Feb. 25, 2026, 5:00 AM EST / Updated Feb. 25, 2026, 12:53 PM EST
Dr. Casey Means appeared before the Senate on Wednesday in a long-awaited hearing to discuss her highly scrutinized nomination for surgeon general
Means faced tough questions from members of the Senate Health, Education, Labor and Pensions Committee about her stances on vaccines, contraception and antidepressant use during pregnancy. She often avoided direct answers, instead echoing refrains from Health Secretary Robert F. Kennedy Jr. and other top health officials
Sens. Bill Cassidy, R-La., and Bernie Sanders, I-Vt., both grilled Means about whether she believed that vaccines cause autism, as Kennedy has claimed
Means said that vaccines save lives and that “anti-vaccine rhetoric has never been a part of my message.” However, she declined to rule out vaccines as a contributor to autism, despite decades of evidence that has not shown a link
“We do not know as a medical community what causes autism,” Means said. “Until we have a clear understanding of why kids are developing this at higher rates, I think we should not leave any stones unturned.”
Scientists largely attribute the rise in autism cases to advances in diagnostic capabilities and greater understanding and awareness of autism spectrum disorder. Genes and environmental factors are likely contributors as well
Means also hesitated when asked several times by Sen. Tim Kaine, D-Va., if the flu vaccine prevents serious disease, hospitalizations or death
“Doctor, this is an easy one,” Kaine said
Means replied: “I support the CDC guidance on the flu vaccine.”
In a highly controversial move, Kennedy altered the Centers for Disease Control and Prevention’s childhood vaccine guidance in January. Instead of a universal recommendation for flu shots, the CDC now recommends shared clinical decision-making between patients and doctors
Means, a popular wellness influencer, was a campaign adviser during Kennedy’s presidential bid and an architect of his “Make America Healthy Again” agenda. Her brother, Calley Means, is a Kennedy ally and senior adviser to the Department of Health and Human Services
Like Kennedy, Means has gained popularity in wellness circles because of her messages about outsize corporate influence in the food and pharmaceutical industries. She has often expressed skepticism of traditional medicine, writing on her website that hormonal birth control has “horrifying health risks” and that the “total burden” of the vaccine schedule — before Kennedy overhauled it — is “causing health declines in vulnerable children.” (Neither claim is substantiated by scientific evidence. Routine childhood shots are backed by decades of safety data, and serious complications from hormonal birth control are rare.)
Sen. Patty Murray, D-Wash., pressed Means on Wednesday about her prior comments on birth control
Means said some of the “horrifying” side effects she was referring to include blood clots and stroke among women who have clotting disorders, are smokers or have obesity
“I absolutely believe these medications should be accessible to all women,” she said, adding that “all medications have risks and benefits.”
Where antidepressant use during pregnancy is concerned, Means reiterated that there are benefits and risks and said patients should have a nuanced conversation with their doctors. (Some Food and Drug Administration officials have questioned whether pregnant women should stay on the medications, despite the American College of Obstetricians and Gynecologists’ recommendation to do so.)
If confirmed to the role, Means would be an outlier among surgeons general: She does not hold an active medical license (her license lapsed in January 2024) and she did not complete her medical residency (she graduated from Stanford University School of Medicine but left a surgical residency program at Oregon Health and Science University in 2018, just months before she was due to complete it)
As a result, many medical professionals have questioned whether Means is qualified to become America’s top doctor with the authority to issue health warnings and advisories for the entire country
In response to questioning from Sen. Andy Kim, D-N.J., Means said that her medical license is inactive because she is not seeing patients
“I do not plan to reactivate because I’m not going to be seeing patients in this role,” she said
Means did not respond to a request for comment ahead of the hearing. Emily Hilliard, a spokesperson for HHS,said that Means’ “credentials, research background, and experience in public life give her the right insights to be the surgeon general who helps make sure America never again becomes the sickest nation on Earth.”
President Donald Trump nominated Means for surgeon general in May on Kennedy’s recommendation after withdrawing his previous choice, former Fox News medical contributor Dr. Janette Nesheiwat
Means’ confirmation hearing — previously scheduled for October — was postponed after she went into labor with her first child. (Means said Wednesday that she went into labor five hours before the hearing was due to start, and her son, Phoenix, was born on the scheduled hearing day.) Her nomination subsequently expired, so Trump nominated her again Jan. 13
In her new role, she would also oversee the Public Health Service Commissioned Corps, a federal branch whose officers include physicians, nurses, scientists and engineers. The branch requires its officers to maintain active licenses in their respective fields
Means’ confirmation hearing comes amid mounting scrutiny of Kennedy’s leadership from Democrats and some Republican lawmakers. In his first year in office, Kennedy has fired top health officials, downplayed the role of vaccinations during an unprecedented measles outbreak and slashed funding for critical research areas like mRNA shots
Prior to her nomination, Means sold dietary supplements, teas and other wellness products on social media — a subject that has generated concern about potential conflicts of interest. A review from Public Citizen, a consumer advocacy group, determined that Means did not consistently disclose that she could profit or benefit from the sale of certain products
The group has also raised questions about whether Means stands to profit from Kennedy’s endorsement of wearable devices, since she co-founded Levels, a company that helps people track their blood glucose
Sen. Tammy Baldwin, D-Wis., asked Means on Wednesday to explain her promotion of supplements that claim to offer longevity and detoxification, as well as her decision to charge people for glucose monitoring
Means said she was proud of her work “using entrepreneurship as a tool … that can help us understand our blood sugar better.”
Means signed an ethics agreement in September stating that she would resign from her advisory position at Levels and stop putting up monetized social media posts. She also agreed to stop producing her newsletter and promoting a 2024 book she co-wrote, “Good Energy.”
The book argues that people can “improve and extend their lives” through “simple principles doctors aren’t taught in medical school” — namely eating healthier, getting more sleep and physical activity, and understanding one’s underlying disease risk
