Maintenance Phase - Why Don't We Have a Surgeon General？

00:00:00.000 okay i actually i actually have one i'm on fire he came prepared maybe welcome to maintenance

00:00:17.860 phase the podcast that has nothing to say about the surgeon specific but a lot to say

00:00:22.620 about the Surgeon General.

00:00:25.600 I like that one so much.

00:00:29.120 I'm Michael Hobbs.

00:00:30.740 I'm Aubrey Gordon.

00:00:32.300 If you would like to support the show,

00:00:33.860 you can do that at patreon.com slash maintenance phase.

00:00:36.880 You can also subscribe on Apple Podcast Premium.

00:00:39.400 It's the same audio content.

00:00:42.200 Michael.

00:00:42.860 Aubrey.

00:00:43.560 We are a year and a half

00:00:46.700 into Donald Trump's second term,

00:00:48.440 and we still don't have a Surgeon General.

00:00:50.160 I have not been following this at all.

00:00:51.420 you and most people there's been so much shock and awe in so many places that it's like hard to

00:00:57.640 keep track we're all sort of like drinking from a fire hose in terms of the news cycles right i

00:01:02.420 know whenever i hear about like an out of work fox news host i'm like yeah they're probably the

00:01:05.760 surgeon general now who fucking cares today we're gonna talk about the three sort of maha aligned 0.57

00:01:12.160 doctors who have been nominated for surgeon general which they're all doctors that's actually 0.93

00:01:17.500 kind of surprising well hang on okay let's not get too crazy i thought it was gonna be like oma

00:01:24.440 rosa or somebody we haven't done like a real maha update in a minute because it's so often just like

00:01:30.620 a soul-sucking slog of a thing yes i would just like to preface this one by saying it's pretty 0.91

00:01:37.120 fun good i want like real housewives shit the surgeon general is often referred to as america's 0.99

00:01:43.160 top doctor. Their role is in part focused on translating scientific findings into guidance 0.97

00:01:51.560 for members of the public. So this is like a very maintenance phase role. He knows when you've been

00:01:56.900 sleeping. He knows when you're not getting enough beef tallow. The Surgeon General can issue reports

00:02:01.540 and recommendations, but the office doesn't have the authority to create policy. It's actually

00:02:08.220 kind of funny we have this role because it is just like a guy who says stuff in chief. It is

00:02:12.500 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 health care provider and a really strong, clear communicator. Don't start laughing yet.

00:02:34.560 Foreshadowing, foreshadowing. Okay. The process for becoming the Surgeon General is that the

00:02:39.680 president nominates someone to become the Surgeon General. The Senate confirms that person and then

00:02:46.060 they serve a four year term. The nominee has to pass through the Health, Education, Labor and

00:02:52.780 Pensions Committee, the HELP Committee, which is currently split with 12 Republicans and 11

00:02:58.080 Democrats. So it's Republican controlled, but only just. It is also a committee where Lisa

00:03:04.220 Murkowski and Susan Collins are both on the committee. So you got a couple of real mavericks

00:03:10.060 pieces of work. A couple of mavericks. So today we're going to talk about the three

00:03:15.380 nominees for Surgeon General and why their nominations haven't been a cinch even in a

00:03:22.840 Republican controlled Senate in a Republican controlled committee. Okay. So in November of

00:03:29.720 2024, after he was elected to his second term, Donald Trump nominated Jeanette Neshwat to be

00:03:38.340 Surgeon General. His statement on Dr. Neshwat's nomination describes her as quote, a proud graduate

00:03:45.660 of the University of Arkansas School for Medical Sciences. At the time of her nomination, she was

00:03:52.280 serving as the medical director for CityMD in New York, which is a chain of urgent care clinics.

00:03:59.200 First red flag.

00:04:00.640 She is one of five children in her family, and she is not the only one with ties to the Trump

00:04:08.460 administration. Her sister, Julia, was a Homeland Security advisor under the first Trump administration.

00:04:15.960 julia's husband so janette's brother-in-law is the current ambassador u.s ambassador to the un

00:04:24.840 he also represented florida as a member of the u.s house from 2019 to 2025 his name is mike waltz

00:04:32.640 is that a name that rings a bell no well michael he's the guy who added a journalist to a signal

00:04:39.620 chat about war plans. Oh, okay. Okay. He's the specific guy who is like clearly added this

00:04:47.360 journalist to the group chat and then was like, I don't know how it happened. It just got sucked 0.58

00:04:51.400 in there. You know how sometimes when you add an app to your phone and it just sucks up all your 0.93

00:04:55.580 content, it just got kind of sucked up in there. So it just got added. This journalist got it.

00:04:59.400 I'm a bit of an offset expert myself. Yeah. So that's one of her siblings. Another of her

00:05:07.400 siblings is her sister Jacqueline, who is a model and a former pageant winner, who was Miss New York

00:05:16.480 USA 2004 and Miss Florida America 2008. Nothing wrong with that. But the fact that there's so

00:05:23.020 many of these people in Donald Trump's orbit is so fucking bizarre. Today, she is the executive 0.96

00:05:27.900 director of her husband's foundation, which is dedicated to, quote, helping underprivileged

00:05:34.380 children around the world that foundation is called the with arms wide open foundation 0.97

00:05:41.420 is it named after the creed song her husband is scott staff no fucking way we could have had a 1.00

00:05:47.520 surgeon general who has thanksgiving with scott staff from creed why just do scott staff fuck it 0.99

00:05:53.640 it scans so hard with the administration that could only get three doors down to play at the 0.98

00:06:01.640 inauguration but also what a fucking stinging indictment that they couldn't get creed no i know 0.52

00:06:06.800 he's right there also i love that the administration like finds people like the 0.97

00:06:13.220 surgeon general the way that at my tiny underfunded ngo we used to find like graphic

00:06:18.600 designers for pdfs we'd be like hey uh you went to college with somebody who like knows illustrator

00:06:23.180 right yeah which like reach out to them oh god ours were more like do you have an afternoon could

00:06:28.420 you figure out illustrator wait wait wait wait i have a thing i have a thing i have you have a

00:06:32.320 creed thing wait we're not done with creed i don't know what was looking at this and he said i'll take

00:06:36.680 a breath i'll take her by my side we stand in awe we've created life i have the lyrics for with arms

00:06:42.140 wide open oh my god i don't know michael this is really counting on me to recognize the lyrics that

00:06:49.620 you also don't know i'm like furiously googling i'm like i need a reference here but i don't know

00:06:54.620 the lyrics to this song you're getting on a plane tomorrow and i'm now imagining that you're gonna

00:06:59.080 spend the entire time like studying the creed oeuvre i'll record a bunch of pickups to like

00:07:05.200 throw it into the episode dr neshwat had likely crossed trump's radar during her time as a tv

00:07:14.540 guest doctor on fox news and the daily caller of course but just six months after she was nominated

00:07:23.060 the day before her scheduled confirmation hearing, Trump withdrew her nomination.

00:07:30.200 Okay. Cancel culture? 0.99

00:07:31.160 So the question here is what happened? Mike, I would like actually for you to hazard a guess.

00:07:36.780 Did she once say like a single boilerplate thing about how like diversity is what makes America

00:07:41.200 great? No and no.

00:07:42.660 And they're like, no, not after 2024.

00:07:45.420 In April of 2025, an independent journalist named Anthony Clark breaks a story

00:07:51.860 that he titles Trump's Surgeon General pick distorted key parts of her resume.

00:07:58.020 Wait, he just Googled like me looking at Creed lyrics?

00:08:00.300 He's just like type, type, type, type, nope.

00:08:02.260 He finds that Dr. Neshwat didn't get her medical degree from the University of Arkansas,

00:08:08.260 as she had claimed, but had completed a residency there as an employee, not a student.

00:08:14.780 So he checks around to figure out where she got her MD from.

