When Dr. Casey Means appeared before the Senate Health Committee last Wednesday, she offered a simple explanation of her approach to medicine. “Our nation is angry, exhausted, and hurting,” she said. “If we’re addressing shared root causes, we’re going to be able to stop the Whac-A-Mole medicine that’s not working for us.” Means, who is Trump’s surgeon-general nominee, says “reactive sick care” contributes to an epidemic of chronic disease that we can solve almost entirely by addressing the “root cause.”

Like many in the MAHA world, Means blames most cases of poor health on a single underlying problem and locates it within the individual mind. The “root cause” is different for everyone but also the same for everyone. People are getting “sicker, heavier, more depressed, and more infertile” because of the food they consume and the decisions they make, she writes in the introduction to Good Energy, which she co-authored with her brother, Calley Means. “Root cause” contaminates our air and food and water, so purification is a full-time job. Good Energy attributes 80 percent of all human deaths to “preventable lifestyle conditions,” and in Senate testimony last year, she blamed cancer, mental illness, and even “congenital abnormalities” on “metabolic dysfunction,” or “the cellular draining of our life force.”

Listen to her remarks in isolation and she makes a certain kind of sense. I’m tired. Aren’t you? Dig a little deeper, though, and problems emerge. The first: Means does not and cannot practice medicine. She obtained a medical license, but it is inactive so she is unable to write prescriptions. She dropped out of a surgical residency in 2018 and is not board certified in any speciality. Instead, she has jargon. Kevin C. Klatt, a nutritional scientist at the University of Toronto, said root cause is a popular term in the world of functional medicine, which promotes expensive but unscientific therapies to consumers. According to some practitioners, hyperbaric oxygen therapy can treat the root cause of ADHD and depression — but there’s no evidence this is true. Others sell bespoke supplements and diet plans. David Gorski, a surgical oncologist and the managing editor of the website Science-Based Medicine, has called functional medicine “a triumph of marketing over science.”

Because root cause is not a medical diagnosis, it can be whatever Means or another practitioner wants it to be, and it can be fixed by whatever they want to sell. If we suffer from “metabolic dysfunction,” as Means says, we might watch our blood glucose in order to keep ourselves healthy. We could even buy a wearable glucose monitor from Levels, a company she co-founded. If poor metabolic health leads to inflammation, we might consider Laird Superfood, another Means sponsor. Critics like Klatt say that Means has a financial incentive to ignore science and safe medical practice. The Levels system can measure blood glucose, but there’s no conclusive evidence that it has any health benefits for people without diabetes or prediabetes. Worse, a user won’t necessarily know what to make of the data or how to apply what they’ve learned to their lives. In February, the watchdog group Public Citizen filed an FTC complaint against Means for potentially violating influencer-marketing rules.

Means links to studies and statistics on her website and in public appearances, adding a scientific veneer to her arguments. But her ideas are essentially spiritual. She often refers to a “life force,” as journalist Rina Raphael wrote in The Atlantic. The use of synthetic pesticides gives “a poor signal to God (Source!) that we want this miracle to continue,” Means opined in a newsletter, and she once urged her followers to commune with “God/spirit/ancestors/nature” to guide them toward a purpose. Erick Erickson, the pro-Trump commentator, has called her a “near Wiccan.” (This was not a compliment.)

Although Means may be too far out for Erickson, she does share some gender politics with the right. Conception is a recurring theme in her work, and she believes we are experiencing an “infertility crisis” with a preventable root cause. Her followers must learn to address it themselves. A March 2024 edition of her newsletter told readers they could “heal” their “metabolism and mitochondria” by quitting alcohol, reducing stress, and purchasing WeNatal, “the most comprehensive prenatal multivitamin on the market.” If that line sounds like an advertisement, that’s because it is, but there’s an underlying ideology at work. Behold “The Devil’s Wellness Plan,” a poem she composed “with some rhyming help from AI.”

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,Till womanhood forgot its name …

I’d teach women that cooking is something to dread,That birth needs control and a hospital bed.

Means said contraceptives “should be accessible to all women” during her hearing last Wednesday, but elsewhere she sounds a lot like the Christian right. The Heritage Foundation also wants to discover the root causes of infertility, as long as IVF is not involved, and it routinely overstates the risks of contraceptives for women. In similar fashion, Means told Tucker Carlson in 2025 that hormonal contraception is “a disrespect of things that create life,” and on her website and at her hearing, she has blamed it for “horrifying” side effects. The Pill can cause complications such as blood clots in some users, but that is rare, and “the same side effects are much more fatal in pregnancy,” said Eve Feinberg, a physician and professor of obstetrics and gynecology at the Northwestern University medical school. In truth, an “infertility crisis” may not even exist, at least as Means construes it. “We definitely have declining birth rates, which is likely more related to economic factors, lack of universal child care, and lack of sufficient parental-leave policies,” Feinberg said.

Means is not the first influencer to dress a reactionary worldview in a New Age costume, but she may be the only one with a chance of becoming our next surgeon general. If the Senate confirms her, she will lead thousands of public-health officers who all earned credentials she does not possess. Credibility matters, argued Jerome Adams, who served as surgeon general in Donald Trump’s first term. In an editorial for STAT, he criticized Means for conflicts of interest and abandoning the practice of medicine. Children are dying of measles, but she “repeatedly withheld a strong endorsement” on vaccines during her confirmation hearing, Adams noted. Klatt, the nutritionist, said her approach falls apart in the context of infectious disease. “There is no one chanting ‘root cause’ about improving indoor air filtration, masking, or vaccination to reduce pathogen exposure and ensure we have immune protection against pathogens,” he wrote. Means tends to avoid structural explanations altogether, and her solutions are vague by design. The root cause is whatever she wants it to be, within certain parameters. When we get sick, that’s on us. It’s every sacred life giver for herself.

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