Why Don't We Have a Surgeon General?

Introduction

0:00okay i actually i actually have one i'm on fire he came prepared maybe welcome to maintenance phase the podcast that has nothing to say about the surgeon specific but a lot to say about the surgeon general hey i like that one so much i'm michael hobbs i'm aubrey gordon if you

0:32would like to support the show you can do that at patreon.com maintenance phase you can also subscribe on apple podcast premium it's the same audio content michael aubrey we are a year and a

Surgeon General Nomination

0:46half into donald trump's second term and we still don't have a surgeon general i have not been following this at all you and most people there's been so much shock and awe in so many places that it's like hard to keep track we're all sort of like drinking from a fire hose in terms of the news cycles right i know whenever i hear about like an out of work fox news host i'm like yeah they're probably the surgeon general now who fucking cares today we're gonna talk about the three sort of maha aligned doctors who have been nominated for surgeon general which they're all doctors that's

1:17actually kind of surprising well hang on okay let's not get too crazy i thought it was gonna be like oma rosa or somebody we haven't done like a real maha update in a minute because it's so often just like a soul-sucking slog of a thing yes i would just like to preface this one by saying it's pretty fun good i want like real housewives shit the surgeon general is often referred to as america's top doctor their role is in part focused on translating scientific findings into guidance for members of

1:52the public so this is like a very maintenance phase role he knows when you've been sleeping he knows when you're not getting enough beef tallow the surgeon general can issue reports and recommendations but it the office doesn't have the authority to create policy it's actually kind of funny we have this role because it is just like a guy who says stuff in chief it is kind of well except there is a very functional part of the role the surgeon general leads over 6 000 uniformed officers in the u.s public health service so it's a role where it's like really helpful to be both

2:26a seasoned health care provider and a really strong clear communicator don't start laughing yet foreshadowing foreshadowing okay the process for becoming the surgeon general is that the president nominates someone to become the surgeon general the senate confirms that person and then they serve a four-year term the nominee has to pass through the health education labor and pensions committee the help committee which is currently split with 12 republicans and 11 democrats so it's republican

3:00controlled but only just it is also a committee where lisa murkowski and susan collins are both on the committee so you got a couple of real mavericks pieces of work couple of mavericks so today we're going to talk about the three nominees for surgeon general and why their nominations haven't been a cinch even in a republican controlled senate in a republican controlled committee okay so in

Neshwat's Background

3:28november of 2024 after he was elected to his second term donald trump nominated janette neshwat okay to be surgeon general his statement on dr neshwat's nomination describes her as quote a proud graduate of the university of arkansas school for medical sciences at the time of her nomination she was serving as the medical director for city md in new york which is a chain of urgent care clinics

3:59first red flag she is one of five children in her family and she is not the only one with ties to the trump administration her sister julia was a homeland security advisor under the first trump administration julia's husband so janette's brother-in-law is the current ambassador u.s ambassador to the un he also represented florida as a member of the u.s house from 2019 to 2025 his name is mike

4:32waltz is that a name that rings a bell no well michael he's the guy who added a journalist to a signal chat about war play out oh okay okay he's the specific guy who is like clearly added this journalist to the group chat and then was like i don't know how it happened it just got sucked in there you know how sometimes when you add an app to your phone and it just sucks up all your content it just got kind of sucked up in there so it just got added this journalist got it i'm a bit of an offset expert myself yeah so that's uh one of her siblings another of her siblings is her sister

5:08jacqueline who is a model and a former pageant winner um who was miss new york usa 2004 and miss florida america 2008 nothing wrong with that but the fact that there's so many of these people in donald trump's orbit is so fucking bizarre today she is the executive director of her husband's foundation which is dedicated to quote helping underprivileged children around the world that foundation is called the with arms wide open foundation is it named after the creed song her

5:43husband is scott stapp no fucking way we could have had a surgeon general who has thanksgiving with scott stapp from creed what just do scott stapp fuck it it scans so hard with the administration that could only get three doors down to play at the inauguration but also what a fucking stinging indictment that they couldn't get creed no i know he's right there also i love that the administration like finds people like the surgeon general the way that at

6:15my tiny underfunded ngo we used to find like graphic designers for pdfs we'd be like hey uh you went to college with somebody who like knows illustrator right yeah which like reach out to them oh god ours were more like do you have an afternoon could you figure out illustrator wait wait wait wait i have a thing i have a thing you have a creed thing wait we're not done with creed i don't know what was looking at this and he said i'll take a breath i'll take her by my side we stand in awe we've created life i have the lyrics for with arms wide open oh my god i don't know michael this is really counting on me to recognize the lyrics that you also don't know i'm like furiously googling i'm

6:53like i need a reference here but i don't know the lyrics to this song you're getting on a plane tomorrow and i'm now imagining that you're gonna spend the entire time like studying the creed i'll record a bunch of pickups to like throw it into the episode

Neshwat's Withdrawal

7:06dr neshwat had likely crossed trump's radar during her time as a tv guest doctor on fox news and the daily caller of course but just six months after she was nominated the day before her scheduled confirmation hearing trump withdrew her nomination okay cancel culture so the question here is what happened mike i would like actually for you to hazard a guess did she once say like a single

7:38boilerplate thing about how like diversity is what makes america great no and no and they're like no not after 2024 in april of 2025 an independent journalist named anthony clark breaks a story that he titles trump's surgeon general pick distorted key parts of her resume wait he just googled like me looking at creed lyrics yes he's just like type type type type nope he finds that dr neshwat didn't get her medical degree from the university of arkansas as she had claimed but had

8:10completed a residency there as an employee not a student okay so he checks around to figure out where she got her md from and where she went was the american university of the caribbean in saint martin oh which is a commercial business also it's probably like a distance learning thing or something oh mike you don't know how close you are that's like uh i got my degree from itunes you in 2011 the american university of the caribbean was bought by ad tolem global education which is

8:46previously no mike i haven't which was previously philip morris or something it's like a made-up name

Casey Means Nomination

8:51previously known as the devry education group oh uh it's her devry medical school because that's like betsy devos's whole like for-profit education thing right 100 dude scammers clark also reports as part of this piece that for-profit medical schools were banned in the u.s for over a century for concerns over admission standards quality of education needing new regulatory structures all kinds of stuff it's also funny because the only thing that offends them is like the lying if she had

