Why Don't We Have a Surgeon General?

Introduction

0:00Okay, I actually, I actually have one. I'm on fire. He came prepared, maybe. Welcome to maintenance phase, the podcast that has nothing to say about the surgeon specific, but a lot to say about the surgeon general. I like that one so much. I'm Michael.

0:30Hobbs. I'm Aubrey Gordon. If you would like to support the show, you can do that at patreon.com slash maintenance phase. You can also subscribe on Apple podcast premium. It's the same audio content, Michael. Aubrey. We are a year and a half into Donald Trump's second term, and we still don't have a surgeon general. I have not been following this at all. You and most people. There's been so much shock and awe in so many places that it's like hard to keep track. We're all sort of like drinking from a fire hose in terms of the news cycles, right? I know. Whenever I hear about

1:03like an out of work Fox news host, I'm like, yeah, they're probably the surgeon general now. Who fucking cares? Today, we're going to talk about the three sort of Maha aligned doctors who have been nominated for surgeon general. Wait, so they're all doctors? That's actually kind of surprising. Well, hang on. Okay. Let's not get too crazy. I thought it was going to be like Omarosa or somebody. We haven't done like a real Maha update in a minute because it's so often just like a soul sucking slog of a thing. Yes. I would just like to preface this one by saying

1:36it's pretty fun. Good. I want like real housewives shit. The surgeon general is often referred to as America's top doctor. Their role is in part focused on translating scientific findings into guidance for members of the public. So this is like a very maintenance phase role. He knows when you've been sleeping. He knows when you're not getting enough beef tallow. The surgeon general can issue reports and recommendations, but the office doesn't have the authority to create policy.

2:07It's actually kind of funny we have this role because it is just like a guy who says stuff in chief. It is kind of. Well, except there is a very functional part of the role. The surgeon general leads over 6,000 uniformed officers in the U S public health service. So it's a role where it's like really helpful to be both a seasoned healthcare provider and a really strong, clear communicator. Don't start laughing yet. Foreshadowing, foreshadowing. Okay. The process for becoming the surgeon

2:38general is that the president nominates someone to become the surgeon general. The Senate confirms that person and then they serve a four year term. The nominee has to pass through the health education, labor and pensions committee, the help committee, which is currently split with 12 Republicans and 11 Democrats. So it's Republican controlled, but only just, it is also a committee where Lisa Murkowski and Susan Collins are both on the committee. So you got a couple of real mavericks pieces of

3:11work. A couple of mavericks. So today we're going to talk about the three nominees for surgeon general and why their nominations haven't been a cinch, even in a Republican controlled Senate in a Republican controlled committee. Okay. So in November of 2024, after he was elected to his second term, Donald Trump nominated Jeanette Neshwat to be surgeon general. His statement on Dr. Neshwat's

3:42nomination describes her as quote, a proud graduate of the University of Arkansas School for Medical Sciences. At the time of her nomination, she was serving as the medical director for City MD in New York, which is a chain of urgent care clinics. First red flag. She is one of five children in her family. And she is not the only one with ties to the Trump administration. Her sister, Julia was a homeland

4:13security advisor under the first Trump administration. Julia's husband, so Jeanette's brother-in-law is the current ambassador, US ambassador to the UN. He also represented Florida as a member of the US house from 2019 to 2025. His name is Mike Waltz. Is that a name that rings a bell? No. Well, Michael, he's the guy who added a journalist to a signal chat about war play. Oh, okay. Okay. He's the specific

4:43guy who is like clearly added this journalist to the group chat and then was like, I don't know how it happened. It just got sucked in there. You know how sometimes when you add an app to your phone and it just sucks up all your content. It just got kind of sucked up in there. So it just got added. This journalist got it. I'm a bit of an offset expert myself. Yeah. So that's one of her siblings. Another of her siblings is her sister, Jacqueline, who is a model and a former pageant winner who was Miss New York USA 2004 and Miss

5:18Florida America 2008. Nothing wrong with that. But the fact that there's so many of these people in Donald Trump's orbit is so fucking bizarre. Today, she is the executive director of her husband's foundation, which is dedicated to quote, helping underprivileged children around the world. That foundation is called the With Arms Wide Open Foundation. Is it named after the Creed song? Her husband is Scott Stapp. No fucking way. We could have had a Surgeon General who has Thanksgiving with

5:49Scott Stapp from Creed. What? Just do Scott Stapp. Fuck it.

5:55It scans so hard with the administration that could only get three doors down to play at the inauguration. But also what a fucking stinging indictment that they couldn't get Creed. No, I know he's right there. Also, I love that the administration like finds people like the Surgeon General the way that at my tiny underfunded NGO, we used to find like graphic designers for PDFs. We'd be like, hey, you went to college with somebody who like knows Illustrator, right? Yeah. Which like reach out to them. Oh, God. Ours were more like, do you have an afternoon? Could you figure out Illustrator?

6:29Wait, wait, wait, wait, wait. I have a thing. I have a thing. I have a thing. You have a Creed thing? Wait. We're not done with Creed. I don't know. I was looking at this and he said, I'll take a breath. I'll take her by my side. We stand in awe. We've created life. I have the lyrics for with arms wide open. Oh, my God. I don't know, Michael. This is really counting on me to recognize the lyrics that you also don't know. I'm like furiously Googling. I'm like, I need a reference here, but I don't know the lyrics to this song. You're getting on a plane tomorrow. And I'm now imagining that you're going to spend the entire time studying the Creed oeuvre. I'll record a bunch of pickups

7:04to like throw it into the episode. Dr. Neshwat had likely crossed Trump's radar during her time as a TV guest doctor on Fox News and The Daily Caller. Of course. But just six months after she was nominated, the day before her scheduled confirmation hearing, Trump withdrew her nomination. Okay. Cancel culture? So the question here is what happened? Mike, I would like actually for you to hazard a guess.

7:36Did she once say like a single boilerplate thing about how like diversity is what makes America great? No and no. And they're like, no, not after 2024. In April of 2025, an independent journalist named Anthony Clark breaks a story that he titles Trump's Surgeon General pick distorted key parts of her resume. Wait, he just Googled like me looking at Creed lyrics? Yes. He's just like type, type, type, type, nope. He finds that Dr. Neshwat didn't get her medical degree from the University of Arkansas,

8:08as she had claimed, but had completed a residency there as an employee, not a student. So he checks around to figure out where she got her MD from. And where she went was the American University of the Caribbean in St. Martin. Oh. Which is a commercial business. And also it's probably like a distance learning thing or something. Oh, Mike, you don't know how close you are. I got my degree from iTunes U. In 2011, the American University of the Caribbean was bought

8:42by Adtelem Global Education, which is previously, nope, Mike, I haven't even gotten there yet. Which is previously Philip Morris or something. It's like a made up name.

Casey Means Nomination

8:51Previously known as the DeVry Education Group, baby. Oh, it's her, yeah. DeVry Medical School. Because that's like Betsy DeVos' whole like for-profit education thing, right? 100%. Dude, scammers. Clark also reports as part of this piece that for-profit medical schools were banned in the U.S. for over a century for concerns over admission standards, quality of education, needing new regulatory structures, all kinds of stuff.

