Maintenance Phase

Why Don't We Have a Surgeon General?

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[Maintenance Phase theme]


Michael: Okay, I actually have one. I'm on fire.


Aubrey: Ooh. He came prepared, maybe.


Michael: Welcome to Maintenance Phase, the podcast that has nothing to say about the surgeon specific, but a lot to say about the Surgeon General.


Aubrey: [laughs] Oh, I like that one so much.


Michael: I'm Michael Hobbes.


Aubrey: I'm Aubrey Gordon. If you would like to support the show, you can do that at patreon.com/maintenancephase. You can also subscribe on Apple Podcast Premium. It's the same audio content. Michael.


Michael: Aubrey.


Aubrey: We are a year and a half into Donald Trump's second term, and we still don't have a Surgeon General.


Michael: I have not been following this at all. [chuckles]


Aubrey: You, and most people. There's been so much shock and awe in so many places that it's hard to keep track. We're all drinking from a fire hose in terms of the news cycles, right?


Michael: I know whenever I hear about an out of work Fox News host, I'm like, "Yeah, they're probably the Surgeon General now. Who fucking cares?"


Aubrey: Today we are going to talk about the three MAHA-aligned doctors, who have been nominated for Surgeon General.


Michael: Which they're all doctors. That's actually surprising. [laughs]


Aubrey: Well, hang on.


Michael: Okay. Okay.


Aubrey: Let's not get too crazy.


Michael: I thought it was going to be like Omarosa or somebody.


Aubrey: We haven't done a real MAHA update in a minute, because it's so often just like a soul sucking slog of a thing.


Michael: Yes. Yes.


Aubrey: I would just like to preface this one by saying, “It's pretty fun.”


Michael: Good. I want like Real Housewives shit.


Aubrey: 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 a very Maintenance Phase role.


Michael: He knows when you've been sleeping, he knows when you're not getting enough beef tallow.


Aubrey: The Surgeon General can issue reports and recommendations, but the office doesn't have the authority to create policy.


Michael: It's actually kind of funny we have this role, because it’s just like a guy who says stuff in chief.


Aubrey: It’s kind of. Well, except there is a very functional part of the role. The Surgeon General leads over 6,000 uniformed officers in the US Public Health Service. So, it's a role where it's really helpful to be both a seasoned healthcare provider and a really strong, clear communicator.


Michael: [chuckles] 


Aubrey: Don't start laughing yet. [chuckles] 


Michael: Foreshadowing. Foreshadowing. Okay.


Aubrey: The process for becoming the Surgeon General 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’s also a committee where Lisa Murkowski and Susan Collins are both on the committee. So, you got a couple real-


Michael: Mavericks.


Aubrey: -pieces of work.


Michael: Couple of mavericks. Yeah.


Aubrey: So, today we are 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.


Michael: Okay.


Aubrey: So, in November of 2024, after he was elected to his second term, Donald Trump nominated Janette Nesheiwat to be Surgeon General. His statement on Dr. Nesheiwat's nomination describes her as "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.


Michael: First red flag. [chuckles] Good.


Aubrey: She’s one of five children in her family, and she’s not the only one with ties to the Trump administration. Her sister Julia was a Homeland Security Advisor under the first Trump administration.


Julia's husband, so Janette's brother-in-law, is the current 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?


Michael: No.


Aubrey: Well, Michael, he's the guy who added a journalist to a Signal chat about war playouts.


Michael: Oh, okay, okay.


Aubrey: He's the specific guy who is 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 contact? It just got sucked up in there. So, this journalist got-- [crosstalk] 


Michael: I'm a bit of an OpSec expert myself. [Aubrey laughs] Yeah.


Aubrey: So, that's one of her siblings. Another of her siblings is her sister Jaclyn, who is a model and a former pageant winner, who was Miss New York USA 2004 and Miss Florida America 2008.


Michael: Nothing wrong with that. But the fact that there's so many of these people in Donald Trump's orbit’s so fucking bizarre.


Aubrey: Today she’s the executive director of her husband's foundation, which is dedicated to “helping underprivileged children around the world.” That foundation is called the With Arms Wide Open Foundation.


Michael: Is it named after the Creed song?


Aubrey: Her husband is Scott Stapp.


Michael: No fucking way.


Aubrey: Michael, we could have had a Surgeon General who has Thanksgiving with Scott Stapp from Creed.


Michael: Just do Scott Stapp. Fuck it.


Aubrey: [laughs] It scans so hard with the administration that could only get 3 Doors Down to play at the inauguration. [Michael laughs] But also, what a fucking stinging indictment that they couldn't get Creed?


Michael: No, I know he's right there. 


[laughter] 


Also, I love that the administration finds people like the Surgeon General the way that at my tiny, underfunded NGO, we used to find graphic designers for PDFs. We'd be like, "Hey, you went to college with somebody who knows Illustrator, right?" Just reach out to them. [chuckles] 


Aubrey: Oh God. Ours were more like, "Do you have an afternoon? Could you figure out Illustrated?" [laughs]


Michael: Wait, wait, wait, wait, wait. I have a thing, I have a thing, I have a thing.


Aubrey: You have a Creed thing? We're not done with Creed?


Michael: Donald Trump 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 in front of me. [laughs]


Aubrey: Oh my God, I don't know, Michael. This is literally counting on me to recognize the lyrics that you also don't know?


Michael: I'm furiously googling. I'm like, "I need a reference here, but I don't know the lyrics to this song."


Aubrey: 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. [Michael laughs]


Michael: I'll record a bunch of pickups to throw it into the episode. [Aubrey laughs]


Aubrey: Dr. Nesheiwat had likely crossed Trump's radar during her time as a TV guest doctor on Fox News and The Daily Caller.


Michael: Of course. 


Aubrey: But just six months after she was nominated, the day before her scheduled confirmation hearing, Trump withdrew her nomination.


Michael: Okay. Cancel culture.


Aubrey: So, the question here is, what happened. Mike, I would like actually for you to hazard a guess.


Michael: Did she once say a single boilerplate thing about how diversity is what makes America great?


Aubrey: No and no. [Michael chuckles]


Michael: And they're like, "No, not after 2024."


Aubrey: 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.


Michael: Wait, he just googled like me looking at Creed lyrics?


Aubrey: Yes.


Michael: He's just like, "Type, type, type. Nope." [laughs] 


Aubrey: He finds that Dr. Nesheiwat didn't get her medical degree from the University of Arkansas as she had claimed, but had completed a residency there as an employee, not a student.


Michael: Okay.


Aubrey: 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-


Michael: Oh.


Aubrey: -which is a commercial business.


Michael: And also, it's probably like a distance learning thing or something.


Aubrey: Oh, Mike, you don't know how close you are.


Michael: I got my degree from iTunes U. [chuckles]


Aubrey: In 2011, the American University of the Caribbean was bought by Adtalem Global Education, [Michael chuckles] which is previously-- No, Mike, I haven't even got there yet.