00:08:18.760 and where she went was the american university of the caribbean in saint martin oh which is a

00:08:26.120 commercial business also it's probably like a distance learning thing or something oh mike

00:08:31.580 you don't know how close you are it's like uh i got my degree from itunes you in 2011

00:08:37.920 the american university of the caribbean was bought by ad tolem global education

00:08:45.280 which is previously no mike i haven't which was previously philip morris or something it's like

00:08:50.560 a made-up name previously known as the devry education group baby uh it's her devry medical

00:08:59.740 school because that's like betsy devos's whole like for-profit education thing right 100 dude

00:09:05.060 scammers clark also reports as part of this piece that for-profit medical schools were banned in the

00:09:12.560 u.s for over a century for concerns over admission standards quality of education needing new

00:09:19.520 regulatory structures all kinds of stuff it's also funny because the only thing that offends

00:09:23.820 them is like the lying if she had just said i have no medical qualifications it's not like the 0.81

00:09:28.040 trump administration gives a shit right i'm so glad that you're like getting a handle on like 0.99

00:09:32.200 the ways in which this episode is fun yeah it's just like a fucking clown car of dinguses it's 0.99

00:09:38.300 also now kind of bleak that like city md didn't care or it met their standards they are also a 0.94

00:09:44.600 for-profit business they're like game recognized game they're like yeah totally they're like oh

00:09:48.600 you guys too cool yeah so on top of all that on our website dr neshwat says that she has a specialty

00:09:55.480 in family and er medicine okay but she's only board certified in family medicine not emergency

00:10:03.140 medicine that's such a weird thing to lie about it's so weird but also she works at an urgent

00:10:09.500 care clinic right i don't know about city md specifically but every time i've gone to an 0.67

00:10:14.040 urgent care the person has been like damn you should see a doctor about this like right 0.58

00:10:18.920 i'm like i fucking know they're like that'll be 200 please in addition clark was unable to verify 0.95

00:10:26.900 neshwat's claim that she had worked in emergency rooms in arkansas okay so she is calling herself 0.87

00:10:34.440 an emergency doc when she has worked for a for-profit urgent care clinic in like a management

00:10:41.080 role which is just different right you must tell these lies and then i guess forget about it because

00:10:46.140 if i had some glaring hole in my resume like a fat lie that i was telling and i was offered some

00:10:51.820 like super prominent role where i would get a bunch of scrutiny i would just turn it down

00:10:55.880 I'd be like, no, they will absolutely find this out.

00:10:58.000 I want to keep my like cushy little life. 1.00

00:10:59.700 She probably makes a couple million dollars a year.

00:11:02.000 So there's all of this bad press happening, but there are also complaints from the right.

00:11:07.160 The Maha crowd was saying that Dr. Neshwat wasn't anti-vax enough.

00:11:11.780 Yeah, I was just gonna make a joke about that.

00:11:14.600 Didn't they find out she's vaccinated?

00:11:16.120 Very early on in the sort of onset of COVID, even before lockdowns,

00:11:22.160 she was doing some media with like Fox news and that sort of thing being

00:11:27.100 like, Hey, here's what you got to do. And it was like, you got to mask up.

00:11:30.700 It's probably airborne. You got to wash your hands real well.

00:11:33.540 You got to bubble up like just giving like very basic information.

00:11:37.400 And as part of that, at some points she goes, you know,

00:11:40.100 we'll need to develop a vaccine for this.

00:11:42.860 Like it's like really not anything, 0.95

00:11:45.900 but she's also not committing to kind of unhinged Maha requests. 0.93

00:11:50.920 like let's do a complete overhaul on the infant vaccine schedule it's so funny that they're mad

00:11:58.200 at her for not preemptively criticizing vaccines like before they were even developed she should

00:12:04.620 have been out here saying like they're killing our kids even the even the idea of a vaccine

00:12:09.040 they're against so her biggest detractor on the right is laura loomer oh yeah well who's probably 0.99

00:12:16.220 the fucking surgeon general now. Why not? For those who are unfamiliar, Laura Loomer is an 0.98

00:12:22.320 advisor to the president. She is like a particularly unhinged presence, even in a

00:12:29.620 White House full of unhinged presences. She was just like a Twitter person, right? She's like a

00:12:34.760 lady on Twitter. Yes. And kept getting banned from different social media platforms for like 0.99

00:12:40.600 straight up hate speech and misinformation right yeah she's awful on may 5th 2025 loomer tweeted

00:12:48.880 about dr neshwat calling her quote a pro covid vaccine nepo appointee well she's right about the

00:12:56.180 second part she is it's funny it's funny how they care about that sometimes they clearly don't give 0.82

00:13:01.900 a shit about it's all nepo all the way down in this administration so i'm sending you a portion 0.92

00:13:07.580 of a tweet from Laura Loomer. Oh man. Okay. I'm not going to yell, but large sections of this 0.99

00:13:13.400 are in all caps. I think you should make it your own. Okay. Dr. Neshwat said vaccine hesitancy is

00:13:21.000 a global health threat. She used her access to Fox News to promote the dangerous COVID vaccine,

00:13:26.160 which is now killing millions of people. She tried to shame people who didn't take the vaccine

00:13:30.800 by calling them global health threats. This is like sub literate. Vaccines are a matter of all

00:13:36.640 caps personal health freedom vaccine hesitancy is a matter of personal freedom and liberty

00:13:41.340 exclamation point it is not a global health threat my body my choice laura loomer saying my body my

00:13:47.940 choice and meaning it about vaccines we've gotten used to it by now but this is like a person at a

00:13:54.060 bus stop ranting and also they're like five years old well she capitalizes global health threat like

00:13:59.940 it's the title of something. In May of 2025, instead of being confirmed, her nomination is 0.60

00:14:08.620 pulled. According to Fox News in 2026, Dr. Neshwat took a new job at Walter Reed.

00:14:15.960 Wait, what? Even though they know her medical qualifications aren't real?

00:14:19.320 The only way that Trump would like pull the nomination or the way that he did it,

00:14:23.180 I should say, I don't know that it was the only way he'd do it. But he was like,

00:14:26.660 uh we're actually gonna withdraw her nomination and put her somewhere else very important if he

00:14:31.640 pulls the nomination then it's a tacit admission that he's giving into criticism or that he got

00:14:35.960 something wrong which he would never do so he's like oh we actually found a better role for you

00:14:39.100 somewhere else yeah that better role is at walter reed working on treatment of havana syndrome

00:14:44.180 wait what are they havana syndrome truthers the administration apparently she is i mean she's

00:14:49.780 working on it now right weird yeah so for folks who are unfamiliar havana syndrome is described

00:14:57.260 as like a sort of constellation of unexplained neurological symptoms it often includes hearing

00:15:03.640 really loud noises that others may or may not be able to hear it is hotly debated yeah some people

00:15:10.860 think it is a mass psychogenic illness others think it is the result of like chemical warfare

00:15:17.380 from foreign actors. But man, oh, man, they really like sent her to the hinterlands.

00:15:23.040 Yeah. Go to Walter Reed, a place that sounds very important and is very important.

00:15:26.600 And then work on Havana syndrome. It's also like lie about your qualifications.

00:15:31.920 Get ready for a different job in this administration.

00:15:34.540 Fail upwards. Yeah, exactly. As if you were a man. I know.

00:15:39.000 The Patricia principle. Yes, it's very inspiring. So we went pretty quickly through Dr. Neshwat

00:15:44.880 because it's such a cut and dry story right the second nominee was a real like hold my beer

00:15:51.200 situation okay it's time for nominee number two casey means oh yeah yeah yeah mike what have you

00:15:58.620 heard about casey means just that she's like nice what but like 50 times more deranged yeah it's

00:16:04.440 funny that her nomination was pulled essentially because she wasn't deranged enough they're like

00:16:07.800 okay let's get you someone oh you want kooky yeah we got kooky for you baby yeah she is a

00:16:15.620 graduate of stanford university both undergrad and medical school she runs a wellness startup

00:16:23.040 called levels and she practices quote-unquote functional medicine which is essentially like

00:16:29.900 a rebrand of what in the 90s would have been called alternative medicine it's medicine but

00:16:34.420 this time it's functional. This time it's personal. Have you tried putting an onion in

00:16:38.540 your sock and going to sleep? Very functional. So she has kind of two origin stories coming

00:16:45.700 into Maha world. The first is her residency. After completing medical school at Stanford,

00:16:53.400 Casey Means took on a five-year residency at Oregon Health and Science University here in

00:16:59.800 portland so she takes on this residency at ohsu specializing in head and neck surgery okay but

00:17:06.920 as she moves through her residency she says she became disillusioned with a system that put so

00:17:13.780 much pressure and strain on doctors a system that was always sort of intervening after things went

00:17:21.080 wrong and not to like help them go right to begin with and in a system with such a pernicious profit

00:17:27.920 motive whatever yeah so i got into a different part of medicine that also has a profit motive 0.94

00:17:32.600 right selling mris to fucking celebrities her story is that she was in a state of great 0.95

00:17:40.640 exhaustion and disillusionment and just six months shy of finishing her five-year 0.99

00:17:47.800 residency she quit okay again she says this is like because she became so disillusioned with

00:17:54.380 the system. And we're actually going to watch a little clip of her telling that story to Tucker

