The Nation’s Doctor Shouldn’t Be an Animatronic
On the absurdity of a non-doctor as America’s top doctor
My father was not everyone’s cup of tea.
He had zero capacity for social performance. Not a chameleon, not a people-pleaser, not even a little. If he thought you were a schmuck, he told you. If he disagreed, you knew it. This cost him—he collected haters the way some people collect compliments. But it also earned him something rarer: the respect of people who valued knowing exactly where they stood.
As a kid, I watched him in awe. It read as effortless cool. Pure authenticity with no performance tax.
I carry that with me professionally, even if I’ve added a layer of polish my Jewish-Tony-Soprano father couldn’t have computed.
I thought about him a lot while watching Casey Means’ Senate confirmation hearing last week.
What I watched was the precise opposite of that. It felt like a scene from Pleasantville. An animatronic figure cycling through pre-loaded responses. Forced smiles. Practiced pivots. Warmth arriving on cue and exiting the same way. She had recently had a baby, and senators congratulated her warmly. She leaned into the softness of the moment, as though it could insulate her from the sharpness of what she wasn’t saying.
Here’s what she said, in rotating order, regardless of the question: root causes. Real food. Informed consent. Have a conversation with your doctor. Rinse and repeat.
A wellness magic 8 ball.
Those phrases sound so good on their face. Who could argue with root causes? With real food? With informed consent? These are words that feel like medicine. But hollow phrases that land well are not a public health vision. They are a performance. Smoke and mirrors. When Sen. Cassidy pressed her (point-blank, more than once) to simply say she would encourage mothers to vaccinate their children against measles, during the worst measles outbreak in decades, one that has already killed two children and put us on the verge of losing our measles elimination status, she said parents need to “have a conversation with their pediatrician.” When he pressed again, she said she isn’t each American’s personal doctor.
Correct. She’s supposed to be something more than that.
Before we even get to the performance, there’s the resume. She graduated from Stanford Medical School, left her surgical residency early, and let her Oregon medical license go inactive in 2024, with no intention of reactivating it. The surgeon general leads nearly 6,000 uniformed officers in the U.S. Public Health Service Commissioned Corps, officers required to maintain active, unrestricted licenses. Former Surgeon General Jerome Adams, who served under Trump, put it plainly: it is incomprehensible that the Senate is considering a nominee who lacks any active license and has never practiced unsupervised. There is also a pending FTC complaint alleging that she failed to disclose financial relationships when promoting products to her followers—supplements, continuous glucose monitors, and wellness goods. And her past statements raise questions she never cleanly answered at the hearing: skepticism about the hepatitis B vaccine for newborns, opposition to hormonal birth control, promotion of psilocybin. For each, she hedged, walked back, or claimed her private views differ from her public health role. Which raises the obvious question: what does she actually believe?
But I keep coming back to one question. This country is full of extraordinary physicians -- clinicians who finished their training, maintained their licenses, treated patients through the full chaos of real medicine, and still care deeply about prevention, chronic disease, and the failures of our healthcare system. There is no shortage of people who believe in root causes AND vaccines. Who can talk about ultra-processed food AND recommend the MMR. So why her?
One uncomfortable answer is that her lack of clinical grounding isn’t a bug, it’s a feature. A practicing physician with actual accountability to patients and colleagues is harder to keep on message. Someone whose entire brand is built on distrust of the medical establishment, who has never had to defend a clinical decision in an exam room, may be precisely the kind of vessel this moment was looking for.
The deeper contradiction, though, is this. A significant portion of the American electorate voted for Donald Trump because he “says what he thinks” -- bluntly, without apology. The “tells it like it is” argument has been central to his appeal for a decade. The entire MAHA movement is premised on disrupting a system people feel has been lying to them. So how does that same coalition look at Casey Means, a person who cannot find a clear sentence on whether a measles vaccine is safe and effective, and see a truth-teller? She is the opposite of unfiltered. She is a highly managed brand in a confirmation hearing, incapable of plain speech on the most basic questions of her field.
The outpouring from physicians and scientists since the hearing has been striking; clinicians imploring people to call their senators, struggling to articulate what it means that this person is just a few votes away from leading the U.S. Public Health Service. These are not partisan operatives. These are working physicians and scientists who have spent careers earning public trust. They are watching the office of the nation’s top doctor potentially go to someone who checked none of those boxes, and who spent two hours in a Senate hearing saying everything and committing to nothing.
The surgeon general’s office exists to cut through noise, to be the authoritative, credible voice Americans turn to when they’re scared and confused. That authority is built on training, clinical experience, and the willingness to say hard, true things even when politically inconvenient. Every past surgeon general, regardless of party, understood that.
My father would have had a word for all of this. Several, actually. None of them printable here.
Where things stand: Means still lacks the votes for confirmation. Collins and Murkowski have told reporters they haven’t decided how they’ll vote. The committee must first advance her nomination before a full Senate floor vote. If she gets there, the Republican majority is expected to confirm her. Contact your Senator on the HELP Committee to make your voice heard.
Outlook not so good.
Stay Curious,
Unbiased Science
She is sooo unqualified. People do not just leave a surgical residency and then not keep an active medical license. When will our senators and reps wake up?
Dr. Steier, I would have liked your father. I don't like Casey Means. My Irish immigrant father would have called her a bullshit artist.