A hearing to examine the nomination of Casey Means

The Senate Committee on Health, Education, Labor, and Pensions will please come to order. Hi, Dr. Means. You came in just as I walked away, so greetings. I'm sorry to have missed shaking your hands down there. Thanks for appearing before the committee and for your willingness to serve the people of the United States in this administration. And by the way, congratulations on your baby.

Thank you.

It gives you a great perspective on life, and I trust all is well. And for the dais on both sides, we will take a break at 11:00 to allow Dr. Means to care for her child. So just a 15-minute break at 11:00 for that. You'll be the nation's doctor. We've got some serious health problems in our country. High rates of mental health and substance use disorders, widespread chronic disease, reemergence of deadly outbreaks, which are preventable by safe, effective vaccines, but unfortunately, there's been a lot of promotion of vaccine skepticism. At the same time, many Americans have lost faith in public health leaders since the COVID-19 pandemic, and families can be confused by the whiplash of conflicting medical guidance. President Trump is committed to rebuilding trust in our health institutions and restoring radical transparency, and that should be how we protect children's health. If confirmed, Dr. Means, you'll have an important platform as the nation's doctor. Americans will look to you for clear medical guidance and direction to protect and promote families' health. Your writings express concern regarding chronic disease, and you speak to mothers and their families. The Surgeon General needs to be an effective and truthful communicator, a calming voice of reason, a steady hand of experience at a time when so many, for whatever reason, sow distrust and confusion. The Surgeon General must be someone who can execute on President Trump's commitment to restoring confidence in public health and to assure the American people that our institutions are making science-based decisions rooted in data that puts families' health first. This is especially important as HHS undergoes substantial personnel and policy changes. Dr. Means, it should be your mission and the mission of every HHS official to restore stability and assure Americans that protecting health is the top priority. I look forward to learning more about your public health priorities and views. With that, I recognize Senator Sanders.

Thank you, Mr. Chairman, and thank you, Dr. Means, for being here. Congratulations on your baby.

Thank you.

Today we are considering President Trump's nominee to be the next Surgeon General of the United States. The Surgeon General is considered the nation's doctor, a trusted leader who tells the American people the truth about science and medicine. Previous Surgeons General have warned the American people over the years about the dangers of smoking, drunk driving, loneliness, providing recommendations based on scientific evidence, not ideology. Dr. Means, you have made it clear to us that you believe it's time to, quote, "make America healthy again." That is a great slogan that I expect that everybody up here agrees with. In America today, we have a very unhealthy society, and there are a lot of reasons for that. The chairman mentioned some of them. But perhaps the most important reason is that we have a healthcare system that is broken, that is dysfunctional, and in fact is very cruel. In America today, we spend over $5 trillion a year on healthcare. Believe it or not, that is more than $15,000 for every man, woman, and child in our nation, twice as much per person of nearly any other major country. And yet, despite that huge expenditure, we remain the only major nation on earth that does not guarantee healthcare to all people as a human right. The result: over 85 million Americans are uninsured or underinsured, more than half a million Americans go bankrupt due to medically related debt, and 68,000 Americans die every year because they cannot afford to see a doctor. If anybody in the world thinks that that is a rational healthcare system, you live on another planet. In terms of life expectancy, we live four years shorter on average than people in other countries. As unacceptable as that is, if you are working class in this country, you can expect to die seven years earlier on average than if you're in the top one percent. Further, as bad as our overall healthcare system is, our primary healthcare system is even worse. Today, tens of millions of people live in a community where they cannot find a doctor, a dentist, or a psychologist, even when they have decent insurance, while others wait months to get seen. Yes, Mr. Chairman, we must make America healthy again. Unfortunately, the problem is that since coming into office, President Trump and Secretary Kennedy have done the exact opposite. As a result of massive cuts to Medicaid and the Affordable Care Act, 15 million people will be losing the healthcare they had. Studies suggest that when you throw 15 million Americans off of healthcare and make over a trillion dollars in cuts to Medicaid and the ACA, some 50,000 of our fellow Americans will die unnecessarily each and every year. Secretary Kennedy and the Trump administration continue to spread dangerous conspiracy theories about vaccines, making it harder for Americans to protect their children from deadly diseases. I am having a hard time understanding how any of this will make America healthy again. In my view, we need a Surgeon General who has the courage to take on President Trump and Secretary Kennedy and say no, it is wrong to throw 15 million off of healthcare, it's wrong to double premiums for 20 million more Americans, it's wrong to spread misinformation about vaccines. And that's just not me talking. That's precisely what six former Surgeons General, three Republicans and three Democrats who served under the Trump, Obama, George W. Bush, Clinton, and George H.W. Bush, have told us. In an op-ed they wrote in the Washington Post a few months ago, they said, quote, "The actions of Health and Human Services Secretary Robert Kennedy Jr. are endangering the health of the nation. He has rejected science, misled the public, and compromised the health of Americans," end quote. That is Republicans and Democratic former Surgeons General. So, Mr. Chairman, there is a lot to be discussed, but I have very serious questions about the ability of Dr. Means to be the kind of Surgeon General this country needs. Thank you very much.

