Casey Means
Casey Means is an American medical doctor, entrepreneur, and author. After graduating from the Stanford Medicine in 2014, she proceeded with an ENT surgical residency at Oregon Health and Science University, but dropped from the program near to the 5-year program's completion, choosing instead to practice functional medicine. She went on to found the app-based health-tracking biotech company, Levels, to co-author Good Energy with her brother, Calley Means, and to participate in a further medical technology company, Truemed, founded by her brother.
Although Means' medical license has been reported inactive since the end of 2023, her career has developed such that she is considered one of the leaders of the Make America Healthy Again movement. On May 7, 2025, President Donald Trump nominated Means as surgeon general, following the withdrawal of his earlier Janette Nesheiwat nomination.
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Early life and education
Born Paula Casey Means on September 24, 1987, Means shared her full birth name in a podcast interview, stating that she was named after St. Paul, but legally dropped her given name after graduating from medical school. She is the first daughter of Grady and Gayle Means; Grady served as an assistant to U.S. Vice President Nelson Rockefeller, worked on health and human welfare issues at the Department of Health, Education, and Welfare, and was a managing partner at PriceWaterhouseCoopers. Gayle died of pancreatic cancer during the COVID-19 pandemic, encouraging her children to resolve "broken health incentives" in the U.S.After graduating from the Madeira School in 2005, Means attended Stanford University, where she graduated with honors with a bachelor's degree in human biology in 2009. She then earned her Doctor of Medicine from the Stanford University School of Medicine in 2014 and was inducted into the Gold Humanism Honor Society. According to a statement by the medical school: "during her time at Stanford, Means demonstrated a strong commitment to comprehensive patient care, published peer-reviewed articles and held a leadership role in the Arbor Free Clinic, which provides care to underserved populations".
After graduating from medical school, Means started a residency in the Department of Otolaryngology-Head and Neck Surgery of Oregon Health and Science University with the aim of becoming an ENT surgeon. During her studies, she held various research positions. Six months before the end of the five-year program, she dropped out of her surgical residency, due to stress and having become disillusioned with healthcare in the United States.
Career
Medical practice
After leaving her residency, Means established a medical practice in 2019, in Portland, Oregon, and as of 2024 was yet reported to be practicing functional medicine. The business appears to have failed to renew its registration in Oregon, in 2021. Per a further Wikipedia analysis, Means's state medical license changed to "inactive" status on January 1, 2024.Teaching appointments
In 2022, Means served as a lecturer in courses on subjects relating to food and health at Stanford, teaching graduate and undergraduate students there.Businesses
Eventually, after leaving her surgical residency, Means founded a company, Levels, and as of 2024 was reported as serving as its chief medical officer; the biotech company has been described as producing a health app that "offers exercise tracking and diet coaching", and that it "uses continuous glucose monitors to help people track their metabolic health". As of May 2025, Gregory Svirnovskiy of Politico relayed that Means' website reports that she is an investor "and/or" adviser in Truemed, a company Calley Means, her brother, founded, that "employs doctors who sign off on the medical necessity of fitness and nutrition programs and advanced health tech so customers can get a tax break".Means also has capitalized on sponsorships from dietary supplements, creams, teas, and other products appearing on her social media accounts.
Writing
Means and her brother, Calley Means, co-wrote a medically related book directed at popular audiences, Good Energy: The Surprising Connection Between Metabolism and Limitless Health, which was published by Penquin-Random House in 2024. As described by Blinkist, the book, which is composed of five points—the leading of which is that "oor metabolic health is a leading cause of chronic disease"—presents "the connection between our lifestyle choices and our energy levels" and that it "offers actionable strategies to enhance wellness, increase vitality, and achieve a balanced, energized life...". As decribed in review by physician and public health professional Joseph E. Scherger, writing for the journal of the Society of Teachers of Family Medicine:...Means describes... all food becom energy in the body, converted by the mitochondria for different purposes. Good energy food that nourishes us in positive ways. Bad energy, which occupies much of the book, food that results in metabolic dysfunction and a variety of health problems. Good energy... from the food of the natural world... unprocessed, nurtures our metabolism. Bad energy comes from ultraprocessed foods, sugars, and inflammatory proteins and fats.Scherger notes that, through the book, the Meanses are "on a mission to eliminate bad energy from as many people as possible." Overall, Scherger reviews the book positively, stating, "Good Energy is an excellent book for a lifestyle medicine book club and may be recommended for patients wanting good nutritional advice. It is well worth reading."
Jessica Winter, The New Yorker family, education, and reproductive rights reporter, criticized the work, describing the Means' book as "a memoir, a quasi-anti-establishment screed, and an orthorexic diet guide" advancing core positions of the Make America Healthy Again movement:
The first is that Big Food and Big Pharma are incentivized to make and keep us sick. The second is that many conventional medicines and interventions do little to improve our health, and often worsen it;... And, third, that most maladies can be prevented or treated through one's own ascetic diet and life-style choices.
Surgeon General nomination
Through her social media impact and close association with Robert F. Kennedy Jr., Means is considered one of the leaders of the Make America Healthy Again movement. Means and her brother, Calley, served as close advisers for Kennedy's 2024 presidential campaign, helping to negotiate his eventual endorsement of Donald Trump. By October 2024, she had been considered as a potential appointee to lead a food and health agency in Trump's second presidency, according to The Washington Post. The Wall Street Journal wrote the following month that she had been mentioned by Kennedy, Trump's then-nominee for secretary of health and human services, for surgeon general or commissioner, as well as assistant secretary for health, according to Politico. Means and her brother, Calley, served as advisers to Kennedy by that month.By January 2025, the Meanses appeared unlikely to join the Department of Health and Human Services, but remained connected to Kennedy. On May 7, the Trump administration began planning to withdraw Janette Nesheiwat's nomination as surgeon general after her résumé was questioned and Laura Loomer, a far-right social media political activist, stated that Nesheiwat was "not ideologically aligned" with Trump. Hours later, Trump announced that he would nominate Means as surgeon general. Trump said he did not know Means but nominated her based on Kennedy's recommendation.
