Aura Kasih
President Trump’s nominee for Surgeon General, Dr. Casey Means, has ascended to a position of significant public health influence by adeptly employing a sophisticated strategy that mirrors the tactics of modern wellness influencers, often leading to a concerning departure from established scientific consensus and ethical disclosure standards.
The trajectory from advocating for personal well-being to promoting scientifically unsupported or even detrimental health practices, such as vaccine skepticism and the embrace of unpasteurized dairy, can appear bewildering. While the proliferation of misinformation on digital platforms certainly plays a role, a deeper examination reveals a more nuanced and strategic approach, particularly evident in the recent confirmation hearing for Dr. Means. Her nomination to serve as the nation’s "doctor" – a role tasked with being the foremost public health advocate and educator utilizing robust scientific evidence – has drawn considerable scrutiny. The controversy stems not only from her professional qualifications, including a lack of an active medical license, current practice, and incomplete surgical residency, but more profoundly from her background as a prominent wellness influencer whose pronouncements on health issues have been met with skepticism and concerns regarding transparency in her financial relationships with various brands.
Dr. Jerome Adams, a former Surgeon General himself, has publicly voiced his opposition, citing Dr. Means’s past stances on vaccines and her entrepreneurial ventures, particularly her co-founding of Levels, a continuous glucose monitor (CGM) startup marketed to non-diabetics. The efficacy and interpretation of CGMs for this population remain subjects of limited scientific evidence and expert consensus, raising questions about the scientific basis for such widespread promotion. Despite her controversial positions, Dr. Means notably moderated her public statements during her confirmation hearing, a stark contrast to her previous challenges to vaccine efficacy, critiques of birth control, and endorsements of raw milk. These shifts highlight a calculated adaptation of her public persona, a common tactic within the "wellness-to-MAHA" (Make America Healthy Again) pipeline, which is not only highly lucrative but also follows a distinct and effective playbook.
Phase One: Establishing Credibility Through Selective Scientific Framing
A cornerstone of the wellness influencer model is the artful interweaving of scientifically validated facts with emotionally resonant narratives, strategically guiding audiences toward potentially misleading conclusions. This tactic is crucial for building trust and authority. Dr. Means’s co-authored book, Good Energy, exemplifies this approach. The book posits that metabolic dysfunction is the root cause of a vast array of ailments. The initial chapters delve into established scientific principles of metabolism, explaining concepts like mitochondrial function and insulin resistance in accessible terms. These explanations, when viewed in isolation, align with general scientific understanding and pass a basic "smell test" for readers familiar with fundamental biology or who conduct simple online research.
This foundation of accurate information is then leveraged to lend credence to less substantiated claims. For instance, the book argues that by optimizing metabolic health through "good energy" practices, individuals can prevent serious diseases like cancer. While metabolic health is undoubtedly a critical component of overall well-being, the assertion that it is the sole or primary preventative measure for such complex diseases oversimplifies scientific realities. The scientific community, while acknowledging the role of mitochondria in health, finds the concept of "combating mitochondrial dysfunction" as a panacea to be a challenging and often overemphasized area, with some researchers labeling it a potential fad.
Another illustrative example is the discussion of erectile dysfunction. Dr. Means attributes it primarily to metabolic disease, specifically citing insulin resistance and atherosclerosis. While metabolic issues can indeed contribute to erectile dysfunction, this framing omits the multitude of other contributing factors, ranging from psychological stressors to medication side effects and neurological conditions. The reliance on other wellness proponents, such as Dr. Sara Gottfried, further solidifies this echo chamber, as functional medicine, while aiming for holistic approaches, is frequently criticized for its potential to promote unnecessary testing and costly interventions. The strategy here is to establish a broad, overarching theory of disease rooted in metabolism, which then serves as a framework to explain a wide range of conditions.
The book also incorporates seemingly practical health advice, such as prioritizing sleep and exercise, and consuming whole foods. Furthermore, the inclusion of reference links at the end of each chapter, combined with Dr. Means’s medical credentials, cultivates an image of rigorous research and expert validation. However, this careful selection and presentation of information create a veneer of scientific legitimacy that can obscure more speculative or unsubstantiated assertions, leading readers to accept a cascade of less evidence-based claims. This includes the classification of common items like oral antibiotics, birth control, and even fluoride toothpaste as "toxins," and the propagation of questionable theories about C-section impacts on infant gut microbiome, often without adequate scientific nuance or disclosure of contrary findings.
Phase Two: Undermining Institutional Trust
A critical component of the wellness grifter playbook involves systematically eroding public trust in established institutions, particularly conventional medicine. Dr. Means skillfully employs personal narratives and anecdotal evidence to portray a disillusionment with the medical establishment, framing it as a system that prioritizes profit over patient well-being. Her own accounts of frustration with the medical system and her experiences as a surgical resident, coupled with acknowledgments of the pharmaceutical industry’s influence and lobbying efforts, serve to validate this narrative.