00:17:59.800 Carlson. Okay. Yeah. You know, I'm in the operating room in my fifth year of my surgical

00:18:05.520 residency and I'm looking down at a patient in front of me who's on our third revision sinus

00:18:08.900 surgery. And, you know, I know how to diagnose her. I know how to write the prescriptions. I

00:18:12.820 know how to do the surgery. But what I kind of realized in that moment was like, I have no idea

00:18:15.900 why this patient's actually sick. She has so many other health issues, prediabetes, arthritis. She's

00:18:20.420 got some brain fog. She's got obesity and she's got this sinus issue. And in my training, I was 1.00

00:18:26.120 never, ever, ever taught to look at the whole patient, to look at how all these things are

00:18:30.420 connected. And I was only taught how to do the surgery and then bill for it. And I realized that

00:18:35.600 there's a huge problem in how we're practicing medicine right now, which is we're ignoring the

00:18:39.920 root causes of why Americans are sick and we're profiting off of patients getting sick and then

00:18:44.820 doing things to them. That's the way the business model of healthcare works. The way that healthcare

00:18:50.300 which is the largest and fastest growing industry in the United States makes money is you have more

00:18:54.380 patients in the system having more things done to them for longer periods of time. And when I kind

00:18:58.580 of put some of these pieces together and realized that my training had totally essentially incapacitated

00:19:04.240 me from really understanding why patients are sick and how to actually help them thrive, I actually

00:19:10.260 had to walk away from the surgical world because I realized that I was going to be making money off

00:19:14.140 of essentially not spending time helping patients understand their health and actually just profiting

00:19:19.240 off their illness. So nine years into medical training at Stanford, you gave it up voluntarily.

00:19:24.580 I, on my birthday, 30th birthday, I walked into the office of my, of the chair of the department

00:19:30.420 and I put down the scalpel and I walked away and I devoted my life to why are Americans getting

00:19:35.340 sicker every year? Why are 50% of American children dealing with a chronic health issue?

00:19:41.760 This was less than 1% 50 years ago. This frustrates the shit out of me. 0.98

00:19:47.360 Yeah, tell me. 0.81

00:19:48.180 Obviously, there's like some kernel of like a reasonable critique of the medical system

00:19:52.720 in here, obviously.

00:19:54.100 But the problem with this whole like root causes analysis is it's not clear how you

00:19:58.880 would operationalize this.

00:20:00.800 Any medical system, even if you do address the quote unquote root causes, you still have

00:20:05.460 doctors who deal with patients in like an acute way.

00:20:09.100 A head and neck surgeon wouldn't be addressing things like diet and lifestyle to prevent

00:20:13.340 that in the first place.

00:20:14.000 obviously we need to do more preventative medicine, but you're still going to have 0.96

00:20:17.440 people who need surgeries. Right. And like, if you are aiming at, as she is, a structural critique, 0.84

00:20:23.760 then you also need to have a structural solution. Yeah, exactly. She doesn't fucking have that.

00:20:28.860 There's a weird kind of judgment behind this. She's like, I had this fat and sick patient and 1.00

00:20:33.180 they wanted me to do surgery on her without exploring why she's fat and sick. Do you think 0.63

00:20:38.640 that fat people who have a, I don't know, a car accident or some sort of accident or some sort of

00:20:42.300 condition don't deserve surgery i'm so sorry i've become hopelessly distracted by the tucker carlson 0.57

00:20:48.760 store merch that is advertised underneath the video clip wait really in the clip that i just

00:20:54.620 sent you underneath the description it says shop the tucker carlson store they have mugs that say 0.77

00:21:00.600 a pack an offer you can't refuse what and hats that say neocons are gay for war

00:21:08.080 how much they cost can i get one

00:21:14.200 part of the reason i got so distracted is i was like i don't know what this means

00:21:23.380 yes you do i do you love it i know what it means if it's coming from me or you

00:21:31.480 i don't know what it means when it's coming from tucker i can hear you clicking by and

00:21:36.420 like typing in your address to get a ship to you take my money yeah yeah yeah oh no

00:21:43.940 so that is one of casey means origin stories right is her that's one okay that's one of the

00:21:53.700 two that we're going to talk about the second comes a few years later oh god i gotta get the

00:21:59.360 giggles out because this is a sad one you're okay okay do you want me to recite some creed

00:22:04.140 lyrics to you would that help i have those in front of me still i'm gonna close the tucker 0.97

00:22:09.100 carlson link so i'm not staring at the neocons are gay for war hat okay sorry i apologize for

00:22:16.380 what my brain just did all right rough transition get us there so casey means second origin story

00:22:22.220 comes a few years later with the sudden death of her mother okay in january of 2021 her mother got

00:22:31.180 the shocking news that she had stage four pancreatic cancer and that her prognosis was not

00:22:38.380 good. According to Casey, doctors pressured her mom to get risky surgery that would only extend

00:22:45.820 her life by a matter of months. And because of COVID protocols at the time, that recovery time

00:22:53.200 would happen in quarantine, right? So they wouldn't be able to, she would have the surgery,

00:22:57.260 she'd have this long recovery time. She wouldn't be able to see her family. And they had already

00:23:01.980 said she had like a short timeline. Okay. As you and I both know, this is sort of part and parcel

00:23:07.220 of having a family member who has a terminal illness, right? Is that you have these like

00:23:14.240 terrible choices to make where you're like, Oh, nothing's a win. Cool. And on some level,

00:23:19.080 that is a, I think, fair critique of the medical system that it is split into these like little

00:23:23.620 specialties. And like, you know, my father recently died of cancer. And the same thing

00:23:26.780 kind of happened to him that he was given all these weird treatments that had miserable side

00:23:31.080 effects yeah and he would sometimes say like uh this actually isn't like worth it for me and his

00:23:35.960 doctors like he got in kind of like fights with his doctors about it they'd be like well you need

00:23:39.360 this and like the minute he switched to palliative care he got like a way better bedside manner yeah

00:23:44.920 there's a long time of kind of like fighting with doctors about this kind of thing and they weren't

00:23:48.640 always totally transparent with like how much benefit is this actually going to give me totally

00:23:52.580 it's like a fair critique of the medical system. And it's also like a, it's like a horrible

00:23:57.440 experience. And your emotions are in a place where like, like, I definitely needed to like

00:24:03.580 fact check and ground myself a couple of times and be like, Hey, did, did I have a fight with

00:24:08.600 this person? Or, uh, did they just say something that reminded me of a terrible way that I already

00:24:13.780 feel? I actually wonder, I mean, it's at least plausible that the doctor sort of presented the

00:24:19.400 options to her there is the surgery it's risky it's not going to prolong your life that much

00:24:24.200 but it's an option yeah people were really nice to my dad when he's like oh i'd prefer to go on

00:24:28.400 palliative care they're like okay that's a choice that you can make yep he could still say no thanks

00:24:32.400 and move on to something else my uh family member who passed of cancer recently was very clear about

00:24:39.420 what he wanted in his treatment and what he did not want and there was like i think a lot of that

00:24:45.380 from doctors being like, all right, well, you're making your choice. Got it. Clearly it's not the

00:24:50.960 thing I would recommend, but like, this is your life and your choice. You don't want to gaslight

00:24:55.120 them about their experience, but she's just such an unreliable narrator that it's like, okay,

00:25:00.040 what was actually happening with this interaction? So I just sent you a quote. This is an excerpt

00:25:06.600 from her book, Good Energy. My mom made it clear to the oncologist that she was not afraid of her

00:25:12.840 rapidly impending death, but she wanted to minimize unnecessary pain or nausea in her final

00:25:17.120 days. Despite being clear, the system pushed the exact procedures that would yield pain and nausea 0.53

00:25:21.840 and aggressively shamed our family for questioning the full-court press approach. The doctor was not

00:25:25.860 consciously trying to recommend a suboptimal procedure, but I knew the invasive route would

00:25:29.840 generate hundreds of thousands of dollars for the hospital, and this doctor's pay was tied to

00:25:33.680 booking these procedures. The profit motive thing is also true. I think it affects your psychology

00:25:37.980 in ways that are probably invisible to you. Sure. But again, she's just like an unreliable narrator.

00:25:42.500 And it's 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.

00:25:56.440 Yeah, yeah, yeah.

00:25:57.080 Right. And it is designed to cast aspersions on the field.

00:26:03.140 Right. Right. And on treatment recommendations that are being given to people who are in life and death scenarios.