Dr. Marshall will introduce the nominee.

Thank you, Mr. Chairman. I'm certainly humbled and honored today to introduce Dr. Casey Means. I want to thank you for joining us here this week. I'm especially glad we're able to hold this meeting, which was long overdue, but being in labor is one of the best excuses we've had to delay a hearing. So congratulations to your family. We hope baby boy Phoenix, 17 weeks old today, is doing great, and again, we appreciate you being here. As my colleagues have already said, today nearly eight in 10 adults, representing almost 200 million people in this country, live with at least one chronic disease: obesity, diabetes, heart disease, hypertension. Our children, our children, the pride of this nation, the situation is equally alarming. Approximately 20 percent of our youth are obese. One in three adolescents age 12 to 17 have pre-diabetes. One in three. And when it comes to our mental health, at least one in five American adults, 60 million people, experience some form of mental illness each year. Those are epidemic numbers. We need a Surgeon General, the nation's doctor, to guide us back to health, mobilizing science-based strategies to prevent disease, promote wellness, and address these epidemics head-on. The Surgeon General serves as our country's chief health educator, but more than an educator, a coach, a cheerleader, providing evidence-based guidance to improve health and respond to crisis while leading the U.S. Public Health Service Commissioned Corps and advising on key policies. Over the course of this process, I've truly enjoyed reading Dr. Means's books, her publications, and getting to know her and hearing her thoughtful vision for improving the health of Americans. Dr. Casey Means is uniquely qualified, a Stanford-trained physician who began surgical training at Oregon Health and Science University, where she excelled in clinical performance and patient care for underserved populations before leaving that traditional system. Like many of us, she was disillusioned by its focus on treating symptoms versus addressing the real causes. She left it to champion preventive metabolic health. She co-founded Levels Health, using innovative glucose monitoring to empower metabolic health insights, and authored the best-selling book "Good Energy," which I'd recommend everybody on this committee to read to better understand exactly who she is. She offered science-backed strategies to prevent chronic illnesses through lifestyle changes. Dr. Means brings a forward-thinking vision focused on prevention, innovation, and patient empowerment. She is a proven communicator. She's appeared on over 200 podcasts. She's a faculty course director at Stanford. She's been featured in articles in the Wall Street Journal, Forbes, New York Times. She inspires, educates on complex health issues. She's poised to shift us from reactive sick care to proactive healthcare, emphasizing metabolic health to truly make America healthy again. Her entrepreneurial spirit and clinical background will drive solutions prioritizing outcomes over bureaucracy, aligning with the Make America Healthy movement again. So that's my formal introduction from my heart. From my heart, go back to our childhood and in my childhood in the 1960s, everybody smoked. Everybody did. But a Surgeon General, Dr. Luther Terry under LBJ, had the courage to stand up and say smoking causes lung cancer. He wasn't able to finish the job. It was then under President Nixon that the next Surgeon General, Dr. Jesse Steinfeld, stepped forward and educated children, who then educated their parents on the hazards of smoking. Something that I see every day, my kids educating me on what good nutrition, healthy nutrition looks like. And then who can forget Surgeon General Dr. C. Everett Koop, who gave us moral and scientific clarity during the AIDS epidemic? And that's what I think Dr. Means can be. I think that she can move the needle. We do have a chronic health epidemic. No one can deny that. And like I said before, we need a Surgeon General who's more than an educator. We need a coach, we need a communicator, we need a cheerleader to address these chronic diseases, and I believe that Dr. Casey Means is the person for the job. Thank you, Chairman.

Thank you. Dr. Means.

