.

[B]

I thought it was gonna be like Omarosa or somebody.

[C]

We haven't done like a real maha update in a minute because it's so often just like a soul sucking slog of a thing. I would just like to preface this one by saying it's pretty fun.

[D]

Good.

[B]

I want like Real Housewives shit.

[C]

The Surgeon General is often referred to as America's top doctor. Their role is, in part focused on translating scientific findings into guidance for members of the public. So this is like a very maintenance phase role.

[B]

He knows when you've been sleeping. He knows when you're not getting enough beef tallow.

[C]

The Surgeon General can issue reports and recommendations, but the office doesn't have the authority to create policy.

[B]

It's actually kind of funny. We have this role because it is just like a guy who says stuff in chief.

[C]

It is kind of. Well, except there is a very functional part of the role. The Surgeon general leads over 6,000 uniformed officers in the US Public Health Service. So it's a role where it's really helpful to be both a seasoned healthcare provider and a really strong, clear communicator. Don't start laughing yet.

[B]

Foreshadowing. Foreshadowing. Okay.

[C]

The process for becoming the Surgeon General is that the President nominates someone to become the Surgeon General. The Senate confirms that person and then they serve a four year term. The nominee has to pass through the Health, Education, labor and pensions committee, the help committee, which is currently split with 12 Republicans and 11 Democrats. So it's Republican controlled, but only just. It is also a committee where Lisa Murkowski and Susan Collins are both on the committee committees. So you got a couple real mavericks, pieces of work.

[B]

Couple of mavericks.

[C]

So today we're going to talk about the three nominees for Surgeon General and why their nominations haven't been a cinch. Even in a Republican controlled Senate, in a Republican controlled committee.

[A]

Okay.

[C]

So In November of 2024, after he was elected to his second term, Donald Trump nominated Jeanette Neshwat to be Surgeon General. His statement on Dr. Neshwat's nomination describes her as, quote, a proud graduate of the University of Arkansas School for Medical Sciences. At the time of her nomination, she was serving as the medical director for CityMD in New York, which is a chain of urgent care clinics.

[B]

First Red Flag.

[C]

She is one of five children in her family and she is not the only one with ties to the Trump administration. Her sister Julia was a Homeland Security advisor under the first Trump administration. Julia's husband, so Jeanette's brother in law, is the current ambassador, U.S. ambassador to the U.N. he also represented Florida as a member of the U.S. house from 2019 to 2025. His name is Mike Waltz. Is that a name that rings a bell?

[B]

No.

[C]

Well, Michael, he's the guy who added a journalist to a signal chat about warplay.

[B]

Oh, okay. Okay.

[C]

He's the specific guy who has like clearly added this journalist to the group chat and then was like, I don't know how it happened. It just got sucked in there. You know how sometimes when you add an app to your phone and it just sucks up all your contact? It just got kind of sucked up in there. So it just got added. This journalist got.

[B]

I'm a bit of an opset expert myself.

[C]

Yeah, so that's one of her siblings. Another of her siblings is her sister Jacqueline, who is a model and a former pageant winner, who was Miss New York USA 2004 and Miss Florida America 2008.

[B]

Nothing wrong with that. But the fact that there's so many of these people in Donald Trump's orbit is so fucking bizarre.

[C]

Today she is the executive director of her husband's foundation, which is dedicated to helping underprivileged children around the world. That foundation is called the With Arms Wide Open Foundation.

[B]

Is it named after the Creed song?

[C]

Her husband is Scott Stapp.

[B]

No fucking way.

[C]

We could have had a Surgeon General who has Thanksgiving with Scott Stapp from Creed.

[B]

Why just do Scott Stapp. Fuck.

[C]

Scanned so hard with the administration that could only get thankful three doors down to play at the inauguration. But also, what a fucking stinging indictment that they couldn't get Creed.

[B]

No, I know he's right there. Also, I love that the administration, like, finds people like the Surgeon General the way that at my tiny, underfunded NGO, we used to find, like, graphic designers for PDFs. We'd be like, hey, you went to college with somebody who, like, knows Illustrator, right?

[C]

Yeah.

[B]

Just, like, reach out to them.

[A]

Oh, God.

[C]

Ours were more like, do you have an afternoon? Could you figure out Illustrated?

[B]

Wait, wait, wait, wait, wait. I have a thing. I have a thing. I have a thing.

[C]

You have a Creed thing. Wait, we're not done with Creed.

[B]

Donald Trump was looking at this, and he said, I'll take a breath. I'll take her by my side. We stand in awe. We've created life. I have the lyrics for With Arms Wide Open. Oh, my God.

[C]

I don't know, Michael. This is literally counting on me to recognize the lyrics that you also don't know.

[B]

I'm, like, furiously Googling. I'm like, I need a reference here, but I don't know the lyrics to this.

[C]

You're getting on a plane tomorrow, and I'm now imagining that you're gonna spend the entire time studying the Creed oeuvre.

[B]

I'll record a bunch of pickups to throw it into the episode.

[C]

Dr. Neshwat had likely crossed Trump's radar during her time as a TV guest doctor on Fox News and the Daily Caller, of course. But just six months after she was nominated, the day before her scheduled confirmation, hear Trump withdrew her nomination.

[B]

Okay, cancel culture.

[C]

So the question here is, what happened? Mike, I would like, actually for you to hazard a guess.

[B]

Did she once say, like, a single boilerplate thing about how, like, diversity is what makes America great?

[C]

No and no.

[B]

And they're like, no, not after 2024.

[C]

In April of 2025, an independent journalist named Anthony Clark breaks a story that he titles Trump's Surgeon General. Pick distorted key parts of her resume.

[B]

Wait, he just Googled, like, me looking at Creed lyrics? Yes. He's just like, type, type, type, type. Nope.

[C]

He finds that Dr. Neshwat didn't get her medical degree from the University of Arkansas, as she had claimed, but had completed a residency there as an employee, not a student.

[D]

Okay.

[C]

So he checks around to figure out where she got her MD from, and where she went was The American University of the Caribbean in St. Martin.

[B]

Oh.

[C]

Which is a commercial business.

[B]

And also it's probably like a distance learning thing or something.

[C]

Oh, Mike, you don't know how close you are.

[B]

That's like a. I got my degree from iTunes U.

[C]

In 2011, the American University of the Caribbean was bought by Adtelem Global Education, which is previously. No, Mike, I haven't.

[B]

Which is previously Philip Morris or something. It's like a made up name previously

[C]

known as the DeVry Education Group, baby. It's her DeVry Medical School.

[B]

Because that's like Betsy DeVos whole like for profit education thing, right?

[C]

100%, dude.

[B]

Scammers.

[C]

Clark also reports as part of this piece that for profit medical schools were banned in the US for over a century for concerns over admission standards, quality of education, needing new regulatory structures, all kinds of stuff.

[B]

It's also funny because the the only thing that offends them is the lying. If she had just said, I have no medical qualifications, it's not like the Trump administration gives a shit, right?

[C]

I'm so glad that you're getting a handle on the ways in which this episode is fun. Yeah, it's just like a fucking clown car of dinguses.

[B]

It's also now kind of bleak that CityMD didn't care or it met their standards.

[C]

They are also a for profit business.

[B]

They're like game recognized game. They're like, yeah, totally.

[C]

They're like, oh, you guys too cool.

[B]

Yeah.

[C]

So on top of all that, on her website, Dr. Nejwat says that she has a specialty in family and ER medicine. Okay, but she's only board certified in family medicine, not emergency medicine.

[B]

That's such a weird thing to lie about.

[C]

It's so weird. But also she works at an urgent care clinic.