9:25just said i have no medical qualifications it's not like the trump administration gives a shit right i'm so glad that you're like getting a handle on like the ways in which this episode is fun yeah it's just like a fucking clown car of dinguses it's also now kind of bleak that like city md didn't care or it met their standards they are also a for-profit business they're like game recognized game they're like yeah totally they're like oh you guys too cool yeah so on top of all that on our website dr neshwat says that she has a specialty in family and er medicine okay but

9:58she's only board certified in family medicine not emergency medicine that's such a weird thing to lie about it's so weird but also she works at an urgent care clinic right i don't know about city md specifically but every time i've gone to an urgent care the person has been like damn you should see a doctor about this like right i'm like i fucking know they're like that'll be two hundred dollars please in addition clark was unable to verify neshwat's claim that she had worked in emergency

10:30rooms in arkansas okay so she is calling herself an emergency doc when she has worked for a for-profit urgent care clinic in like a management role which is just different right you must tell these lies and then i guess forget about it because if i had some glaring hole in my resume like a fat lie that i was telling and i was offered some like super prominent role where i would get a bunch of scrutiny i would just turn it down i'd be like no they will absolutely find this out i want to keep my like cushy little life she probably makes a couple million dollars a year so there's all of this

11:03bad press happening but there are also complaints from the right the maha crowd was saying that dr neshwat wasn't anti-vax enough yeah i was just gonna make a joke about that did they find out she's vaccinated very early on in the sort of onset of covid even before lockdowns she was doing some media with like fox news and that sort of thing being like hey here's what you got to do and it was like you gotta mask up it's probably airborne you gotta wash your hands real

11:33well you gotta blah blah like just giving like very basic information and as part of that at some she goes you know we'll need to develop a vaccine for this like it's like really not anything but she's also not committing to kind of unhinged maha requests like let's do a complete overhaul on the infant vaccine schedule it's so funny that they're mad at her for not preemptively criticizing vaccines like before they were even developed she should have been out here saying like they're killing our kids

12:06even the even the idea of a vaccine they're against so her biggest detractor on the right is laura loomer oh yeah well who's probably the fucking surgeon general now why not for those who are unfamiliar laura loomer is an advisor to the president she is like a particularly unhinged presence even in a white house full of unhinged presences she was just like a twitter person right she's like a lady on twitter yes and kept getting banned from different social

12:38media platforms for like straight up hate speech and misinformation right yeah she's awful on may 5th 2025 loomer tweeted about dr neshwat calling her quote a pro covid vaccine nepo appointee well she's right about the second part she is she it's funny it's funny how they care about that sometimes they clearly don't give a shit about it's all nepo all the way down in this administration so i'm sending you a portion of a tweet from laura loomer oh man okay i'm not gonna yell but large sections of this are

13:13in all caps i think you should make it your own okay dr neshwat said vaccine hesitancy is a global health threat she used her access to fox news to promote the dangerous covid vaccine which is now killing millions of people she tried to shame people who didn't take the vaccine by calling them global health threats this is like sub literate vaccines are a matter of all caps personal health freedom vaccine hesitancy is a matter of personal freedom and liberty exclamation point it is not a global health threat my body my choice laura loomer saying my body my choice

13:48and meaning it about vaccines we've gotten used to it by now but this is like a person at a bus stop ranting and also they're like five years old well she capitalizes global health threat like it's the title of something in may of 2025 instead of being confirmed her nomination is pulled according to fox news in 2026 dr neshwat took a new job at walter reed like what even though they know her medical qualifications aren't real the only way that trump would like pull the nomination or the way

14:22that he did it i should say i don't know that it was the only way he'd do it but he was like uh we're actually gonna withdraw her nomination and put her somewhere else very important if he pulls the nomination then it's a tacit admission that he's giving into criticism or that he got something wrong which he would never do so he's like oh we actually found a better role for you somewhere else yeah that better role is at walter reed working on treatment of havana syndrome wait what are they havana syndrome truthers the administration apparently she is i mean she's working on it now right weird yeah so for folks who are unfamiliar havana syndrome is described as like a sort of constellation of

14:59unexplained neurological symptoms it often includes hearing really loud noises that others may or may not be able to hear it is hotly debated yeah some people think it is a mass psychogenic illness others think it is the result of like chemical warfare from foreign actors but man oh man they really like sent her to the hinterlands yeah go to walter reed a place that sounds very important and is very important and then work on havana syndrome it's also like lie about your qualifications get ready

15:32for a different job in this administration fail upwards yeah exactly you were a man i know the patricia principle yes it's very inspiring so we went pretty quickly through dr neshwat because it's such a cut and dry story right the second nominee was a real like hold my beer situation okay

Means' Background

15:52it's time for nominee number two casey means oh yeah yeah yeah mike what have you heard about casey means just that she's like neshwat but like 50 times more deranged yeah it's funny that her nomination was pulled essentially because she wasn't deranged enough they're like okay let's get you someone oh you want kooky yeah we got kooky for you baby yeah she is a graduate of stanford university both undergrad and medical school she runs a wellness startup called levels and she practices quote

16:27unquote functional medicine which is essentially like a rebrand of what in the 90s would have been called alternative medicine it's medicine but this time it's functional this time it's personal have you tried putting an onion in your sock and going to sleep very functional so she has kind of two origin stories coming into maha world the first is her residency after completing medical school at stanford casey means took on a five-year residency at oregon health and science university here in

16:59portland so she takes on this residency at ohsu specializing in head and neck surgery okay but as she moves through her residency she says she became disillusioned with a system that put so much pressure and strain on doctors a system that was always sort of intervening after things went wrong and not to like help them go right to begin with and in a system with such a pernicious profit motive whatever yeah so i got into a different part of medicine that also has a profit motive right selling mris to

17:35fucking celebrities her story is that she was in a state of great exhaustion and disillusionment and just six months shy of finishing her five-year residency she quit okay again she says this is like because she became so disillusioned with the system and we're actually gonna watch a little clip of her telling that story to tucker carlson okay yeah you know i'm in the operating room in my fifth year of