Thank you. Good morning, Chairman Cassidy, Ranking Member Sanders, and members of the Senate HELP Committee. I want to thank President Trump for nominating me to serve as Surgeon General and for Secretary Kennedy for his support. Thank you for also being willing to postpone this hearing when I went into labor five hours before the hearing started in October. Our precious baby boy was born on the hearing day. As a physician, I have always been inspired that the root of the word healing means to return to wholeness. Nothing is more urgent than restoring wholeness for Americans: physically, mentally, and societally. We are now the most chronically ill high-income nation in the world. We live shorter, sicker lives than peer high-income nations. Today's children are projected to live shorter, sicker lives than their parents. We spend trillions annually on reactive sick care. Nearly 150 million Americans are on federal healthcare programs, and we spend $50 billion per year on research. Yet outcomes are worsening and disparities are widening. Our nation is angry, exhausted, and hurting from preventable diseases. Rates of high blood pressure, many cancers, autoimmune conditions, type 2 diabetes, mental health disorders, dementia, neurodevelopmental challenges, and youth suicide have all increased in the past two decades. This public health crisis is touching every American family. It is robbing our children of possibility, our workforce of productivity, and our nation of security. It strains our federal budget and dims hope for millions. We must confront this epidemic through a vision grounded in science, dignity, shared humanity, and a respect for freedom, not politicization and division. Public health leaders must address the evidence-based, modifiable drivers of chronic diseases, which include ultra-processed foods, industrial chemical exposure, lack of physical activity, chronic stress and loneliness, and over-medicalization. I've been asked to help our nation get healthy and answer the call of millions, especially mothers, who are begging for transparency and support. That is what I'm here to do. I believe that every American shares a core yearning to thrive and help their families thrive, but we are asking people to make healthy choices in environments that are squarely structured against them. Good policy and education can make health easier, more affordable, and more accessible. ...have shorter, sicker lives than peer high-income nations. Today's children are projected to live shorter, sicker lives than their parents. We spend trillions annually on reactive sick care. Nearly 150 million Americans are on federal healthcare programs and we spend $50 billion per year on research. Yet outcomes are worsening and disparities are widening. Our nation is angry, exhausted, and hurting from preventable diseases. Rates of high blood pressure, many cancers, autoimmune conditions, type 2 diabetes, mental health disorders, dementia, neurodevelopmental challenges, and youth suicide have all increased in the past two decades. This public health crisis is touching every American family. It is robbing our children of possibility, our workforce of productivity, and our nation of security. It strains our federal budget and dims hope for millions. We must confront this epidemic through a vision grounded in science, dignity, shared humanity, and a respect for freedom, not politicization and division. Public health leaders must address the evidence-based, modifiable drivers of chronic diseases, which include ultra-processed foods, industrial chemical exposure, lack of physical activity, chronic stress and loneliness, and over-medicalization. I've been asked to help our nation get healthy and answer the call of millions, especially mothers, who are begging for transparency and support. That is what I'm here to do. I believe that every American shares a core yearning to thrive and help their families thrive. But we are asking people to make healthy choices in environments that are squarely structured against them. Good policy and education can make health easier, more affordable, and more accessible. I know our current leaders at HHS and across the federal government are committed to the ambitious policies outlined in the MAHA strategy released last year that focuses on advancing research, aligning incentives, increasing public awareness, and fostering private sector collaboration to end the chronic disease epidemic. Specific efforts are already underway to fund and promote more whole healthy food for Americans, address financial conflicts of interest in our agencies, fund research focused on disease prevention and reversal, and make institutions accountable to measurable health outcomes for all Americans. President Trump and Secretary Kennedy have invited a mature, candid, grand conversation about how our medical education and fixing perverse incentives can pull us back from the brink, and for this I am profoundly grateful. My professional history has prepared me to meet these very complex times as an innovative, unifying, and practical leader focused on reversing chronic disease. Over the past 15 years, I have treated thousands of patients in clinics and operating rooms. I have run my own medical practice and co-founded a health technology company that empowers individuals with metabolic health data to address blood sugar dysregulation, a problem now affecting over 50 percent of American adults and 30 percent of teens. In this role, I recruited leading researchers from Yale, UCSF, Brigham Young University, Cleveland Clinic, and more to support this effort, and the company launched a 10,000-person participant academic industry research collaboration on early metabolic disease detection. I've held biomedical research positions at the National Institutes of Health, Stanford University, New York University, Oregon Health and Science University, and published this biomedical research in leading medical journals. I was recruited as a faculty course director at Stanford University where I taught undergraduate and graduate students on nutrition and health. I have served as an associate editor of an international medical journal focused on prevention and disease reversal. I have spoken internationally on chronic disease and wrote one of the most successful health books of the decade outlining a vision for reversing this epidemic through personal empowerment, culture change, and policy reform. I graduated from Stanford University with honors and from Stanford Medical School where I was inducted by unanimous faculty vote into the Honor Society for Patient Care. In conclusion, mental and physical health are unraveling from shared root causes that we can fix. Preventable heart disease, our number one killer in men and women, is emblematic of a nation with a broken heart. Diabetes, representing cellular energy collapse, is draining our human potential. Dementia, depression, and neurodevelopmental decline reflects a society losing its mind. Our bodies are telling us this current path is totally unsustainable. There is another way, a path that unites rigorous science with reverence for our miraculous bodies and planet and brings Americans and our medical institutions together around actual healing and prevention. This path is also economically sound with the potential to save trillions of dollars annually. As I sit here in the early months of motherhood, I feel profound awe at the privilege we have as adults to create a better world for future generations, and that is why I'm here. As Surgeon General, I would call on every American and the Public Health Service to join in a great national healing, one that halts preventable chronic disease, makes healthy living the easiest choice, honors the body's connection to the environment, and puts America back on the road towards wholeness and health. I look forward to answering your questions. Thank you.

