No, She Doesn't Wear Prada: The Devil Wears a Lab Coat.
Casey Means built a wellness empire on undisclosed deals and unfinished credentials. Now she wants to be America’s doctor.
If you follow me, you know I’ve been watching RFK Jr. like a hawk for years. I know about his checkered work history (he’s not the clean river guy you might think), his womanizing, his ex-wife’s suicide, his chaotic childhood and of course his crank healthcare ideology. In a nutshell I think he has serious mental health challenges and no moral compass.
To be clear there are real issues in healthcare. In no small measure these are caused by the loud voice of pharmaceutical companies and health insurance. In recent times, the opioid epidemic is a clear example of big money influencing physicians. I worked on this epidemic for three years as a project manager for the HEALing Communities Study, an NIH-funded project at Columbia University. The damage was and is real. Of course health insurance companies that until Richard Nixon’s intervention were never allowed to be operational for profit, but now it is all about providing huge dividends to shareholders – this process keeps people away from healthcare and often denies life saving or helping care. These are big problems.
One of the gems in our healthcare system are the “boots on the ground” folks – our physicians. Most are very dedicated and well trained. The system for training and board certification is meaningful and pumps out routinely high-quality professionals. Not every kid going into medical school graduates. Not every graduate goes on to residency and there are those who do who never become board certified. These folks, be it by personal choice or not making the grade, share space in healthcare: they are not qualified.
Before I worked on the HEALing Communities Study, I was a CEO for many, many years and hired more than my fair share of physicians, many of them surgeons. Sometimes right out of residency, before they became board certified, in a period of time where they were “board eligible” and part of their contract gave them a window to take their boards. Many do not realize that some board certifications require a certain amount of clinical experience after residency before being able to take their boards. I never entertained hiring a physician who dropped out. Casey Means is a drop out. She never finished her residency. She is not board eligible. While her academic pedigree is impressive, it is at best incomplete. What she did after dropping out is unethical on a host of levels – from practicing a non-studied nor regulated, non-data driven form of predatory medicine to her serial lying while hawking “wellness” products.
On the morning of February 25, 2026, Dr. Casey Means took her seat before the Senate Health, Education, Labor, and Pensions Committee. She was there to convince the United States Senate that she should become the Surgeon General of the United States, the overseer of 6,000 public health officers, the voice Americans are supposed to trust when disease comes knocking.
The hearing had been delayed for months. Means was originally scheduled to appear the previous October but went into labor on the day of her testimony. Now, finally, she was ready. She wore the quiet confidence of someone who had spent years cultivating a brand built on authority and relatability: the Stanford-educated physician who walked away from the operating room to tell you the real truth about your health, one Instagram post at a time.
“Our nation is angry, exhausted, and hurting from preventable diseases,” she told the committee. It was a polished line, the kind she had delivered on podcasts with Tucker Carlson and Joe Rogan, on her Substack newsletter to 200,000 subscribers, in her bestselling book. The packaging was familiar. But as the hearing wore on, senators began pulling at the seams. What tumbled out was not the story of a visionary reformer but something considerably less flattering: a carefully constructed influence operation in which the boundaries between medical authority, product endorsement, and personal enrichment had been quietly, systematically, and profitably erased.
The Education of Casey Means
On paper, the early chapters are impressive enough. Stanford, class of 2009, honors, human biology. Stanford School of Medicine, class of 2014, Gold Humanism Honor Society. Research positions at the National Institutes of Health and New York University. Stanford released a statement calling her a “distinguished scholar.” So far, so dazzling. The kind of résumé that gets passed around at dinner parties in Palo Alto with the reverence normally reserved for sacred texts.
After medical school, Means entered one of the most competitive training programs in American medicine: a five-year residency in otolaryngology (head and neck surgery) at Oregon Health and Science University. She was on track to become a surgeon.
She never finished. She quit roughly six months before the finish line, which in the world of surgical residencies is a bit like dropping out of a marathon at mile twenty-five to open a smoothie stand.
The reasons she gives for leaving are, shall we say, curated. On her website, Means frames the departure as a principled stand against a broken system. “During my training as a surgeon, I saw how broken and exploitative the healthcare system is and left to focus on how to keep people out of the operating room,” she writes. It is a lovely sentence. It belongs in a TED Talk. It also, according to her former department chair, has only a passing acquaintance with the truth.