18:05my surgical residency and i'm looking down at a patient in front of me who's on our third revision sinus surgery and you know i know how to diagnose her i know how to write the prescriptions i know how to do the surgery but what i kind of realized in that moment was like i have no idea why this patient's actually sick she has so many other health issues pre-diabetes arthritis she's got some brain fog she's got obesity and she's got this sinus issue and in my training you know i was never ever ever taught to look at the whole patient to look at how all these things are connected and i was only taught how to you know do the surgery and then bill for it and i realized that there's a huge uh problem in

18:37how we're practicing medicine right now which is what we're ignoring the root causes of why americans are sick and we're profiting off of patients getting sick and then doing things to them that's the way the business model of health care works you know the most the way that health care which is the largest and fastest growing industry in the united states makes money is you have more patients in the system having more things done to them for longer periods of time and when i kind of put some of these pieces together and realized that my training had totally essentially incapacitated me from really understanding why patients are sick and and how to actually help them thrive i actually had to walk away

19:10from the surgical world because i realized that i was going to be making money off of essentially uh not spending time helping patients understand their health and actually just profiting off their illness so nine years into medical training at stanford yeah you gave it up voluntarily i on my birthday 30th birthday i walked into the office of my of the chair of the department and i put down the scalpel and i i walked away and i devoted my life to why are americans getting sicker every year why are 50 percent of american children dealing with a chronic health issue this was less than one percent

19:4450 years ago this frustrates the shit out of me yeah tell me obviously there's like some kernel of like a reasonable critique of the medical system in here obviously but the problem with this whole like root causes analysis is it's not clear how you would operationalize this any medical system even if you do address the quote-unquote root causes you still have doctors who deal with patients in like an acute way a head and neck surgeon wouldn't be addressing things like diet and lifestyle to prevent that in the first place obviously we need to do more preventative medicine but you're still going

20:17to have people who need surgeries right and like if you are aiming at as she is a structural critique then you also need to have a structural solution yeah exactly she doesn't fucking have that there's a weird kind of judgment behind this she's like i had this fat and sick patient and they wanted me to do surgery on her without exploring why she's fat and sick do you think that fat people who have a i don't know a car accident or some sort of accident or some sort of condition don't deserve surgery i'm so sorry i've become hopelessly distracted by the tucker carlson store merch that is advertised

20:51underneath the video clip wait really in the clip that i just sent you underneath the description it says shop the tucker carlson store they have mugs that say apac an offer you can't refuse what and hats that say neocons are gay for war how much did they cost did i get one part of the reason i got so distracted is i was like i don't know what this means yes you do i do you

21:25love it i know what it means if it's coming from me or you i don't know what it means when it's coming from tucker i can hear you clicking by like typing in your address to get it shipped to you take my money tucker carl yeah yeah yeah oh no woo so that is one of casey means origin stories right is her

Means' Origin Story

21:51sort of one okay that's one of the two that we're going to talk about the second comes a few years later oh god i gotta get the giggles out because this is a sad one you're okay okay i'm do you want me to recite some creed lyrics to you would that help no i have those in front of me still i'm gonna close the tucker carlson link so i'm not staring at the neocons are gay for war hat okay sorry i apologize for what my brain just did all right rough transition get us there so casey means second origin story comes a few years later with the sudden death of her mother okay in january of 2021

22:29her mother got the shocking news that she had stage 4 pancreatic cancer okay and that her prognosis was not good according to casey doctors pressured her mom to get risky surgery that would only extend her life by a matter of months and because of covid protocols at the time that recovery time would happen in quarantine right so they wouldn't be right she would have the surgery she'd have this long recovery time she wouldn't be able to see her family and they had already said she had like a

23:03short timeline okay as you and i both know this is sort of part and parcel of having a family member who has a terminal illness right yeah is that you have these like terrible choices to make where you're like oh nothing's a win cool and on some level that is a i think fair critique of the medical system that it is split into these like little specialties and like you know my father recently died of cancer and the same thing kind of happened to him that he was given all these weird treatments that had miserable side effects yeah and he would sometimes say like uh this actually isn't like worth it for

23:35me and his doctors like he got in kind of like fights with his doctors about it they'd be like well you need this and like the minute he switched to palliative care he got like a way better bedside manner yeah there's a long time of kind of like fighting with doctors about this kind of thing and they weren't always totally transparent with like how much benefit is this actually going to give me totally it's like a fair critique of the medical system and it's also like a it's like a horrible experience yeah and your emotions are in a place where like like i definitely needed to like fact check and ground myself a couple of times and be like yeah yeah yeah hey did did i have a fight

24:08with this person or uh did they just say something that reminded me of a terrible way that i already feel exactly i actually wonder i mean it's at least plausible that the doctor sort of presented the options to her there is the surgery it's risky it's not going to prolong your life that much but it's an option yeah people were really nice to my dad when he's like oh i'd prefer to go on palliative care they're like okay that's a choice that you can make yep he could still say no thanks and move on to something else my uh family member who passed of cancer recently was very clear about what

24:39he wanted in his treatment and what he did not want and there was like i think a lot of that from doctors being like all right well you're making your choice got it yeah yeah clearly it's not the thing i would recommend but like this is your life and your choice you don't want to gaslight them about their experience but she's just such an unreliable narrator right that it's like okay what was actually happening with this interaction so i just sent you a quote this is an excerpt from her book okay good energy my mom made it clear to the oncologist that she was not afraid of her

25:12rapidly impending death but she wanted to minimize unnecessary pain or nausea in her final days despite being clear the system pushed the exact procedures that would yield pain and nausea and aggressively shamed our family for questioning the full court press approach the doctor was not consciously trying to recommend a suboptimal procedure but i knew the invasive route would generate hundreds of thousands of dollars for the hospital and this doctor's pay was tied to booking these procedures the profit motive thing is also true i think it affects your psychology in ways that are probably invisible to you sure but again she's just like an unreliable narrator and it's she's doing i would say a similar thing to what she was doing on tucker carlson which is

25:47she's going from this intense personal experience straight to this sort of like i'm not saying i'm just saying yeah yeah right and it is designed to cast aspersions on the field right right and on treatment recommendations that are being given to people who are in life and death scenarios right what she's doing here is sort of using like a very emotional personal experience which again