[B]

I don't know about CityMD specifically, but every time I've gone to an urgent care, the person has been like, damn, you should see a doctor about this. Right? I'm like, I fucking know. They're like, that'll be $200 doll dollars, please.

[C]

In addition, Clark was unable to verify Neshwat's claim that she had worked in emergency rooms in Arkansas. So she is calling herself an emergency doc when she has worked for a for profit urgent care clinic in like a management role, which is just different. Right?

[B]

You must tell these lies. And then I guess forget about it because if I had some glaring hole in my resume, like a fat lie that I was telling and I was offered some like super prominent role where I would get a bunch of scrutiny, I would just Turn it down and be like, no, they will absolutely find this out. I want to keep my, like, cushy little life. She probably makes a couple million dollars a year.

[C]

So there's all of this bad press happening. But there are also complaints from the right. The Maha crowd was saying that Dr. Neshwat wasn't anti vax enough.

[B]

Yeah, I was just gonna make a joke about that. Did they find out she's vaccinated Very

[C]

early on in the. The sort of onset of COVID Even before lockdowns, she was doing some media with, like, Fox News and that sort of thing, being like, hey, here's what you gotta do. And it was like, you gotta mask up. It's probably airborne. You gotta wash your hands real well. You gotta blah, blah. Like, just giving, like, very basic information. And as part of that, at some points, she goes, you know, we'll need to develop a vaccine for this. It's like, really not anything. But she's also not committing to kind of unhinged Maha requests, like, let's do a complete overhaul on the infant vaccine schedule.

[B]

It's so funny that they're mad at her for not preemptively criticizing vaccines, like, before they were even developed. She should have been out here saying, like, they're killing our kids. Even the idea of a vaccine they're against.

[C]

So her biggest detractor on the right is Laura Loomer.

[B]

Oh, yeah. Well, who's probably the fucking Surgeon General now. Why not?

[C]

Who are unfamiliar? Laura Loomer is an advisor to the President. She is like a particularly unhinged presence, even in a White House full of unhinged presences.

[B]

She was just like a Twitter person, Right? She was like a lady on Twitter.

[C]

Yes. And kept getting banned from different social media platforms for, like, straight up hate speech and misinformation. Right?

[B]

Yeah, she's awful.

[C]

On May 5, 2025, Loomer tweeted about Dr. Neshwat calling her, quote, pro COVID vaccine nepo appointee.

[B]

Well, she's right about the second part.

[C]

She is.

[B]

It's funny how they care about that sometimes. They clearly don't give a shit about. It's all Nepo all the way down in this administration.

[C]

So I'm sending you a portion of a tweet from Laura Loomer.

[D]

Oh, man.

[B]

Okay, I'm not gonna yell, but large sections of this are in all caps.

[C]

I think you should make it your own.

[B]

Okay. Dr. Neshwat said vaccine hesitancy is a global health threat. She used her access to Fox News to promote the dangerous COVID vaccine, which is now killing millions of people. She tried to shame people who didn't take the vaccine by calling them global health threats. This is like sub literate vaccines are a matter of all caps. Personal health freedom. Vaccine hesitancy is a matter of personal freedom and liberty. It is not a global health threat. My body, my choice.

[C]

Laura Loomer saying my body, my choice and meaning it about vaccines.

[B]

We've gotten used to it by now, but this is like a person at a bus stop ranting. And also they're like five years old.

[C]

Well, and she capitalizes global health threat like it's the title of something. In May of 2025, instead of being confirmed, her nomination is polled. According to fox news, in 2026, Dr. Neshwat took a new job at Walter Reed.

[D]

Wait, what?

[B]

Even though they know her medical qualifications aren't real.

[C]

The only way that Trump would like pull the nomination or the way that he did it, I should say, I don't know that it was the only way he'd do it, but he was like, we're actually going to withdraw her nomination and put her somewhere else. Very important.

[B]

If he pulls the nomination, then it's a tacit admission that he's giving into criticism or that he got something wrong, which he would never do. So he's like, we actually found a better role for you somewhere else.

[D]

Yeah.

[C]

That better role is Alter Reed working on treatment of Havana syndrome.

[B]

Wait, what are they? Havana Syndrome truthers, the administration.

[C]

Apparently she is. I mean, she's working on it now. Right.

[B]

Weird.

[C]

Yeah. So for folks who are unfamiliar, Havana syndrome is described as like a sort of constellation of unexplained neurological symptoms. It often includes hearing really loud noises that others may or may not be able to hear. It is hotly debated.

[D]

Yeah.

[C]

Some people think it is a mass psychogenic illness. Others think it is the result of like chemical warfare from foreign actors. But man, oh man, they really like sent her to the hinterlands.

[B]

Yeah.

[C]

Go to Walter Reed, a place that sounds very important and is very important, and then work on Havana Syndrome.

[B]

It's also like, lie about your qualifications, get ready for a different job in this administration.

[C]

Fail upwards.

[B]

Exactly.

[A]

Yeah, exactly.

[C]

We're a man.

[B]

I know the Patricia Principle. Yes, it's very inspiring.

[C]

So we went pretty quickly through Dr. Neshwat because it's such a cut and dry story. Right. The second nominee was a real like, hold my beer situation. Okay, it's time for nominee number two. Casey Means.

[B]

Oh, yeah, yeah, yeah.

[C]

Mike, what have you Heard about Casey Means.

[B]

Just that she's like, nice Swat, but like, 50 times more deranged.

[C]

Yeah.

[B]

It's funny that her nomination was pulled essentially because she wasn't deranged enough. They're like, okay, let's get you someone to.

[C]

Oh, you want kooky? Yeah, we got kooky for you, baby.

[B]

Yeah.

[C]

She is a graduate of Stanford University, both undergrad and medical school. She runs a wellness startup called Levels, and she practices, quote, unquote, functional medicine, which is essentially like a rebrand of what in the 90s would have been called alternative medicine.

[B]

It's medicine, but this time it's functional.

[C]

This time it's personal.

[B]

Have you tried putting an onion in your sock and going to sleep? Very functional.

[C]

So she has kind of two origin stories coming into MAHA world. The first is her residency. After completing medical school at Stanford, Casey Means took on a five year residency at Oregon Health and Science University here in Portland. So she takes on this residency at ohsu, specializing in head and neck surgery.

[B]

Okay.

[C]

But as she moves through her residency, she says she became disillusioned with a system that put so much pressure and strain on doctors. A system that was always sort of intervening after things went wrong and not to help them go right to begin with. And in a system with such a pernicious profit motive.

[B]

Whatever.

[D]

Yeah.

[B]

So I got into a different part of medicine that also has a profit motive.

[C]

Right.

[B]

Selling MRIs to fucking celebrities.

[C]

Her story is that she was in a state of great exhaustion and disillusionment. And just six months shy of finishing her five year residency, she quit.

[B]

Okay.

[C]

Again, she says this is like, because she became so disillusioned with the system. And we're actually gonna watch a little clip of her telling that story to Tucker Carlson.

[D]

Okay.

[A]

Yeah. You know, I'm in the operating room in my fifth year of my surgical residency, and I'm looking down at a patient in front of me who's on our third revision sinus surgery. And, you know, I know how to diagnose her, I know how to write the prescript, I know how to do the surgery. But what I kind of realized in that moment was like, I have no idea why this patient's actually sick. She has so many other health issues. Pre diabetes, arthritis, she's got some brain fog, she's got obesity, and she's got this sinus issue. And in my training, you know, I was never, ever, ever taught to look at the whole patient, to look at how all these things are connected. And I was only taught how to you know, do the surgery and then bill for it. And I realized that there's a huge problem in how we're practicing medicine right now, which is what? We're ignoring the root causes of why Americans are sick. And we're profiting off of patients getting s and then doing things through them. That's the way the business model of healthcare works, you know, the most. The way that healthcare, which is the largest and fastest growing industry in the United States, makes money is you have more patients in the system having more things done to them for longer periods of time. And when I kind of put some of these pieces together and realized that my training had totally, essentially incapacitated me from really understanding why patients are sick and. And how to actually help them thrive, I actually had to walk away from the surgical world because I realized that I was only making money off of essentially not spending time helping patients understand their health and actually just profiting off their illness.