Michael: Which was previously Philip Morris or something. It's like a made-up name.

 

Aubrey: Previously known as the DeVry Education Group, baby.


Michael: Oh. It's her. Yeah.


Aubrey: DeVry Medical School. [chuckles]


Michael: Because that's Betsy DeVos whole for-profit education thing, right?


Aubrey: 100%.


Michael: Dude, scammers.


Aubrey: Clark also reports as part of this piece that for-profit medical schools were banned in the US for over a century for concerns over admission standards, quality of education, needing new regulatory structures, all kinds of stuff.


Michael: It's also funny, because the only thing that offends them is the lying. If she had just said, "I have no medical qualifications--" It's not like the Trump administration gives a shit, right? [chuckles]


Aubrey: I'm so glad that you're getting a handle on the ways in which this episode is fun. [chuckles]


Michael: Yeah.


Aubrey: It's just a fucking clown car of dinguses.


Michael: It's also now bleak that CityMD didn't care.


Aubrey: Or, it met their standards. They are also a for-profit business.


Michael: They're like, "Game recognized game." They're like, "Nice one." Yeah.


Aubrey: Totally. They're like, "Oh, you guys too? Cool."


Michael: Yeah.


Aubrey: So, on top of all that, on her website, Dr. Nesheiwat says that she has a specialty in family and ER medicine. But she's only board certified in family medicine, not emergency medicine.


Michael: That's such a weird thing to lie about.


Aubrey: It's so weird. But also, she works at an urgent care clinic, right?


Michael: 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." [Aubrey laughs] I'm like, "I fucking know." They're like, "That'll be $200, please." [chuckles]


Aubrey: In addition, Clark was unable to verify Nesheiwat's claim that she had worked in emergency rooms in Arkansas. So, she’s calling herself an emergency doc when she has worked for a for-profit urgent care clinic in a management role, which is just different.


Michael: 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 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 cushy little life." She probably makes a couple million dollars a year.


Aubrey: So, there's all of this bad press happening, but there are also complaints from the right. The MAHA crowd was saying that Dr. Nesheiwat wasn't anti-vax enough.


Michael: Yeah, I was just going to make a joke about that. 


[laughter] 


Did they find out she's vaccinated?


Aubrey: Very early on in the onset of COVID, even before lockdowns, she was doing some media with Fox News and that thing, being like, "Hey, here is what you are going to do." It was like, "You are going to mask up. It’s probably airborne. You are going to wash your hands real well. You are going to blah, blah, blah," just giving very basic information. 


As part of that, at some points she goes, "We will need to develop a vaccine for this," and da, da, da, da, da, da. [Michael chuckles] It's really not anything. But she’s also not committing to unhinged MAHA requests like, "Let us do a complete overhaul on the infant vaccine schedule."


Michael: It's so funny that they are mad at her for not preemptively criticizing vaccines. Before they were even developed, she should have been out here saying, "They are killing our kids," even the idea of a vaccine they are against.


Aubrey: So, her biggest detractor on the right is Laura Loomer.


Michael: Oh yeah, well, who is probably the fucking Surgeon General now. [Aubrey laughs] Why not?


Aubrey: For those who are unfamiliar, Laura Loomer is an advisor to the president. She’s a particularly unhinged presence, even in a White House full of unhinged presences.


Michael: She was just like a Twitter person, right? She was like a lady on Twitter.


Aubrey: Yes, and she kept getting banned from different social media platforms for straight up hate speech and misinformation, right?


Michael: Yeah, she’s awful.


Aubrey: On May 5th, 2025, Loomer tweeted about Dr. Nesheiwat calling her, "A pro COVID vaccine nepo appointee."


Michael: Well, she’s right about the second part.


Aubrey: [laughs] Yes. She’s.


Michael: It’s funny how they care about that sometimes. They clearly don't give a shit about-- It’s all nepo all the way down in this administration.


Aubrey: So, I am sending you a portion of a tweet from Laura Loomer.


Michael: Oh man. Okay. I am not going to yell, but large sections of this are in all caps.


Aubrey: I think you should make it your own.


Michael: Okay. 


[chuckles] 


“Dr. Nesheiwat 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 PERSONAL HEALTH FREEDOM. Vaccine hesitancy is a matter of personal freedom and liberty! It’s not a global health threat. My body, my choice.”


Aubrey: Laura Loomer saying, "My body, my choice," and meaning it about vaccines.


Michael: We have gotten used to it by now, but this is like a person at a bus stop ranting and also they are like five years old.


Aubrey: Well, and she capitalizes Global Health Threat, like it’s the title of something. [Michael laughs] In May of 2025, instead of being confirmed, her nomination is pulled. According to Fox News, in 2026, Dr. Nesheiwat took a new job at Walter Reed.


Michael: Wait, what? Even though they know her medical qualifications aren't real?


Aubrey: The only way that Trump would pull the nomination, or the way that he did it, I should say-- I don't know that it was the only way he would do it, but he was like, "We are actually going to withdraw her nomination and put her somewhere else very important."


Michael: If he pulls the nomination, then it's a tacit admission that he is giving into criticism or that he got something wrong, which he would never do. So, he is like, "We actually found a better role for you somewhere else."


Aubrey: Yeah. That better role is Walter Reed, working on treatment of Havana syndrome.


Michael: Wait, what are they? Havana Syndrome truthers, the administration?


Aubrey: Apparently, she’s. I mean, she’s working on it now.


Michael: Weird.


Aubrey: Yeah. So, for folks who are unfamiliar, Havana syndrome is described as a constellation of unexplained neurological symptoms. It often includes hearing really loud noises that others may or may not be able to hear. It’s hotly debated. Some people think it’s a mass psychogenic illness, others think it’s the result of chemical warfare from foreign actors. But man, oh, man, they really sent her to the hinterlands. Go to Walter Reed, a place that sounds very important and is very important, and then work on Havana syndrome.


Michael: It's also like, lie about your qualifications and get ready for a different job in this administration. [chuckles]


Aubrey: Fail upwards-


Michael: Yeah. Exactly.


Aubrey: -as if you are a man.


Michael: I know. 


[laughter] 


The Patricia principle. Yeah, it's very inspiring.


Aubrey: So, we went pretty quickly through Dr. Nesheiwat, because it’s such a cut and dry story. The second nominee was a real like "Hold my beer" situation.


Michael: Okay.


Aubrey: It's time for nominee number two, Casey Means.


Michael: Oh, yeah, yeah, yeah.


Aubrey: Mike, what have you heard about Casey Means?


Michael: Just that she's like Nesheiwat, but 50 times more deranged. It's funny that her nomination was pulled essentially, because she wasn't deranged enough. They are like, "Okay, let us get you someone deranged." [laughs] 


Aubrey: Oh, you want kooky?