Dr. Paul Flint, who led the department at OHSU, told reporters that roughly four and a half years into the program, Means came to him and said she wasn’t sure medicine was right for her at all. Not that the system was broken. Not that she had a higher calling in metabolic health. She wasn’t sure medicine was right for her. He and the residency director offered her three months of paid leave. She took it, came back, and resigned. “She was under so much stress,” Flint said. “She did not like that level of stress.” Another person close to her during that period said she never once mentioned metabolic health or systemic disillusionment. She was anxious. She wanted out.
People leave residencies. The pressure of surgery is real and unrelenting. There is no shame in it. But there is something rather breathtaking about the distance between the actual story, a trainee who buckled under a very hard job, and the founding myth Means constructed from the rubble. The courageous doctor who saw through the machine. The maverick. The truth-teller. Strip away the Instagram filters and what you have is a woman who quit a very hard job and then, with the unerring instincts of a Silicon Valley founder, figured out how to monetize the quitting.
The Wellness Doctor Hangs a Shingle
After leaving OHSU, Means did not retreat to a cabin in the woods to commune with her disillusionment. Within two weeks (two weeks!) she attended a business retreat for physicians on designing an “Ideal Medical Practice.” The speed of this pivot would make a McKinsey consultant blush. By December 2018, she had her Oregon medical license. By January 2019, she had incorporated Means Health, a “functional medicine” practice in Portland.
A brief word about functional medicine, for those unfamiliar with this particular corner of the health bazaar. Functional medicine borrows the vocabulary of science (“root cause,” “systems-based approach,” “biomarkers”) in the same way a con artist borrows a good suit. It sounds authoritative. It is not recognized as a specialty by the American Board of Medical Specialties. Its certifications come from the Institute for Functional Medicine, a private organization whose imprimatur carries, in the world of credentialed medicine, the approximate weight of a gold star from your kindergarten teacher. In the world I come from, hiring surgeons, credentialing physicians, building medical staffs, a functional medicine certificate is a participation trophy.
But what Means lacked in legitimate credentials, she made up for in what can only be described as entrepreneurial spirituality. In her newsletter, she shared her personal wellness journey with her audience, which included setting up an ancestor shrine, praying to photographs, writing manifestations on small pieces of paper, doing full moon ceremonies with “grounded, powerful women,” working with a spiritual medium, talking (literally out loud, she specified, in case you thought she meant telepathically) to trees, and doing “plant medicine experiences,” which she helpfully illustrated with a mushroom emoji.
The practice itself proved to be short-lived, which is what tends to happen when your business model rests on the twin pillars of tree conversation and basil seed supplements. Means Health failed to renew its Oregon registration by 2021.
Let us pause to appreciate the full absurdity of this trajectory. A woman who dropped out of a surgical residency under stress, who opened a practice built on non-evidence-based medicine that folded within two years, whose medical license went inactive, and who once told her newsletter subscribers she talks to trees. This woman is sitting before the United States Senate asking to become America’s doctor. It is the kind of career arc that, in a novel, an editor would reject as implausible. But not in the Trump/RFK Jr. era. Nope. You can be anything.
Finding a Pot of Gold on the Internet
The American wellness industry is approaching $1 trillion, which tells you everything you need to know about the relationship between scientific evidence and the American consumer. In that sprawling bazaar of supplements, wearables, detox elixirs, and glucose monitors, few figures have risen as fast or as profitably as Casey Means.
After the practice collapsed, Means executed the pivot that would make her rich. She co-founded Levels, a biotech company that pairs continuous glucose monitors with a slick app. She became its chief medical officer, a title that sounds impressive until you remember she is a physician who does not practice medicine. She co-authored a bestselling book on metabolic dysfunction with her brother Calley. She built a newsletter, an Instagram following north of 850,000, a TikTok presence, and an orbit that included anyone with a microphone and an audience that had grown suspicious of their own doctors.
And then the checks started rolling in.
Financial disclosures filed with the Office of Government Ethics revealed a bounty that would make a pharmaceutical sales rep whistle through his teeth: more than $130,000 from supplement company Amazentis. $27,000 from probiotics company Pendulum Therapeutics. Nearly $60,000 from Function Health, a lab testing platform in which Means is also, naturally, an investor. $22,000 from Zen Basil, a specialty seed company (because of course there is a specialty seed company). $20,000 from Genova Diagnostics, which, in a detail so perfect it could only be real, had previously agreed to pay $43 million to settle allegations of billing for medically unnecessary lab tests. $12,000 from Daily Harvest, a meal kit company. All told, at least $325,000 in supplement promotion money since the beginning of 2024.