[C]

So nine years into medical training at Stanford, you gave it up voluntarily.

[A]

I. On my birthday, 30th birthday, I walked into the office of the chair of the department and I put down the scalpel and I walked away. And I devoted my life to why are Americans getting sicker every year? Why are 50% of American children dealing with a chronic health issue? This was less than 1% 50 years ago.

[B]

This frustrates the shit out of me.

[C]

Yeah, tell me.

[B]

Obviously, there's like, some kernel of, like, a reasonable critique of the medical system in here, obviously. But the problem with this whole, like, root causes analysis is it's not clear how you would operationalize this any medical system. Even if you do address the quote, unquote, root causes, you still have doctors who deal with patients in, like, an acute way. A head and neck surgeon wouldn't be addressing things like diet and lifestyle to prevent that in the first place. Obviously we need to do more preventative medicine. But you're still going to have people who need surgeries, right?

[C]

And, like, if you are aiming at, as she is, a structural critique, then you also need to have a structural solution.

[B]

Yeah, exactly.

[C]

And she doesn't fucking have that.

[B]

There's a weird kind of judgment behind this. She's like, I had this fat and sick patient and they wanted me to do surgery on her without exploring why she he's fat and sick. Do you think that fat people who have a, I don't know, a car accident or some sort of accident or some sort of condition don't deserve surgery?

[C]

I'm so sorry. I've become hopelessly Distracted by the Tucker Carlson store merch that is advertised underneath the video clip.

[B]

Wait, really?

[C]

In the clip that I just sent you, underneath the description, it says shop the Tucker Carlson store. They have mugs that say apac. An offer you can't refuse.

[B]

What?

[C]

And hats that say neocons are gay for war.

[B]

How much did they cost? Can I get one?

[C]

Part of the reason I got so distracted is I was like, I don't know what this means.

[B]

Yes, you do.

[C]

I do.

[B]

You love it.

[C]

I know what it means if it's coming from me or you. I don't know what it means when it's coming from Tucker.

[B]

I can hear you clicking buy and, like, typing in your address to get

[D]

it shipped to you.

[C]

Take my money, Tucker car.

[B]

Yeah, yeah, yeah.

[C]

No. Woo. So that is one of Casey means origin stories, right? Is her.

[B]

That's one.

[C]

Okay. That's one of the two that we're going to talk about. The second comes a few years later. Oh, God, I got to get the giggles out because this is a sad one.

[B]

You're okay. Okay.

[D]

Okay.

[B]

Do you want me to recite some Creed lyrics? Would that help? No, I have those in front of me still.

[C]

I'm gonna close the Tucker Carlson link so I'm not staring at the neocons are gay for war hat. Okay, sorry. I apologize for what my brain just did.

[B]

All right, Rough transition. Get us there.

[C]

So Kacey means second origin story comes a few years later with the sudden death of her mother.

[D]

Okay.

[C]

In January of 2021, her mother got the shocking news that she had stage 4 pancreatic cancer and that her prognosis was not good. According to Casey, doctors pressured her mom to get risky surgery that would only extend her life by a matter of months. And because of COVID protocols at the time, that recovery time would happen in quarantine. Right. So they wouldn't be able to. She would have this surgery, she'd have this long recovery time. She wouldn't be able to see her family. And they had already said she had had, like, a short timeline.

[D]

Okay.

[C]

As you and I both know, this is sort of part and parcel of having a family member who has a terminal illness. Right. Is that you have these, like, terrible choices to make where you're like, oh, nothing's a win. Cool.

[B]

And on some level, that is a, I think, fair critique of the medical system that it is split into these, like, little specialties. And, like, you know, my father recently died of cancer, and the same thing kind of happened to him that he was given all These weird treatments that had miserable side effects. And he would sometimes say, like, this actually isn't worth it for me. And his doctors. He got in kind of, like, fights with his doctors about it. They'd be like, well, you need this. And the minute he switched to palliative care, he got a way better bedside manner. There's a long time of kind of fighting with doctors about this kind of thing. And they weren't always totally transparent with how much benefit is this actually going to give me?

[C]

Totally. It's like a fair critique of the medical system. And it's also like a. It's like a horrible experience. And your emotions are in a place where, like, I definitely needed to, like, fact check and ground myself a couple of times and be like, hey, did I have a fight with this person, or did they just say something that reminded me of a terrible way that I already feel?

[B]

Exactly. I actually wonder. I mean, it's at least plausible that the doctor sort of presented the options to her. There is the surgery. It's risky. It's not gonna prolong your life that much, but it's an option. People were really nice to my dad when he was like, oh, I'd prefer to go on palliative care. They're like, okay, that's a choice that you can make. He could still say, no, thanks, and move on to something else.

[C]

My family member who passed of cancer recently was very clear about what he wanted in his treatment and what he did not want. And there was like, I think a lot of that from doctors being like, all right, well, you're making your choice. Got it.

[B]

Yeah, yeah, yeah.

[C]

Clearly it's not the thing I would recommend, but, like, this is your life and your choice.

[B]

You don't want to gaslight them about their experience. But she's just such an unreliable narrator that it's like, okay, what was actually happening with this interaction?

[C]

So I just sent you a quote. This is an excerpt from her book, Good Energy.

[B]

My mom made it clear to the oncologist that she was not afraid of her rapidly impending death, but she wanted to minimize unnecessary pain or nausea in her final days. Despite being clear the system pushed the exact procedures that would yield pain and nausea and aggressively shamed our family for questioning the full court procedure approach. The doctor was not consciously trying to recommend a suboptimal procedure, but I knew the invasive route would generate hundreds of thousands of dollars for the hospital. And this doctor's pay was tied to booking these procedures. The private motive thing is also true. I think it affects your Psychology in ways that are probably invisible to you.

[C]

Sure.

[B]

But again, she's just like an unreliable narrator.

[C]

And she's doing, I would say, a similar thing to what she was doing on Tucker Carlson, which is she's going from this intense personal experience straight to this sort of like. I'm not saying, I'm just.

[D]

Yeah, yeah, yeah. Right.

[C]

And it is designed to cast aspersions on the field. Right, right. And on treatment recommendations that are being given to people who are in life and death scenarios. Right. What she's doing here is sort of using like a very emotional personal experience, which, again, both you and I have been through in different ways. Right. She is using that to kind of shake the foundation and go, what if the whole thing is bummed?

[B]

Right, exactly. Because it's also totally plausible that her doctor was just a huge fucking asshole.

[C]

Right.

[B]

And so maybe you had a really bad experience with this, like, complete prick. That's absolutely plausible. But she is making it a bigger argument about the medical system and for profit healthcare, et cetera, et cetera, which again, you'd have to sort of marshal different kinds of evidence to support.

[C]

Yeah.

[B]

And also, if this was your issue, you would actually move us toward, like a universal healthcare system where the doctors just get paid salaries, which is actually what they have in many countries. That would be the thing that you would then start pushing toward. You wouldn't then leave the system and start selling people other shit for profit. That's just what destroys her entire credibility to me.

[C]

Her functional medicine clinic is in the Pearl District in Portland.

[B]

Pearl District, parentheses, derogatory.