Means's scheduled confirmation hearing before the Senate Committee on Health, Education, Labor and Pensions, which was to be the first such hearing held virtually, was postponed on October 30, 2025, after she went into labor. On January 3, 2026, Means's nomination expired per Senate rules, but Donald Trump renominated her 10 days later.
In addition to proponents of evidence-based medicine, Means' appointment has been criticized by anti-vaccination campaigners who favored health influencer Kelly Victory, such as Americans for Health Freedom's Mary Talley Bowden, Steve Kirsch and Suzanne Humphries. Far-right activist Laura Loomer was sharply critical of Means' nomination, calling her a "total crack pot". RFK Jr's 2024 running mate Nicole Shanahan was also critical of the nomination, claiming there was an understanding that the Means would not play a role in the Trump administration. On July 31, Politico reported that Means' nomination is currently stalled in the Senate HELP committee, pending Means' submission of financial disclosure and ethics paperwork.
Published works
Books
*Journal articles
Means published more than a half dozen scholarly articles in medical journals during her training years, most from Oregon Health and Science University related to her post-graduate specialisation in otorhinolaryngology, but also from Stanford Medicine and Means Health in Portland Oregon, as well as articles in the areas of sleep studies and oncology—including in John Wiley & Sons' Head & Neck, in the journal, The Laryngoscope, and the International Journal of Pediatric Otorhinolaryngology, as well as in Cytometry. Part A, Metabolism: Clinical and Experimental, and others.Views
After withdrawing from her surgical residency, Means became a practitioner of functional medicine. Her efforts since have been promoted, e.g., by Stanford Medicine faculty member Andrew Huberman, who has lauded her for providing people a "sense of agency through knowlege and actionable tools".A primary focus of her efforts has been on metabolic function and dysfunction, In such a discussion, in 2024, Means stated that she believes it important for people to realize that ones "metabolism is actually the foundation of all health", indeed "the core foundational pathway that drives all other aspects of health, and... that's truly getting crushed in the modern American world," going on to state her belief that such dysfunction "underl 9 of the 10 leading causes of death in the United States today", and stating her conclusion that "the spectrum of metabolic-rooted disease is vast, and... relevant to most Americans", noting that "research from American College of Cardiology suggests that 93% of American adults have sub-optimal metabolism". As to mechanism, she has argued that
When metabolism is not working properly it's essentially creating underpowered cells... not having adequate power will lead to dysfunction. ... over 200 cell types in the body... underpowering in different cell types... different symptoms, because underpowering in an astrocyte is going to look different than underpowering an ovarian Theca cell or an endothelial cell".
From a public policy perspective, Means notes that
the biggest blind spot in Western healthcare, and... the reason that health outcomes are... getting worse every year in the United States, is because fundamentally we are ignoring metabolic health... We are laser-focused on the downstream symptoms that result from metabolic dysfunction in different cell types, and... focusing on those symptoms, playing "Whac-a-Mole" with them... really ignoring underlying, foundational root cause... metabolic function.... hat's so facinating to me... as an ENT surgeon—is that... the more we specialize... the more we do technological innovation in all these different specialties, the sicker we're getting.... The real nugget... needs to understand is that we've bought into a system where we value specialization... ut, while we've done that,...we have the worst chronic disease epidemic, and the lowest life expectancy of any high income country in the world... n that specialization, we're focused on the downstream manifestation of underpowering of cells, the cell-specific symptoms, and not the metabolic function itself. So... our chronic disease epidemic in this countery is a metabolic dysfunction epidemic, and underpowering epidemic, and that is the biggest blindspot in healthcare. And I think a focus on metabolic function as the center of our healthcare system—it's a completely new paradigm for health that is urgently... needed. We know we are not in the right paradigm, right now...
Likewise, in a 2024 NPR interview, Means analogised "Type 2 diabetes, obesity, Alzheimer's, dementia, cancer, chronic kidney disease" to being akin to different "branches" of a tree, the trunk of which she argued is metabolic dysfunction. Her views have been criticized by science communicator Jonathan Jarry of the McGill Office for Science and Society, who wrote that " is not a metabolic health expert" and "theories claiming to have found a single cause for all diseases never pan out". Means has been noted to "blam the ultra-processed food system for much of the chronic disease in America", and has had ascribed to her the view that the origin of most diseases lie in our exposures to ultra-processed foods and environmental factors, to a lack of sunlight, and to lack of exercise.
Medical error, vaccination, and other issues
Means has repeated FDA Commissioner Marty Makary's claim that the third leading cause of death in the United States is medical error, a claim that has been criticized by experts as "self-serving, irresponsible sensationalism", and based on "incredible numbers borne out of unreliable calculations."In addition, Means has criticized the National Childhood Vaccine Injury Act, and, per New York magazine, she has "raised long-settled questions about the safety and efficacy of vaccines despite not representing herself as an anti-vaxxer".
Means has referred to infertility as a crisis, and has been critical of hormonal contraception on both medical grounds, questioning how it affects women's health, and moral grounds, referring to it as a "disrespect of life".
Means has spoken in support of raw milk, stating, "When it comes to a question like raw milk, I want to be free to form a relationship with a local farmer, understand his integrity, look him in the eyes, pet his cow, and then decide if I feel safe to drink the milk from his farm."