00:26:10.620 right yeah what she's doing here is sort of using like a very emotional personal experience which

00:26:17.320 again both you and i have been through in different ways right she is using that to kind of shake the

00:26:25.560 foundation and go what if the whole thing is right exactly because it's also totally plausible that 0.99

00:26:30.800 her doctor was just a huge fucking asshole right and so maybe you had a really bad experience with 0.99

00:26:35.460 this like complete prick that's absolutely plausible but she is making it a bigger argument 1.00

00:26:42.400 about the medical system and for-profit health care etc etc which again you'd have to sort of 0.86

00:26:48.380 marshal different kinds of evidence to support yeah and also if this was your issue you would

00:26:53.560 actually move us toward like a universal health care system where the doctors just get paid

00:26:57.560 salaries which is actually what they have in many countries that would be the thing that you would

00:27:02.000 then start pushing toward, you wouldn't then leave the system and start selling people other 0.96

00:27:06.760 shit for profit. That's just what destroys her entire credibility to me. Her functional medicine 0.94

00:27:11.940 clinic is in the Pearl District in Portland. Pearl District, parentheses, derogatory.

00:27:20.000 Yes, yes, Michael. So when I was growing up, the Pearl was like a predominantly industrial

00:27:26.580 area, there were significant numbers of homeless folks. And when I was in like maybe middle school

00:27:33.740 or high school, it started getting gentrified to the fucking max. Yeah. So now those industrial 0.98

00:27:39.920 buildings are overwhelmingly like luxury condos and lofts. She's like, the medical system is kind

00:27:46.720 of a grift. And I want to get in on that grift. It feels very telling that you go to the wealthiest

00:27:52.940 Exactly. Yeah. Right. When my dad was a teacher at dental school, he also had a systemic critique

00:27:57.560 because these profit motives were starting to take over dentistry at the time. And he started

00:28:01.060 volunteering at a homeless shelter to do dentistry on homeless people. There's like other things that

00:28:06.240 you can do. That's right. Other than this, you know, Casey Means is a really interesting mix

00:28:11.860 of sort of like crunchy granola Maha style stuff and really dyed in the wool conservative pedigree

00:28:21.160 In 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.

00:28:32.900 The first of those is her father, Grady Means, who was a longtime Republican operative in D.C.

00:28:43.140 Okay. He worked for Nixon and after Nixon's resignation for Vice President Nelson Rockefeller

00:28:50.340 during the Ford administration. During the Ford administration, he worked on the Food and

00:28:56.180 Nutrition Task Force, which sought, among other things, to dramatically scale back food stamps.

00:29:02.420 There's that systemic critique, baby.

00:29:04.540 Right. The like, food is medicine, ladies. Dad is the reason that fewer people have the medicine 1.00

00:29:10.880 food that she wants everyone to have. Poor people have too much food. Grady also worked as a

00:29:16.360 consultant before selling off the consulting wing of his firm for $3.5 billion in 2002.

00:29:24.780 Billion? So that's her dad, Grady Means. She also has a brother named Callie Means.

00:29:31.320 Which the description on this Tucker Carlson YouTube video tells me has also been interviewed

00:29:36.480 by tucker carlson yes correct yeah so they have become a little bit of like a package deal they're

00:29:43.520 sort of a one-two punch in maha world and they co-authored their book together oh okay cali means

00:29:49.080 went to stanford undergrad and went to harvard for his mba he interned both for the george w bush

00:29:58.720 white house and for the heritage foundation nice he worked on the mccain campaign reportedly as

00:30:06.380 part of the quote unquote pit crew that was working to improve sarah palin's reputation

00:30:11.800 okay he did that debate prep he's furious he's sending her links to schoolhouse rock

00:30:17.120 he describes himself as a former never trumper who became one of rfk jr's advisors after that

00:30:26.840 appearance on tucker carlson callie means is an entrepreneur who founded a company called

00:30:33.140 True Med, which helps people apply for HSA coverage of like Peloton bikes and infrared

00:30:41.160 saunas. Oh, wait, really? He's trying to get people reimbursed for like alternative medicines.

00:30:46.080 Yep. So health savings accounts, HSAs are tax free accounts. You essentially are allowed to

00:30:53.160 set aside money that you're going to spend on health care, not be taxed on that money and

00:30:58.340 spend that money tax-free. Functionally, there's been a bunch of research into this. It really just

00:31:04.740 ends up benefiting rich people who want to pay less in taxes for their luxury health and fitness

00:31:10.400 purchases, right? True Med allows people to log onto their website, fill out a quick survey,

00:31:17.380 and get delivered a letter of medical necessity that allows their purchase to be covered by HSA

00:31:23.320 dollars in exchange true med takes a cut of the sales oh okay okay that's scammy so they've been

00:31:32.240 used for like red light therapy devices including the like skincare red light masks they've been

00:31:39.960 used for supplements for smart mattresses sure vanity fair did an incredible deep dive piece

00:31:47.880 into cali means i strongly recommend it and as part of that they got their hands on some early

00:31:53.940 true med marketing materials which at its outset focused on rebranding companies like sweet green

00:32:02.700 and daily harvest as health care yes my daily salad is actually a prescription my dad did cut

00:32:11.040 food stamps but but now my work lunch is health care so the mean siblings both have very close

00:32:20.940 ties with the sweet green guy the daily harvest get like all of these people are people that they

00:32:27.640 know and work with very frequently yeah through the quote-unquote end chronic disease coalition

00:32:35.920 how do i know that's a scam right right any other time in history you're like oh and in chronic

00:32:41.220 disease that sounds good but it's like nope my brain is too broken from doing this show the

00:32:45.680 coalition is mostly they're advocating for something called the hope act the health out

00:32:51.620 of pocket expense act which would expand eligible uses for hsa dollars and the end chronic disease

00:32:59.660 coalition which rfk jr and like other folks on the right will like tout oh like oh my god cali

00:33:07.080 means work with this incredible coalition yeah the coalition is largely made up of companies

00:33:11.580 whose products would be covered under those proposed expanded rules so it sounds like nice

00:33:15.920 like oh we're expanding the hsa but it's actually just like you're gonna get profits out of this

00:33:19.500 basically and the name of the coalition is end chronic disease like oh my god this guy is so 0.94

00:33:25.400 dedicated to ending chronic disease no he's fucking not he's dedicated to selling his buddies

00:33:31.660 like food and then taking a cut of those sales yeah yeah yeah so michael are you ready for cali 0.98

00:33:40.380 means origin story oh yeah give it to me cali means says that he was a lobbyist for big food

00:33:46.540 and big pharma okay and that he saw firsthand the kind of corruption at play there on one podcast

00:33:53.680 he claimed among other things that he brokered a deal between the american diabetes association

00:33:58.900 and coca-cola what then it's like hush money to like stop oh opposing us in public or whatever

00:34:05.600 and i was just like dude what are we doing so he's doing it like confessions of an assassin

00:34:10.720 kind of thing where he's like oh i brokered these evil deals yes confessions of a lobbyist

00:34:16.280 yeah on tucker carlson's podcast he claims to have attended a meeting where food corporations

00:34:22.200 were quote, paying off nutrition researchers at Harvard and Stanford. And he alleged on Twitter

00:34:30.980 that in his time as a lobbyist for food corporations, that Coca-Cola gave quote,

00:34:35.680 unquote, millions to the NAACP and the Hispanic Federation in exchange for publicly calling any

00:34:43.000 policies hindering soda sales as racist. Okay. Describing the whole thing as quote,

00:34:50.320 unquote, depressingly transactional. Those seem like easily verifiable claims, but whatever.

00:34:54.900 So Vanity Fair in this deep dive piece fact checked him and his story simply did not check

00:35:03.560 out. Yeah, of course not. They interviewed more than 60 people who had worked with Callie Means.

00:35:09.380 Nine of his former colleagues from PR world from Mercury and Edelman disputed his version of

00:35:17.020 events okay where cali means claimed that he had been a quote-unquote director at mercury brokering

00:35:23.960 these high-level deals his colleague said he was an executive assistant who wouldn't have even been

00:35:29.100 in the room for the deals that he said executive assistant is hella funny it's as removed as you

00:35:35.820 could be from like the halls of power that you're talking about they're like hey can you grab us a

00:35:40.760 cup of coffee he's like i was in the room the room where it happens that's right yeah not only

00:35:46.080 do they dispute the roles that he held they also dispute that they the companies represented the

00:35:53.560 clients that he claimed nice so in the three years that cali means worked at mercury they didn't

00:36:00.040 represent coca-cola nor did they represent the american beverage association mercury which is

00:36:06.460 where cali means was working was working the other side of the issue they were campaigning to reduce

00:36:12.660 soda consumption and their client was the california endowment it's funny because he

00:36:17.260 could have just said i was on the ground working to reduce the influence of big food like i was

00:36:22.280 advocating against soda companies he could have just said that but instead he's like

00:36:25.800 creating this weird narrative right it's it's a really strange thing to sort of manufacture a

00:36:31.640 heel turn that you don't appear to have had right the vanity fair piece also uncovered some real

00:36:37.020 gems about Callie means as a coworker. I just sent you a quote. It says at the office, 0.95

00:36:43.740 several colleagues recall his air of self-importance. He seemed to have bigger and

00:36:47.740 better plans ahead, which didn't include them. He walked around the office saying Callie means

00:36:52.300 business. Wait, Callie means business. He walked around the office saying Callie means business.