9:22It's also funny because the only thing that offends them is like the lying. If she had just said, I have no medical qualifications, it's not like the Trump administration gives a shit, right? I'm so glad that you're like getting a handle on like the ways in which this episode is fun. Yeah. It's just like a fucking clown car of dinguses. It's also now kind of bleak that like CityMD didn't care. Or it met their standards. They are also a for-profit business. They're like game recognized game. They're like nice one. Yeah, totally. They're like, oh, you guys too? Cool. Yeah. So on top of all that, on our website, Dr. Neshwat says that she has a specialty in family and ER

9:57medicine. Okay. But she's only board certified in family medicine, not emergency medicine. That's such a weird thing to lie about. It's so weird. But also, she works at an urgent care clinic, right? Dude, I don't know about CityMD specifically, but every time I've gone to an urgent care, the person has been like, damn, you should see a doctor about this. I'm like, right. I'm like, I fucking know. They're like, that'll be $200, please. In addition, Clark was unable to verify Neshwat's claim that she had worked in emergency rooms in

10:31Arkansas. So she is calling herself an emergency doc when she has worked for a for-profit urgent care clinic in like a management role, which is just different, right? You must tell these lies and then I guess forget about it. Because if I had some glaring hole in my resume, like a fat lie that I was telling, and I was offered some like super prominent role where I would get a bunch of scrutiny, I would just turn it down. I'd be like, no, they will absolutely find this out. I want to keep my like cushy little life. She probably makes a couple million dollars a year.

11:01So there's all of this bad press happening, but there are also complaints from the right. The Maha crowd was saying that Dr. Neshwat wasn't anti-vax enough. Yeah, I was just gonna make a joke about that. Didn't they find out she's vaccinated? Very early on in the sort of onset of COVID, even before lockdowns, she was doing some media with like Fox News and that sort of thing being like, hey, here's what you got to do. And it was like, you got to mask up. It's probably airborne. You got to wash your hands real well. You got to blah,

11:34blah, blah. Like just giving like very basic information. And as part of that, at some points, she goes, you know, we'll need to develop a vaccine for this. Like, it's like, really not anything. But she's also not committing to kind of unhinged Maha requests. Like, let's do a complete overhaul on the infant vaccine schedule. It's so funny that they're mad at her for not preemptively criticizing vaccines. Like before they were even developed, she should have been out here saying like, they're killing our kids.

12:06Even the, even the idea of a vaccine they're against. So her biggest detractor on the right is Laura Loomer. Oh, yeah. Well, who's probably the fucking Surgeon General now. Why not? For those who are unfamiliar, Laura Loomer is an advisor to the president. She is like a particularly unhinged presence, even in a White House full of unhinged presences. She was just like a Twitter person, right? She's like a lady on Twitter. Yes. And kept getting banned from different social media platforms for like straight up

12:41hate speech and misinformation, right? Yeah, she's awful. On May 5th, 2025, Loomer tweeted about Dr. Neshwat calling her, quote, a pro COVID vaccine Nepo appointee. Well, she's right about the second part. She is. She is. It's funny. It's funny how they care about that sometimes. They clearly don't give a shit about it. It's all Nepo all the way down in this administration. So I'm sending you a portion of a tweet from Laura Loomer. Oh, man. OK. I'm not going to yell, but large sections of this are in all caps.

13:14I think you should make it your own. OK.

13:18Dr. Neshwat said vaccine hesitancy is a global health threat. She used her access to Fox News to promote the dangerous COVID vaccine, which is now killing millions of people. She tried to shame people who didn't take the vaccine by calling them global health threats. This is like sub literate. Vaccines are a matter of, all caps, personal health, freedom. Vaccine hesitancy is a matter of personal freedom and liberty, exclamation point. It is not a global health threat. My body, my choice. Laura Loomer saying my body, my choice and meaning it about vaccines.

13:50We've gotten used to it by now, but this is like a person at a bus stop ranting. And also they're like five years old. Well, she capitalizes global health threat like it's the title of something. In May of 2025, instead of being confirmed, her nomination is pulled. According to Fox News in 2026, Dr. Neshwat took a new job at Walter Reed. Wait, what? Even though they know her medical qualifications aren't real? The only way that Trump would like pull the nomination or the way that he did it, I should

14:23say. I don't know that it was the only way he'd do it, but he was like, ah, we're actually going to withdraw her nomination and put her somewhere else. Very important. If he pulls the nomination, then it's a tacit admission that he's giving into criticism or that he got something wrong, which he would never do. So he's like, oh, we actually found a better role for you somewhere else. Yeah. That better role is at Walter Reed working on treatment of Havana syndrome. Wait, what? Are they Havana syndrome truthers? The administration? Apparently she is. I mean, she's working on it now, right? Weird. Yeah. So for folks who are unfamiliar, Havana syndrome is described as like a sort of

14:58constellation of unexplained neurological symptoms. It often includes hearing really loud noises that others may or may not be able to hear. It is hotly debated. Yeah. Some people think it is a mass psychogenic illness. Others think it is the result of like chemical warfare from foreign actors. But man, oh man, they really like sent her to the hinterlands. Yeah. Go to Walter Reed, a place that sounds very important and is very important. And then work on Havana syndrome.

15:29It's also like lie about your qualifications. Get ready for a different job in this administration. Fail upwards. Yeah, exactly. As if you were a man. I know. The Patricia principle. Yes, it's very inspiring. So we went pretty quickly through Dr. Neshwat because it's such a cut and dry story, right? The second nominee was a real like hold my beer situation.

Means' Background

15:52Okay.

Means' Background

15:53It's time for nominee number two, Casey Means. Oh, yeah, yeah, yeah. Mike, what have you heard about Casey Means? Just that she's like Neshwat, but like 50 times more deranged. It's funny that her nomination was pulled essentially because she wasn't deranged enough. They're like, okay, let's get you someone deranged. Oh, you want Kooky? Yeah. We got Kooky for you, baby. Yeah. She is a graduate of Stanford University, both undergrad and medical school. She runs a wellness startup called Levels.

16:24And she practices, quote unquote, functional medicine, which is essentially like a rebrand of what in the 90s would have been called alternative medicine. It's medicine, but this time it's functional. This time it's personal. Have you tried putting an onion in your sock and going to sleep? Very functional. So she has kind of two origin stories coming into Maha world. The first is her residency. After completing medical school at Stanford, Casey Means took on a five-year residency at

16:57Oregon Health and Science University here in Portland. So she takes on this residency at OHSU specializing in head and neck surgery. But as she moves through her residency, she says she became disillusioned with a system that put so much pressure and strain on doctors, a system that was always sort of intervening after things went wrong and not to like help them go right to begin with. And in a system with such a pernicious profit motive.

17:29Yeah. So I got into a different part of medicine that also has a profit motive. Right. Selling MRIs to fucking celebrities. Her story is that she was in a state of great exhaustion and disillusionment. And just six months shy of finishing her five-year residency, she quit. Again, she says this is like because she became so disillusioned with the system. And we're actually going to watch a little clip of her telling that story to Tucker Carlson.