[C]

Yes, yes, Michael. So when I was growing up, the Pearl was like a predominantly industrial area. There were significant numbers of homeless folks. And when I was in like maybe middle school or high school, it started getting gentrified to the fucking max.

[D]

Yeah.

[C]

So now those industrial buildings are overwhelmingly like luxury condos and lofts.

[B]

She's like, the medical system is kind of a grift, and I want to get in on that grift.

[C]

It feels very telling that you go to the wealthiest. Exactly. Right.

[B]

When my dad was a teacher at dental school, he also had a systemic critique because these profit motives were starting to take over dentistry at the time. And he started volunteering at a homeless shelter to do dentistry on homeless people. There's like, other things that you can do.

[C]

That's Right.

[B]

Other than this. You know, Kasey Means is a really

[C]

interesting mix of sort of like crunchy granola, maha style stuff and really dyed in the wool, conservative pedigree. In order to understand that conservative pedigree. We have to talk about the other two sort of surviving members of her immediate family, both of whom are high profile conservatives. The first of those is her father, Grady Means, who was a longtime Republican operative in D.C. okay. He worked for Nixon and after Nixon's resignation, for Vice President Nelson Rockefeller. During the Ford administration. During the Ford administration, he worked on the Food and Nutrition Task Force, which sought, among other things, to dramatically scale back food stamps.

[B]

There's that systemic critique, baby.

[C]

Right. The like food is medicine lady's dad is the reason that fewer people have the medicine food that she wants everyone to have.

[D]

Right.

[B]

Poor people have too much food.

[C]

Grady also worked as a consultant before selling off the consulting wing of his firm for. For $3.5 billion in 2000.

[B]

2 billion.

[C]

So that's her dad, Grady Means. She also has a brother named Callie

[B]

Means, which the description on this Tucker Carlson YouTube video tells me has also been interviewed by Tucker Carlson.

[C]

Yes, correct. So they have become a little bit of like a package deal. They're sort of a little one, two punch in maha world. And they co authored their book together.

[B]

Oh, okay.

[C]

Kali Means went to Stanford undergrad and went Harvard. For his mba, he interned both for the George W. Bush White House and for the Heritage Foundation.

[D]

Nice.

[C]

He worked on the McCain campaign, reportedly as part of the quote, unquote pit crew that was working to improve Sarah Palin's reputation.

[B]

Okay. He did that debate prep. He's furiously sending her links to Schoolhouse Rock.

[C]

He. He describes himself as a former never Trumper who became one of RFKJR's advisors after that appearance on Tucker Carlson. Kali Means is an entrepreneur who founded a company called Trumed, which helps people apply for HSA coverage of like, peloton bikes and infrared saunas.

[B]

Oh, wait, really? He's trying to get people reimbursed for, like, alternative medicines.

[C]

Yep. So health savings accounts, HSAs are tax free accounts. You essentially are allowed to set aside money that you're going to spend on health care, not be taxed on that money and spend that money tax free. Yeah, functionally. There's been a bunch of research into this. It really just ends up benefiting rich people who want to pay less in taxes for their luxury, health and fitness purchases. Right.

[B]

And also most people use it and then just like never, like, you just forget that you have it. It's such a hassle to use it that a lot of people just don't use it.

[C]

And then you're like, oh, I gotta buy two pairs of glasses this week.

[B]

Yeah, yeah, yeah, yeah.

[C]

True Med allows people to log onto their website, fill out a quick survey, and get delivered a letter of medical necessity that allows their purchase to be covered by hsa. In exchange, True Med takes a cut of the sales.

[B]

Oh, okay, okay. That's scammy.

[C]

So they've been used for, like, red light therapy devices, including the, like, skincare red light masks. They've been used for supplements for smart mattresses.

[B]

Sure.

[C]

Vanity Fair did an incredible deep dive piece into Cali Means. I strongly recommend it. And as part of that, they got their hands on some early True Med marketing materials, which. Which, at its outset, focused on rebranding companies like sweetgreen and Daily Harvest as healthcare companies.

[B]

My daily salad is actually a prescription.

[C]

My dad did cut food stamps, but now my work lunch is healthcare. So the mean siblings both have very close ties with the sweet green guy, the Daily Harvest guy.

[B]

Oh, really?

[C]

Of course. All of these people are people that they know and work with very frequently through the quote, unquote, End Chronic Disease Coalition.

[B]

How do I know that's a scam?

[C]

Right?

[A]

Right.

[B]

Any other time in history, you're like, oh, endocrine disease. That sounds good, but it's like, nope, my brain is too broken from doing this show.

[C]

The coalition is mostly. They're advocating for something called the HOPE act, the Health out of Pocket Expense Act.

[A]

Oh.

[C]

Which would be Expand eligible uses for HSA dollars. And the End Chronic Disease Coalition, which RFK Jr. And like, other folks on the right will like tout. Oh, like, oh, my God. Cali Means work with this incredible coalition. The coalition is largely made up of companies whose products would be covered under those proposed expanded rules.

[B]

So it sounds, like, nice, like, oh, we're expanding the hsa, but it's actually just like, you're going to get profits out of this, basically.

[C]

And the name of the coalition is End Chronic Disease. Like, oh, my God, this guy's so dedicated to ending chronic disease. No, he's fucking not. He's dedicated to selling his buddies like food and then taking a cut of those sales.

[B]

Yeah, yeah, yeah.

[C]

So, Michael, are you ready for Cali Means origin story?

[B]

Oh, yeah, Give it to me.

[C]

Cali Means says that he was a lobbyist for Big Food and Big Pharma.

[D]

Okay.

[C]

And that he saw firsthand the kind of corruption at play there. On one podcast, he claimed, among other things, that he brokered a deal between the American Diabetes association and Coca Cola.

[D]

What?

[C]

That it's like hush money to, like, stop opposing us in public or whatever. And I was just like, dude, what are we doing?

[B]

So he's doing it like Confessions of an Assassin kind of thing, where he's like, ooh, I brokered these evil deals.

[C]

Yes. Confessions of a Lobbyist. Yeah. On Tucker Carlson's podcast, he claims to have attended a meeting where food corporations were paying off nutrition researchers at Harvard and Stanford. And he alleged on Twitter that in his time as a lobbyist for food corporations that Coca Cola gave, quote, unquote, millions to the NAACP and the Hispanic Federation in exchange for publicly calling any policies hindering soda sale as racist.

[A]

Okay.

[C]

Describing the whole thing as, quote, unquote, depressingly transactional.

[B]

Those seem like easily verifiable claims, but whatever.

[C]

So Vanity Fair, in this deep dive piece, fact checked him and his story simply did not check out.

[B]

Yeah, of course not.

[C]

They interviewed more than 60 people who had worked with Kali Means. Nine of his former colleagues from PR World, from Mercury and Adelman disputed his version of events.

[A]

Okay.

[C]

Where Kali Means claimed that he had been a quote, unquote, director at Mercury, brokering these high level deals. His colleagues said he was an executive assistant who wouldn't have even been in the room for the deals that he said he would.

[B]

An executive assistant is hella funny.

[C]

It's as removed as you could be from, like, the halls of power that you're talking about.

[B]

They're like, hey, can you grab us a cup of coffee? And he's like, I was in the

[C]

room where it happens. That's right.

[B]

Yeah.

[C]

Not only do they dispute the roles that he held, they also dispute that they, the companies represented the clients that he claimed.

[B]

Nice.

[C]

So in the three years that Cali Means worked at Mercury, they didn't represent Coca Cola, nor did they represent the American Beverage Association. Mercury, which is where Cali Means was working, was working. The other side of the issue, they were campaigning to reduce soda consumption, and their client wasn't was the California Endowment.