Michael: Yeah. [laughs]


Aubrey: We got kooky for you, baby. 


Michael: Yeah.


Aubrey: She’s a graduate of Stanford University, both undergrad and medical school. She runs a wellness startup called Levels, and she practices “functional medicine”, which is essentially a rebrand of what in the 1990s would have been called alternative medicine.


Michael: It’s medicine, but this time it’s functional.


Aubrey: This time, it’s personal. Yeah.


Michael: Have you tried putting an onion in your sock and going to sleep? [Aubrey chuckles] Very functional.


Aubrey: So, she has 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 Oregon 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 intervening after things went wrong and not to help them go right to begin with and in a system with such a pernicious profit motive.


Michael: Whatever. Yeah, so, I got into a different part of medicine that also has a profit motive.


Aubrey: Right.


Michael: Selling MRIs to fucking celebrities.


Aubrey: 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. We are actually going to watch a little clip of her telling that story to Tucker Carlson.


Michael: [chuckles] Okay.


Casey: Yeah. I am in the operating room in my fifth year of my surgical residency, and I am looking down at a patient in front of me who is on her third revision sinus surgery. I know how to diagnose her, I know how to write the prescription, and I know how to do the surgery. But what I realized in that moment was like, "I have no idea why this patient is actually sick.

She has so many other health issues. Pre-diabetes, arthritis. She has some brain fog, she has obesity, and she has this sinus issue.” 


In my training, I was never, ever, ever taught to look at the whole patient, to look at how all these things are connected. I was only taught how to do the surgery and then bill for it. I realized that there is a huge problem in how we are practicing medicine right now, which is what? We are ignoring the root causes of why Americans are sick. We are 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. 


When I put some of these pieces together and realized that my training had totally, essentially incapacitated me from really understanding why patients are sick and how to actually help them thrive, I actually had to walk away from the surgical world. Because I realized that I was only making money off of essentially not spending time helping patients understand their health and actually just profiting off their illness.


Tucker: So, nine years into medical training at Stanford, you gave it up voluntarily.


Casey: On my birthday, 30th birthday, I walked into the office 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? This was less than 1% 50 years ago.


Michael: This frustrates the shit out of me.


Aubrey: Yeah, tell me.


Michael: Obviously, there is some kernel of a reasonable critique of the medical system in here, obviously. But the problem with this whole root causes analysis is it’s not clear how you would operationalize this. Any medical system, even if you do address the "root causes,” you still have doctors who deal with patients in an acute way. A head and neck surgeon would not be addressing things like diet and lifestyle to prevent that in the first place. Obviously, we need to do more preventative medicine. But you are still going to have people who need surgeries.


Aubrey: Right. And if you are aiming at, as she’s, a structural critique, then you also need to have a structural solution.


Michael: Yeah. Exactly.


Aubrey: And she does not fucking have that.


Michael: There is a weird 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 car accident or some sort of accident or some sort of condition don’t deserve surgery?


Aubrey: I am so sorry. I have become hopelessly distracted by the Tucker Carlson store merch that’s advertised underneath the video clip.


Michael: Wait, really?


Aubrey: 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."


Michael: What?


Aubrey: And hats that say, "Neocons are gay for war." 


[laughter] 


Michael: How much did they cost? Can I get one?


Aubrey: [laughs] Part of the reason I got so distracted is I was like, "I don't know what this means."


Michael: [laughs] Yes, you do.


Aubrey: I don’t. [chuckles]


Michael: You love it.


Aubrey: [laughs] I 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.


Michael: I can hear you clicking buy and typing in your address to get it shipped to you.


Aubrey: Take my money, Tucker Carlson.


Michael: Yeah, yeah, yeah.


[laughter] 


Aubrey: Oh no. Woo. So, that’s one of Casey Means’ origin stories, right, is her residency--


Michael: So, that's one. Okay.


Aubrey: That’s one of the two that we are going to talk about. The second comes a few years later-- Oh God, I have to get the giggles out, because this is a sad one. [chuckles]


Michael: Yeah. Okay. Right. Right. Do you want me to recite some Creed lyrics to you? Would that help? [Aubrey laughs] I have those in front of me still.


Aubrey: No, I [crosstalk] to hear that. I am going to close the Tucker Carlson link, so I am not staring at the neocons are gay for war hat. [Michael laughs] Okay. Sorry. I apologize for what my brain just did.


Michael: All right. Rough transition. Get us there.


Aubrey: So, Casey Means second origin story comes a few years later with the sudden death of her mother. In January of 2021, her mother got the shocking news that she had stage IV pancreatic cancer 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,-


Michael: Right.


Aubrey: -so she would have this surgery, she would have this long recovery time, she wouldn’t not be able to see her family, and they had already said she had a short timeline.


Michael: Okay.


Aubrey: As you and I both know, this is part and parcel of having a family member who has a terminal illness, is that you have these terrible choices to make where you are like, "Oh, nothing is a win? Cool."


Michael: And on some level, that’s, I think, fair critique of the medical system that it’s split into these little specialties. My father recently died of cancer. The same thing happened to him. He was given all these weird treatments that had miserable side effects. He would sometimes say, "This actually is not worth it for me." He got in fights with his doctors about it. 


They would be like, "Well, you need this." And the minute he switched to palliative care, he got a way better bedside manner. There is a long time of fighting with doctors about this thing, and they were not always totally transparent with how much benefit’s this actually going to give me.


Aubrey: Totally. It’s a fair critique of the medical system, and it’s also like a-- It’s like a horrible experience. And your emotions are in a place where I definitely needed to fact check and ground myself a couple of times and be like, "Hey, 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?"


Michael: Exactly. I mean, it’s at least plausible that the doctor presented the options to her. There is the surgery, it’s risky, it’s is not going to prolong your life that much, but it’s an option. People were really nice to my dad when he was like, "Oh, I would prefer to go on palliative care." They are like, "Okay, that’s a choice that you can make."


Aubrey: Yep.


Michael: He could still say, "No, thanks," and move on to something else.


Aubrey: My family member who passed of cancer recently was very clear about what he wanted in his treatment and what he did not want. There was, I think, a lot of that from doctors being like, "All right, well, you are making your choice. Got it."


Michael: Yeah, yeah. Yeah.


Aubrey: “Clearly, it’s not the thing I would recommend, but this is your life and your choice.”


Michael: You don’t want to gaslight them about their experience. But she’s just such an unreliable narrator that it’s like, "Okay, what was actually happening with this interaction?"


Aubrey: So, I just sent you a quote. This is an excerpt from her book, Good Energy.


Michael: "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 complex court press approach.


The 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.


Aubrey: Sure.


Michael: But again, she’s just like an unreliable narrator.


Aubrey: 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 like, "I am not saying. I am just saying."


Michael: Yeah, yeah, yeah.