26:17both you and i have been through in different ways right she is using that to kind of shake the foundation and go what if the whole thing is right exactly because it's also totally plausible that her doctor was just a huge fucking asshole right and so maybe you had a really bad experience with this like complete prick that's absolutely plausible but she is making it a bigger argument about the medical system and for-profit health care etc etc which again you'd have to sort of marshal different

26:49kinds of evidence to support yeah and also if this was your issue you would actually move us toward like a universal health care system where the doctors just get paid salaries which is actually what they have in many countries that would be the thing that you would then start pushing toward you wouldn't then leave the system and start selling people other shit for profit that's just what destroys her entire credibility to me her functional medicine clinic is in the pearl district in portland pearl district parentheses derogatory yes yes michael so when i was growing up the pearl

27:24was uh like a predominantly industrial area there were um significant numbers of homeless folks and when i was in like maybe middle school or high school uh it started getting gentrified to the fucking max yeah so now those industrial buildings are overwhelmingly like luxury condos and lofts she's like the medical system is kind of a grift and i want to get in on that grift it feels very telling that you go to the wealthiest exactly yeah right when my dad was a teacher at dental school he also had a systemic

27:57critique because these profit motives were starting to take over dentistry at the time and he started volunteering at a homeless shelter to do dentistry on homeless people there's like other things that you can do that's right other than this you know casey means is a really interesting mix of sort of like crunchy granola maha style stuff and really dyed in the wool conservative pedigree

Means' Family Ties

28:21in order to understand that conservative pedigree we have to talk about the other two sort of surviving members of her immediate family both of whom are high profile conservatives the first of those is her father grady means who was a long time republican operative in dc okay he worked for nixon and after nixon's resignation for vice president nelson rockefeller during the ford administration

28:51during the ford administration he worked on the food and nutrition task force which sought among other things to dramatically scale back food stamps there's that systemic critique baby right the like food is medicine ladies dad is the reason that fewer people have the medicine food that she wants everyone to have right people have too much food grady also worked as a consultant before selling off the consulting wing of his firm for 3.5 billion dollars in 2002 billion so that's her dad grady

29:26means um she also has a brother named callie means which the description on this tucker carlson youtube video tells me has also been interviewed by tucker carlson yes correct yeah so they have become a little bit of like a package deal they're sort of like one-two punch in maha world and they co-authored their book together oh okay callie means went to stanford undergrad and went to harvard for his mba he interned both for the george w bush white house and for the heritage foundation nice he worked on the

30:03mccain campaign reportedly as part of the quote-unquote pit crew that was working to improve sarah palin's reputation okay he did that debate prep he's furious he's sending her links to schoolhouse rock he describes himself as a former never trumper who became one of rfk juniors advisors after that appearance on tucker carlson callie means is an entrepreneur who founded a company called true

30:33med which helps people apply for hsa coverage of like peloton bikes and infrared saunas oh wait really he's trying to get people reimbursed for like alternative medicines yep so health savings accounts hsas are tax-free accounts you essentially are allowed to set aside money that you're going to spend on health care not be taxed on that money and spend that money tax-free yeah functionally um there's been a bunch of research into this it really just ends up benefiting rich people who want to pay less

31:07in taxes for their luxury health and fitness purchases right right true med allows people to log on to their website fill out a quick survey and get delivered a letter of medical necessity that allows their purchase to be covered by hsa okay in exchange true med takes a cut of the sales oh okay okay that's scammy so they've been used for like red light therapy devices including the like skincare red

31:38light masks they've been used for supplements for smart mattresses sure vanity fair did an incredible deep dive piece into cali means i strongly recommend it and as part of that they got their hands on some early true med marketing materials which at its outset focused on rebranding companies like sweet green and daily harvest as health care yes my daily salad is actually a prescription my dad did cut food stamps

32:12but but now my work lunch is health care oh so the mean siblings both have very close ties with the sweet green guy the daily harvest get like all of these people are people that they know and work with very frequently yeah through the quote-unquote end chronic disease coalition how do i know that's a scam right right any other time in history you're like oh and in chronic disease that sounds good but it's like

32:42nope my brain is too broken from doing this show the coalition is mostly they're advocating for something called the hope act the health out of pocket expense act which would expand eligible uses for hsa dollars and the end chronic disease coalition which rfk jr and like other folks on the right will like tout oh like oh my god cali means work with this incredible coalition yeah the coalition is largely made up of companies whose products would be covered under those proposed expanded rules so it sounds like nice

33:15like oh we're expanding the hsa but it's actually just like you're gonna get profits out of this basically and the name of the coalition is end chronic disease like oh my god this guy is so dedicated to ending chronic disease no he's fucking not he's dedicated to selling his buddies like food and then taking a cut of those sales yeah yeah yeah so michael are you ready for cali means origin story oh yeah give it to me cali means says that he was a lobbyist for big food and big pharma okay and that he saw firsthand the

33:50kind of corruption at play there on one podcast he claimed among other things that he brokered a deal between the american diabetes association and coca-cola what that it's like hush money to like stop opposing us in public or whatever and i was just like dude what are we doing so he's doing it like confessions of an assassin kind of thing where he's like oh i brokered these evil deals yes confessions of a lobbyist yeah on tucker carlson's podcast he claims to have attended a meeting where food

34:21corporations were quote paying off nutrition researchers at harvard and stanford and he alleged on twitter that in his time as a lobbyist for food corporations that coca-cola gave quote unquote millions to the naacp and the hispanic federation in exchange for publicly calling any policies hindering soda sales as racist okay describing the whole thing as quote unquote depressingly

34:51transactional those seem like easily verifiable claims but whatever so vanity fair in this deep dive piece fact-checked him and his story simply did not check out yeah of course not they interviewed more than 60 people who had worked with cali means nine of his former colleagues from pr world from mercury and edelman disputed his version of events okay where cali means claimed that he had been a quote-unquote director at mercury brokering these high-level deals his colleague said he was an

