Trump Withdraws Surgeon General Nominee Dr. Casey Means and Announces Replacement

On April 30, 2026, President Donald Trump pulled the surgeon general nomination of Dr. Casey Means, a Stanford-trained physician and wellness influencer who had become the public face of the Make America Healthy Again movement [1]. In her place, Trump named Dr. Nicole Saphier, a radiologist at Memorial Sloan Kettering Cancer Center and former Fox News medical contributor [2]. The switch marks the third time the administration has put forward a name for the nation's top public health communicator — and the second withdrawal — without a single confirmation hearing producing a favorable vote.

How the Nomination Collapsed

Means' path to confirmation was troubled from the start. She graduated from Stanford Medical School but did not complete her surgical residency in head and neck surgery, and she does not hold a current medical license [3]. Former Surgeon General Jerome Adams publicly questioned her qualifications, noting that the role has historically been filled by a licensed, practicing physician [4].

Her February 26, 2026, confirmation hearing before the Senate Health, Education, Labor, and Pensions (HELP) Committee crystallized the opposition. Committee Chairman Sen. Bill Cassidy (R-La.), himself a physician who specialized in liver disease, pressed Means on whether she would recommend the hepatitis B vaccine — a question she struggled to answer directly [5]. Her equivocation on routine childhood immunizations alarmed moderate Republicans.

By mid-April, the math was clear. Sens. Cassidy, Lisa Murkowski (R-Alaska), and Susan Collins (R-Maine) had all signaled they would not support the nomination [6]. "She didn't have the votes to pass," Cassidy told NBC News. "The White House has known for a while she didn't have the votes to pass" [1].

Trump, characteristically, blamed Cassidy rather than his nominee. In a social media post, Trump called the senator "very disloyal" and urged Louisiana voters to replace him [7].

A Pattern of Failed Nominations

Saphier is Trump's third pick for surgeon general in his second term. His first nominee, Dr. Janette Nesheiwat, another Fox News medical contributor, was withdrawn in May 2025 — one day before her scheduled confirmation hearing — after reports surfaced that she had misrepresented her medical education credentials. Nesheiwat's LinkedIn profile listed a medical degree from the University of Arkansas, when she actually received her degree from the American University of the Caribbean in St. Maarten [8].

The back-to-back failures are unusual. While presidential nominees for various offices are occasionally withdrawn, two consecutive surgeon general nominations pulled within a single term is without recent precedent. The surgeon general position, which carries the rank of vice admiral in the U.S. Public Health Service Commissioned Corps, has historically attracted less political controversy than Cabinet-level posts [2].

The Credentials Question

Critics of Means' nomination pointed to a thin clinical and research record. She has zero peer-reviewed publications indexed in PubMed on metabolic health — the subject she has built her public career around [9]. Jonathan Jarry of the McGill Office for Science and Society argued that "Means is not a metabolic health expert" and that "theories claiming to have found a single cause for all diseases never pan out" [9].

Means co-authored "Good Energy," a 2024 New York Times bestseller on metabolic health, with her brother Calley Means [10]. But reviewers noted the book, while not outright pseudoscience, involves "manipulation of data, emotional manipulation through identifying 'good' and 'bad' food lists/items, and ultimately attempting to drive people to purchase things she has a financial interest in" [9]. Means made at least $325,000 from supplement promotions since early 2024, including nearly $135,000 for a "longevity supplement" [9].

She also repeated a widely debunked claim — originally from FDA Commissioner Marty Makary — that medical error is the third leading cause of death in the United States, a figure experts have called "self-serving, irresponsible sensationalism" based on "incredible numbers borne out of unreliable calculations" [9].

Defenders, including RFK Jr. himself, described Means as "the most articulate, eloquent and erudite evangelist for the MAHA movement" who "wrote the bible on metabolic health" [10]. They argued that the surgeon general role is primarily a communications position and that Means' ability to reach mass audiences through social media and publishing was more relevant than traditional clinical credentials.

The MAHA Policy Agenda at Stake

The withdrawal is not just a personnel matter. It strikes at the heart of whether the Make America Healthy Again movement can translate its populist energy into federal policy.

The MAHA agenda, championed by HHS Secretary Robert F. Kennedy Jr., encompasses a broad set of goals: revamping agricultural subsidies, rethinking childhood vaccination schedules, banning marketing of ultra-processed foods to children, and reviewing food additives currently approved by the FDA [10]. Trump formalized some of these priorities through Executive Order 14212, signed February 13, 2025, which established the President's Make America Healthy Again Commission and mandated an assessment by May 24, 2025, of "the threat that potential over-utilization of certain food ingredients pose to children" [11].

But execution has lagged behind rhetoric. Kennedy has acknowledged that the FDA has no formal agreement with industry to phase out synthetic food dyes or any other ingredients, relying instead on voluntary compliance and public pressure [11]. No enforceable rulemaking or statutory changes have compelled industry to cease using targeted ingredients [11].