Aubrey: It’s designed to cast aspersions on the field and on treatment recommendations that are being given to people who are in life and death scenarios. What she’s doing here is using a very emotional personal experience, which, again, both you and I have been through in different ways. She’s using that to shake the foundation and go, "What if the whole thing is bummed?"


Michael: Right. Exactly. Because it’s also totally plausible that her doctor was just a huge fucking asshole.


Aubrey: Right.


Michael: So, maybe you had a really bad experience with this complete prick. That’s absolutely plausible. But she’s making it a bigger argument about the medical system and for-profit healthcare, et cetera, et cetera, which, again, you would have to marshal different kinds of evidence to support.


Aubrey: Yeah. That’s right.


Michael: And also, if this was your issue, you would actually move us toward a universal healthcare system where the doctors just get paid salaries, which is actually what they have in many countries, that would be the thing that you would then start pushing toward. You would not then leave the system and start selling people other shit for profit. That’s just what destroys her entire credibility to me.


Aubrey: Her functional medicine clinic is in the Pearl District in Portland. [Michael chuckles]


Michael: Pearl District (derogatory). [laughs] 


Aubrey: Yes, yes, Michael. So, when I was growing up, the Pearl was like a predominantly industrial area. There were significant numbers of homeless folks. When I was in maybe middle school or high school, it started getting gentrified to the fucking max. So, now, those industrial buildings are overwhelmingly luxury condos and lofts.


Michael: She’s like, "The medical system is a grift, and I want to get in on that grift."


Aubrey: It feels very telling that you go to the wealthiest era-


Michael: Oh, exactly. 


Aubrey: -right?


Michael: Yeah. 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. There’s other things that you can do [laughs] other than this, you know?


Aubrey: That’s right. Casey Means is a really interesting mix of crunchy granola MAHA style stuff and really dyed in the wool conservative pedigree. In order to understand that conservative pedigree, we have to talk about the other two 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 DC. He worked for Nixon. And after Nixon's resignation, for Vice President Nelson Rockefeller during the Ford administration. During the Ford administration, he worked on the Food and Nutrition Task Force, which sought, among other things, to dramatically scale back food stamps.


Michael: There’s that systemic critique, baby. [laughs]


Aubrey: Right. The food is medicine lady's dad is the reason that fewer people have the medicine food that she wants everyone to have, right?


Michael: Poor people have too much food.


Aubrey: Grady also worked as a consultant before selling off the consulting wing of his firm for $3.5 billion in 2000.


Michael: Billion?


Aubrey: So, that’s her dad, Grady Means. She also has a brother named Calley Means.


Michael: Which the description on this Tucker Carlson YouTube video tells me has also been interviewed by Tucker Carlson.


Aubrey: Yes, correct. So, they have become a little bit of like a package deal. They are one-two punch in MAHA world. And they co-authored their book together.


Michael: Oh, okay.


Aubrey: Calley Means went to Stanford undergrad and went to Harvard for his MBA. He interned both for the George W. Bush White House and for the Heritage Foundation.


Michael: Nice.


Aubrey: He worked on the McCain campaign, reportedly as part of the "pit crew" that was working to improve Sarah Palin's reputation.


Michael: Okay. He did that debate prep. [Aubrey laughs] He’s furiously sending her links to Schoolhouse Rock.


Aubrey: He describes himself as a former Never Trumper who became one of RFK Jr.'s advisors after that appearance on Tucker Carlson. Calley Means is an entrepreneur who founded a company called TrueMed, [Michael chuckles] which helps people apply for HSA coverage of Peloton bikes and infrared saunas. [chuckles]


Michael: Oh, wait, really?


Aubrey: Yep.


Michael: He is trying to get people reimbursed for alternative medicines.


Aubrey: Yep. So, health savings accounts, HSAs, are tax-free accounts. You essentially are allowed to set aside money that you are going to spend on healthcare, not be taxed on that money and spend that money tax-free. 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?


Michael: Right.


Aubrey: 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 covered by HAS, of course. In exchange, TrueMed takes a cut of the sales.


Michael: Oh. Okay. Okay. That’s scammy. [chuckles]


Aubrey: So, they have been used for red light therapy devices,-


Michael: Yeah. Of course, yeah. 


Aubrey: -including the skin care red light masks. They have been used for supplements for smart mattresses.


Michael: Sure.


Aubrey: Vanity Fair did an incredible deep dive piece into Calley 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.


Michael: Yes. [laughs] My daily salad is actually a prescription. [laughs] 


Aubrey: My dad did cut food stamps. But now my work lunch is healthcare. So, the Means siblings both have very close ties with the sweetgreen guy, The Daily Harvest guy.


Michael: Oh, really? Of course.


Aubrey: All of these people are people that they know and work with very frequently through the "End Chronic Disease Coalition." [Michael chuckles]


Michael: How do I know that’s a scam? [laughs] 


Aubrey: Right. Right.


Michael: Any other time in history, you are like, "Oh, End Chronic Disease, that sounds good." But it’s like, "Nope, [chuckles] my brain is too broken from doing this show."


Aubrey: 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 other folks on the right will tout like, "Oh my God, Calley Means worked with this incredible coalition." The coalition is largely made up of companies whose products would be covered under those proposed expanded rules.


Michael: So, it sounds nice like, "Oh, we're expanding the HAS." But it's actually just like, “You're going to get profits out of this,” basically.


Aubrey: And the name of the coalition is End Chronic Disease. Like, "Oh my God, this guy's so dedicated to ending chronic disease." No, he's fucking not. He's dedicated to selling his buddies food and then taking a cut of those sales.


Michael: Yeah, yeah, yeah.


Aubrey: So, Michael, are you ready for Calley Means's origin story?


Michael: Oh yeah, give it to me.


Aubrey: Calley Means says that he was a lobbyist for Big Food and Big Pharma, 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-


Michael: What?


Aubrey: -that it's like hush money to stop opposing us in public or whatever. And I was just like, "Dude, what are we doing?"


Michael: So, he's doing it like Confessions of an Assassin thing, where he's like, "Oh, I brokered these evil deals."


Aubrey: Yes. Confessions of a Lobbyist.


Michael: Yeah.


Aubrey: On Tucker Carlson's podcast, he claims to have attended a meeting where food corporations were "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 "millions" to the NAACP and that Hispanic Federation in exchange for publicly calling any policies hindering soda sales as racist, [Michael laughs] describing the whole thing as "depressingly transactional."


Michael: Those seem like easily verifiable claims, but whatever.


Aubrey: So, Vanity Fair, in this deep dive piece, fact checked him and his story simply did not check out.


Michael: Yeah, of course not.


Aubrey: They interviewed more than 60 people who had worked with Calley Means. Nine of his former colleagues from PR world, from Mercury and Adelman disputed his version of events.


Michael: Okay. 


Aubrey: Where Calley Means claimed that he had been a "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 he was an executive.