00:36:59.480 Another former colleague recounts. That's like his cute little, it's almost like a bumper sticker

00:37:04.220 a phrase for like when he runs for congress totally kelly i just want you to imagine an

00:37:11.140 executive assistant dude who is trying to play or something who's like trying to get into every

00:37:18.520 strategy conversation is acting like they're better than everybody around them at like a

00:37:25.380 pretty high-powered firm where they are very junior yeah and they're walking around just 1.00

00:37:30.460 muttering callie means business to themselves like what a fucking dork a real pearl district 0.98

00:37:36.980 resident is the way i is the way i think of him just the kind of guy who live in the pearl district 0.95

00:37:42.220 so that's grady means and callie means it felt important to lift up that casey means because

00:37:48.480 she sounds kind of like portlandy maha crunchy granola e it felt really important to establish

00:37:55.860 just how committed to extreme conservatism her family is i'm so curious how this nomination

00:38:03.720 fell apart now because all of this so far sounds like everyone in the term administration would

00:38:07.380 just love these people right and welcome them with arms wide open baby

00:38:11.820 well michael when it comes to this story can i take you higher

00:38:21.520 that's it that's all of my creed that's it we're done i know the title of two songs the end

00:38:30.060 so back to casey means unlike her predecessor dr neshwat casey means basic cv checks out

00:38:39.640 she did graduate from stanford undergrad in 2009 and from stanford school of medicine in 2014

00:38:47.500 she did go on to pursue her residency at ohsu it was a five-year program but she dropped out

00:38:54.900 six months before completing it she did get a medical license but it has now been inactive

00:39:01.100 for a couple of years she has offered two reasons for leaving her program one is that sort of state

00:39:09.300 of american health care thing and the other is the stress and pressure of her surgical residency

00:39:15.980 After leaving her residency, she opens her functional medicine practice called Means Health in 2019.

00:39:24.880 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.

00:39:38.100 Okay.

00:39:38.500 As well as quote unquote AI insights.

00:39:40.920 There it is.

00:39:41.480 There it is.

00:39:42.060 A full membership to Levels for a year, including glucometers, costs about $1,500 per year.

00:39:51.060 I'm so against profit medicine.

00:39:52.480 The problem with medicine is all of the profit.

00:39:54.140 That's why I charge you $1,500. 0.99

00:39:55.620 That's why it's like more than $100 fucking a month. 1.00

00:39:58.820 So she founds Levels and her functional medicine clinic in 2019. 0.95

00:40:03.800 And in 2020, COVID hits.

00:40:07.280 Casey Means takes that as an opportunity.

00:40:09.860 Of course.

00:40:10.480 And submits an LTE to the journal Metabolism, Clinical and Experimental.

00:40:17.440 In it, she argues that metabolic dysfunction is a core issue for COVID-19 and that managing

00:40:25.140 blood sugar in a data-driven way was an essential intervention for COVID.

00:40:30.480 Oh, so buy my products.

00:40:33.120 So she submits this letter in April of 2020.

00:40:36.740 by november of 2020 she had reportedly raised 12 million dollars in seed funding for levels okay

00:40:44.680 by 2022 the company was reportedly valued at 300 million dollars oh wow okay it is then 2022

00:40:52.420 during callie and casey means appearance on the tucker carlson show that really establishes them

00:40:59.900 in the right-wing just-asking-questions circuit.

00:41:04.500 From there, they both start doing the rounds,

00:41:07.500 showing up on Joe Rogan's show

00:41:09.220 and a ton of, like, right-wing podcasts, right?

00:41:12.100 After the Tucker Carlson thing,

00:41:13.840 that really seems to, like, blow things wide open.

00:41:15.880 It's also reportedly where RFK Jr. comes across their work, right?

00:41:20.080 All of that leads up to the release of

00:41:23.800 Callie and Casey Means' book in 2024,

00:41:27.140 which is called good energy the surprising connection between metabolism and limitless

00:41:33.680 health how is it not called means tested they have so many puns at their disposal

00:41:40.500 think of the possibilities lean means health care machines means is great they're leaving

00:41:47.860 grifts on the table in promotion of the book they publish an excerpt on the free press of course

00:41:57.120 the excerpt on the website is titled i'm a doctor you shouldn't always trust us god the chapter in

00:42:05.440 the book is titled trust yourself not your doctor this website loves laundering most far-right

00:42:11.600 garbage but like through the mouths of experts who went to all of these like ivy and ivy adjacent

00:42:16.680 institutions yeah like i read the whole book callie and casey means both say some very accurate 0.93

00:42:23.600 reasonable criticisms of the US healthcare system. They also write really compellingly

00:42:29.500 about the shortcomings of the food system and the heartbreak of people needing to pay more

00:42:34.780 money than they have just to stay healthy or stay alive. And that's why we've joined the

00:42:39.100 Republican Party, which wants to make all of these things worse. Right. So in talking about

00:42:44.260 the importance of like eating whole foods and healthy fats, rather than directly increasing

00:42:48.700 access to those things through like snap or wick right they instead shift to this personal

00:42:55.240 responsibility frame yeah yeah saying that like it's actually on you to make sure that you're 1.00

00:43:00.080 eating very expensive ingredients she's an anti-seed oil lady so she's like she is yeah

00:43:05.400 right like buy the oil that is like five or six times as much right they are totally silent on

00:43:12.480 like how any of this would be possible for low-income families right they're just of course

00:43:17.460 as usual just inflating the ability of like a virtuous lifestyle to solve all of these issues

00:43:25.160 like you did something wrong if you get one of these chronic conditions that's the ideology

00:43:29.200 on the press tour for the book she becomes a real hot take factory she has said that quote

00:43:36.380 many if not most covid19 deaths could be prevented with optimal metabolic health

00:43:42.380 nice and called covid a quote darwinian moment for america oh what in like a good way yeah like 0.94

00:43:50.760 the least fit did not survive way just saying it they're out here just fucking saying it she also 0.69

00:43:56.920 has some anti-vax positions that i think are dressed up to appear more moderate than they are 0.79

00:44:02.680 in her newsletter she wrote quote there is growing evidence that the total burden of the current

00:44:08.980 extreme and growing vaccine schedule is causing health declines in vulnerable children vulnerable

00:44:15.520 we're really looking out for the vulnerable by giving them measles it's so important that they

00:44:19.420 get measles she has said quote i think vaccine mandates are criminal i mean they are in the 0.74

00:44:25.620 sense that we never fucking had them in america so whatever she said that in response to somebody 0.96

00:44:30.140 on twitter giving her shit for not being anti-vax enough and she was like i have said innumerable 0.98

00:44:34.240 public times i love that i love that um actually um actually i'm the most anti-vax i'm actually 0.95

00:44:40.560 pretending when i say we need more research and stuff i'm actually super anti-vax don't worry

00:44:44.760 about it michael aren't we having a good time with these you keep reminding me isn't this fun

00:44:50.980 it's kind of fun i'm having fun this is like my parents on road trips as a kid this is fun right

00:44:55.980 she has written quote when it comes to a question like raw milk i want to be free to form a

00:45:02.580 relationship with a local farmer understand his integrity look him in the eyes pet his cow

00:45:09.140 and then decide if i feel safe to drink the milk from his farm i want buying food to be a just 0.93

00:45:14.880 constant fucking chore where i have to know every single thing and do all the work myself i would 0.93

00:45:19.920 love that the way that you know if there is listeria in milk is a good hard look in the eye 0.99

00:45:26.160 i want other people to have the freedom to fucking lie to my face about the health impact 0.97

00:45:30.240 to their product she is also a proponent of both psilocybin and mdma she likes shrooms she likes 0.99

00:45:37.120 molly why are all these people into fucking psychedelics it's so fascinating all they do is 0.97

00:45:41.060 bitch about like prozac and stuff but they're like no no take these other drugs it's so weird 0.99