The Brother Grimm and Cash Reaper
To understand how Casey Means arrived at a Senate confirmation hearing, you must first meet the impresario behind the curtain: her brother Calley.
Calley Means is not a doctor. He is not a scientist. He is not a nutritionist, an epidemiologist, a pharmacologist, or a public health researcher. He has no formal education in any health-related discipline whatsoever. He is a former management consultant and political operative who, by his own cheerful admission, once lobbied in Washington on behalf of the very pharmaceutical and food companies he now positions himself as crusading against. He has described himself as a lobbyist, though he never actually registered as one, which is its own kind of tell.
After the siblings’ mother died of pancreatic cancer during the pandemic, Calley and Casey used her death as a launching pad. They said pancreatic cancer was preventable. They said her end-of-life care was harmful. They blamed her oncologist for receiving payment for her care. They made the podcast rounds—Carlson, Rogan, the whole MAGA road often traveled.
They became fixtures of the anti-establishment health space that eventually coalesced around the slogan “Make America Healthy Again.” A phrase with the unmistakable DNA of MAGA branding, which is to say it is three parts populist grievance, two parts merchandising opportunity.
And Calley got himself into the innermost orbit of Robert F. Kennedy Jr. The relationship was part ideology, part transaction, and all hustle. Calley became a key adviser to Kennedy’s 2024 presidential bid.
Calley was rewarded with a title: special government employee at HHS, later promoted to senior adviser working directly with Kennedy. A man with zero health credentials was now shaping nutrition and food policy for 330 million Americans. Meanwhile, his company, TrueMed, continued to hum along. TrueMed’s business model is worth savoring for its sheer circularity: it helps consumers obtain letters of medical necessity so they can use tax-free health savings account dollars to buy supplements, Peloton bikes, cold plunge tanks, saunas, and other wellness merchandise that would not normally qualify as medical expenses. The IRS issued a formal alert about exactly this kind of arrangement: “Beware of companies misrepresenting nutrition, wellness and general health expenses as medical care.”
And here is the part that would be funny if it weren’t so brazen: the MAHA policies that Calley helped shape at HHS call for expanding HSA eligibility to cover precisely these kinds of purchases. The legislative vehicle, the One Big Beautiful Bill Act, contained provisions to do exactly that, at a projected cost to the federal government of $180 billion over ten years. In other words, Calley Means was in a position to write rules that would directly enrich his own company. Congressional Democrats launched an investigation.
When a reporter asked President Trump why he had nominated Casey Means for Surgeon General, his answer had the disarming honesty of a man who simply does not care enough to lie. “Because Bobby thought she was fantastic,” he said. “She’s a brilliant woman who went through Stanford. … I don’t know her.” But watchdogs did.
79 Out of 140: The Odds of a Good Grift
In February 2026, the group Public Citizen filed a formal complaint with the Federal Trade Commission urging an investigation into Means’s endorsement practices. The complaint was assembled with the care of a forensic accountant, cross-referencing every social media post, newsletter, and website promotion against the financial relationships disclosed in her government ethics filings.
The findings were, even by Washington standards, spectacular. Out of 140 instances in which Means promoted products from companies that paid her, she failed to disclose the financial relationship 79 times. That is a failure rate of 56 percent.
The breakdown is almost monotonous in its consistency, the work of someone who had clearly decided that disclosure was optional and stuck with the decision across every brand partnership she signed. Function Health: disclosed in only 4 of 13 promotions. Genova Diagnostics: 2 of 9. Daily Harvest: 3 of 14. Zen Basil: 2 of 13. It was not a lapse. It was a business model.
The FTC’s rules on this are not ambiguous, not complicated, and not new. When a person with a platform recommends a product and has a financial relationship with that product’s maker, they must disclose it. Every time. In every post. The principle exists because people have a right to know when they are being sold to. This is especially true, and I cannot stress this enough, when the person doing the selling carries the letters M.D. after her name and speaks to her audience with the implied authority of a medical education from one of the most prestigious universities in the country.
Senator Chris Murphy of Connecticut laid these numbers out at the hearing with the unhurried patience of a man who has already read the last page of the mystery. “This seems systemic,” he said. “It seems that in the majority of instances in which you were, as a medical professional, recommending a product, you were hiding the fact that you had a financial partnership. You seem to be in regular, willful violation of the FTC rules.”
Means said she didn’t think that was true. She said she takes conflicts of interest seriously. She said that if any failure to disclose had occurred, it was inadvertent.
