Casey Means faces the Senate health committee in a confirmation hearing to be US surgeon general

But Means also will likely face tough questions about her qualifications and potential conflicts. The Stanford-educated physician's disillusionment with traditional medicine drove her to a career in which she has promoted a wide range of products, at times without disclosing how she could benefit financially.

As the nation’s doctor, the surgeon general is a leader for Americans and health officials on public health issues. If confirmed, Means would be empowered to issue advisories that warn of public health threats. She also would be tasked with promoting Kennedy's sprawling MAHA agenda, which calls for removing thousands of additives from U.S. foods, rooting out conflicts of interest at federal agencies and promoting healthier foods in school lunches and other nutrition programs.

Surgeons general also have sometimes used the office to advocate on issues related to vaccination — though the office has no role in creating vaccine policy. Means has mostly steered clear of Kennedy’s debunked views on vaccines but has called for more investigations into their safety.

Means has no government experience, and her license to practice as a physician is not currently active. After graduating from medical school at Stanford University with a doctor of medicine degree, she dropped out of her surgical residency program at Oregon Health and Science University in 2018. She has cited her belief that the health care system was broken and exploitative as the reason for her withdrawal.

Means then turned to alternative approaches to address what she has described as widespread metabolic dysfunction driven largely by poor nutrition and an overabundance of ultraprocessed foods.

Because she had completed enough postgraduate training to obtain a medical license, she did so and started her own functional medicine practice in Oregon, which later closed. She co-founded Levels, a nutrition-, sleep- and exercise-tracking app that also can give users insights from blood tests and continuous glucose monitoring.

Financial disclosures show she made hundreds of thousands of dollars promoting health and wellness products, including specialty basil seed supplements, teas and elixirs, probiotic products and a prepared meal delivery service. An Associated Press investigation found that while recommending these products, she at times failed to disclose that she could profit or benefit from the sales.

In an ethics filing, Means said that if she is confirmed for the post by the full Senate, she will resign from her position with Levels and forfeit or divest stock options and stock in the company. She also pledged to stop working for Rupa, a specialty lab work company for which she developed an online course. While she may continue receiving royalty payments from her book “Good Energy,” she will not promote it, the filing said.

The filing also noted she will “not acquire any direct financial interest in entities listed on the Food and Drug Administration’s prohibited holdings list.”

At least two previous surgeons general have publicly suggested Means is not fit for the job.

In an op-ed in The Hill last May, former Bush administration surgeon general Dr. Rich Carmona wrote that Means' professional qualifications “raise significant concerns.” Later that month, President Donald Trump's first-term surgeon general, Dr. Jerome Adams, wrote on the social platform X that the surgeon general's traditional leadership of the U.S. Public Health Service Commissioned Corps requires a medical license.

Means is seeking to join an administration for which her brother, Calley Means, already works. As a senior adviser to the U.S. Department of Health and Human Services, he has helped promote the Republican administration's message about the dangers of ultraprocessed foods.

The nomination for Trump’s first pick for surgeon general, former Fox News Channel medical contributor Janette Nesheiwat, was withdrawn after she came under criticism from the president’s allies. Means was nominated to the role last May.