00:45:45.840 yeah i mean i think there's like a rift right both within maha world and within republican world 0.98

00:45:51.840 writ large where you have sort of older school republicans who are like drugs yeah and you have 0.99

00:46:00.080 this sort of like newer wave of like red pill fucking assholes who are like drugs yeah yeah 0.98

00:46:06.600 it becomes a liability because it exposes that rift which doesn't often get tested in like federal 0.99

00:46:12.600 policy making right right so in addition to all of those hot takes sometimes her hot takes take

00:46:21.260 the form of poetry okay for april fool's day she wrote a poem for her newsletter as she notes she

00:46:29.720 got quote some help from ai i'm sending you four verses from a poem that has like 20 verses like

00:46:37.680 there's so many so i just picked a few she puts it in full in her newsletter the title of the poem

00:46:43.420 is the devil's wellness plan i'm not i'm not reading this is way too much aubrey you're reading

00:46:49.680 it michael you're reading it if i were the devil i'd ditch the disguise no pitchfork no flames

00:46:56.060 just marketing lies. I'd feed you poison, call it a snack, and label you elitist when you want 0.96

00:47:01.960 your health back. I'd bury research, seal the locks, then line you up for 73 shots. Doesn't 0.94

00:47:07.780 rhyme. I'd cancel critical thinking, stop dissenters with bots, then jab your kids without

00:47:13.140 a second thought. Also, doesn't really rhyme. I'd break your trust in ancient ways and mock

00:47:18.960 the moon and cycles phase. I'd push the pill and dull women's flame till womanhood forgot its name. 1.00

00:47:26.060 I'd give boys man boobs through toxic food and call masculine strength aggressive and lewd. 1.00

00:47:31.980 I'd whisper, you're too much, too loud, and shame men's fire as something rude. 0.99

00:47:37.100 There you go.

00:47:38.640 I miss Creed, Aubrey.

00:47:40.980 Can we go back to Creed?

00:47:42.920 Mike, he's a professional.

00:47:44.900 You can't expect her to be on his level.

00:47:46.640 That at least had like an okay, like, pentameter or whatever.

00:47:49.740 It was at least the correct number of syllables.

00:47:52.500 So Good Energy, Callie and Casey Means' book, came out in 2024. By May of 2025, Casey Means was

00:48:01.660 announced as the Trump administration's nominee for Surgeon General. That is so far to get in

00:48:08.420 such a short period of time. The reactions to Casey Means' nomination are swift and they are

00:48:14.940 negative. This means war. So a number of former Surgeons General come forward and are like,

00:48:21.680 absolutely fucking not jerome adams actually like writes an op-ed about it and is like hey part of 0.95

00:48:28.200 your job as the head of the u.s public health service is um to weed out people who don't have 0.98

00:48:34.520 license to practice and casey means does not have an active medical license oh right yeah there is 0.97

00:48:40.680 uh criticism from maha folks who once again criticize her for not being anti-vax enough 0.98

00:48:46.600 really even her uh-huh fucking hell once again queen gremlin laura loomer weighs in on twitter 0.98

00:48:55.480 i just think you quote casey means said when she was looking for romance she would do shrooms 0.99

00:49:00.640 talk to trees participate in full moon ceremonies and pray to inanimate objects with a spiritual

00:49:06.360 medium so basically the new surgeon general is a total crackpot a shroom consumer and she talks 0.99

00:49:12.960 to trees and doesn't even have an active medical license. Another failure by the geniuses who work 1.00

00:49:19.120 for President Trump on his non-existent vetting team. I guess there isn't a single conservative

00:49:23.860 doctor in America who doesn't have a history of being a Marxist tree hugger. This is bizarre.

00:49:29.440 Casey Means is like a complete nutcase. They should love this lady. 1.00

00:49:32.620 The reactions to her nomination are so bad on Twitter in particular that RFK Jr. rushes to

00:49:39.860 her defense on the platform he says that maha is taking on powerful corporate players and that

00:49:46.040 those companies quote will continue to pay bloggers and other social media influencers

00:49:51.480 to weaponize innuendo to slander and vilify casey the same way they try to defame me and president

00:50:00.500 trump the fights between these people are always just like the spider-man meme of people pointing

00:50:04.020 to each other it's like vaguely different shades of lunatic it's like why they're mad at her i mean

00:50:09.280 I think this is part of what makes me feel less despairing about this episode is that early on

00:50:16.580 when RFK Jr. was nominated, you and I talked about him and his priorities being on kind of a pretty

00:50:24.000 direct collision course with the Trump administration, right? That he's like, I want to regulate

00:50:28.320 corporations. I want to ban all this advertising. I want to blah, blah, blah. And Trump is the guy

00:50:32.480 who's like let corporations do whatever the fuck they want right and that the maha coalition was 0.86

00:50:39.860 like sort of like looking for a home and republicans offered them a home right but the rift and the

00:50:47.140 sort of differences and disconnects are starting to show and part of the way that that's starting

00:50:51.580 to show is in these kinds of like infighting moments and part of the ways that's starting

00:50:55.980 to show is in having three nominees for surgeon general right and not having one still and also

00:51:02.740 these the whole maha thing you can't have a stable coalition when it's built on the back of lies and 0.92

00:51:09.300 misinformation because everyone is ultimately just making shit up and cherry picking you don't have 0.71

00:51:14.340 like a referee or like an objective standard of facts to point to to adjudicate a dispute about 0.99

00:51:20.060 like do shrooms work or are shrooms bad they don't give a shit about what actual science looks like 0.55

00:51:25.960 so you can't really have like a good faith debate even within these coalitions right it's all power 0.92

00:51:31.360 games right yeah so on top of all those negative reactions there's also this new wave of reporting

00:51:35.800 about like who is this new surgeon general nominee and one of the things that they find in that

00:51:41.860 reporting is that there are pretty significant gaps between how she describes her residency and

00:51:46.680 how other people at her residency described her at her residency okay vanity fair interviewed uh

00:51:53.880 the chair of the department where her residency took place who said that Casey means found the

00:52:01.000 job quote unquote too stressful that she quit in tears and that other residents had to quote

00:52:07.940 cover for her and we're a small department and all the calls fall on them no way the funny thing is

00:52:13.300 that's also a structural critique of the American medical system people are so overworked yeah it's

00:52:18.620 also funny that she like makes it this like virtuous like I chose to leave thing two other

00:52:23.380 residents who served with her in the same department at the same time said that she was

00:52:28.300 very anxious and primarily like afraid of hurting patients. Has she tried zinc? Has she tried taking

00:52:34.700 zinc for anxiety? I think it just maybe it's her lifestyle. So all of this leads up to Casey Means

00:52:40.800 confirmation hearing, which happened in February of this year. Her initial confirmation hearing

00:52:48.180 was scheduled for October 2025, but it was postponed when she went into labor with her

00:52:52.840 child. So she got maternity leave, basically something the administration is also decidedly

00:52:57.600 against. Initially, the confirmation hearing is scheduled for October. It ends up taking place

00:53:02.880 in February after her parental leave. And in that time, the conditions and the sort of political

00:53:09.660 calculus here really change. Among other things, the chair of the committee where the confirmation

00:53:17.500 hearing will happen, the help committee is Bill Cassidy. Bill Cassidy is in that intervening time

00:53:25.260 defeated in his Republican primary by a Trump endorsed challenger to the right. Okay. Bill

00:53:31.000 Cassidy is now a lame duck with serious like flame duck potential. But there's also a long 0.97

00:53:38.700 standing rift between Senator Cassidy and President Trump dating back to at least 2021

00:53:44.140 when Cassidy voted to convict Trump

00:53:46.620 of inciting a riot on January 6th.

00:53:49.540 Okay.

00:53:50.000 He's a physician who did practice for a long time

00:53:54.060 in a lot of situations, right? 0.99

00:53:56.600 Like say what you fucking will about Bill Cassidy. 0.99

00:53:58.960 I'm not going to cape for any Louisiana Republicans 0.99

00:54:01.440 at this point,

00:54:02.300 but he is an actual doctor who did actually practice,

00:54:05.940 who does actually have a medical license.

00:54:08.540 All of that does feel relevant here.

00:54:11.660 There's also a long history of Republicans

00:54:13.320 like kind of doing the right thing once they don't have an election to win anymore.

00:54:17.780 Totally. So like, as I have told you, I'm not a fan of congressional hearings.

00:54:24.020 Yeah.

00:54:24.240 They feel like political theater. They feel like they're not accomplishing anything. They're

00:54:27.720 definitely not fact finding missions like ever. Right. I think that this confirmation hearing

00:54:33.880 was pretty effective as political theater. Cool.