Michael: Executive assistant is hella funny. [laughs] 


Aubrey: It's as removed as you could be from the halls of power that you're talking about.


Michael: They're like, "Hey, can you grab us a cup of coffee?" And he's like, "I was in the room."


Aubrey: The Room Where It Happens. That's right.


Michael: Yeah.


Aubrey: Not only do they dispute the roles that he held, they also dispute that they, the companies, represented the clients that he claimed.


Michael: Nice.


Aubrey: So, in the three years that Calley Means worked at Mercury, they didn't represent Coca-Cola, nor did they represent the American Beverage Association. Mercury, which is where Calley 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.


Michael: 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 creating this weird narrative.


Aubrey: Right. It's a really strange thing to manufacture a heel turn that you don't appear to have had. The Vanity Fair piece also uncovered some real gems about Calley Means as a coworker. I just sent you a quote.


Michael: 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, 'Calley Means business.'" [Aubrey laughs]


Wait, Calley Means business? He walked around the office saying, "Calley Means business," another former colleague recounts. That's like his cute little-- It's almost like a bumper sticker phrase for when he runs for Congress.


Aubrey: Totally.


Michael: Calley Means Business.


Aubrey: I just want you to imagine an executive assistant [Michael laughs] who is trying to-- [crosstalk] 


Michael: [crosstalk] or something. 


Aubrey: Who's trying to get into every strategy conversation, is acting like they're better than everybody around them at a pretty high powered firm where they are very junior.


Michael: Yeah, yeah, yeah.


Aubrey: And they're walking around just muttering, "Calley Means business" to themselves. [Michael laughs] What a fucking dork.


Michael: A real Pearl District resident [Aubrey laughs] is the way I think of him. Just the kind of guy who live in the Pearl District.


Aubrey: So, that's Grady Means and Calley Means. It felt important to lift up that Casey Means because she sounds like Portlandy, MAHA, crunchy granola-y. It felt really important to establish just how committed to extreme conservatism her family is.


Michael: 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-


Aubrey: Right.


Michael: -and welcome them with arms wide open.


Aubrey: Baby. [laughs] Well, Michael, when it comes to this story, can I take you higher? [Michael laughs] That's it. That's all of my Creed-- [crosstalk]


Michael: That's it. We're done. [laughs] 


Aubrey: I know the title of two songs. The end. So, back to Casey Means. Unlike her predecessor, Dr. Nesheiwat, 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. 


She 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 the state of American health care 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 [Michael chuckles] 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 "AI insights."


Michael: There it’s. There it’s. [chuckles]


Aubrey: A full membership to Levels for a year including glucometers costs about $1,500 per year.


Michael: 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.


Aubrey: She founds Levels and her functional medicine clinic in 2019. And in 2020, COVID hits. Casey Means takes that as an opportunity-


Michael: Of course.


Aubrey: -and submits an LTE to the journal Metabolism: Clinical and Experimental. In 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.


Michael: Oh. So, buy my products.


Aubrey: So, she submits this letter in April of 2020. By November of 2020, she had reportedly raised $12 million in seed funding for Levels. By 2022, the company was reportedly valued at $300 million.


Michael: Oh, wow. Okay.


Aubrey: It is then 2022, during Calley 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 right-wing podcasts. After the Tucker Carlson thing, that really seems to blow things wide open. It's also reportedly where RFK Jr. comes across their work. All of that leads up to the release of Calley and Casey Means' book in 2024, which is called Good Energy: The Surprising Connection Between Metabolism and Limitless Health.


Michael: How is it not called Means Tested? [Aubrey laughs] They have so many puns at their disposal. Think of the possibilities.


Aubrey: Lean Means Healthcare Machines?


Michael: Lean Means is great. [Aubrey laughs] They're leaving grifts on the table.


Aubrey: In promotion of the book, they publish an excerpt on The Free Press.


Michael: Of course. Yeah. 


Aubrey: The excerpt on the website is titled, I’m a Doctor. You Shouldn’t Always Trust Us.


Michael: Got it.


Aubrey: The chapter in the book is titled, Trust Yourself, Not Your Doctor."


Michael: This website loves laundry. Most far right garbage.


Aubrey: But through the mouths of experts who went to all of these Ivy and Ivy-adjacent institutions. I read the whole book. Calley and Casey Means both say some very accurate, reasonable criticisms of the US 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.


Michael: And that's why we've joined the Republican Party, which is to make all of these things worse.


Aubrey: Right. So, in talking about the importance of eating whole foods and healthy fats, rather than directly increasing access to those things through SNAP or WIC, they instead shift to this personal responsibility frame. They say that like, “It's actually on you to make sure that you're eating very expensive ingredients.” She's an anti-seed oil lady.


Michael: Oh, of course. She’s. Yeah.


Aubrey: Right. She's like, "Buy the oil," that’s five or six times as much.


Michael: Right.


Aubrey: They are totally silent on how any of this would be possible for low-income families.


Michael: And they're just, of course, as usual, just inflating the ability of a virtuous lifestyle to solve all of these issues. Like, “You did something wrong if you get one of these chronic conditions.” That's the ideology.


Aubrey: On the press tour for the book, she becomes a real hot take factory. She has said that "many, if not most, COVID 19 deaths could be prevented with optimal metabolic health-"


Michael: Nice.


Aubrey: -and called COVID a, "Darwinian moment for America."


Michael: Oh. What? In a good way? [laughs] 


Aubrey: Yeah. Like, the least fit did not survive way.


Michael: Just saying it. They're out here just fucking saying it.


Aubrey: She also has some anti-vax positions that I think are dressed up to appear more moderate than they are. In her newsletter, she wrote, "There is growing evidence that the total burden of the current extreme and growing vaccine schedule is causing health declines in vulnerable children."


Michael: Vulnerable. We're really looking out for the vulnerable [Aubrey chuckles] by giving them measles. It's so important that they get measles.


Aubrey: She has said, "I think vaccine mandates are criminal."


Michael: They are in the sense that we never fucking had them in America. So, whatever.


Aubrey: She said that in response to somebody on Twitter giving her shit for not being anti-vax enough, and she was like, "I have seen said innumerable public times."


Michael: I love that. I love that. Actually--


Aubrey: Actually, I'm the most anti-vax.


Michael: I'm actually pretending when I say we need more research and stuff. I'm actually super anti-vax. Don't worry about it.


Aubrey: Michael, aren't we having a good time with these-- [crosstalk] 


Michael: You keep reminding me. Isn't this fun?


Aubrey: It's kind of fun. I'm having fun.


Michael: This is like my parents on road trips as a kid. This is fun, right?


Aubrey: She has written, "When it comes to a question like raw milk, I want to be free to form a relationship with a local farmer,-


Michael: Oh God.


Aubrey: -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."


Michael: 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.