The surgeon general, while lacking regulatory authority, serves as the nation's chief health communicator — issuing advisories, publishing reports, and shaping public discourse on health priorities. A MAHA-aligned surgeon general would have amplified Kennedy's agenda through the office's bully pulpit. Without one, that amplification depends on Kennedy himself and FDA Commissioner Makary, both of whom face their own political headwinds [12].

The Food and Pharma Lobby Connection

The industries that stood to lose most under a MAHA-aligned surgeon general wield substantial influence over the senators who blocked Means' confirmation.

The pharmaceutical and health product industry spent $388 million on federal lobbying in 2023 alone, more than any other industry sector [13]. Over the 2023-2024 election cycle, more than two-thirds of Congress received campaign contributions from pharmaceutical PACs [14].

Source: OpenSecrets

Data as of Apr 30, 2026CSV

Sen. Cassidy, who chairs the HELP Committee that controls the surgeon general confirmation process, has received over $1 million in career donations from the pharmaceutical and health product industries, according to OpenSecrets data [15]. In the 2023-2024 cycle alone, he received $290,375 from pharmaceutical and health product interests [15]. Individual contributions have come from the CEOs of Pfizer ($5,800), Eli Lilly ($5,000), Bristol Myers Squibb ($2,900), and Biogen ($2,500) [16].

Source: OpenSecrets

Data as of Apr 30, 2026CSV

This does not prove that Cassidy's opposition to Means was driven by industry pressure — his stated objections focused on her vaccine views and clinical credentials, both legitimate concerns for a physician-senator. But the financial ties create the appearance of a conflict of interest that MAHA supporters have seized upon. A large food and agricultural industry coalition has also formed to oppose MAHA-aligned state food additive bans [11].

Who Is Nicole Saphier?

Trump's third nominee brings a markedly different profile. Saphier holds active medical licenses in New York, New Jersey, and Arizona [2]. She earned her medical degree from Ross University School of Medicine, completed a residency at Maricopa Integrated Health System, and a fellowship at the Mayo Clinic [2]. She currently serves as director of breast imaging at Memorial Sloan Kettering's Monmouth County facility [2].

Saphier authored the 2020 book "Make America Healthy Again" — a title that predated and later became the slogan for Kennedy's movement [17]. The book discusses chronic disease prevention through lifestyle factors including diet and exercise, themes that overlap with the MAHA agenda. Her 2021 book, "Panic Attack," criticizes pandemic-era shutdowns and school closures, views aligned with Kennedy and Dr. Jay Bhattacharya, the director of the National Institutes of Health [17].

However, Saphier has been openly critical of Kennedy on social media. When Trump promoted unproven ties between Tylenol, vaccines, and autism, Saphier publicly pushed back, noting that "untreated fever or severe pain can also pose serious risks to mothers and babies" [17]. She has also made a false claim that the CDC would imminently require all schoolchildren to receive COVID-19 vaccines [17].

Kennedy, for his part, endorsed Saphier warmly, calling her "a long-time warrior for the MAHA movement" whose experience with breast cancer patients would be "essential to putting prevention at the center of the country's health system" [18].

Can Saphier Get Confirmed?

The key question is whether Saphier can succeed where two predecessors failed. Her active medical licenses, clinical practice at a major cancer center, and Mayo Clinic training address the credentialing concerns that sank Means. But her Fox News background — she served as a contributor since 2018 — and her history of politically charged health commentary may attract different objections [2].

Cassidy has not yet publicly committed to supporting Saphier. The HELP Committee's schedule for a confirmation hearing has not been announced. And the broader political environment has grown more hostile to MAHA-aligned nominees as some Republican officials worry that Kennedy's vaccine skepticism could become a midterm election liability [12].

What Happens to MAHA Without a Surgeon General?

The Make America Healthy Again agenda is not entirely dependent on the surgeon general position, but the prolonged vacancy weakens its institutional foothold. Executive Order 14212 remains in effect, and Kennedy continues to lead the MAHA Commission from his position as HHS Secretary [11]. FDA Commissioner Makary has pledged to act on food additives and school meal reform [11].

But executive orders can be revoked, and voluntary industry compliance requires sustained political pressure. Significant layoffs and leadership departures across HHS, USDA, and related agencies have hollowed out the bureaucratic capacity to implement MAHA priorities [11]. Several MAHA policy goals — particularly around food additive regulation — have advanced more at the state level, where legislatures have passed binding bans that are more durable than federal executive action [11].

The surgeon general's office, meanwhile, sits empty for the foreseeable future — its bully pulpit silent on the chronic disease crisis that both Means and Saphier have identified as the central health challenge facing the country. Whether Saphier can thread the needle between MAHA's populist health message and the Senate's institutional expectations will determine whether that silence ends or extends deeper into Trump's second term.