18:00Okay. Yeah. Yeah. You know, I'm in the operating room in my fifth year of my surgical residency and I'm looking down at a patient in front of me who's on our third revision sinus surgery. And, you know, I know how to diagnose her. I know how to write the prescriptions. I know how to do the surgery. But what I kind of realized in that moment was like, I have no idea why this patient's actually sick. She has so many other health issues, prediabetes, arthritis. She's got some brain fog. She's got obesity and she's got this sinus issue. And in my training, you know, I was never, ever, ever taught to look at the whole patient, to look at how all these things are connected.

18:31And I was only taught how to, you know, do the surgery and then bill for it. And I realized that there's a huge problem in how we're practicing medicine right now, which is what we're ignoring the root causes of why Americans are sick. And we're profiting off of patients getting sick and then doing things to them. That's the way the business model of healthcare works. The way that healthcare, which is the largest and fastest growing industry in the United States, makes money is you have more patients in the system having more things done to them for longer periods of time. And when I kind of put some of these pieces together and realized that my training had totally, essentially incapacitated me from really understanding why patients are sick

19:06and how to actually help them thrive, I actually had to walk away from the surgical world because I realized that I was going to be making money off of essentially not spending time helping patients understand their health and actually just profiting off their illness. So nine years into medical training at Stanford, you gave it up voluntarily. I, on my birthday, 30th birthday, I walked into the office of my, of the chair of the department and I put down the scalpel and I walked away and I devoted my life to why are Americans getting sicker every year? Why are 50% of American children dealing with a chronic health issue?

19:41This was less than 1% 50 years ago. This frustrates the shit out of me. Yeah, tell me. Obviously there's like some kernel of like a reasonable critique of the medical system in here, obviously. But the problem with this whole like root causes analysis is it's not clear how you would operationalize this. Any medical system, even if you do address the quote unquote root causes, you still have doctors who deal with patients in like an acute way. A head and neck surgeon wouldn't be addressing things like diet and lifestyle to prevent that

20:13in the first place. Obviously we need to do more preventative medicine, but you're still going to have people who need surgeries. Right. And like, if you are aiming at, as she is, a structural critique, then you also need to have a structural solution. Yeah, exactly. And she doesn't fucking have that. There's a weird kind of judgment behind this. She's like, I had this fat and sick patient and they wanted me to do surgery on her without exploring why she's fat and sick. Do you think that fat people who have a, I don't know, a car accident or some sort of accident or some sort of condition don't deserve surgery?

20:44I'm so sorry. I've become hopelessly distracted by the Tucker Carlson store merch that is advertised underneath the video clip. Wait, really? In the clip that I just sent you underneath the description, it says shop the Tucker Carlson store. They have mugs that say APAC, an offer you can't refuse. What? And hats that say neocons are gay for war.

21:12Wait, how much did they cost? Can I get one?

21:15I died. Part of the reason I got so distracted is I was like, I don't know what this means. Yes, you do. I do. You love it.

21:28I know what it means if it's coming from me or you. I don't know what it means when it's coming from Tucker Carlson. I can hear you clicking buy and like typing in your address to get it shipped to you. Take my money, Tucker Carlson. Yeah.

21:42Oh no. Woo. So that is one of Casey Means origin stories, right?

Means' Origin Story

21:51Is her residency. That's one of the two that we're going to talk about. The second comes a few years later. Oh God, I got to get the giggles out because this is a sad one. Okay, okay, okay. Do you want me to recite some Creed lyrics to you? Would that help? No, I appreciate that. Because I have those in front of me still. I'm going to close the Tucker Carlson link so I'm not staring at the neocons are gay for war hat. Okay, sorry. I apologize for what my brain just did. All right, rough transition. Get us there. So Casey Means' second origin story comes a few years later with the sudden death of her mother.

22:26Okay. In January of 2021, her mother got the shocking news that she had stage four pancreatic cancer. Okay. And that her prognosis was not good. According to Casey, doctors pressured her mom to get risky surgery that would only extend her life by a matter of months. And because of COVID protocols at the time, that recovery time would happen in quarantine, right? So they wouldn't be able to, she would have the surgery, she'd have this long recovery time, she wouldn't be able to see her family.

23:00And they had already said she had like a short timeline. Okay. As you and I both know, this is sort of part and parcel of having a family member who has a terminal illness, right? Yeah, yeah. Is that you have these like terrible choices to make where you're like, oh, nothing's a win? Cool. And on some level, that is a, I think, fair critique of the medical system that it is split into these like little specialties. And like, you know, my father recently died of cancer and the same thing kind of happened to him that he was given all these weird treatments that had miserable side effects.

23:31Yeah. And he would sometimes say like, uh, this actually isn't like worth it for me. And his doctors, like he got in kind of like fights with his doctors about it. They'd be like, well, you need this. And like the minute he switched to palliative care, he got like a way better bedside manner. Yeah. There's a long time of kind of like fighting with doctors about this kind of thing. And they weren't always totally transparent with like how much benefit is this actually going to give me? Totally. It's like a fair critique of the medical system.

And it's also like a, it's like a horrible experience. Yeah. And your emotions are in a place where like, like I definitely needed to like fact check and ground myself a couple of times and be like, hey, did, did I have a fight with this person or did they just say something that reminded me of a terrible way that I already feel?

24:14Exactly. I actually wonder, I mean, it's at least plausible that the doctor sort of presented the options to her. There is the surgery. It's risky. It's not going to prolong your life that much, but it's an option. Yeah. People were really nice to my dad when he was like, oh, I prefer to go on palliative care. They're like, okay, that's a choice that you can make. Yep. He could still say no thanks and move on to something else. My family member who passed of cancer recently was very clear about what he wanted in his treatment and what he did not want. And there was like, I think a lot of that from doctors being like, all right, well, you're making your choice.

24:48Got it. Yeah. Yeah. Clearly, it's not the thing I would recommend. But like, this is your life and your choice. You don't want to gaslight them about their experience. But she's just such an unreliable narrator. Right. That it's like, okay, what was actually happening with this interaction? So, I just sent you a quote. This is an excerpt from her book, Food Energy. My mom made it clear to the oncologist that she was not afraid of her rapidly impending death, but she wanted to minimize unnecessary pain or nausea in her final days. Despite being clear, the system pushed the exact procedures that would yield pain and nausea and aggressively shamed our family for questioning the full court press approach.

25:24The doctor was not consciously trying to recommend a suboptimal procedure, but I knew the invasive route would generate hundreds of thousands of dollars for the hospital, and this doctor's pay was tied to booking these procedures. The profit motive thing is also true. I think it affects your psychology in ways that are probably invisible to you. Sure. But again, she's just like an unreliable narrator. And she's doing, I would say, a similar thing to what she was doing on Tucker Carlson, which is she's going from this intense personal experience straight to this sort of like, I'm not saying, I'm just saying.

25:56Yeah, yeah, yeah. Right? And it is designed to cast aspersions on the field. Right, right. And on treatment recommendations that are being given to people who are in life and death scenarios, right? Like, what she's doing here is sort of using, like, a very emotional personal experience, which, again, both you and I have been through in different ways, right? She is using that to kind of shake the foundation and go, what if the whole thing is bunk?