Inadvertent. Across multiple companies. Over a period of years. More than half the time. This is like a shoplifter telling the judge the merchandise just keeps accidentally falling into her purse.
The Vaccine Question, or: How to Say Nothing With Great Conviction
If the financial disclosures raised the question of whether Means could be trusted, the vaccine exchange at her hearing raised a far more dangerous one: whether she should be trusted with the health of the entire country during a measles outbreak in which children were dying.
Casey Means was asked, repeatedly, by senators from both parties, whether she would encourage parents to vaccinate their children against measles, the flu, and whooping cough.
She would not say yes.
She said vaccines “save lives” and are “an important part of public health.” Boilerplate so generic you could print it on a napkin at a pharmaceutical convention. When Senator Bill Cassidy, a Republican, a physician, and the chairman of the committee, pointed to the measles outbreak that had sickened nearly a thousand people and to the children who had died, and asked her directly whether she would encourage mothers to vaccinate their children, she offered more gauze. When Senator Tim Kaine asked whether the flu vaccine prevents serious disease, she began, “I believe that all patients should talk to their doctor—” and Kaine cut her off. That was not what he asked. It was not, of course, what she was prepared to answer.
Then came the autism question, and with it, the moment that told you everything. When Cassidy and then Sanders asked whether she accepted the overwhelming, multiply replicated, exhaustively investigated scientific evidence showing that vaccines do not cause autism, Means gave the answer that has become the secret handshake of the vaccine-skeptical movement: “We do not know as a medical community what causes autism. Until we have a clear understanding of why kids are developing this at higher rates, I think we should not leave any stones unturned.” And then, the coup de grâce: “I do accept that evidence. I also think that science is never settled.” A sentence so perfectly engineered for plausible deniability that it deserves to be studied in rhetoric courses. On Joe Rogan’s podcast, she had been less disciplined: “I bet that one vaccine probably isn’t causing autism, but what about the 20 that they’re getting before 18 months?” This maps, with the precision of a tracing, onto Kennedy’s debunked talking points. She told the Senate that vaccine advocacy has never been a part of my message. She does not need it to be. When the nation’s doctor hedges on measles vaccination during a measles outbreak, the silence speaks fluently.
And it does not stop at vaccines. On Tucker Carlson’s show, Means drew a direct line between hormonal birth control and industrial pesticides: “You’ve got the pill, and it just goes hand in hand with the rise … of industrial agriculture, the spraying of these pesticides.” When Cassidy asked at the hearing whether oral contraceptives should be widely accessible, she said yes, and then immediately hedged, because hedging is what she does the way other people breathe.
The Nation’s Doctor and the Question She Never Asks Herself
What strikes me most about Casey Means is not the ambition but the apparently total absence of self-awareness about the canyon between what she is and what the Surgeon General of the United States is supposed to be.
She does not have an active medical license and has told the Senate she does not intend to get one. She did not complete her residency. She is not board certified in any specialty recognized by any legitimate medical body. She has no training in public health, no MPH, no experience in epidemiology, no background in health policy or administration. She has never served in the Commissioned Corps. She has never run a hospital, a clinic, or a government health agency.
And yet there she sat, before the United States Senate, apparently untroubled by the notion that any of this might be a problem. Asked whether she understood that the role of Surgeon General required active clinical authority and the public’s trust, she responded with the same imperturbable confidence she brings to selling basil seed supplements.
Casey Means had every opportunity, in that hearing room, to demonstrate she understood the gravity of what she was asking for. She was asked direct questions and given clear openings. Tell American mothers to vaccinate their children. Acknowledge that the autism question has been answered. Explain why she routinely failed to disclose her financial relationships. Level with the Senate about why she really left her residency.
She did none of it. She hedged, she deflected, she offered the committee her “deep hope to be a unifying, practical messenger,” a sentence so empty of content it could float. And the fact that it apparently never occurred to her that any of this was disqualifying, that she seemed genuinely baffled that senators might want the nation’s doctor to have, say, a medical license, tells you everything you need to know.
What the Senate heard on February 25th was not the nation’s doctor. It was a carefully rehearsed con performance by a woman who has spent years learning exactly how much she can leave unsaid, how much ambiguity the market will bear, and how much money there is in the silence.
If Casey Means becomes Surgeon General, preventable and once nearly eradicated diseases will continue to rise. People will die. Misinformation will keep replacing medicine as mainstream guidance, and it will take decades to restore public health.
This is terrifying.
©2026 The Powell House Press | josh@thepowellhousepress.com