Aubrey: The way that you know if there is listeria in milk is a good hard look in the eye.


Michael: I want other people to have the freedom to fucking lie to me my face about the health impact of their products.


Aubrey: She’s also a proponent of both psilocybin and MDMA. She likes shrooms, she likes molly.


Michael: Why are all these people into fucking psychedelics? It's so fascinating. All they do is bitch about Prozac and stuff. But they're like, "No, no. Take these other drugs." It's so weird.


Aubrey: Yeah. I think there is like a rift, both within MAHA world and within Republican world writ large, where you have older school Republicans who are like, "Drugs?"


Michael: Yeah.


Aubrey: And you have this newer wave of red pill fucking assholes who are like, "Drugs." It becomes a liability, because it exposes that rift, which doesn't often get tested in federal policymaking, right?


Michael: Right.


Aubrey: So, in addition to all of those hot takes, sometimes her hot takes take the form of poetry.


Michael: Okay.


Aubrey: For April Fool's Day, [Michael chuckles] she wrote a poem for her newsletter. As she notes, she got "some help from AI." I'm sending you four verses from a poem that has 20 verses. Like, there's so many. So, I just picked a few.


Michael: And she puts it in full in her newsletter?


Aubrey: Mm-hmm. The title of the poem is The Devil's Wellness Plan.


Michael: I'm not reading. This is way too much, Aubrey.


Aubrey: You're reading it. Michael, you're reading it.


Michael: " 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 seventy-three shots.”


Doesn't rhyme. 


"I’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.”


Aubrey: There you go. [Michael laughs]


Michael: I miss Creed, Aubrey. [Aubrey laughs] Can we go back to Creed?


Aubrey: Like, he's a professional. You can't expect her to be on his level.


Michael: That at least had an okay pentameter or whatever it was at least-- the correct number of syllables.


Aubrey: So, Good Energy, Calley 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.


Michael: Nice.


Aubrey: That’s so far to get in such a short period of time. The reactions to Casey Means' nomination are swift and they are negative.


Michael: This means war.


Aubrey: So, a number of former surgeons general come forward and are like, "Absolutely fucking not." Jerome Adams actually writes an op-ed about it and is like, "Hey, part of your job as the head of the USA 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.”


Michael: Oh, right. Yeah.


Aubrey: There is criticism from MAHA folks who once again criticize her for not being anti-vax enough.


Michael: Really? Even her?


Aubrey: Uh-huh.


Michael: Fuck it. Hell.


Aubrey: Once again, Queen Gremlin Laura Loomer weighs in on Twitter. I just sent you a quote.


Michael: “Casey Means said when she was looking for romance, she would do Shrooms, talk to trees, participate in full moon ceremonies and pray to inanimate objects with a “spiritual medium”.


So basically the new Surgeon General is a total crack pot, a shroom consumer and she talks to trees [Aubrey chuckles] and doesn’t even have an active medical license.


Another failure by the “geniuses” who 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 being a Marxist tree hugger?" [Aubrey laughs] This is bizarre. Casey Means is like a complete nutcase. They should love this lady.


Aubrey: The reactions to her nomination are so bad on Twitter, in particular, that RFK Jr. rushes to her defense on the platform.


Michael: Right.


Aubrey: He says that MAHA is taking on powerful corporate players and that those companies "will continue to pay bloggers and other social media influencers to weaponize innuendo, to slander and vilify Casey the same way they tried to defame me and President Trump."


Michael: The fights between these people are always just like the Spider-Man meme of people pointing to each other. [Aubrey laughs] It's like vaguely different shades of lunatic is why they're mad at her.


Aubrey: 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 and his priorities being on a pretty direct collision course with the Trump administration 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."


Michael: Right.


Aubrey: And that the MAHA coalition was looking for a home and Republicans offered them a home.


Michael: Right.


Aubrey: But the rift and the differences and disconnects are starting to show. And part of the way that that’s starting to show is in these kinds of infighting moments and part of the ways that that’s starting to show is in having three nominees for Surgeon General-


Michael: Right.


Aubrey: -and not having one still.


Michael: And also, 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 a referee or an objective standard of facts to point to, to adjudicate a dispute about do shrooms work or are shrooms bad. They don't give a shit about what actual science looks like. So, you can't really have a good faith debate even within these coalitions.


Aubrey: Right. It's all power games, right?


Michael: Yeah.


Aubrey: So, on top of all those negative reactions, there's also this new wave of reporting about 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.


Michael: Okay.


Aubrey: Vanity Fair interviewed the chair of the department where her residency took place who said that Casey Means found the job "too stressful" that she quit in tears, and that other residents had to "cover for her." And we are a small department and all the calls fall on them.


Michael: No way. The funny thing is that’s also a structural critique of the American medical system. People are so overworked.


Aubrey: Yes.


Michael: But it’s also funny that she makes it this virtuous, like, "I chose to leave" thing.


Aubrey: Two other residents who served with her in the same department at the same time said that she was very anxious and primarily afraid of hurting patients.


Michael: Has she tried zinc? Has she tried taking zinc for anxiety? [Aubrey chuckles] I think it just maybe it's her lifestyle.


Aubrey: 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.


Michael: So, she got maternity leave basically, something the administration is also decidedly against.


Aubrey: Yes. Initially, the confirmation hearing was scheduled for October. It ends up taking place in February after her parental leave. And in that time, the conditions and the political calculus here really change.


Among other things, the chair of the committee where the confirmation hearing will happen, the HELP Committee, is Bill Cassidy. Bill Cassidy is, in that intervening time, defeated in his Republican primary by a Trump-endorsed challenger to the right.


Michael: Okay.


Aubrey: Bill Cassidy is now a lame duck with serious flame-duck potential. But there's also a long-standing 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.


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 at 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.


Michael: There's also a long history of Republicans doing the right thing once they don't have an election to win anymore.


Aubrey: Totally. So, as I have told you, I'm not a fan of congressional hearings. They feel like political theater, they feel like they're not accomplishing anything, they're definitely not fact-finding missions ever. I think that this confirmation hearing was pretty effective as political theater.


Michael: Cool.


Aubrey: They had a really clear, good division of labor. Folks had drafted their questions in a really tight way and came in with 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 are concerned about the health risks of AI data centers.


Michael: What?


Aubrey: I will say, Hawley softballs it And he's like, "Well, I would invite you to give it some thought,” blah, blah, blah.


Michael: Oh, right.


Aubrey: He'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.” They are doing the thing of being like, "Hey, this is an issue."


Michael: It’s all theater, though, because none of them give a shit about any of this stuff. But whatever.


Aubrey: 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-


Michael: Right.


Aubrey: -his willingness to push back in that way. I was like, "Oh, that's interesting."


Michael: It's weird. Yeah.


Aubrey: But he's not the only Republican on the committee who has more direct and 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 moderate her response, and not be kooky and start yelling about “The Dow.” 