[B]

It's funny, cause he could have just said, I was on the ground working to reduce the influence of Big Food. Like I was advocating against soda companies. He could have just said that. But instead, he's like creating this weird narrative.

[C]

Right. It's a really strange thing to sort of manufacture a heel turn that you don't appear to have had. Right. The Vanity Fair piece also uncovered some real gems about Kali Means as a co worker. I just sent you a quote.

[B]

It's an. At the office, several colleagues recall his air of self importance. He seemed to have bigger and better plans ahead, which didn't include them. He walked around the office saying, cali means business. Wait, Cali means business. He walked around the office saying Cali means business. Another former colleague recounts. That's like his cute little. It's almost like a bumper sticker phrase for like when he runs for Congress.

[C]

Totally.

[B]

Kelly means business. Can you.

[C]

I just want you to imagine an executive assistant who is trying to. Or something who's like trying to get into every strategy conversation.

[B]

Yeah, yeah, yeah.

[C]

Is acting like they're better than everybody around them at like a pretty high powered firm where they are very junior.

[B]

Yeah, yeah.

[C]

And they're walking around just muttering Cali means business to themselves. Like, what a fucking dork.

[B]

A real Pearl District resident is the way I think of him. Just the kind of guy who live in the Pearl District.

[C]

So that's Grady Means and Callie Means. It felt important to lift up that Casey Means because she sounds kind of like Portlandy Maha Crunchy Granola Y. It felt really important to establish just how committed to extreme conservatism her family is.

[B]

I'm so curious how this nomination fell apart now because all of this so far sounds like everyone in the term administration would just love these people.

[C]

Right?

[B]

And welcome them with arms wide open.

[C]

Bab. Well, Michael, when it comes to this story, can I take you higher? That's it. That's all of my creative.

[A]

That's it. That's it.

[B]

We're done.

[C]

I know the title of two songs.

[A]

The End.

[C]

So back to Casey Means. Unlike her predecessor, Dr. Neshwat, Casey means. Basic CV checks out. She did graduate from Stanford undergrad in 2009 and from Stanford School of Medicine in 2014. She did go on to pursue her residency at OHSU. It was a five year program, but she dropped out six months before completing it. She did get a medical license, but it has now been inactive for a couple of years. She has offered two reasons for leaving her program. One is that sort of state of American health care thing. And the other is the stress and pressure of her surgical residency. After leaving her residency, she opens her functional medicine practice called means Health in 2019, the same year that she opened her functional medicine practice. She also co founded Levels, a health tech company that sells continuous glucose monitors and lab testing services as well as as quote unquote AI insights.

[D]

There it is.

[B]

There it is.

[C]

A full membership to levels for a year, including glucometers, costs about $1,500 per year.

[B]

I'm so against profit medicine. The problem with medicine is all of the profit. That's why I charge you $1,500. That's why? It's like 100. More than 100 fucking dollars a month.

[C]

So she founds levels and her functional medicine clinic in 2019. And in 2020, Covid hits. Kasey Means takes that as an opportunity, of course, and submits an LTE to the journal Metabolism Clinical and Experimental. In it, she argues that metabolic dysfunction is a core issue for COVID 19 and that managing blood sugar in a data driven way was an essential intervention for Covid.

[B]

Oh, so buy my. Buy my product.

[C]

So she submits this letter in April of 2020. By November of 2020, she had reportedly raised $12 million in seed funding for levels. By 2022, the company was reportedly valued at $300 million.

[B]

Oh, wow. Okay.

[C]

It is then 2022 during Callie and Casey Means appearance on the Tucker Carlson show that really establishes them in the right wing just asking questions circuit. From there they both start doing the rounds, showing up on Joe Rogan's show and a ton of like right wing podcasts right after the Tucker Carlson thing that really seems to blow things wide open. It's also reportedly where RFK Jr comes across their work. Right. All of that leads up to the release of Callie and Casey means book in 2024, which is called Good. The Surprising connection between Metabolism and Limitless health.

[B]

How is it not called Means test? They have so many puns at their disposal. Think of the possibilities.

[C]

Lean Means healthcare machines.

[B]

Lean Means is great. They're leaving grifts on the table.

[C]

In promotion of the book, they publish an excerpt on the Free Press.

[B]

Of course.

[D]

Yeah.

[C]

The excerpt on the website is titled I'm a doctor, you shouldn't always trust us.

[B]

Got it.

[C]

The chapter in the book is titled trust yourself, not your doctor.

[B]

This website loves laundering most far right

[C]

garbage, but like through the mouths of experts who went to all of these like IV and IV adjacent institutions. Yeah, like I read the whole book. Callie and Casey Means both say some very accurate, reasonable criticisms of the US healthcare system. They also write really compellingly about the shortcomings of the food system and the heartbreak of people needing to pay more money than they have just to stay healthy or stay alive.

[B]

And that's why we've joined the Republic Republican Party, which wants to make all of these things worse.

[C]

Right. So in talking about the importance of like eating whole foods and healthy fats, rather than directly increasing access to those things through like SNAP or wic, they instead shift to this personal responsibility frame, saying that like it's actually on you to make sure that you're eating very expensive ingredients. She's an anti seed oil lady. So she's like, right, like buy the oil. That is like, like five or six times as much.

[B]

Right.

[C]

They are totally silent on like how any of this would be possible for low income families. Right.

[B]

And they're just, of course, as usual, just inflating the ability of like a virtuous lifestyle to solve all of these issues. Like you did something wrong if you get one of these chronic conditions. That's the ideology.

[C]

On the press tour for the book, she becomes a real hot take factory. She has said that, quote, many, if not most COVID 19 deaths could be prevented with optimal metabolic health.

[D]

Nice.

[C]

And called Covid a quote, Darwinian moment for America.

[B]

Oh, what, in like a good way?

[C]

Yeah, like the least fit, did not survive way.

[B]

Just saying it. They're out here just fucking saying it.

[C]

She also has some anti vax positions that I think are dressed up to appear more moderate than they are. In her newsletter she wrote, quote, quote, there is growing evidence that the total burden of the current extreme and growing vaccine schedule is causing health declines in vulnerable children.

[B]

Vulnerable. We're really looking out for the vulnerable. By giving them measles. It's so important that they get measles.

[C]

She has said, quote, I think vaccine mandates are criminal.

[B]

I mean they are in the sense that we never fucking had them in America. So whatever.

[C]

She said that in response to somebody on Twitter giving her shit for not being anti vaxx enough. And she was like, I have seen said innumerable public times.

[B]

I love that.

[C]

I love that. Actually, actually I'm the most anti vax.

[B]

I'm actually pretending when I say we need more research and stuff. I'm actually super anti vax. Don't worry about it, Michael.

[C]

Aren't we having a good time with these?

[B]

Isn't this fun?

[C]

It's kind of fun. I'm having fun.

[B]

This is like my parents on road trips as a kid. This is fun, right?

[C]

She has written, quote, when it comes to a question like raw milk, I want to be free to form a relationship with a local farmer, understand his integrity, look him in the eyes, pet his cow and then decide if I feel safe to drink the milk from his farm.

[B]

I want buying food to be a just constant fucking chore where I have to know every single thing and do all the work myself. I would love that.

[C]

The way that, you know, if there is listeria in milk is a good hard look in the eye.

[B]

I want other people to have the freedom to fucking lie to me my face about the health impact of their Products.

[C]

She is also a proponent of both psilocybin and mdma. She likes shrooms. She likes molly.

[B]

Why are all these people into fucking psychedelics? It's so fascinating. All they do is bitch about, like, Prozac and stuff, but they're like, no, no, no. Take these other drugs. It's so weird.