26:28Right, exactly. Because it's also totally plausible that her doctor was just a huge fucking asshole. Right! And so maybe you had a really bad experience with this, like, complete prick. Like, that's absolutely plausible, but she is making it a bigger argument about the medical system and for-profit health care, et cetera, et cetera, which, again, you'd have to sort of marshal different kinds of evidence to support. Yeah, that's right. If this was your issue, you would actually move us toward, like, a universal health care system where the doctors just get paid salaries, which is actually what they have in many countries.

27:00That would be the thing that you would then start pushing toward. You wouldn't then leave the system and start selling people other shit for profit. That's just what destroys her entire credibility to me. Her functional medicine clinic is in the Pearl District in Portland. Pearl District, parentheses, derogatory. Yes! Yes, Michael! So when I was growing up, the Pearl was, like, a predominantly industrial area. There were significant numbers of homeless folks.

27:31And when I was in, like, maybe middle school or high school, it started getting gentrified to the fucking max. Yeah. So now those industrial buildings are overwhelmingly, like, luxury condos and lofts. She's like, the medical system is kind of a grift, and I want to get in on that grift. Like, it feels very telling that you go to the wealthiest area, right? When my dad was a teacher at dental school, he also had a systemic critique because these profit motives were starting to take over dentistry at the time. And he started volunteering at a homeless shelter to do dentistry on homeless people.

28:05There's, like, other things that you can do. That's right! But Casey Means is a really interesting mix of sort of, like, crunchy granola Maha-style stuff and really dyed-in-the-wool conservative pedigree.

Means' Family Ties

28:21In order to understand that conservative pedigree, we have to talk about the other two sort of surviving members of her immediate family, both of whom are high-profile conservatives. The first of those is her father, Grady Means, who was a longtime Republican operative in D.C. He worked for Nixon and after Nixon's resignation for Vice President Nelson Rockefeller during the Ford administration.

28:52During the Ford administration, he worked on the Food and Nutrition Task Force, which sought, among other things, to dramatically scale back food stamps. There's that systemic critique, baby. Right! The, like, food is medicine, ladies. Dad is the reason that fewer people have the medicine food that she wants everyone to have, right? Or we will have too much food! Grady also worked as a consultant before selling off the consulting wing of his firm for $3.5 billion in 2002.

29:24Billion? So that's her dad, Grady Means. She also has a brother named Callie Means. Which the description on this Tucker Carlson YouTube video tells me has also been interviewed by Tucker Carlson. Yes, correct. Yeah. So they have become a little bit of, like, a package deal. They're sort of a little one-two punch in Maha World. And they co-authored their book together. Oh, okay. Callie Means went to Stanford undergrad and went to Harvard for his MBA.

29:54He interned both for the George W. Bush White House and for the Heritage Foundation. Nice. He worked on the McCain campaign, reportedly as part of the quote-unquote pit crew that was working to improve Sarah Palin's reputation. Ooh, okay. He did that debate prep. He's furiously sending her links to Schoolhouse Rock. He describes himself as a former never-Trumper who became one of RFK Jr.'s advisors after that appearance on Tucker Carlson.

30:28Callie Means is an entrepreneur who founded a company called TrueMed, which helps people apply for HSA coverage of, like, Peloton bikes and infrared saunas. Oh, wait, really? He's trying to get people reimbursed for, like, alternative medicines. Yep, so health savings accounts, HSAs, are tax-free accounts. You essentially are allowed to set aside money that you're going to spend on health care, not be taxed on that money, and spend that money tax-free.

31:00Yeah. Functionally, there's been a bunch of research into this. It really just ends up benefiting rich people who want to pay less in taxes for their luxury health and fitness purchases, right? TrueMed allows people to log onto their website, fill out a quick survey, and get delivered a letter of medical necessity that allows their purchase to be covered by HSA owners. In exchange, TrueMed takes a cut of the sales. Oh, okay, okay.

31:30That's scammy. So they've been used for, like, red light therapy devices, including the, like, skincare red light masks. They've been used for supplements, for smart mattresses. Vanity Fair did an incredible deep dive piece into Cali Means. I strongly recommend it. And as part of that, they got their hands on some early TrueMed marketing materials, which, at its outset, focused on rebranding companies like Sweetgreen and Daily Harvest as healthcare companies.

32:05My Daily Salad is actually a prescription. My dad did cut food stamps, but now my work lunch is healthcare. So the mean siblings both have very close ties with the sweet green guy, the Daily Harvest guy. Oh, really? Of course, sure. All of these people are people that they know and work with very frequently through the, quote-unquote, end chronic disease coalition.

32:36How do I know that's a scam? Right, right. Any other time in history, you're like, oh, end chronic disease, that sounds good, but it's like, nope, my brain is too broken from doing this show. The coalition is mostly, they're advocating for something called the HOPE Act, the Health Out-of-Pocket Expense Act, which would expand eligible uses for HSA dollars. And the end chronic disease coalition, which RFK Jr. and, like, other folks on the right will, like, tout, oh, like, oh, my God, Cali Means work with this incredible coalition.

33:09The coalition is largely made up of companies whose products would be covered under those proposed expanded rules. So it sounds, like, nice, like, oh, we're expanding the HSA, but it's actually just, like, you're going to get profits out of this, basically. And the name of the coalition is End Chronic Disease. Like, oh, my God, this guy is so dedicated to ending chronic disease. No, he's fucking not. He's dedicated to selling his buddies, like, food and then taking a cut of those sales. Yeah, yeah, yeah. So, Michael, are you ready for Cali Means' origin story?

33:42Oh, yeah, give it to me. Cali Means says that he was a lobbyist for big food and big pharma. Okay. And that he saw firsthand the kind of corruption at play there. On one podcast, he claimed, among other things, that he brokered a deal between the American Diabetes Association and Coca-Cola. What? That it's, like, hush money to, like, stop opposing us in public or whatever. And I was just like, dude, what are we doing? So he's doing, like, confessions of an assassin kind of thing where he's like, oh, I brokered these evil deals.

34:14Yes, confessions of a lobbyist. Yeah. On Tucker Carlson's podcast, he claims to have attended a meeting where food corporations were, quote, paying off nutrition researchers at Harvard and Stanford. And he alleged on Twitter that in his time as a lobbyist for food corporations that Coca-Cola gave, quote, unquote, millions to the NAACP and the Hispanic Federation in exchange for publicly calling any policies hindering soda sales as racist.

34:46Okay. Describing the whole thing as, quote, unquote, depressingly transactional. Those seem like easily verifiable claims, but whatever. So Vanity Fair, in this deep dive piece, fact-checked him and his story simply did not check out. Yeah, of course not. They interviewed more than 60 people who had worked with Cali Means. Nine of his former colleagues from PR world, from Mercury and Edelman, disputed his version of events.

35:17Okay. Where Cali Means claimed that he had been a, quote, unquote, director at Mercury, brokering these high-level deals, his colleague said he was an executive assistant who wouldn't have even been in the room for the deals that he said. Executive assistant is hella funny. It's as removed as you could be from, like, the halls of power that you're talking about. They're like, hey, can you grab us a cup of coffee? He's like, I was in the room. The room where it happens, that's right. Not only do they dispute the roles that he held, they also dispute that they, the companies, represented the clients that he claimed.