Michael: Yeah, yeah.


Aubrey: So, her response to Cassidy's question about vaccines and autism is, "We have an autism crisis that’s increasing. This is devastating to many families and we don’t know as a medical community what causes autism."


Michael: Which I can see the anti-vaxxers being mad about that.


Aubrey: It's the one answer that like, "We don't actually know what causes autism," is the one answer that’s guaranteed to piss off everybody.


Michael: She should have just said they fucking cause autism and then the anti-vaxxers would get on her side.


Aubrey: 10 toes down, standing on business.


Michael: Yeah. Yeah, yeah, yeah. [chuckles]


Aubrey: So, in that same hearing, Tim Kaine asks her about flu shots, which is not a huge part of the anti-vax discourse.


Michael: Right.


Aubrey: We're going to watch a clip. I apologize in advance for how infuriating this clip is to listen to.


Senator Kaine: In a news report on January 7th, just a month or so ago, Secretary Kennedy stated, "There 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?


Casey: Senator Kaine, as I've said, I believe vaccines save lives and are an important part of our--


[laughter]

 

Senator Kaine: 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 is no evidence that the flu vaccine prevents serious disease or that it prevents hospitalizations or death in children?


Casey: I have not personally seen that quote or that article. I would want to review it before I decide on that.


Senator Kaine: Okay, I'm going to set the quote aside. I'll introduce for the record-


Michael: She’s so bad at this.


Senator Kaine: -an article from CBS News, "RFK Jr. says it may be better if fewer children receive the flu vaccine", dated January 7th, 2026 without objection. Do you believe that there is evidence that the flu vaccine prevents serious disease and prevents hospitalization or deaths in children?


Casey: I believe that all patients should talk to their doctors.


Senator Kaine: And so, do I. 


[laughter] 


And that's not what I'm asking. Your qualifications have been much discussed. There is a mountain of evidence about this. Do you believe that there is no evidence that the flu vaccine has efficacy in reducing serious injury or hospitalization?


Michael: You could see a little hamster wheel in her brain.


Senator Kaine: This is an easy one, doctor. This is an easy one.


Casey: I support the CDC's guidance on the flu vaccine.


Michael: There. She’s like, “I found it.” 


Casey: And we all will be working with the CDC, ASAP. 


Senator Kaine: So, you believe it’s an efficacious vaccine to reduce hospitalization? [Michael laughs] 


Casey: Is was not.


Senator Kaine: Is. You believe it is.


Casey: As I said, I support the CDC's guidance on the flu vaccine.


Senator Kaine: Let me just say, do you think the flu vaccine reduces the risk of [Aubrey chuckles] hospitalization or serious injury?


Casey: I've said it. I won’t repeat it. I believe vaccines save lives. I believe the [crosstalk] public health strategy.


Senator Kaine: The flu vaccine, does it reduce the risk of injury or hospitalization?


Casey: At the population level, I certainly think that it does.


Senator Kaine: Let me introduce for the record, if I can, Mr. Chair, CDC seasonal flu vaccine effectiveness studies dated May 30th, 2025, from the CDC that goes into this in some detail. This is not a hard question.


Casey: I answered your question.


Senator Kaine: And yes, after three minutes, you acknowledge that at a population level-- [crosstalk]


Casey: I haven't seen that report.


Senator Kaine: Yeah, but know about the flu vaccine.


Casey: 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-- [crosstalk] 


Senator Kaine: I'm not asking you about the quote. I'm asking you about something in your remit, the effectiveness of the flu vaccine.


Aubrey: Stunning.


Michael: He did eventually get her to admit it, which is actually interesting that she did.


Aubrey: I think it's again an indicator of how bad she’s at this. 


Michael: Yeah. Yeah, yeah, yeah.


Aubrey: 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."


Michael: She clearly also didn't know what the CDC guidance was. Because the CDC guidance is all pre-RFK Jr. So, most of its still pretty pro-vaccine at this point.


Aubrey: It's all the DOGE guys being asked to define what DEI is and they're like, "It's whatever was in the EEO." [chuckles]


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 medical equipment/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. It becomes clear that she has failed to disclose many, many financial relationships. In her newsletter, on Instagram, on social media broadly, she’s frequently recommending products. 


Michael: Oh.


Aubrey: Right.


Michael: Like not disclosing those FTC regulations where you have to say like, #sponsored or whatever. 


Aubrey: Correct.


Michael: Yeah.


Aubrey: Those regulations about disclosing when something is an ad on social media came into effect after Fyre Fest. That's why we got those fucking things. She's doing a wellness Fyre Fest of not disclosing. [Michael chuckles]


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,-


Michael: Oh yeah, of course. 


Aubrey: -$12,000 from Daily Harvest, $16,000 from Florasophy, [Michael chuckles] a fiber supplement company. [chuckles] 

 

Michael: That sounds like a fake word that she made up for one of her poems, so that it rhymed. 


Aubrey: $27,000 from ENERGYbits, [laughs] an algae supplement company. 


Michael: Wait, what was the one we talked about on the bonus episode, food cube or whatever? [Aubrey laughs] Is she getting cube bucks?


Aubrey: $500 from WeNatal prenatal vitamins.


Michael: Oh, that’s pretty good actually.


Aubrey: And $130,000 from Amazentis, a supplement company.

 

Michael: Also $200,000 from Tati Westbrook's hair vitamins.

 

Aubrey: [laughs] Yeah, that's right. Bye, sister. 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, "Hey, I agree, we should ban junk food advertising. Hey, good point on this thing."

 

Michael: Yeah, everyone's going out of their way to do this shit. I know.


Aubrey: Bernie Sanders is trying to be like, "You know, I disagree with the Trump administration on a lot of stuff, but I think you got some good points here," and then he posts a clip on social media and is like, "Hey, we had a real one. This is a good conversation. I don't agree with her on everything, but I support her in this thing."


Michael: Oh my God.


Aubrey: And people just absolutely shredded him on it, was like, "You don't have to hand it to her." 


Michael: This is why these people make these disingenuous, plausible-sounding arguments. It's because they attract people who want to give them credit and want to give them good faith, but these people are not acting in good faith.


Aubrey: Correct.


Michael: You cannot listen to what they say. You have to look at what they fucking do.


Aubrey: Correct.


Michael: What is she doing with her life? There's no 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. You have to ignore all this bullshit. They are saying that as a fucking trap, as bait to get people who don’t care or don’t know about their actual background to do exactly what Bernie is doing.

 

Aubrey: 100%. I was like, "This is uncharacteristically anti-shrewd.”


Michael: Also, for just a failed fucking candidate.


Aubrey: It’s really stunning.

 

Michael: [crosstalk] It's clear by this point that she's not going to make it through. 


Aubrey: So, on April 30th of this year, in a Truth Social post, Donald Trump acknowledged that Casey Means didn't have the votes to be confirmed.