35:27executive assistant who wouldn't have even been in the room for the deals that he said executive assistant is hella funny it's as removed as you could be from like the halls of power that you're talking about they're like hey can you grab us a cup of coffee he's like i was in the room the room where it happens that's right yeah not only do they dispute the roles that he held they also dispute that they the companies represented the clients that he claimed nice so in the three years that cali

35:57means worked at mercury they didn't represent coca-cola nor did they represent the american beverage association mercury which is where cali means was working was working the other side of the issue they were campaigning to reduce soda consumption and their client was the california endowment it's funny because he could have just said i was on the ground working to reduce the influence of big food like i was advocating against soda companies he could have just said that but instead he's like creating this weird narrative right it's it's a really strange thing to sort of

36:30manufacture a heel turn that you don't appear to have had right the vanity fair piece also uncovered some real gems about cali means as a co-worker i just sent you a quote it says at the office several colleagues recall his air of self-importance he seemed to have bigger and better plans ahead which didn't include them he walked around the office saying cali means business wait cali means business he walked around the office saying cali means business another former colleague

37:00recounts that's like his cute little it's almost like a bumper sticker phrase for like when he runs for congress totally cali means i just want you to imagine an executive assistant dude who is trying to get four or something who's like trying to get into every strategy conversation yeah yeah is acting like they're better than everybody around them at like a pretty high-powered firm where they are very junior yeah and they're walking around just muttering cali means business to themselves like

37:33what a fucking dork a real pearl district resident is the way i is the way i think of him just the kind guy who live in the pearl district so that's grady means and cali means it felt important to lift up that casey means because she sounds kind of like portlandy maha crunchy granola e it felt really important to establish just how committed to extreme conservatism her family is i'm so curious how this nomination fell apart now because all of this so far sounds like everyone in the term administration

38:07would just love these people right and welcome them with arms wide open baby well michael when it comes to this story can i take you higher

Means' Nomination Fallout

38:21that's it that's all of my creed that's it we're done i know the title of two songs the end so back to casey means unlike her predecessor dr neshwat casey means basic cv checks out she did graduate from stanford undergrad in 2009 and from stanford school of medicine in 2014 she did go on to pursue her residency at ohsu it was a five-year program but she dropped out six months before

38:55completing it she did get a medical license but it has now been inactive for a couple of years she has offered two reasons for leaving her program one is that sort of state of american health care thing and the other is the stress and pressure of her surgical residency after leaving her residency she opens her functional medicine practice called means health in 2019 the same year that she opened

39:26her functional medicine practice she also co-founded levels a health tech company that sells continuous glucose monitors and lab testing services okay as well as quote-unquote ai insights there it is there it is a full membership to levels for a year including glucometers costs about 1500 per year i'm so against profit medicine the problem with medicine is all of the profit that's why i charge you 1500 that's why it's like a hundred more than a hundred fucking dollars a month so she founds levels

40:00and her functional medicine clinic in 2019 and in 2020 covid hits casey means takes that as an opportunity of course and submits an lte to the journal metabolism clinical and experimental in it she argues that metabolic dysfunction is a core issue for covid 19 and that managing blood sugar in a data driven way was an essential intervention for covid oh so buy my buy my products so she submits this letter

40:34in april of 2020 by november of 2020 she had reportedly raised 12 million dollars in seed funding for levels okay by 2022 the company was reportedly valued at 300 million dollars oh wow okay it is then 2022 during callie and casey means appearance on the tucker carlson show that really establishes them in the right wing just asking questions circuit from there they both start doing the rounds showing up on joe

41:08rogan's show and a ton of like right wing podcasts right after the tucker carlson thing that really seems to like blow things wide open it's also reportedly where rfk jr comes across their work right all of that leads up to uh the release of callie and casey means book in 2024 which is called good energy the surprising connection between metabolism and limitless health how is it not called means tested they have so many puns at their disposal think of the possibilities lean means health care machines

41:45is great they're leaving grifts on the table in promotion of the book they publish an excerpt on the free press of course the excerpt on the website is titled i'm a doctor you shouldn't always trust us god the chapter in the book is titled trust yourself not your doctor this website loves laundering most far-right garbage but like through the mouths of experts who went to all of these like ivy and ivy adjacent institutions yeah like i read the whole book callie and casey means

42:21both say some very accurate reasonable criticisms of the u.s health care system they also write really compellingly about the shortcomings of the food system and the heartbreak of people needing to pay more money than they have just to stay healthy or stay alive and that's why we've joined the republican party which wants to make all of these things worse right so in talking about the importance of like eating whole foods and healthy fats rather than directly increasing access to those things through like snap or wick right they instead shift to this personal responsibility frame yeah yeah saying that

42:57like it's actually on you to make sure that you're eating very expensive ingredients she's an anti-seed oil lady so she's like she is yeah right like buy the oil that is like five or six times as much right they are totally silent on like how any of this would be possible for low-income families right and they're just of course as usual just inflating the ability of like a virtuous lifestyle to solve all of these issues like you did something wrong if you get one of these chronic conditions that's

43:28the ideology on the press tour for the book she becomes a real hot take factory she has said that quote many if not most covid19 deaths could be prevented with optimal metabolic health nice and called covid a quote darwinian moment for america oh what it was like a good way yeah like the least fit did not survive way just saying it they're out here just fucking saying it she also has some anti-vax

43:58positions that i think are dressed up to appear more moderate than they are in her newsletter she wrote quote there is growing evidence that the total burden of the current extreme and growing vaccine schedule is causing health declines in vulnerable children vulnerable we're really looking out for the vulnerable by giving them measles it's so important that they get measles she has said quote i think vaccine mandates are criminal i mean they are in the sense that we never fucking had them in america so whatever she said that in response to somebody on twitter giving her shit for

44:31not being anti-vax enough and she was like i have said innumerable public times i love that i love that um actually um actually i'm the most anti-vax uh i'm actually pretending when i say we need more research and stuff i'm actually super anti-vax don't worry about it michael aren't we having a good time with these you keep reminding me isn't this fun it's kind of fun i'm having fun this is like my parents on road trips as a kid this is fun right she has written quote when it comes to a question like raw milk i want to be free to form a relationship with a local farmer understand his integrity look