35:55Nice. So in the three years that Cali Means worked at Mercury, they didn't represent Coca-Cola, nor did they represent the American Beverage Association. Mercury, which is where Cali Means was working, was working the other side of the issue. They were campaigning to reduce soda consumption, and their client was the California Endowment. It's funny because he could have just said, I was on the ground working to reduce the influence of big food. Like, I was advocating against soda companies. He could have just said that, but instead he's, like, creating this weird narrative.

36:27Right. It's a really strange thing to sort of manufacture a heel turn that you don't appear to have had, right? The Vanity Fair piece also uncovered some real gems about Cali Means as a co-worker. I just sent you a quote. It says, At the office, several colleagues recall his air of self-importance. He seemed to have bigger and better plans ahead, which didn't include them. He walked around the office saying, Cali Means business. Wait. Cali Means business? He walked around the office saying, Cali Means business, another former colleague recounts.

37:01That's, like, his cute little, it's almost like a bumper sticker phrase for, like, when he runs for Congress. Cali Means business. Like, can you, I just want you to imagine an executive assistant. Dude. Who is trying to get. Like, four or something. Who's, like, trying to get into every strategy conversation. Yeah, yeah, yeah. Is acting like they're better than everybody around them at, like, a pretty high-powered firm where they are very junior. Yeah, yeah, yeah. And they're walking around just muttering, Cali Means business to themselves, like, what a fucking dork.

37:35A real Pearl District resident. Is the way I, is the way I think of him. Just the kind of guy who live in the Pearl District. So, that's Grady Means and Cali Means. It felt important to lift up that Casey Means, because she sounds kind of, like, Portland-y, Maha, crunchy, granola-y. It felt really important to establish just how committed to extreme conservatism her family is. I'm so curious how this nomination fell apart now. Because all of this so far sounds like everyone in the Trump administration would just love these people.

38:08Right. And welcome them with arms wide open. Baby. Well, Michael, when it comes to this story, can I take you higher?

38:24That's it. That's all of my creed. That's it. We're done. I know the title of two songs. The end. So, back to Casey Means. Unlike her predecessor, Dr. Neshwat, Casey Means' basic CV checks out. She did graduate from Stanford undergrad in 2009 and from Stanford School of Medicine in 2014. She did go on to pursue her residency at OHSU. It was a five-year program, but she dropped out six months before completing it.

38:56She did get a medical license, but it has now been inactive for a couple of years. She has offered two reasons for leaving her program. One is that sort of State of American Healthcare thing, and the other is the stress and pressure of her surgical residency. After leaving her residency, she opens her functional medicine practice called Means Health in 2019. The same year that she opened her functional medicine practice, she also co-founded Levels, a health tech company that sells continuous glucose monitors and lab testing services, as well as quote-unquote AI insights.

39:40There it is. There it is. A full membership to Levels for a year, including glucometers, costs about $1,500 per year. I'm so against profit medicine. The problem with medicine is all of the profit. That's why I charge you $1,500. That's why it's like more than $100 fucking dollars a month. So she founds Levels and her functional medicine clinic in 2019, and in 2020, COVID hits. Casey Means takes that as an opportunity. Of course. And submits an LTE to the journal Metabolism Clinical and Experimental.

40:17In it, she argues that metabolic dysfunction is a core issue for COVID-19, and that managing blood sugar in a data-driven way was an essential intervention for COVID. Oh, so buy my products. So she submits this letter in April of 2020. By November of 2020, she had reportedly raised $12 million in seed funding for Levels. Okay. By 2022, the company was reportedly valued at $300 million.

40:49Oh, wow. Okay. It is then 2022, during Callie and Casey Means' appearance on the Tucker Carlson show, that really establishes them in the right-wing, just-asking-questions circuit. From there, they both start doing the rounds, showing up on Joe Rogan's show and a ton of, like, right-wing podcasts, right? After the Tucker Carlson thing, that really seems to, like, blow things wide open. It's also reportedly where RFK Jr. comes across their work, right?

41:19All of that leads up to the release of Callie and Casey Means' book in 2024, which is called Good Energy, The Surprising Connection Between Metabolism and Limit. How is it not called Means' Tested? They have so many puns at their disposal. Think of the possibilities. Lean Means' healthcare machines. Lean Means is great. They're leaving grifts on the table.

41:49In promotion of the book, they publish an excerpt on the free press. Of course. The excerpt on the website is titled, I'm a doctor, you shouldn't always trust us. God. The chapter in the book is titled, Trust Yourself, Not Your Doctor. This website loves laundering, most far-right garbage. But, like, through the mouths of experts who went to all of these, like, Ivy and Ivy-adjacent institutions. Yeah. Like, I read the whole book.

42:20Callie and Casey Means both say some very accurate, reasonable criticisms of the U.S. healthcare system. They also write really compellingly about the shortcomings of the food system and the heartbreak of people needing to pay more money than they have just to stay healthy or stay alive. And that's why we've joined the Republican Party, which wants to make all of these things worse. Right. So, in talking about the importance of, like, eating whole foods and healthy fats, rather than directly increasing access to those things through, like, SNAP or WIC,

42:52Right. They instead shift to this personal responsibility frame. Yeah, yeah, yeah. Saying that, like, it's actually on you to make sure that you're eating very expensive ingredients. She's an anti-seed oil lady. So, she's like, right, like, buy the oil that is, like, five or six times as much. Right. They are totally silent on, like, how any of this would be possible for low-income families. Right. And they're just, of course, as usual, just inflating the ability of, like, a virtuous lifestyle to solve all of these issues.

43:25Like, you did something wrong if you get one of these chronic conditions. That's the ideology. On the press tour for the book, she becomes a real hot take factory. She has said that, quote, many, if not most, COVID-19 deaths could be prevented with optimal metabolic health. Nice. And called COVID a, quote, Darwinian moment for America. Oh, what? Like, a good way? Yeah, like, the least fit did not survive way. Just saying it. They're out here just fucking saying it.

43:56She also has some anti-vax positions that I think are dressed up to appear more moderate than they are. In her newsletter, she wrote, quote, There is growing evidence that the total burden of the current extreme and growing vaccine schedule is causing health declines in vulnerable children. Oh, vulnerable. We're really looking out for the vulnerable. By giving them measles. It's so important that they get measles. She has said, quote, I think vaccine mandates are criminal. I mean, they are in the sense that we never fucking had them in America.

44:27So, whatever. She said that in response to somebody on Twitter giving her shit for not being anti-vax enough. And she was like, I have said innumerable public times. I love that. I love that. Um, actually. Um, actually, I'm the most anti-vax. I'm actually pretending when I say we need more research and stuff. I'm actually super anti-vax. Don't worry about it. Michael, aren't we having a good time? With these. You keep reminding me. Isn't this fun? It's kind of fun. I'm having fun. This is like my parents on road trips as a kid. This is fun, right? She has written, quote,

44:57When 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. I want buying food to be a just constant fucking chore where I have to know every single thing and do all the work myself. I would love that. The way that you know if there is listeria in milk is a good hard look in the eye. I want other people to have the freedom to fucking lie to my face about the health impact of their product.