This narrative is powerfully reinforced by the chapter title, "Trust yourself, not your doctor," in Good Energy. While Dr. Means may offer a disclaimer about respecting physicians, the core message planted in the reader’s mind is one of skepticism towards professional medical advice. This subtle yet pervasive suggestion opens the door for alternative interpretations, such as the idea that the healthcare system intentionally keeps individuals sick for financial gain, a concept readily available on her website where she describes herself as a critic of "sick care" medicine.
The narrative of being a whistleblower, challenging the status quo out of ethical imperative, positions Dr. Means as a more authentic and trustworthy source of health information. This is further amplified by encouraging followers to "do your own research," a common refrain that, in practice, often directs individuals to curated sources that align with the influencer’s agenda, mirroring the strategies employed by figures like Robert F. Kennedy Jr. The inherent counter-argument to any scientific refutation from reputable institutions becomes the assertion that these institutions are inherently corrupt and untrustworthy. This creates an information silo where any evidence contradicting the influencer’s claims is preemptively dismissed.
Reports from outlets like the Los Angeles Times have pointed to discrepancies in Dr. Means’s personal narrative, suggesting that her departure from residency was due to anxiety rather than a principled rejection of the medical system. However, for the average consumer, the emotional resonance of her story and the constant barrage of messages questioning institutional authority are far more persuasive than a deep dive into factual verification. The influencer’s role is to present themselves as a courageous truth-teller, offering simple, empowering solutions that ostensibly place health control back into the hands of the individual, often culminating in a commercial transaction.
Phase Three: Monetizing "Simple" Solutions
The final stage of this playbook involves translating the established credibility and distrust in institutions into profitable ventures. Dr. Means has strategically positioned herself to offer "real" answers to widespread health concerns, primarily revolving around metabolic dysfunction, and to provide products and services that promise to address these issues. Her "good energy" philosophy has manifested in various commercial endeavors, including her book, a newsletter with affiliate links, and recommendations for specific brands and supplements.
Examples include her endorsement of Function Health for blood testing and supplements like WeNatal and ENERGYBits. Notably, ENERGYBits, a spirulina and chlorella product, has faced significant criticism, including a harsh reception on Shark Tank and from scientific bodies that have questioned its purported health benefits and marketing claims. The scientific literature on spirulina supplements also offers inconclusive evidence regarding their health benefits.
A significant ethical concern arises from the lack of transparency regarding Dr. Means’s financial relationships with these brands. While she co-founded Levels, and this affiliation is mentioned in her book, her endorsements of other companies, such as Function Health, for which she is an investor, are often not disclosed within the text or in promotional materials. The Associated Press and consumer advocacy groups like Public Citizen have highlighted instances where Dr. Means has failed to disclose affiliate links and financial partnerships, raising questions about her adherence to advertising disclosure standards. Such omissions can mislead consumers into believing that recommendations are purely based on objective merit rather than financial incentives.
This pattern of undisclosed financial relationships is not an isolated incident. Investigations have revealed that Dr. Means has neglected to disclose financial ties to numerous brands she promotes, leading to concerns about potential violations of advertising regulations. The strategy is to present these products and services not as commercial offerings, but as essential components of a scientifically grounded approach to health, conveniently available for purchase.
The Pervasive Impact of Wellness Trends
The effectiveness of this influencer playbook extends beyond individual practitioners like Dr. Means, profoundly influencing broader public health discourse and the health technology sector. This strategy underpins the rise of unregulated markets for certain health products and fuels skepticism towards well-established medical interventions, including vaccines, despite decades of supporting evidence.
The health tech industry is also feeling the impact, with an increasing number of devices and services emerging that capitalize on popular wellness trends like hormone balancing and inflammation reduction. The proliferation of at-home testing kits for various bodily fluids and the integration of AI-driven nutrition and metabolism tracking in wearable devices are direct manifestations of this trend. These technologies, while offering potential benefits, are often marketed within a framework that emphasizes simplistic solutions to complex biological processes.
The most concerning aspect of Dr. Means and other wellness influencers is the strategic integration of factual information with unsubstantiated claims. They adeptly identify and exploit genuine frustrations with healthcare systems and the overwhelming volume of conflicting health information. However, where scientific inquiry acknowledges complexity and nuance, the wellness influencer offers a seemingly straightforward solution: a product or service that requires a financial investment. This model, while personally lucrative for the influencer, poses a significant risk to public health by potentially leading individuals away from evidence-based care and towards unproven or even harmful interventions. The potential elevation of such an individual to the position of Surgeon General raises critical questions about the future of public health communication and the safeguarding of scientific integrity.
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