President Trump’s choice of Dr. Casey Means, a Los Angeles holistic medicine doctor and wellness influencer, as his nominee for surgeon general appears to mark another attempt to defy establishment medicine and longstanding federal policy.

Trump portrayed Means — a 37-year-old Stanford medical school graduate and author who describes herself on LinkedIn as a “former surgeon turned metabolic health evangelist” — in his announcement as fully in sync with Robert F. Kennedy Jr.’s mission to “Make America Healthy Again.”

“Casey has impeccable ‘MAHA’ credentials, and will work closely with our wonderful Secretary of Health and Human Services, Robert F. Kennedy, Jr., to ensure a successful implementation of our Agenda in order to reverse the Chronic Disease Epidemic, and ensure Great Health, in the future, for ALL Americans,” Trump said in a statement on Truth Social.

Some have raised questions about Means’ credentials. Although she graduated from medical school, she is not an active doctor licensed to practice medicine.

After graduating from Stanford, Means was nearly 4½ years into a five-year physician residency to be a head and neck surgeon at Oregon Health & Science University when she dropped out.

“During my training as a surgeon, I saw how broken and exploitative the healthcare system is and left to focus on how to keep people out of the operating room,” she says on her website.

Dr. Paul Flint, a former chair of Otolaryngology/Head and Neck Surgery at Oregon Health and Science University, said Means resigned from the residency because of anxiety.

After four years of training, Means came to him and Dr. Mark Wax, the residency program director, and said she wasn’t sure it was the right job for her.

“She wasn’t even sure she wanted to be in medicine,” Flint said. “She wanted to do something different. She wanted to resign.”

Flint and Wax urged Means to think about it more and offered her three months paid time off.

“She was under so much stress,” he said. “She did that, came back and decided she wanted to leave the program. She did not like that level of stress.”

Flint said Means was competent, a good resident. “But there was a lot of anxiety around this,” he said of the role of the surgeon. “You become much more responsible the more senior you get.”

Did he think Means would make an effective surgeon general?

“I don’t know,” Flint said. “Time will tell.”

According to public records from the Oregon Medical Board, Means’ medical postgraduate license was granted in 2014 and shifted to inactive status in 2019.

Some who know Means question whether she is completely aligned with Kennedy.

Robert Lustig, professor emeritus of pediatrics in the division of endocrinology at UC San Francisco, who is a friend of Means, told The Times he was shocked and surprised.

“What’s surprising to me is that she wanted the job, because she had difficulties adopting RFK’s full portfolio,” Lustig said, citing Kennedy’s controversial pronouncements on vaccines and fluoride in public water supplies. “She didn’t want to be part of the administration, in part because she couldn’t accede to those views. So what has changed is not clear.”

Means did not respond to requests for comment. Still, she attended a January confirmation hearing at the U.S. Capitol for Kennedy and celebrated in February when he was sworn in, saying on an X post that “his vision of the future aligns with what I want for my family, future children, and the world.”

Over the last year, she has raised public concerns about some vaccines. In August, she spoke out on X against CDC guidelines that all infants should receive a dose of hepatitis B vaccine at birth.

“There is growing evidence that the total burden of the current extreme and growing vaccine schedule is causing health declines in vulnerable children,” she wrote in an October newsletter, linking to a blog about vaccines and autism. “This needs to be investigated.”

“I have said innumerable times publicly I think vaccine mandates are criminal,” she said on X in November.

But when Lustig spoke to Means four weeks ago, he told The Times, Means had left her home in Pacific Palisades, worried about toxic air and water after the L.A.-area wildfires, and had moved to Hawaii. He said she wanted to start a family and did not express interest in working with Kennedy at the time.

“I know that her views are not his — that’s why she didn’t accept it earlier,” Lustig said. “If you’re an employee, you have to take the whole portfolio. You don’t get to choose parts of it, and she was uncomfortable.”

The president announced Means as his pick a day before his initial choice for the position, New York family physician and Fox News contributor Janette Nesheiwat, was scheduled to have a hearing with senators Thursday.

Trump has yet to explain why Nesheiwat was replaced as his nominee, but he said she would work at the Department of Health and Human Services in “another capacity.”

Asked by a reporter Thursday why he picked a nominee for surgeon general who never finished her residency and is not a practicing physician, Trump said: “Because Bobby thought she was fantastic. She’s a brilliant woman who went through Stanford. … I don’t know her.”

The U.S. surgeon general is known as “the nation’s doctor.” According to the Department of Health and Human Services, the role is to provide Americans with “the best advice on how to improve their health, by issuing advisories, reports and calls to action to offer the best available scientific information on crucial issues.”