45:07him in the eyes pet his cow and then decide if i feel safe to drink the milk from his farm i want buying food to be a just constant fucking chore where i have to know every single thing and do all the work myself i would love that the way that you know if there is listeria in milk is a good hard look in the eye i want other people to have the freedom to fucking lie to my face about the health impact of their product she is also a proponent of both psilocybin and mdma she likes shrooms she likes molly why are all these people into fucking psychedelics it's so fascinating all they do is

45:41bitch about like prozac and stuff but they're like no no take these other drugs it's so weird yeah i mean i think there's like a rift right both within maha world and within republican world writ large where you have sort of older school republicans who are like drugs yeah and you have this sort of like newer wave of like red pill fucking assholes who are like drugs yeah yeah it becomes a liability because it exposes that rift which doesn't often get tested in like federal policy making right

46:13right so in addition to all of those hot takes sometimes her hot takes take the form of poetry okay for april fool's day she wrote a poem for her newsletter as she notes she got quote some help from ai i'm sending you four verses from a poem that has like 20 verse like there's so many so i just picked a few and she puts it in full in her newsletter the title of the poem is the devil's

46:45wellness plan i'm not i'm not reading this is way too much aubrey you're reading it michael you're reading it if i were the devil i'd ditch the disguise no pitchfork no flames just marketing lies i'd feed you poison call it a snack and label you elitist when you want your health back i'd bury research seal the locks then line you up for 73 shots doesn't rhyme i'd cancel critical thinking stop dissenters with bots then jab your kids without a second thought also doesn't really rhyme i'd break your trust in

47:17ancient ways and mock the moon and cycles phase i'd push the pill and dull women's flame till womanhood forgot its name i'd give boys man boobs through toxic food and call masculine strength aggressive and lewd i'd whisper you're too much too loud and shame men's fire as something rude there you go i miss creed aubrey can i can we go back to creed like he's a professional you can't expect her to be on his level that at least had like an okay like pentameter or whatever it was at least the correct

47:51number of syllables so good energy callie and casey means book came out in 2024 by may of 2025

Nicole Sapphire Nomination

48:00casey means was announced as the trump administration's nominee for surgeon general nice that is so far to get in such a short period of time the reactions to casey means nomination are swift and they are negative this means war so a number of former surgeons general come forward and are like absolutely fucking not jerome adams actually like writes an op-ed about it and is like hey part of your job as the head of the u.s public health service is um to weed out people who don't

48:34have license to practice and casey means does not have an active medical license oh right yeah there is uh criticism from maha folks who once again criticize her for not being anti-vax enough really even her uh-huh fucking hell once again queen gremlin laura loomer weighs in on twitter i just see you quote casey means said when she was looking for romance she would do shrooms talk to trees participate in full moon ceremonies and pray to inanimate objects with a spiritual medium

49:06so basically the new surgeon general is a total crackpot a shroom consumer and she talks to trees and doesn't even have an active medical license another failure by the geniuses who work for president trump on his non-existent vetting team i guess there isn't a single conservative doctor in america who doesn't have a history of being a marxist tree hugger this is bizarre casey means is like a complete nutcase they should love this lady the reactions to her nomination are so bad on twitter in

49:37particular that rfk jr rushes to her defense on the platform he says that maha is taking on powerful corporate players and that those companies quote will continue to pay bloggers and other social media influencers to weaponize innuendo to slander and vilify casey the same way they try to defame me and president trump the fights between these people are always just like the spider-man meme of people pointing to each other it's like vaguely different shades of lunatic it's like why they're mad at her

50:08i mean i think this is part of what makes me feel less despairing about this episode is that early on when rfk jr was uh nominated you and i talked about him and his priorities being on kind of a pretty direct collision course with the trump administration right that he's like i want to regulate corporations i want to ban all this advertising i want to blah blah blah and trump is the guy who's like let corporations do whatever the fuck they want right and that the maha coalition

50:39was like sort of like looking for a home and republicans offered them a home right but the rift and the sort of differences and disconnects are starting to show and part of the way that that's starting to show is in these kinds of like infighting moments and part of the ways that's starting to show is in having three nominees for surgeon general right and not having one still and also these the whole maha thing you can't have a stable coalition when it's built on the back of lies and misinformation

51:09because everyone is ultimately just making shit up and cherry picking you don't have like a referee or like an objective standard of facts to point to to adjudicate a dispute about like do shrooms work or are shrooms bad they don't give a shit about what actual science looks like so you can't really have like a good faith debate even within these coalitions right it's all power games right yeah so on top of all those negative reactions there's also this new wave of reporting about like who is this new surgeon general nominee and one of the things that they find in that reporting is that there are pretty significant gaps

51:44between how she describes her residency and how other people at her residency described her at her residency okay vanity fair interviewed uh the chair of the department where her residency took place who said that casey means found the job quote unquote too stressful that she quit in tears and that other residents had to quote cover for her and we're a small department and all the calls fall on them no way the funny thing is that's also a structural critique of the american medical system people are so overworked

52:17yeah but yeah it's also funny that she like makes it this like virtuous like i chose to leave thing two other residents who served with her in the same department at the same time said that she was very anxious and primarily like afraid of hurting patients has she tried to zinc has she tried taking for anxiety i think it just maybe it's her lifestyle so all of this leads up to casey means confirmation hearing which happened in february of this year her initial confirmation hearing was

52:48scheduled for october 2025 but it was postponed when she went into labor with her child so she got maternity leave basically something the administration is also decidedly against initially the confirmation hearing is scheduled for october it ends up taking place in february after her parental leave and in that time the conditions and the sort of political calculus here really change among other things the chair of the committee um where the confirmation hearing will happen the health committee

53:19is bill cassidy bill cassidy is in that intervening time defeated in his republican primary by a trump endorsed challenger to the right okay bill cassidy is now a lame duck with serious like flame duck potential but there's also a long-standing rift between senator cassidy and president trump dating back to at least 2021 when cassidy voted to convict trump of inciting a riot on january 6th okay he's a physician who did practice for a long time in a lot of situations right like say what you