[C]

Yeah. I mean, I think there's, like, a rift, right. Both within Maha world and within Republican world writ large, where you have sort of older school Republicans who are like drugs, and you have this sort of, like, newer wave of, like, red pill fucking assholes who are like drugs. It becomes a liability because it exposes that rift, which doesn't often get tested in federal policymaking. Right, Right. So in addition to all of those hot takes, sometimes her hot takes take the form of poetry.

[D]

Okay.

[C]

For April Fool's Day, she wrote a poem for her newsletter. As she notes, she got, quote, some help from AI. I'm sending you four verses from a poem that has, like, 20 verses. Like, there's so many. So I just picked a few, and

[B]

she puts it in full in her newsletter.

[C]

Mm. The title of the poem is the Devil's Wellness Plan.

[D]

I'm not.

[B]

I'm not reading. This is way too much.

[C]

Aubrey, you're reading it. Michael, you're reading it.

[B]

If I were the devil, I'd ditch the disguise. No pitchfork, no flames, just marketing lies. I'd feed you poison, call it a snack, and label you elitist. When you want your health back. I'd bury research, seal the locks, then line you up for 73 shots. Doesn't rhyme. I'd cancel critical thinking, stop dissenters with bots, then jab your kids without a second thought. Also, doesn't really rhyme. I'd break your trust in ancient ways and mock the moon and cycles phase. I'd push the pill and dull women's flame til womanhood forgot its name. I'd give boys man boobs through toxic food and call masculine strength aggressive and lewd. I'd whisper, you're too much, too loud, and shame men's fire as something rude.

[C]

There you go.

[B]

I miss Creed. Aubrey, can we go back to Creed?

[C]

Like, he's a professional. You can't expect her to be on his level.

[B]

I'd at least had, like, an okay pentameter or whatever it was. Least the correct number of syllables.

[C]

So good energy. Callie and Casey Means book came out in 2024. By May of 2025, Casey Means was announced as the Trump administration's nominee for Surgeon General.

[D]

Nice.

[C]

That is so far to get in such a short period of time. The reactions to Casey Means nomination are swift and they are negative.

[B]

This means war.

[C]

So a number of former surgeons general come forward and are like, absolutely fucking not. Jerome Adams actually like writes an op ed about it and is like, hey, part of your job as the head of the U.S. public Health Service is to weed out people who don't have license to practice. And Kasey Means does not have an active medical license.

[B]

Oh, right, yeah.

[C]

There is criticism from Maha folks who once again criticize her for not being anti acts enough.

[B]

Really? Even her?

[C]

Uh huh.

[B]

Fuck it hell.

[C]

Once again, Queen gremlin Laura Loomer weighs in on Twitter. I just sent you a quote.

[B]

Casey Means said when she was looking for romance, she would do shrooms, talk to trees, participate in full moon ceremonies, and pray to inanimate objects with a spiritual medium. So basically the new Surgeon General is a total crackpot, a shroom consumer, and she talks to trees and doesn't even have a an active medical license. Another failure by the geniuses who work for President Trump on his non existent vetting team. I guess there isn't a single conservative doctor in America who doesn't have a history of being a Marxist tree hugger. This is bizarre. Kissy Beans is like a complete nutcase. They should love this lady.

[C]

The reactions to her nomination are so bad on Twitter in particular, that RFK Jr rushes to her defense on the platform. He says that Maha is taking on powerful corporate players and that those companies, quote, will continue to pay bloggers and other social media influencers to weaponize innuendo, to slander and vilify Casey the same way they tried to defame me and President Trump.

[B]

The fights between these people are always just like the Spider man meme of people pointing to each other. It's like vaguely different shades of lunatic is like why they're mad at her.

[C]

I mean, I think this is part of what makes me feel less despairing about this episode is that early on when RFK Jr. Was nominated, you and I talked about him and his priorities being on kind of a pretty direct collision course with the Trump administration, right? That he's like, I want to regulate corporations, I want to ban all this advertising, I want to blah, blah, blah. And Trump is the guy who's like, let corporations do whatever the fuck they want, right? And that the Maha coalition was like, sort of like looking for a home and Republicans offered them a home, right? But the rift and the sort of differences and disconnects are starting to show. And part of the Way that that's starting to show is in these kinds of, like, infighting moments. And part of the ways that that's starting to show is in having three nominees for Surgeon General.

[B]

Right.

[C]

And not having one still.

[B]

And also these, the whole MAHA thing. You can't have a stable coalition when it's built on the back of lies and misinformation, because everyone is ultimately just making shit up and cherry picking. You don't have a referee or an objective standard of facts to point to to adjudicate a dispute about, like, do shrooms work or are shrooms bad? They don't give a shit about what actual science looks like. So you can't really have, like, a good faith debate even within these coalitions.

[C]

Right. It's all power games, right?

[B]

Yeah.

[C]

So on top of all those negative reactions, there's also this new wave of reporting about, like, who is this new Surgeon General nominee? And one of the things that they find in that reporting is that there are pretty significant gaps between how she describes her residency and how other people at her residency described her at her residency.

[D]

Okay.

[C]

Vanity Fair interviewed the chair of the department where her residency took place who said that Casey Means found the job, quote, unquote, too stressful, that she quit in tears and that other residents had to, quote, cover for her. And we're a small department and all the calls fall on them.

[B]

No way. The funny thing is that's also a structural critique of the American medical system. People are so overworked.

[C]

Yeah.

[B]

But, yeah, it's also funny that she, like, makes it this, like, virtuous, like, I chose to leave thing.

[C]

Two other residents who served with her in the same department at the same time said that she was very anxious and primarily, like, afraid of hurting patients.

[B]

Has she tried zinc? Has she tried taking zinc for anxiety? I think it just maybe it's her lifestyle.

[C]

So all of this leads up to Casey Means confirmation hearing, which happened in February of this year. Her initial confirmation hearing was scheduled for October 2025, but it was postponed when she went into labor with her child.

[B]

So she got maternity leave, basically something the administration is also decidedly against.

[C]

Initially, the confirmation hearing is scheduled for October. It ends up taking place in February after her parental leave. And in that time, the conditions and the sort of political calculus here really change. Among other things, the chair of the committee where the confirmation hearing will happen, the help committee, is Bill Cassidy. Bill Cassidy is, in that intervening time, defeated in his Republican primary by a Trump endorsed challenger to the right. Bill Cassidy is now a lame duck with serious like flame duck potential. But there's also a long standing rift between Senator Cassidy and President Trump dating back to at least 2021, when Cassidy voted to convict Trump of inciting a riot on January 6th.

[D]

Okay.

[C]

He's a physician who did practice for a long time in a lot of situations. Right, right. Like, say what you fucking will about Bill Cassidy. I'm not going to cape for any Louisiana Republicans at this point. But he is an actual doctor who did actually practice, who does actually have a medical license. All of that does feel relevant here.

[B]

There's also a long history of Republicans, like, kind of doing the right thing once they don't have an election to win anymore.

[C]

Totally. So, like, as I have told you, I'm not a fan of, of congressional hearings. They feel like political theater. They feel like they're not accomplishing anything. They're definitely not fact finding missions, like, ever. Right. I think that this confirmation hearing was pretty effective as political theater.

[B]

Cool.

[C]

They had like a really clear, good division of labor folks had drafted their questions in a really tight way and came in with like a pretty unified front across party lines. Bizarrely, Josh Hawley is like, hey, I need to talk to you about what I'm hearing from my constituents, which is they're concerned about the health risks of AI data centers. What I will say Holly kind of softballs it. And he's like, well, I'd invite you to give it some thought. He's not like an asshole to her about it. He's not like confrontational about it at all. But he does raise it up and is like, these are the kinds of things that people are concerned about. They're concerned about water quality that looks like this.