 

Michael: She will also be joining Walter Reed. 


Aubrey: Unsurprisingly, Trump blames Bill Cassidy, the chair of the HELP Committee, but also there appear to be holdouts that were-- Cassidy, Collins, and Murkowski were all like, "I don't know."


Michael: Okay.


Aubrey: After the administration withdraws Casey Means' nomination, the political landscape starts to shift again. New polls come out revealing that changing the vaccine schedule is hugely unpopular with voters. Plus, the anti-vax stuff has faced a large number of court challenges. So, it's costly and time-consuming to defend against. So, they're really testing how much political capital the Trump administration is willing to spend on MAHA priorities.

 

Michael: Right. And this is more of an RFK thing than a Trump thing.

 

Aubrey: Yes, correct. We're seeing how far is Trump willing to go for RFK Jr. Not as far as Casey Means is the answer. That's when they announce the third and newest current nominee. Nicole Saphier is her name. She went to Arizona State University for her undergrad. For her MD, she's telling us that out front, she didn't go to med school in the USA. She went to Ross University in Barbados.

 

Michael: Is that like a for-profit scam factory?


Aubrey: It doesn't appear to be. I didn't look into Ross University to a great degree because I was like, "They're not going to do that again." But maybe. Who knows?


Aubrey: She’s currently a radiologist at the Sloan Kettering Cancer Center.


Michael: A licensed doctor.


Aubrey: Her career as a public figure is a very MAHA, like got to catch them all kind of thing. She has a podcast, she has a supplement company, she’s a Fox News contributor.


Michael: Great.


Aubrey: She has written three books: Love, Mom: Inspiring Stories Celebrating Motherhood, Make America Healthy Again: How Bad Behavior and Big Government Caused a Trillion Dollar Crisis.


Michael: Yeah, big government is definitely the problem.


Aubrey: She also published that before RFK Jr. was using MAHA.


Michael: Oh wait, really?


Aubrey: Uh-huh. She tried to trademark it, which is very funny, and then she dropped it. She hosts a podcast called Wellness Unmasked. And she wrote another book called Panic Attack: Playing Politics with Science in the Fight Against COVID-19.


Michael: I could just write that book from memory. I could sit down and write that fucking book right now.


Aubrey: 1,000,000%. You already know lab leak, whatever. Dr. Saphier's positions on core MAHA issues are often presented in a way that seems a little more moderate than a Casey Means, which not hard to do. I think a good example on that’s her position on vaccines. She, like Casey Means, is very strident in her vaccine-saves-lives stance, but she has also said that the pediatric vaccine schedule should be "less stringent."


Michael: Yeah, there it’s. Yeah.


Aubrey: And that she opposes vaccine mandates. She has also been publicly and directly critical of RFK Jr's approach on vaccines.


Michael: Really?


Aubrey: She has done that criticism in right of center media outlets.


Michael: Weird.


Aubrey: It’s fascinating. She’s a real mixed bag. Most notably, she wrote an op-ed in the Wall Street Journal just last year called The Madness in RFK Jr's Autism Method.


Michael: Woke queen. I am into it now.


Aubrey: Comparatively I heard she said "defund the police." 


[laughter] 


I don’t think she did. She has publicly criticized Trump, but those posts are now deleted. So, she has been speaking her mind, but then doing the Trump nominee thing, scrubbing the record afterwards. She tweeted at one point, "Seems like they may not want to admit the USA measles elimination status is gone until after the midterms."


Michael: Nice.


Aubrey: On Trump's Tylenol warning, she posted, "As a mom of three kids, I don’t love a man telling me to tough it out when it comes to pregnancy."


Michael: Wow.


Aubrey: This is the bar is in hell portion, right?


Michael: Yeah, yeah, yeah.


Aubrey: But also, not a lot of people are exceeding the bar


Michael: Right.


Aubrey: So far, the reactions have been much less alarmed than last time. The reactions from people who 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." [Michael laughs]


Michael: It all feels like, not that it was, but all feels like a strategy that we are going to nominate the two worst fucking people alive. And then when we get to the third nominee, who is also trash, everyone is going to be like, "Whatever."


Aubrey: Folks have been worn down so hard.


Michael: I am sleepy.


Aubrey: Dr. Saphier has not faced confirmation hearings yet, but 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’s herbal tinctures, like liquid tinctures in eyedropper bottles. In true supplement biz form, their supplements are named things like Boost, Relief, Allure, Sleep, and Intimacy.


Michael: Taste test episode incoming.


Aubrey: So, there are two problems here. One is Dr. Saphier works for the Memorial Sloan Kettering Cancer Center, which has a clear policy that bans employees from "endorsement of products or commercial ventures." It’s also suspect as hell for a Surgeon General, so she would likely need to divest as with Casey Means and Levels.


Problem number two is 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.


Michael: Cheap champagne. What is kava?


Aubrey: It’s a root that’s supposed to 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 banned completely. But the USDA and FDA have already issued warnings 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?


Michael: Do you know how easy it’s to find a practicing doctor who is not a fucking grifter? It’s crazy. They cannot find a single one.


Aubrey: They are all tree hugging Marxists, Mike. [Michael laughs] For now, she appears to be much more in the vein of Dr. Nesheiwat than Casey Means.


Michael: Right.


Aubrey: And that honestly feels like a pretty grounded win to have someone who is grifting from one angle but not like seven. [Michael laughs]


Michael: That’s as good as it gets in America in 2026.


Aubrey: Right now?


Michael: She’s only one grifter.


Aubrey: Count your blessings. She’s only selling herbal tinctures.


Michael: I know. She’s a mono grifter. [Aubrey laughs] That’s the best we can do.


Aubrey: At the start of this episode, I started by saying that the research made me feel less despairing. Here's why.


One, this is a place where the Trump administration is failing. They are not getting their nominees confirmed. This is also true of other Trump nominees, too. According to Brookings, the average confirmation delay Trump nominees has doubled from his first term to his second.


Michael: Although in fairness, they are twice as bad this time.


Aubrey: They are pretty bad from a harm reduction standpoint. I genuinely think it's more helpful to have no Surgeon General rather than one of these ultra gremlins.


Michael: And it's a win that Casey Means didn't get through, because she's a complete nut case.


Aubrey: I think the last thing that makes me feel groundedly, cautiously optimistic about all of this is that Trump is immensely unpopular right now. Again, Republicans who are already pushing back on this committee are going to be incentivized to push back more. You know good news is few and far between at the moment, this is like a very, very, very low bar to meet. But I think we've got to accept the good news we get with arms wide open.


Michael: Yeah, I know. You're going to go back to the house. 


[laughter] 


One of us is going to do it.


[Maintenance Phase theme]


[Transcript provided by SpeechDocs Podcast Transcription]

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Aubrey Gordon

Host
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Michael Hobbes

Host