53:57fucking will about bill cassidy i'm not gonna cape for any louisiana republicans at this point but he is an actual doctor who did actually practice who does actually have a medical license all of that does feel relevant here there's also a long history of republicans like kind of doing the right thing once they don't have an election to win anymore totally so like as i have told you i'm not a fan of congressional hearings yeah they feel like political theater they feel like they're not accomplishing anything they're definitely not fact finding missions like ever right i think that this

54:33confirmation hearing was pretty effective as political theater cool they had like a really clear good division of labor folks had drafted their questions in a really tight way and came in with like a pretty unified front across party lines bizarrely josh holly is like hey i need to talk to you about what i'm hearing from my constituents which is they're concerned about the health risks of ai data centers what i will say holly kind of softballs it and he's like well i'd invite you to give it some thought

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

55:34right his willingness to push back in that way i was like oh that's interesting it's weird yeah but he's not the only republican on the committee who has sort of more direct uh and sort of harder questions for her at one point um senator cassidy asked her if she believed that vaccines cause autism this is after the pam bondy hearings so it's clear that she's trying to like moderate her response and not be kooky and start yelling about like the dow yeah yeah so her response to cassidy's question about

56:07vaccines and autism is quote we have an autism crisis that is increasing this is devastating to many families and we do not know as a medical community what causes autism which i can see the anti-vaxxers being mad about that it's the one answer the like we don't actually know what causes autism is the one answer that is guaranteed to piss off everybody she should have just said they fucking cause autism and then like the anti-vaxxers would get on her side 10 toes down standing on business yeah yeah yeah

56:38so in that same hearing tim kane asks her about flu shots which is not a huge part of the anti-vax discourse right so i just sent you we're gonna watch a clip i apologize in advance for how infuriating this clip is to listen to in a news report on january 7 just a month or so ago secretary kennedy stated quote there is no evidence that the flu vaccine prevents serious disease or that it prevents

57:11hospitalization or deaths in children do you agree with that statement senator kane as i've said i'm i believe vaccines save lives and are an important part of it i'm not asking about the general i heard that testimony earlier but you're an md your qualifications have been much discussed earlier do you agree with the statement that there's no evidence that the flu vaccine prevents serious disease or that it prevents hospitalizations or death in children i have not

57:44personally seen that quote or that article i would want to review it before i decide on that okay i'm gonna i'm gonna set the quote aside i'll introduce for the record she's so bad at this an article cbs news rfk jr says it may be better if fewer children receive the flu vaccine dated january 7 2026 without objection do you believe that there is evidence that the flu vaccine prevents serious disease and prevents hospitalization or deaths in children i believe that all patients should talk to

58:14their doctor and so do i and that's not what i'm asking your qualifications have been much discussed there is a mountain of evidence about this do you believe that there's no evidence that there's the flu vaccine has efficacy in reducing serious injury or hospitalization i i i you could see the little hamster wheel in her brain this is an easy one doctor this is an easy one i support the cdc's guidance on the flu vaccine and i will always be working with the cdc asip and so you believe it

58:49it is an efficacious vaccine to reduce hospitalization and is or is not is you believe it is as i said i support the cdc's guidance on the flu let me just say do you think the flu vaccine reduces the risk of hospitalization or serious injury i've said you're a doctor i believe vaccines save lives a public health strategy the flu vaccine does it reduce the risk of injury or hospitalization at the population level uh i i certainly think that it does let me introduce for the record if i can mr

59:22chair cdc seasonal flu vaccine effectiveness studies dated may 30 2025 from the cdc that goes into this in some detail this is not a hard question i answered your question and yes after three minutes you acknowledge that at a population level i haven't seen that report i have not seen yeah but you know about the flu vaccine if i had a nickel for every time i was misquoted in the media i'd be a very wealthy woman i would like to understand what his comments i'm not i'm not asking you about the quote i'm asking you about something in your remit the effectiveness of the flu vaccine

59:52stunning he did eventually get her to admit it which is actually interesting that she did i think it's again an indicator of how bad she is at this yeah yeah part of what sinks her in this hearing is that she keeps trying to rely on these phrases like i believe vaccines save lives or right i uh support the cdc guidance she clearly also didn't know what the cdc guidance was because the cdc guidance is all like pre-rfk jr so most of it is still pretty pro-vaccine at this point it's all

1:00:22the doge guys being like asked to define what dei is and they're like it's whatever was in the eo yeah yeah yeah yeah another piece that becomes like a big challenge for casey means is her financial conflicts which are significant of course she owns and operates levels um her sort of medical equipment slash wellness startup but on top of that as we've mentioned she has a really strong presence on sub stack and instagram and social media sort of writ large and it becomes clear that

1:00:59she has failed to disclose many many financial relationships okay and in her newsletter on instagram on social media broadly she is frequently recommending products oh right and like not disclosing like those fdc regulations where you have to say like hashtag sponsored or whatever correct yeah those regulations those regulations about disclosing when something is an ad on social media came into effect after fire fest that's why we got those fucking things yeah and she's like doing a

1:01:34wellness fire fest of like not right disclosing the associated press investigated her disclosures and found that she had been taking big payments that she did not disclose publicly $59,000 from function health mark hyman's company oh yeah of course $12,000 from daily harvest $16,000 from fluorosophy a fiber supplement company that sounds like a fake word that she made up for one of her

1:02:06poems so that it rhymed $27,000 from energy bits okay algae supplement company wait what was the one we talked about on the bonus episode food cube or whatever is she getting cube bucks $500 from we natal prenatal vitamins oh that's pretty good actually and $130,000 from amazentis oh a supplement company also $200,000 from tati westbrook's hair vitamins yeah that's right bye sister uh-huh i will also say not for

1:02:42fucking nothing in her confirmation hearing one of the members of the committee is bernie sanders who questions her on stuff and mostly is like hey i agree we should ban junk food advertising hey good point on this thing uh yeah everyone's going out of their way to do this shit i know bernie sanders is like trying to sort of be like you know i disagree with the trump administration on a lot of stuff but i think you got some good points here yeah and then like posts a clip on social media and is like hey we had a real one this is a good conversation like i don't agree with her on everything but i