[D]

This.

[B]

Right.

[C]

Like, they're like doing the thing of being like, hey, this is an issue.

[B]

It is all theater, though, because they none of them give a shit about any of this stuff. But whatever.

[C]

It's totally theater. But it was surprising to me that if you're doing a performance and the performance of every Republican at this point is to some degree just for Donald Trump.

[D]

Right.

[C]

His willingness to push back in that way, I was like, oh, that's interesting.

[B]

It's weird. Yeah.

[C]

But he's not the only Republican on the committee who has sort of more direct and sort of harder questions for her. At one point, Senator Cassidy asked her if she believed that vaccines cause autism. This is after the Pam Bondi hearings. So it's clear that she's trying to, like, moderate her response and not be kooky and start yelling about like, the Dow Yeah, yeah. So her response to Cassidy's question about vaccines and autism is. Is quote, we have an autism crisis that is increasing. This is devastating to many families and we do not know as a medical community what causes autism.

[B]

Which I can see the anti vaxxers being mad about that.

[C]

It's the one answer. The like we don't actually know what causes autism is the one answer that is guaranteed to piss off everybody.

[B]

She should have just said they fucking cause autism and then like the anti vaxxers would get on her side, 10

[C]

toes down, standing on business.

[B]

Yeah, yeah, yeah, yeah.

[C]

So in that same hearing, Tim Kaine asks her about flu shots, which is not a huge part of the anti vax discourse.

[B]

Right.

[C]

So I just sent you. We're going to watch a clip. I apologize in advance for how infuriating this clip is to listen to.

[D]

In a News report. On January 7, just a month or so ago, Secretary Kennedy stated, quote, there is no evidence that the flu vaccine prevents serious disease or that it prevents hospitalization or deaths in children. Do you agree with that statement,

[A]

Senator Kaine? As I've said, I believe vaccines save lives and are an important part of our.

[D]

I'm not asking about the general. I heard that testimony earlier. But you're an md. Your qualifications have been much discussed earlier. Do you agree with the statement that there's no evidence that the flu vaccine prevents serious disease or that it prevents hospitalizations or death in children?

[A]

I have not personally seen that quote or that article. I would want to review it before

[B]

I decide on that.

[D]

Okay, I'm going to. I'm going to set the quote aside. I'll introduce for the record, so bad at this, an article CBS News RFK Jr says it may be better if fewer children receive the flu. Flu vaccine dated January 7, 2026, without objection. Do you believe that there is evidence that the flu vaccine prevents serious disease and prevents hospitalization or deaths in children?

[A]

I believe that all patients should talk to their doctors.

[D]

And so do I. And that's not what I'm asking. Your qualifications have been much discussed. There is a mountain of evidence about this. Do you believe that there's no evidence that there's. The flu vaccine has efficacy in reducing serious injury or hospitalization?

[B]

You could see a little hamster wheel in her brain.

[D]

This is an Easy one, doctor. This is an easy one.

[A]

I support the CDC's guidance on the flu vaccine and I will only with the cdc, ACIP and the ac.

[D]

So you believe it is an efficacious vaccine to reduce hospitalization and Is or is not? Is. You believe it is.

[A]

As I said, I support the CDC's guidance on the flu vaccine.

[D]

Let me just say, do you think the flu vaccine reduces the risk of hospitalization or serious injury? You're a doctor.

[A]

I believe vaccines save lives. I think a public health strategy.

[D]

The flu vaccine, does it reduce the

[C]

risk of injury or hospitalization at the population level?

[A]

I certainly think that it does.

[D]

Let me introduce, for the record, If I can, Mr. Chair, CDC seasonal flu vaccine effectiveness studies dated May 30, 2025, from the CDC that goes into this in some detail. This is not a hard question.

[A]

I answered your question.

[D]

And yes, after three minutes, you acknowledge that at a population level.

[A]

I haven't seen that report. I have not seen.

[D]

Yeah, but you know about the flu vaccine.

[A]

If I had a nickel for every time I was misquoted in the media, I'd be a very wealthy woman. I would like to understand what his comments.

[D]

I'm not asking you about the quote. I'm asking you about something in your remit. The effectiveness of the flu vaccine.

[C]

Stunning.

[B]

He did eventually get her to admit it, which is actually interesting that she did.

[C]

I think it's, again, an indicator of how bad she is at this.

[B]

Yeah, yeah.

[C]

Part of what sinks her in this hearing is that she keeps trying to rely on these phrases like, I believe vaccines save lives or Right, I support the CDC guidance.

[B]

She clearly also didn't know what the CDC guidance was because the CDC guidance is all like pre RFK Jr. So most of it is still pretty pro vaccine at this point.

[C]

It's all the DOGE guys being, like, asked to define what DEI is, and they're like, it's whatever was in the eo.

[B]

Yeah, yeah, yeah, yeah.

[C]

Another piece that becomes like a big challenge for Casey Means is her financial conflict, which are significant. Of course. She owns and operates levels, her sort of medical equipment, wellness startup. But on top of that, as we've mentioned, she has a really strong presence on substack and Instagram and social media sort of writ large. And it becomes clear that she has failed to disclose many, many financial relationships.

[A]

Okay.

[C]

And in her newsletter on Instagram, on social media, broadly, she is frequently recommending products. Oh, right.

[B]

And like not disclosing, like those FTC regulations where you have to say like, hashtag sponsored or whatever.

[C]

Correct. Yeah, those regulations. Those regulations about disclosing when something is an ad on social media came into effect after Fyre Fest. That's why we got those fucking things.

[B]

Yeah.

[C]

And she's like doing a wellness Fire fest of like, not disclosing. The Associated Press investigated her disclosures and found that she had been taking big payments that she did not disclose publicly. $59,000 from Function Health, Mark Hyman's company.

[B]

Oh, yeah, of course.

[C]

$12,000 from Daily Harvest. $16,000 from. From Fluorosophy, a fiber supplement company.

[B]

That sounds like a fake word that she made up for one of her poems so that it rhymed.

[C]

$27,000 from Energy Bits, an algae supplement company.

[B]

Wait, what was the one we talked about on the bonus episode? Food cube or whatever? Is she Getting cube bucks?

[C]

$500 from. From Wenatal Prenatal Vitamins.

[B]

Oh, that's pretty good, actually.

[C]

And $130,000 from Amazentis. Oh, a supplement company.

[B]

Also $200,000 from Tati Westbrook's Hair Vitamins.

[A]

That's right.

[C]

Bye, sister. I will also say not for fucking nothing. In her confirmation hearing, one of the members of the committee is Bernie Sanders, who questions her on stuff and mostly is. Is like, hey, I agree we should ban junk food advertising. Hey, good point on this thing.

[B]

Yeah. Everyone's going out of their way to do this shit.

[C]

I know Bernie Sanders is, like, trying to sort of be like, you know, I disagree with the Trump administration on a lot of stuff, but I think you got some good points here.

[B]

Yeah, yeah.

[C]

And then like, posts a clip on social media and is like, hey, we had a real one. This was a good conversation. Like, I don't agree with her on everything, but I support her in this thing. And people just, like, absolutely shredded him on it and was like, you don't gotta hand it to her.

[B]

This is. But this is why these people make these disingenuous, plausible sounding arguments is because they attract people who, like, want to give them credit and want to give them good faith, but these people are not acting in good faith.

[C]

Correct.

[B]

You cannot listen to what they say. You have to look at what they do.

[C]

Correct.