45:31She is also a proponent of both psilocybin and MDMA. She likes shrooms. She likes Molly. Why are all these people into fucking psychedelics? It's so fascinating. All they do is bitch about like Prozac and stuff, but they're like, no, no, no. Take these other drugs. It's so weird. Yeah, I mean, I think there's like a rift, right? Both within Maha world and within Republican world writ large, where you have sort of older school Republicans who are like, drugs? Yeah. And you have this sort of like newer wave of like red pill fucking assholes

46:03who are like, drugs! Yeah. It becomes a liability because it exposes that rift, which doesn't often get tested in like federal policymaking, right? Right. So, in addition to all of those hot takes, sometimes her hot takes take the form of poetry. Okay. For April Fool's Day, she wrote a poem for her newsletter. As she notes, she got, quote, some help from AI. I'm sending you four verses from a poem that has like 20 verses.

46:37Like there's so many. So I just picked a few. And she puts it in full in her newsletter? Mm-hmm. The title of the poem is The Devil's Wellness Plan. I'm not reading. This is way too much, Aubrey. You're reading it. Michael, you're reading it. If I were the devil, I'd ditch the disguise. No pitchfork, no flames, just marketing lies. I'd feed you poison, call it a snack, and label you elitist when you want your health back. I'd bury research, seal the locks, then line you up for 73 shots. Doesn't rhyme.

47:08I'd cancel critical thinking, stop dissenters with bots, then jab your kids without a second thought. Also, doesn't really rhyme. 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 give boys man boobs through toxic food and call masculine strength aggressive and lewd. I'd whisper, you're too much, too loud, and shame men's fire as something rude. There you go. I miss Creed, Aubrey.

47:40Can we go back to Creed? Mike, he's a professional. You can't expect her to be on his level. That at least had an okay pentameter or whatever. It was at least the correct number of syllables. So Good Energy, Callie and Casey Means' book, came out in 2024. By May of 2025, Casey Means was announced as the Trump administration's nominee for Surgeon General. Nice. That is so far to get in such a short period of time. The reactions to Casey Means' nomination are swift

48:13and they are negative. This means war. So a number of former Surgeon General come forward and are like, absolutely fucking not. Jerome Adams actually like writes an op-ed about it and is like, hey, part of your job as the head of the U.S. Public Health Service is to weed out people who don't have license to practice. And Casey Means does not have an active medical license. Oh, right, yeah. There is criticism from Maha folks who once again criticize her for not being anti-vax enough.

48:46Really? Even her? Uh-huh. Fucking hell. Once again, Queen Gremlin, Laura Loomer, weighs in on Twitter. I just need a quote. Casey Means said, So basically, the new Surgeon General is a total crackpot, a shroom consumer, and she talks to trees and doesn't even have an active medical license. Another failure by the geniuses

49:18who work for President Trump on his non-existent vetting team. I guess there isn't a single conservative doctor in America who doesn't have a history of being a Marxist tree hugger. This is bizarre. Casey Means is like a complete nutcase. They should love this lady. The reactions to her nomination are so bad, on Twitter in particular, that RFK Jr. rushes to her defense on the platform. He says that Maha is taking on powerful corporate players and that those companies, quote, will continue to pay bloggers

49:49and other social media influencers to weaponize Innuendo, to slander and vilify Casey the same way they try to defame me and President Trump. The fights between these people are always just like the Spider-Man meme of people pointing to each other. It's like vaguely different shades of lunatic. It's like why they're mad at her. I mean, I think this is part of what makes me feel less despairing about this episode is that early on when RFK Jr. was nominated, you and I talked about him

50:21and his priorities being on kind of a pretty direct collision course with the Trump administration, right? That he's like, I want to regulate corporations. I want to ban all this advertising. I want to blah, blah, blah. And Trump is the guy who's like, let corporations do whatever the fuck they want. Right. And that the Maha coalition was like sort of like looking for a home and Republicans offered them a home. Right. But the rift and the sort of differences and disconnects are starting to show. And part of the way that that's starting to show

50:52is in these kinds of like infighting moments. And part of the ways that that's starting to show is in having three nominees for Surgeon General. Right. And not having one still. And also these, the whole Maha thing, you can't have a stable coalition when it's built on the back of lies and misinformation because everyone is ultimately just making shit up and cherry picking. You don't have like a referee or like an objective standard of facts to point to to adjudicate a dispute about like, do shrooms work or are shrooms bad?

51:23They don't give a shit about what actual science looks like. So you can't really have like a good faith debate even within these coalitions. Right. It's all power games, right? Yeah. So on top of all those negative reactions, there's also this new wave of reporting about like who is this new Surgeon General nominee. And one of the things that they find in that reporting is that there are pretty significant gaps between how she describes her residency and how other people at her residency described her at her residency. Vanity Fair interviewed the chair of the department

51:55where her residency took place, who said that Casey Means found the job, quote unquote, too stressful, that she quit in tears and that other residents had to, quote, cover for her and were a small department and all the calls fall on them. No way. The funny thing is that's also a structural critique of the American medical system. People are so overworked. Yes. But yeah, it's also funny that she like makes it this like virtuous, like I chose to leave thing. Two other residents who served with her in the same department at the same time

52:27said that she was very anxious and primarily like afraid of hurting patients. Has she tried zinc? Has she tried taking zinc for anxiety? I think it's just maybe it's her lifestyle. So all of this leads up to Casey Means confirmation hearing, which happened in February of this year. Her initial confirmation hearing was scheduled for October 2025, but it was postponed when she went into labor with her child. So she got maternity leave, basically, something the administration is also decidedly against.

52:58Initially, the confirmation hearing is scheduled for October. It ends up taking place in February after her parental leave. And in that time, the conditions and the sort of political calculus here really change. Among other things, the chair of the committee where the confirmation hearing will happen, the health committee, is Bill Cassidy. Bill Cassidy is in that intervening time defeated in his Republican primary by a Trump-endorsed challenger to the right.

53:30Bill Cassidy is now a lame duck with serious, like, flame duck potential. But there's also a longstanding rift between Senator Cassidy and President Trump, dating back to at least 2021, when Cassidy voted to convict Trump of inciting a riot on January 6th. Okay. He's a physician who did practice for a long time in a lot of situations. Like, say what you fucking will about Bill Cassidy. I'm not going to cape for any Louisiana Republicans

54:01at this point, but he is an actual doctor who did actually practice, who does actually have a medical license. All of that does feel relevant here. There's also a long history of Republicans, like, kind of doing the right thing once they don't have an election to win anymore. Totally. So, like, as I have told you, I'm not a fan of congressional hearings. Yeah. They feel like political theater. They feel like they're not accomplishing anything. They're definitely not fact-finding missions, like, ever, right?

54:31I think that this confirmation hearing was pretty effective as political theater. Cool. They had, like, a really clear, good division of labor. Folks had drafted their questions in a really tight way and came in with, like, a pretty unified front across party lines. Bizarrely, Josh Hawley is like, hey, I need to talk to you about what I'm hearing from my constituents, which is they're concerned about the health risks of AI data centers. What? I will say Hawley kind of softballs it, and he's like, well, I'd invite you to give it some thought.