1:03:17this thing and people just like absolutely shredded him on it and was like you don't gotta hand it to her this is this is why these people make these disingenuous plausible sounding arguments is because they attract people who like want to give them credit and want to give them good faith but these people are not acting in good faith correct you cannot listen to what they say you have to look at what they fucking do correct what is she doing with her life there's no fucking way these people are like oh i just want to fix the diet of americans is that what rfk jr has spent the last 20 years of his life dedicated to no he's dedicated it to fucking getting kids infected with measles

1:03:50that's what they actually believe you have to ignore all this bullshit they are saying that as a fucking trap as bait to get people who do not care or do not know about their actual background to do exactly what bernie is doing 100 i was like this is uncharacteristically like anti-shrewd also for just a failed fucking candidate too it's really stunning like it's clear by this point that she's not gonna make it through so on april 30th of this year in a truth social post donald trump

1:04:23acknowledged that casey means didn't have the votes to being confirmed she will also be joining walter reed unsurprisingly trump blames bill cassidy the chair of the help committee yeah but also there appear to be holdouts that were um cassidy collins and murkowski were all like i don't know okay after the administration withdraws casey means nomination the political landscape starts to shift again new polls come out revealing that changing the vaccine schedule is hugely unpopular

1:04:59with voters yeah plus the anti-vax stuff has faced a large number of court challenges so it is costly and time consuming to defend against right so they're really testing like how much political capital the trump administration is willing to spend on maha priorities right and this is more of an rfk thing than a trump thing yes correct so we're seeing like how far is trump willing to go for rfk junior right and not as far as casey means is the answer yeah that's when they announce uh the newest third and

1:05:31newest current nominee nicole sapphire is her name she went to arizona state university for her undergrad for her md she's telling us out front she didn't go to med school in the u.s okay she went to ross university in barbados is that like a for-profit scam factory uh it doesn't appear to be i didn't look into ross university to a great degree because i was like they're not going to do that again right but maybe who knows she is currently a radiologist at the sloan kettering cancer center a licensed doctor

1:06:03her career as a public figure is a very maha like gotta catch them all kind of thing she has a podcast she has a supplement company she's a fox news contributor great she's written three books love mom inspiring stories celebrating motherhood okay make america healthy again how bad behavior and big government caused a trillion dollar crisis yeah big government's definitely the problem she also published that before rfk jr was using maha oh wait really uh-huh she tried to trademark it which

1:06:40is very funny and then she sort of dropped it yeah she owes a podcast called wellness unmasked and she wrote another book called panic attack playing politics with the science in the fight against covid19 i could just like write that book from memory i could like sit down one million percent you already know lab leak whatever dr sapphire's positions on core maha issues are often presented in a way that seems a little more moderate than a casey means which like not hard to do i think a good

1:07:11example on that is her position on vaccines she like casey means is very strident in her vaccine save lives stance um but she has also said that the pediatric vaccine schedule should be quote unquote less stringent yeah there it is yeah and that she opposes vaccine mandates yeah she has also been publicly and directly critical of rfk jr's approach on vaccines really she's done that criticism in right of center media outlets it's fascinating okay she's a real mixed bag yeah most

1:07:43notably she wrote an op-ed in the wall street journal just last year called the madness in rfk jr's autism method woke queen she's i'm into it now comparatively i heard she said defund the police i don't think she did she has publicly criticized trump but those posts are now deleted so she's like been speaking her mind but then doing the trump nominee thing and like scrubbing the record afterwards so she tweeted at one point quote seems like they may not want to admit the u.s measles

1:08:19elimination status is gone until after the midterms nice on trump's tylenol warning she posted quote as a mom of three kids i don't love a man telling me to tough it out when it comes to pregnancy wow this is the bar is in hell portion right yeah but also like not a lot of people are exceeding the bar right so far the reactions have been much less alarmed than last time the reactions from people who sort of reacted to casey means the first time around including past surgeons general

1:08:52those responses have been essentially like this is a qualified nominee with an active medical license it all feels like not that it was but it all feels like a strategy they're like we're going to nominate the two worst fucking people alive and then when we get to the third nominee who's also trash everyone's gonna be like whatever folks have been worn down so hard i'm sleepy dr sapphire hasn't faced confirmation hearings yet there is one thing that may become an issue in her hearings she has a supplement brand called drop rx it's called drop rx because it is herbal tinctures like

1:09:29liquid tinctures in eyedropper bottles okay in true supplement biz form their supplements are named things like boost relief allure okay sleep and intimacy taste test episode incoming so there are two problems here one is uh 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

1:10:02means and levels problem number two is that their supplements include kava which the usda and fda warn is associated with significant liver damage and which is regulated differently in different states cheap champagne what is kava it is a root that is supposed to sort of promote like a sense of calm and in some states you can use it in supplements in some states you can serve it in the cafe in some states it's like banned completely but the usda and fda have already issued warnings about it so it's

1:10:37just real weird to have a surgeon general who is selling a product that runs counter to public health guidance from other agencies right do you know how easy it is to find a practicing doctor who isn't a fucking grifter it's crazy they can't find a single one they're all tree hugging marxists mike for now she appears to be much more in the vein of dr neshwat than these means right and that honestly feels like a pretty grounded win right to have someone who is not who's like grifting from

1:11:12one angle but not like seven that's as good as it gets in america in 2026 right now she's only one kind of grifter count your blessings she's only selling herbal tinctures i know she's a mono grifter that's the best we can do at the start of this episode i started by saying that the research made me feel like less despairing here's why one this is a place where the trump administration is failing they are not getting their nominees confirmed yeah this is also true of other trump nominees too

1:11:46according to brookings the average confirmation delay for trump nominees has doubled from his first term to his second although in fairness they are twice as bad this time they are pretty bad from a harm reduction standpoint i genuinely think it's more helpful to have no surgeon general rather than one of these ultra gremlins and at the wind that casey means didn't get through because she's a complete nutcase i think the last thing that makes me feel sort of like groundedly cautiously optimistic about all of this is that trump is immensely unpopular yeah right now which means that again

1:12:19republicans who are already pushing back on this committee are going to be incentivized to push back more yeah you know good news is few and far between at the moment this is like a very very very low bar to meet yeah but i think we've got to accept the good news we get with arms wide open yeah i know you're i think you're gonna go back to that one of us is gonna do it you you you

1:13:03you you you you you