[B]

What is she doing with her life? There's no way. These people are like, oh, I just want to fix the diet of a man. Americans. Is that what RFK Jr has spent the last 20 years of his life dedicated to? No, he's dedicated it to fucking getting kids infected with measles. That's what they actually believe. You have to ignore all this bullshit. They are saying that as a fucking trap, as bait to get people who do not care or do not know about their actual background to do exactly what Bernie is doing.

[C]

100%. I was like, this is uncharacteristically. Like anti shrewd also for just a failed fucking candidate.

[B]

Two, you're also. It's clear by this point that like she's not going to make it through.

[C]

So on April 30th of this year, in a truth social post, Donald Trump acknowledged that Kasey Means didn't have the votes to being confirmed.

[B]

She will also be joining Walter Reed.

[C]

Unsurprisingly, Trump blames Bill Cassidy, the chair of help Committee. But also there appear to be holdouts that were Cassidy, Collins and Murkowski were all like, I don't know.

[A]

Okay.

[C]

After the administration withdraws Casey Means nomination, the political landscape starts to shift again. New polls come out revealing that changing the vaccine schedule is hugely unpopular with voters. Plus the anti vax stuff has faced a large number of court challenges. So it's, it is costly and time consuming to defend against. Right. So they're really testing like how much political capital the Trump administration is willing to spend on Maha priorities.

[A]

Right.

[B]

And this is more of an RFK thing than a Trump thing.

[C]

Yes, Correct. So we're seeing like how far is Trump willing to go for RFK Jr. Right. And not as far as Casey Means is the answer.

[D]

Yeah.

[C]

That's when they announce the newest third and newest current nominee. Nicole Sapphire is her name. She went to Arizona State University for her undergrad for her md. She's telling us out front she didn't go to med school in the U.S. okay. She went to Ross University in Barbados.

[B]

Is that like a for profit scam factory?

[C]

It doesn't appear to be. I didn't look into Ross University to a great degree because I was like, they're not going to do that again. Right. But maybe, who knows. She is currently a radiologist at the Sloan Kettle Veteran Cancer Center, a licensed doctor. Her career as a public figure is a very Maha like gotta catch em all kind of thing. She has a podcast. She has a supplement company. She's a Fox News contributor. Great. She's written three books. Love Inspiring stories celebrating motherhood.

[B]

Okay.

[C]

Make America Healthy Again. How Bad Behavior and Big Guy Government Caused a Trillion Dollar Crisis.

[B]

Yeah, the government's definitely the problem.

[C]

She also published that before RFK Jr. Was using MAHA.

[B]

Oh, wait, really?

[C]

Uh huh. She tried to trademark it, which is very funny, and then she sort of dropped it. Yeah, yeah. She hosts a podcast called Wellness Unmasked and she wrote another book called Panic Attack, Playing politics with the science in the fight against COVID 19.

[B]

I could just like write that book from memory. I could like sit down and read that book.

[C]

One million percent. You already know labs leak. Whatever. Dr. Sapphire's positions on core MAHA issues are often presented in a way that seems a little more moderate than a Casey Means, which, like, not hard to do. I think a good example on that is her position on vaccines. She, like Casey Means, is very strident in her vaccine save lives stance. But she has also said that the pediatric vaccine schedule should be, quote, unquote, less stringent.

[B]

Yeah, there it is.

[D]

Yeah.

[C]

And that she opposes vaccine mandate dates. She has also been publicly and directly critical of RFKJR's approach on vaccines.

[A]

Really?

[C]

And she's done that criticism in right of center media outlets. It's fascinating.

[B]

Okay.

[C]

She's a real mixed bag. Most notably, she wrote an op ed in the Wall Street Journal just last year called the Madness in RFK jr's Autism Method Woke Queen.

[D]

She's.

[B]

I'm into it now, comparatively.

[C]

I heard she said defund the police. I don't think she did. She has publicly criticized Trump, but those posts are now deleted. So she's like, been speaking her mind, but then doing the Trump nominee thing, scrubbing the record afterwards.

[B]

Right.

[C]

She tweeted at one point, quote, seems like they may not want to admit the US Measles elimination status is gone until after the midterm terms.

[A]

Nice.

[C]

On Trump's Tylenol warning, she posted, quote, as a mom of three kids, I don't love a man telling me to tough it out when it comes to pregnancy. Wow, this is the bar is in hell portion. Right. But also, like, not a lot of people are exceeding the bar.

[D]

Right.

[C]

So far, the reactions have been much less alarmed than last time. The reactions from people who sort of reacted to Casey Means the first time around, including past surgeons general, those responses have been essentially like, this is a qualified nominee with an active medical license.

[B]

It all feels like, not that it was, but it all feels like a strategy that, like, we're gonna nominate the two worst fucking people alive. And then when we get to the third nominee, who's also trash, everyone's gonna be like, whatever.

[C]

Folks have been worn down so hard, I'm sleepy. Dr. Sapphire hasn't faced confirmation hearings yet, but there is one thing that may become an issue in her hearings. She has a supplement brand called droprx. It's called Droprx because it is herbal tinctures, like liquid tinctures in eyedropper bottles. In true supplement biz form, their supplements are named things like Boost Relief, Allure,

[B]

Sleep and Intimacy Taste test Episode Incoming.

[C]

So there are two problems here. One is Dr. Safire works for the Memorial Sloan Kettering Cancer center center, which has a clear policy that bans employees from, quote, endorsement of products or commercial ventures. It's also suspect as hell for a surgeon general, so she would likely need to divest. Right. As with Casey Means and levels, problem number two is that their supplements include kava, which the USDA and FDA warn is associated with significant liver damage and which is regulated differently in different states.

[B]

Cheap champagne. What is kava?

[C]

It is a root that is supposed to sort of promote, like a sense of calm. And in some states you can use it in supplements. In some states, you can serve it in the cafe. In some states it's like banned completely. But the USDA and FDA have already issued warnings about it. So it's just real weird to have a surgeon general who is selling a product that runs counter to public health guidance from other agencies. Right.

[B]

Do you know how easy it is to find a practicing doctor who isn't a fucking grifter? It's crazy. They can't find a single one.

[C]

They're all tree hugging Marxists. Mike, for now, she appears to be much more in the vein of Dr. Neshwat than these means.

[B]

Right.

[C]

And that honestly feels like a pretty grounded win.

[B]

Right.

[C]

To have someone who is not, who's like grifting from one angle but not like seven.

[B]

That's as good as it gets in America in 2026. Right now, she's only one kind of grifter.

[C]

Count your blessings. She's only selling herbal tinctures.

[B]

I know. She's a mono grifter.

[C]

That's the best we can do at the start of this episode. I started by saying that the research made me feel like less despairing. Here's why. One, this is a place where the Trump administration is failing. They are not getting their nominees confirmed.

[A]

Yeah.

[C]

This is also true of other Trump nominees too. According to Brookings, the average confirmat delay for Trump nominees has doubled from his first term to his second.

[B]

Although in fairness, they are twice as bad this time.

[C]

They are pretty bad.

[D]

Yeah.

[C]

From a harm reduction standpoint, I genuinely think it's more helpful to have no surgeon General rather than one of these ultra gremlins.

[B]

And it's a win that Kasey Means didn't get through because she's a complete nutcase.

[C]

I think the last thing that makes me feel sort of like groundedly, cautiously optimistic about all of this is that Trump is is immensely unpopular right now. Which means that again, Republicans who are already pushing back on this committee are going to be incentivized to push back more.

[D]

Yeah.

[C]

You know, good news is few and far between at the moment. This is like a very, very, very low bar to meet.

[B]

Yeah.

[C]

But I think we've got to accept the good news we get with arms wide open.

[B]

Yeah, I know. You're. I knew you were going to go

[D]

back to the house.

[B]

One of us is going to do it,

[C]

Sam.