55:03He's not, like, an asshole to her about it. He's not, like, confrontational about it at all, but he does raise it up and is like, these are the kinds of things that people are concerned about. They're concerned about water quality that looks like this. Right? Like, they're, like, doing the thing of being like, hey, this is an issue. It is all theater, though, because none of them give a shit about any of this stuff, but whatever. It's totally theater, but it was surprising to me that if you're doing a performance, and the performance of every Republican at this point is, to some degree, just for Donald Trump,

55:34his willingness to push back in that way, I was like, oh, that's interesting. It's weird, yeah. But he's not the only Republican on the committee who has sort of more direct and sort of harder questions for her. At one point, Senator Cassidy asked her if she believed that vaccines cause autism. This is after the Pam Bondi hearings, so it's clear that she's trying to, like, moderate her response and not be kooky and start yelling about, like, the Dow!

56:04Yeah, yeah. So her response to Cassidy's question about vaccines and autism is, quote, we have an autism crisis that is increasing. This is devastating to many families, and we do not know, as a medical community, what causes autism. Which I can see the anti-vaxxers being mad about that. It's the one answer, the, like, we don't actually know what causes autism, is the one answer that is guaranteed to piss off everybody. She should have just said they fucking cause autism, and then, like, the anti-vaxxers would get on her side.

56:35Ten toes down, standing on business. Yeah, yeah, yeah, yeah. So, in that same hearing, Tim Kaine asks her about flu shots, which is not a huge part of the anti-vax discourse. Right. So I just sent you, we're gonna watch a clip. I apologize in advance for how infuriating this clip is to listen to. In a news report on January 7, just a month or so ago, Secretary Kennedy stated, quote,

57:05there is no evidence that the flu vaccine prevents serious disease or that it prevents hospitalization or deaths in children. Do you agree with that statement?

57:17Senator Kaine, as I've said, I'm, I believe vaccines save lives and are an important part of it. I'm not asking about the general. I heard that testimony earlier, but you're an MD, your qualifications have been much discussed earlier. Do you agree with the statement that there's no evidence that the flu vaccine prevents serious disease or that it prevents hospitalizations or death in children? I have not personally seen that quote or that article. I would want to review it before I comment on that.

57:49Okay, I'm gonna set the quote aside. I'll introduce for the record. She's so bad at this. An article, CBS News, RFK Jr. says it may be better if fewer children receive the flu vaccine dated January 7, 2026. Without objection. Do you believe that there is evidence that the flu vaccine prevents serious disease and prevents hospitalization or deaths in children? I believe that all patients should talk to their doctors. And so do I. And that's not what I'm asking. Your qualifications have been much discussed.

58:21There is a mountain of evidence about this. Do you believe that there's no evidence that there's the flu vaccine has efficacy in reducing serious injury or hospitalization? You would see the little hamster wheel in her brain. This is an easy one, doctor. This is an easy one. I support the CDC's guidance on the flu vaccine and I will always be working with the CDC, ACIP, and the agency. So you believe it is an efficacious vaccine

58:51to reduce hospitalization? Is or is not? Is. You believe it is? As I said, I support the CDC's guidance on the flu vaccine. Let me just say, do you think the flu vaccine reduces the risk of hospitalization or serious injury?

59:06I've said it. You're a doctor. I believe vaccines save lives. I believe they're an important part of public health strategy. The flu vaccine, does it reduce the risk of injury or hospitalization? At the population level, I certainly think that it does. Let me introduce for the record if I can, Mr. Chair. CDC seasonal flu vaccine effectiveness studies dated May 30, 2025 from the CDC that goes into this in some detail. This is not a hard question. I answered your question. And yes, after three minutes you acknowledge that at a population level

59:36you would disagree with it. I haven't seen that report. I have not seen it. Yeah, but you know about the flu vaccine. If I had a nickel for every time I was misquoted in the media, I'd be a very wealthy woman. I would like to understand what his comments were. I'm not asking you about the quote. I'm asking you about something in your remit, the effectiveness of the flu vaccine.

59:54Stunning! He did eventually get her to admit it, which is actually interesting that she did. I think it's, again, an indicator of how bad she is at this. Yeah, yeah. Part of what sinks her in this hearing is that she keeps trying to rely on these phrases like, I believe vaccines save lives or I support the CDC guidance. She clearly also didn't know what the CDC guidance was because the CDC guidance is all like pre-RFK Jr. So most of it is still pretty pro-vaccine at this point. It's all the Doge guys being like asked to define what DEI is

1:00:26and they're like, it's whatever was in the EO. Yeah, yeah, yeah, yeah. Another piece that becomes like a big challenge for Casey Means is her financial conflicts, which are significant. Of course, she owns and operates Levels, her sort of medical equipment slash wellness startup. But on top of that, as we've mentioned, she has a really strong presence on Substack and Instagram and social media sort of writ large.

1:00:57And it becomes clear that she has failed to disclose many, many financial relationships. And in her newsletter on Instagram on social media broadly, she is frequently recommending products. Oh, right. And like not disclosing like those FTC regulations where you have to say like hashtag sponsored or whatever. Correct. Yeah. Those regulations, those regulations about disclosing when something is an ad on social media

1:01:28came into effect after Fyre Fest. That's why we got those fucking things. Yeah. And she's like doing a wellness Fyre Fest of like not disclosing. The Associated Press investigated her disclosures and found that she had been taking big payments that she did not disclose publicly. $59,000 from Function Health, Mark Hyman's company. Oh, yeah, of course. $12,000 from Daily Harvest. $16,000 from Fluorosophy,

1:01:59a fiber supplement company. That sounds like a fake word that she made up for one of her poems so that it rhymed. $27,000 from Energy Bits. Okay. An algae supplement company. Wait, what was the one we talked about on the bonus episode? Food Cube or whatever?

1:02:20Is she getting cube bucks? $500 from Weenatal, prenatal vitamins. Oh, that's pretty good, actually. And $130,000 from Amazentis, a supplement company. Also, $200,000 from Tati Westbrook's hair vitamins. Yeah, that's right. Bye, sister. Uh-huh. I will also say, not for fucking nothing, in her confirmation hearing, one of the members of the committee is Bernie Sanders who questions her on stuff and mostly is like,

1:02:51hey, I agree we should ban junk food advertising. Hey, good point on this thing. Uh, yeah, everyone's going out of their way to do this shit. I know. Bernie Sanders is like trying to sort of be like, you know, I disagree with the Trump administration on a lot of stuff, but I think you got some good points here. Yeah, yeah, yeah. And then like, posts a clip on social media and is like, hey, we had a real one. This was a good conversation. Like, I don't agree with her on everything, but I support her in this thing. And people just like, absolutely shredded him on it

1:03:21and was like, you don't gotta hand it to her. This is why these people make these disingenuous, plausible-sounding arguments is because they attract people who like, want to give them credit and want to give them good faith, but these people are not acting in good faith. Correct. You cannot listen to what they say. You have to look at what they fucking do. Correct. What is she doing with her life? There's no fucking way these people are like, oh, I just want to fix the diet of Americans. Is that what RFK Jr. has spent the last 20 years of his life dedicated to? No, he's dedicated it to fucking getting kids infected with measles. That's what they actually believe.