00:54:36.440 They had like a really clear, good division of labor. Folks had drafted their questions in a

00:54:40.740 really tight way and came in with like a pretty unified front across party lines bizarrely josh

00:54:49.320 holly is like hey i need to talk to you about what i'm hearing from my constituents which is

00:54:54.580 they're concerned about the health risks of ai data centers what i will say holly kind of softballs 0.94

00:55:01.100 it and he's like well i'd invite you to give it some thought but he's not like an asshole to her

00:55:06.100 about it he's not like confrontational about it at all but he does raise it up and is like these

00:55:12.260 are the kinds of things that people are concerned about they're concerned about water quality that

00:55:15.760 looks like this right like they're like doing the thing of being like hey this is an issue it is all 0.85

00:55:21.640 theater though because they none of them give a shit about any of this stuff but whatever it's

00:55:25.400 totally theater but it was surprising to me that if you're doing a performance and the performance 0.90

00:55:29.920 of every republican at this point is to some degree just for donald trump right his willingness

00:55:35.360 to push back in that way. I was like, oh, that's interesting. It's weird. Yeah. But he's not the

00:55:40.520 only Republican on the committee who has sort of more direct and sort of harder questions for her.

00:55:47.200 At one point, Senator Cassidy asked her if she believed that vaccines cause autism.

00:55:54.720 This is after the Pam Bondi hearings. So it's clear that she's trying to like moderate her

00:55:59.880 response and not be kooky and start yelling about like the Dow. Yeah. Yeah. So her response

00:56:06.240 to Cassidy's question about vaccines and autism is quote, we have an autism crisis that is

00:56:12.160 increasing. This is devastating to many families. And we do not know as a medical community,

00:56:18.260 what causes autism, which I can see the anti-vaxxers being mad about that. It's the one

00:56:23.760 answer that like, we don't actually know what causes autism is the one answer that is guaranteed

00:56:29.280 to piss off everybody. She should have just said they fucking cause autism. And then like 0.99

00:56:33.420 the anti-vaxxers would get on her side. Ten toes down, standing on business. Yeah, yeah, yeah.

00:56:39.120 So in that same hearing, Tim Kaine asks her about flu shots, which is not a huge part of

00:56:49.060 the anti-vax discourse. Right. So I just sent you, we're going to watch a clip. I apologize

00:56:54.400 in advance for how infuriating this clip is to listen to. In a news report on January 7,

00:57:01.780 just a month or so ago, Secretary Kennedy stated, quote, there is no evidence that the flu vaccine

00:57:08.540 prevents serious disease or that it prevents hospitalization or deaths in children. Do you

00:57:15.020 agree with that statement? Senator Kaine, as I've said, I believe vaccines save lives and

00:57:24.320 an important part of it. I'm not asking about the general. I heard that testimony earlier, but

00:57:28.840 you're an MD. Your qualifications have been much discussed earlier. Do you agree with the

00:57:35.600 statement that there's no evidence that the flu vaccine prevents serious disease or that it

00:57:40.600 prevents hospitalizations or death in children? I have not personally seen that quote or that

00:57:45.560 article. I would want to review it before I comment on that. Okay, I'm going to set the

00:57:50.320 quote aside, I'll introduce for the record. She's so bad at this. An article CBS News, 0.99

00:57:54.260 RFK Jr. says it may be better if fewer children receive the flu vaccine dated January 7,

00:57:59.220 2026. Without objection. Do you believe that there is evidence that the flu vaccine prevents

00:58:05.460 serious disease and prevents hospitalization or deaths in children? I believe that all patients

00:58:13.540 should talk to their doctor. And so do I. And that's not what I'm asking. Your qualifications

00:58:19.060 have been much discussed there is a mountain of evidence about this do do you believe that

00:58:27.740 there's no evidence that there's the flu vaccine has efficacy in reducing serious injury or

00:58:33.060 hospitalization i i you would see a little hamster wheel in her brain this is an easy one doctor

00:58:38.640 this is an easy one i support the cdc's guidance on the flu vaccine and i will always be working

00:58:45.940 with the CDC, ASIP, and the agency.

00:58:48.280 So you believe it is an efficacious vaccine

00:58:51.660 to reduce hospitalization?

00:58:53.860 Is or is not.

00:58:54.940 Is, you believe it is.

00:58:56.460 As I said, I support the CDC's guidance on the flu vaccine.

00:58:59.040 Let me just say, do you think the flu vaccine

00:59:01.760 reduces the risk of hospitalization or serious injury?

00:59:06.420 I've said it.

00:59:06.920 You're a doctor.

00:59:07.820 I believe vaccines save lives.

00:59:09.240 I believe they're an important part of public health strategy.

00:59:12.420 The flu vaccine, does it reduce the risk of injury

00:59:15.660 or hospitalization? At the population level, I certainly think that it does. Let me introduce

00:59:21.180 for the record, if I can, Mr. Chair, CDC seasonal flu vaccine effectiveness studies dated May 30,

00:59:27.360 2025 from the CDC that goes into this in some detail. This is not a hard question. I answered

00:59:32.620 your question. And yes, after three minutes, you acknowledge that at a population level. I haven't

00:59:37.140 seen that report. I have not seen. Yeah, but you know about the flu vaccine. If I had a nickel for

00:59:41.640 every time i was misquoted in the media i'd be a very wealthy woman i would like to understand

00:59:46.260 what his comments i'm not i'm not asking you about the quote i'm asking you about something

00:59:49.800 in your remit the effectiveness of the flu vaccine stunning he did eventually get her to admit it

00:59:57.240 which is actually interesting that she did i think it's again an indicator of how bad she is at this

01:00:02.020 yeah yeah part of what sinks her in this hearing is that she keeps trying to rely on these phrases

01:00:08.940 like i believe vaccines save lives or right i uh support the cdc guidance she clearly also didn't

01:00:16.200 know what the cdc guidance was because the cdc guidance is all like pre-rfk junior so most of

01:00:20.660 it is still pretty pro-vaccine at this point it's all the doge guys being like asked to define what

01:00:25.540 dei is and they're like it's whatever was in the eo yeah yeah yeah yeah another piece that becomes

01:00:30.640 like a big challenge for Casey Means is her financial conflicts, which are significant. 0.95

01:00:39.720 Of course, she owns and operates Levels, her sort of medical equipment slash wellness startup.

01:00:48.160 But on top of that, as we've mentioned, she has a really strong presence on Substack and Instagram

01:00:54.900 and social media sort of writ large. And it becomes clear that she has failed to disclose

01:01:01.720 many, many financial relationships. And in her newsletter on Instagram, on social media broadly,

01:01:10.480 she is frequently recommending products. Oh, right. And like not disclosing like those FTC

01:01:18.380 regulations where you have to say like hashtag sponsored or whatever. Correct. Yeah. Those

01:01:23.440 regulations those regulations about disclosing when something is an ad on social media came into 1.00

01:01:29.140 effect after fire fest that's why we got those fucking things yeah and she's like doing a 1.00

01:01:34.360 wellness fire fest of like not right disclosing the associated press investigated her disclosures 0.94

01:01:41.380 and found that she had been taking big payments that she did not disclose publicly $59,000 from

01:01:49.280 function health mark hyman's company oh yeah of course twelve thousand dollars from daily harvest

01:01:55.460 sixteen thousand dollars from fluorosophy a fiber supplement company that sounds like a

01:02:04.500 fake word that she made up for one of her poems so that it rhymed twenty seven thousand dollars

01:02:09.220 from energy bits okay algae supplement company wait what was the one we talked about on the

01:02:15.880 bonus episode food cube or whatever is she getting cube bucks five hundred dollars from

01:02:23.800 we natal prenatal vitamins oh that's pretty good actually and 130 000 from amazentis oh

01:02:32.980 a supplement company also 200 000 from tati westbrook's hair vitamins yeah that's right 0.87

01:02:39.060 bye sister yeah i will also say not for fucking nothing in her confirmation hearing one of the 0.91

01:02:46.960 members of the committee is bernie sanders who questions her on stuff and mostly is like 0.91

01:02:50.680 hey i agree we should ban junk food advertising hey good point on this thing uh yeah everyone's 0.94

01:02:56.320 going out of their way to do this shit i know bernie sanders is like trying to sort of be like 0.96

01:03:01.160 you know i disagree with the trump administration on a lot of stuff but i think you got some good 0.98

01:03:05.420 points here yeah and then like posts a clip on social media and is like hey we had a real one