Lustig said he had no doubt Means — whom he got to know by advising Levels Health, a digital metabolic health company she co-founded — would bring a different perspective to the U.S. government.

“Here’s the problem: We have an epidemic of chronic disease and there are no medicines that fix any of these diseases,” Lustig said. “They’re not fixable by drugs. They’re fixable by food. And the reason is because all of these diseases are mitochondrial diseases, and we don’t have drugs that get to the mitochondria.

“We have to change the food supply,” he added. “There is no option. Casey knows that. So as surgeon general, she would be able to make that case.”

In that sense, Lustig agreed with Trump, who said, “Dr. Casey Means has the potential to be one of the finest Surgeon Generals in United States History.”

“I think she’s a terrific person,” Lustig said. “She will bring a very different mindset to the office.”

But Lustig said he believed Kennedy was flat-out wrong on vaccines.

“I know why he’s wrong on vaccines,” he said. “I understand where his brain is, because I got a half-hour with him on the phone, one on one. But I cannot alter my integrity to match that — and I thought that Casey couldn’t either.”

Means is an unorthodox pick for a president famed for his diet of Big Macs and Diet Cokes.

Her website features pictures of broccoli and almonds. Her Instagram page shows bright bowls of tofu scrambles with heirloom tomatoes, avocado and beet sauerkraut.

Her newsletter recounts how, at the age of 35, after she moved to L.A., she embraced the “woo woo (aka, the mystery),” set up a meditation shrine in her home and sought relationship advice from trees.

Means was raised in Washington, D.C., the daughter of mildly religious, Republican parents. Her Californian-born father, Grady Means, a retired American business executive and government official, served in the White House as assistant to Vice President Nelson Rockefeller, led the Food and Nutrition Task Force to reform the food stamp program and provided oversight to the National Health Insurance Experiment.

Casey Means earned a bachelor’s degree in human biology with honors at Stanford and went on to graduate with a doctor of medicine degree in 2014. But Lustig said she dropped out of her residency in Oregon, disillusioned.

“The reason she quit was because she saw that the same patients were coming back with the same problems, and her mentors, the faculty at Stanford, when she would ask, ‘Why is this happening?’ would say, ‘Shut up and operate,’” Lustig said.

“She had a crisis of confidence that she was actually not helping the problem, or was actually part of the system that was actually making the problems.”

But that’s not how some people who knew Means when she was a resident surgeon in Oregon remember it.

“She didn’t mention metabolic health, she didn’t mention any of that,” said one person with whom she discussed her work regularly at that time and who declined to be named for fear of retaliation. “She was scared of accidentally hurting someone in surgery. She just didn’t want to mess up. She genuinely cared about her patients — she wanted them to be healthy and well — and I think her heart in that is genuine. But she was not talking about what she’s talking about now.”

Means’ recent rhetoric about the medical profession, they said, was disappointing.

“She’s claiming doctors are just trying to cut and make money, but she’s making money too,” they said. “Surgeons, they’re trained to be the last resort and actually help with solving after something’s gone wrong. If she wanted to help preventatively, she was in the wrong field, so I’m glad she went elsewhere. … But to be upset with a system that is trying to help when it does get down the line is very strange.”

In 2019, Means co-founded Levels Health, which works to “empower individuals to radically optimize their health and well-being by providing real-time continuous glucose biofeedback.”

Two years later, her break with establishment medicine became more intense — and more personal — when her mother was diagnosed with Stage 4 pancreatic cancer.

“What put her over the edge was when her mother passed away of pancreatic cancer, and it was missed,” Lustig said. “She had all the symptoms and signs of metabolic syndrome in her and none of her doctors addressed any of them.”

Means served as Levels Health’s chief medical officer until last year, when she and her brother, Calley, published a 400-page diet and self-help book titled “Good Energy: The Surprising Connection Between Metabolism and Limitless Health.”

In August, she catapulted to mainstream fame — particularly on the right — when Tucker Carlson featured her and her brother on his podcast for a show titled “How Big Pharma Keeps You Sick, and the Dark Truth About Ozempic and the Pill.”

“The system is rigged against the American patient to create diseases and then profit off of them,” Means told Carlson.

Over the last few months, Means and her brother, who now serves as a White House health advisor, made public appearances at “Make America Healthy Again” events.

In September, she addressed a U.S. Senate roundtable on chronic disease, listing all the things she didn’t learn in medical school: “For each additional serving of ultra-processed food we eat,” she said, “early mortality increases by 18%.”

Critics were quick to take to X to mock her statistics.

“I’ve easily had 1000 bags of chips in my life,” said Brad Stulberg, adjunct clinical assistant professor of health management and policy at the University of Michigan’s School of Health. “If this is true, it means my mortality risk has increased by 18,000 percent. That seems unlikely.”