1:03:52You have to ignore all this bullshit. They are saying that as a fucking trap, as bait, to get people who do not care or do not know about their actual background to do exactly what Bernie is doing. 100%. I was like, this is uncharacteristically like anti-shrewd. Also for just a failed fucking candidate, too. It's really stunning. It's clear by this point that she's not going to make it through. So on April 30th of this year, in a truth social post,

1:04:23Donald Trump acknowledged that Casey Means didn't have the votes to be confirmed. She will also be joining Walter Reed. Unsurprisingly, Trump blames Bill Cassidy, the chair of the help committee. Yeah. But also, there appear to be holdouts that were Cassidy Collins and Murkowski were all like, I don't know. Okay. After the administration withdraws Casey Means nomination, the political landscape starts to shift again. New polls come out

1:04:53revealing that changing the vaccine schedule is hugely unpopular with voters. Yeah. Plus, the anti-vax stuff has faced a large number of court challenges, so it is costly and time-consuming to defend against, right? So they're really testing like how much political capital the Trump administration is willing to spend on Maha priorities. Right. And this is more of an RFK thing than a Trump thing. Yes, correct. So we're seeing like how far is Trump willing to go

1:05:23for RFK Jr., right? And not as far as Casey Means is the answer. Yeah. That's when they announce the newest, third and newest current nominee, Nicole Sapphire is her name. She went to Arizona State University for her undergrad. For her MD, she's telling us out front she didn't go to med school in the US. Okay. She went to Ross University in Barbados. Is that like a for-profit scam factory? It doesn't appear to be. I didn't look into Ross University

1:05:53to a great degree because I was like, they're not going to do that again, right? But maybe, who knows? She is currently a radiologist at the Sloan-Kettering Cancer Center. A licensed doctor. Her career as a public figure is a very ma-ha, like, gotta catch them all kind of thing. She has a podcast, she has a supplement company, she's a Fox News contributor. Oh, great. She's written three books, Love Mom, Inspiring Stories Celebrating Motherhood,

1:06:23Make America Healthy Again, How Bad Behavior and Big Government Caused a Trillion Dollar Crisis. Yeah, big government's definitely the problem. She also published that before RFK Jr. was using Maha. Oh, wait, really? Uh-huh. She tried to trademark it, which is very funny, and then she sort of dropped it. Yeah, yeah. She owns a podcast called Wellness Unmasked, and she wrote another book called Panic Attack, Playing Politics with the Science in the Fight Against COVID-19. I could just, like, write that book from memory.

1:06:54I could, like, sit down and write that fucking book right now. You already know, lab leak, whatever. Dr. Sapphire's positions on core Maha issues are often presented in a way that seems a little more moderate than a Casey Means, which, like, not hard to do. I think a good example on that is her position on vaccines. She, like Casey Means, is very strident in her Vaccines Save Lives stance, but she has also said that the pediatric vaccine schedule should be quote-unquote

1:07:24less stringent. Yeah, there it is, yeah. And that she opposes vaccine mandates. Yeah. She has also been publicly and directly critical of RFK Jr.'s approach on vaccines. Really? And she's done that criticism in right-of-center media outlets. It's fascinating. Okay. She's a real mixed bag. Yeah. Most notably, she wrote an op-ed in the Wall Street Journal just last year called The Madness in RFK Jr.'s Autism Method. Woke Queen.

1:07:55I'm into it now. Comparatively. I heard she said defund the police.

1:08:01I don't think she did. She has publicly criticized Trump, but those posts are now deleted. So she's like been speaking her mind, but then doing the Trump nominee thing and like scrubbing the record afterwards. Right. So she tweeted at one point, quote, seems like they may not want to admit the U.S. measles elimination status is gone until after the midterms. Nice. On Trump's Tylenol warning, she posted, quote, as a mom of three kids, I don't love a man telling me to tough it out when it comes to pregnancy.

1:08:32Wow. This is the bar is in hell portion, right? Yeah. But also like not a lot of people are exceeding the bar. Right. So far, the reactions have been much less alarmed than last time. The reactions from people who sort of reacted to Casey Means the first time around, including past Surgeons General, those responses have been essentially like this is a qualified nominee with an active medical license. It all feels like, not that it was, but it all feels like a strategy.

1:09:03They're like, we're going to nominate the two worst fucking people alive. And then when we get to the third nominee, who's also trash, everyone's gonna be like, whatever. Folks have been worn down so hard. I'm sleepy. Dr. Sapphire hasn't faced confirmation hearings yet. There is one thing that may become an issue in her hearings. She has a supplement brand called DropRx. It's called DropRx because it is herbal tinctures, like liquid tinctures in eyedropper bottles. Okay. In true supplement biz form,

1:09:34their supplements are named things like boost, relief, allure, sleep, and intimacy. Taste test episode incoming. So there are two problems here. One is Dr. Sapphire works for the Memorial Sloan Kettering Cancer Center, which has a clear policy that bans employees from quote, endorsement of products or commercial ventures. It's also suspect as hell for a surgeon general. So she would likely need to divest, right? As with Casey Means Problem number two

1:10:04is that their supplements include kava, which the USDA and FDA warn is associated with significant liver damage and which is regulated differently in different states. Cheap champagne? What is kava? It is a root that is supposed to sort of promote like a sense of calm. And in some states you can use it in supplements. In some states you can serve it in the cafe. In some states it's like banned completely. But the USDA and FDA have already issued

1:10:35warnings about it. So it's just real weird to have a surgeon general who is selling a product that runs counter to public health guidance from other agencies, right? Do you know how easy it is to find a practicing doctor who isn't a fucking grifter? It's crazy. They can't find a single one. They're all tree-hugging Marxists, Mike. For now, she appears to be much more in the vein of Dr. Neshwat than Pacey Means. Right. And that honestly

1:11:05feels like a pretty grounded win to have someone who is not, who's like grifting from one angle but not like seven.

1:11:15That's as good as it gets in America in 2026. Right now? She's only one kind of grifter. Count your blessings. She's only selling herbal tinctures. I know, she's a mono-grifter. That's the best we can do. At the start of this episode, I started by saying that the research made me feel like less despairing. Here's why. One, this is a place where the Trump administration is failing. They are not getting their nominees confirmed. Yeah. This is also true of other Trump nominees, too.

1:11:46According to Brookings, the average confirmation delay for Trump nominees has doubled from his first term to his second. Although, in fairness, they are twice as bad this time. They are pretty bad. Yeah. From a harm reduction standpoint, I genuinely think it's more helpful to have no Surgeon General rather than one of these ultra-gremlins. And at the win that Casey Means didn't get through because she's a complete nutcase. I think the last thing that makes me feel sort of like groundedly, cautiously optimistic about all of this is that Trump is immensely unpopular

1:12:17right now. Which means that, again, Republicans who are already pushing back on this committee are going to be incentivized to push back more. Yeah. You know, good news is few and far between at the moment. This is like a very, very, very low bar to meet. Yeah. But I think we've got to accept the good news we get with arms wide open. Yeah, I know you're going to go back to that.

1:12:43One of us is going to do it. One of us is going to be