01:03:13.940 this is a good conversation like i don't agree with her on everything but i support her in this

01:03:17.720 thing and people just like absolutely shredded him on it was like you don't gotta hand it to her

01:03:24.460 this is why these people make these disingenuous plausible sounding arguments is because they

01:03:29.720 attract people who like want to give them credit and want to give them good faith but these people

01:03:34.520 are not acting in good faith you cannot listen to what they say you have to look at what they 0.99

01:03:38.160 fucking do correct what is she doing with her life there's no fucking way these people are like 0.98

01:03:41.800 oh i just want to fix the diet of americans is that what rfk jr has spent the last 20 years of 1.00

01:03:46.220 his life dedicated to no he's dedicated it to fucking getting kids infected with measles 0.99

01:03:50.920 that's what they actually believe you have to ignore all this bullshit they are saying that 1.00

01:03:55.420 as a fucking trap as bait to get people who do not care or do not know about their actual background 0.99

01:04:01.440 to do exactly what bernie is doing 100 i was like this is uncharacteristically like anti-shrewd 0.99

01:04:10.020 also for just a failed fucking candidate too you're also really like it's clear by this point 0.62

01:04:15.320 that like she's not gonna make it through so on april 30th of this year in a truth social post 0.99

01:04:22.820 donald trump acknowledged that casey means didn't have the votes to being confirmed she will also be

01:04:28.580 joining Walter Reed. Unsurprisingly, Trump blames Bill Cassidy, the chair of the help committee.

01:04:34.900 But also there appear to be holdouts that were Cassidy Collins and Murkowski were all like,

01:04:42.920 I don't know. After the administration withdraws Casey Means nomination, the political landscape

01:04:49.960 starts to shift again. New polls come out revealing that changing the vaccine schedule is

01:04:57.340 hugely unpopular with voters. Yeah. Plus, the anti-vax stuff has faced a large number of court

01:05:05.260 challenges. So it is costly and time consuming to defend against, right? So they're really testing

01:05:12.180 like how much political capital the Trump administration is willing to spend on Maha

01:05:16.420 priorities. Right. And this is more of an RFK thing than a Trump thing. Yes, correct. So we're

01:05:21.180 seeing like how far is trump willing to go for rfk jr right and not as far as casey means is the

01:05:28.600 answer yeah that's when they announce uh the newest third and newest current nominee nicole

01:05:33.920 sapphire is her name she went to arizona state university for her undergrad for her md she's

01:05:40.740 telling us out front she didn't go to med school in the u.s okay she went to ross university in

01:05:46.480 barbados is that like a for-profit scam factory uh it doesn't appear to be i didn't look into

01:05:52.880 ross university to a great degree because i was like they're not going to do that again right

01:05:56.480 but maybe who knows she is currently a radiologist at the sloan kettering cancer center a licensed

01:06:03.140 doctor her career as a public figure is a very maha like gotta catch them all kind of thing

01:06:11.340 she has a podcast she has a supplement company she's a fox news contributor great she's written

01:06:17.640 three books love mom inspiring stories celebrating motherhood okay make america healthy again how bad

01:06:26.820 behavior and big government caused a trillion dollar crisis yeah big government's definitely

01:06:31.560 the problem she also published that before rfk jr was using maha oh wait really uh-huh she tried

01:06:39.500 to trademark it which is very funny and then she sort of dropped it yeah she owes a podcast called

01:06:44.300 wellness unmasked and she wrote another book called panic attack playing politics with the

01:06:50.520 science in the fight against covid19 i could just like write that book from memory i could like sit

01:06:55.060 1 million percent you already know lab leak whatever dr sapphire's positions on core maha

01:07:03.020 issues are often presented in a way that seems a little more moderate than a casey means which

01:07:09.320 like not hard to do. I think a good example on that is her position on vaccines. She, like Casey

01:07:15.820 Means, is very strident in her vaccine save lives stance. But she has also said that the pediatric

01:07:22.920 vaccine schedule should be, quote unquote, less stringent. Yeah, there it is. Yeah. And that she

01:07:27.820 opposes vaccine mandates. Yeah. She has also been publicly and directly critical of RFK Jr.'s

01:07:34.800 approach on vaccines and she's done that criticism in right of center media outlets

01:07:39.840 it's fascinating okay she's a real mixed bag yeah most notably she wrote an op-ed in the

01:07:46.180 wall street journal just last year called the madness in rfk jr's autism method woke queen

01:07:54.680 i'm into it now comparatively i heard she said defund the police

01:08:00.140 i don't think she did she has publicly criticized trump but those posts are now deleted so she's

01:08:08.760 like been speaking her mind but then doing the trump nominee thing like scrubbing the record

01:08:13.740 afterwards so she tweeted at one point quote seems like they may not want to admit the u.s

01:08:19.180 measles elimination status is gone until after the midterms nice on trump's tylenol warning she

01:08:26.780 posted quote as a mom of three kids i don't love a man telling me to tough it out when it comes to

01:08:31.220 pregnancy wow this is the bar is in hell portion right yeah but also like not a lot of people are

01:08:37.920 exceeding the bar right so far the reactions have been much less alarmed than last time

01:08:45.420 the reactions from people who sort of reacted to casey means the first time around including

01:08:50.660 past surgeons general those responses have been essentially like this is a qualified nominee

01:08:56.740 with an active medical license it all feels like not that it was but it all feels like a strategy 0.98

01:09:02.880 they're like we're gonna nominate the two worst fucking people alive and then when we get to the 0.99

01:09:06.060 third nominee who's also trash everyone's gonna be like whatever folks have been worn down so hard 0.99

01:09:12.200 i'm sleepy dr sapphire hasn't faced confirmation hearings yet there is one thing that may become 0.89

01:09:18.540 an issue in her hearings. She has a supplement brand called DropRx. It's called DropRx because

01:09:27.680 it is herbal tinctures, like liquid tinctures in eyedropper bottles. In true supplement biz form,

01:09:35.160 their supplements are named things like Boost, Relief, Allure, Sleep, and Intimacy.

01:09:42.820 Taste test episode incoming.

01:09:44.240 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 and Levels. 0.97

01:10:03.500 problem number two is that their supplements include kava which the usda and fda warn is

01:10:10.500 associated with significant liver damage and which is regulated differently in different states

01:10:15.980 cheap champagne what is kava it is a root that is supposed to sort of promote like a sense of calm

01:10:22.380 and in some states you can use it in supplements in some states you can serve it in the cafe in

01:10:30.020 some states it's like banned completely but the usda and fda have already issued warnings

01:10:35.800 about it so it's just real weird to have a surgeon general who is selling a product that

01:10:42.340 runs counter to public health guidance from other agencies right do you know how easy it is to find 0.96

01:10:48.320 a practicing doctor who isn't a fucking grifter it's crazy they can't find a single one they're 0.93

01:10:54.020 all tree hugging marxists mike for now she appears to be much more in the vein of dr neshwat than 0.98

01:11:02.760 means right and that honestly feels like a pretty grounded win right to have someone who is not

01:11:11.120 who's like grifting from one angle but not like seven that's as good as it gets in america in 0.97

01:11:17.960 2026 right now she's only one kind of grifter count your blessings she's only selling herbal 1.00

01:11:24.340 tinctures i know she's a mono grifter that's the best we can do at the start of this episode i

01:11:31.380 started by saying that the research made me feel like less despairing here's why one this is a

01:11:38.760 place where the trump administration is failing they are not getting their nominees confirmed

01:11:43.140 Yeah. This is also true of other Trump nominees, too. According to Brookings, the average

01:11:48.280 confirmation delay for Trump nominees has doubled from his first term to his second.

01:11:54.340 Although in fairness, they are twice as bad this time.

01:11:56.820 They are pretty bad. From a harm reduction standpoint, I genuinely think it's more

01:12:01.280 helpful to have no Surgeon General rather than one of these ultra gremlins. 1.00

01:12:05.640 And at the win that Casey Means didn't get through because she's a complete nutcase.

01:12:08.540 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 right now, which means that, again, Republicans who are already pushing back on this committee are going to be incentivized to push back more.

01:12:27.460 Yeah.

01:12:27.700 You know, good news is few and far between at the moment.

01:12:30.880 This is like a very, very, very low bar to meet.

01:12:35.120 Yeah.

01:12:35.340 But I think we've got to accept the good news we get with arms wide open.

01:12:39.940 Yeah, I know you're going to go back to that.

01:12:43.420 One of us is going to do it.

01:13:05.340 Thank you.

Maintenance Phase - July 27, 2026

Why Don't We Have a Surgeon General？

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