Thank you, Dr. Means. I'll start. If confirmed, you'll be the nation's doctor, and to better understand your best medical opinion on various topics, I'll ask you some things that have been of concern to this committee. I have seven things to ask in five minutes, so please be tight. They won't be trick questions. Do you believe that the abortion pill, mifepristone, is safe and should be prescribed without an in-person visit with a physician?

Thank you so much, Senator Cassidy, for your question and also thank you so much for meeting with me virtually before the hearing and also to your staff for meeting. I think that every medication has risks and benefits. I think that all patients need to have a thorough conversation with their doctor and have true informed consent before taking any medication.

Should there be an in-person visit required?

The question of whether there should be an in-person visit is out of the purview of the Surgeon General's office, but I do believe that every patient needs to have a very thorough conversation with their doctor before taking any medication. Unfortunately, in our current healthcare system, because of how overburdened doctors are, this often doesn't happen whether it's in person or online.

Do you believe that birth control is safe, should be widely accessible, including perhaps without a prescription?

I absolutely think that oral contraception should be widely accessible. Just as I said with mifepristone, I believe that especially when it comes to oral contraceptives, we need to have patients having a conversation with their doctor about risks and benefits. Like all medications, oral contraceptives do have significant risk and we need to make sure that women are empowered with information and informed consent before getting on a medication that's often prescribed for several years without follow-up.

Tragically, next question, we've had two children die from measles in West Texas. We've now have an outbreak of like a thousand children almost in South Carolina area. You're a mom. We're on the verge of losing our measles elimination status. Would you encourage other mothers to have their children vaccinated against measles with the MMR vaccine?

Like you, I'm a physician. I believe vaccines save lives. I believe that vaccines are a key part of any infectious disease public health strategy, and I would work with you, the CDC, NIH, ACIP, FDA...

But would you encourage mothers to vaccinate their children with the MMR vaccine seeing how we've had children die and this outbreak in South Carolina?

I'm supportive of vaccination. I do believe that each patient, mother, parent needs to have a conversation with their pediatrician about any medication they're putting in their body or their children's body.

But you would be the nation's doctor. Would you encourage her to have her child vaccinated?

I'm not an individual's doctor and every individual needs to talk to their doctor before putting a medication in their body. I absolutely am in supportive of the measles vaccine and I do believe vaccines save lives and are an important part of the public health strategy.

We've had a tough flu season this year. Would you, as past Surgeons General have, encourage Americans to get vaccinated with the flu vaccine?

At the risk of sounding repetitive, I do think it's very important as a physician and to rebuild trust in public health to make sure that patients are encouraged to have informed consent with their doctor before getting any medication. I believe vaccines save lives. I believe they're an important part of public health. I also do not want to not encourage patients to have a conversation with their doctor. I think it's incredibly important and informed consent is going to be part of building trust in public health.

We've had an outbreak of whooping cough in Louisiana, vaccine-preventable disease. Children have actually died from it. Think about it, a child about the age of your child dying from a vaccine-preventable disease. And some have been scared to vaccinate their children because they've been told incorrectly that vaccines cause autism. Do you believe that vaccines, whether individually or collectively, contribute to autism?

Senator Cassidy, you're a physician, I'm a physician. The reality is that we have an autism crisis that's increasing and this is devastating to many families. And we do not know as a medical community what causes autism. The administration has just committed a huge amount of funding to look at the exposome of all environmental factors that could be contributing to autism, and until we have a clear understanding of why kids are developing this at higher rates, I think we should not leave any stones unturned.

There's been a lot of evidence showing that they're not implicated. Do you not accept that evidence?

I do accept that evidence. I also think that science is never settled and I think there is... I think that the effort to look at comprehensive cumulative exposures of our exposome into what is causing autism is important and I look forward to seeing those results and sharing the best public health information with the American people.

Well, I got through five out of my seven, so thank you for cooperating. Senator Sanders.

Thank you. And like the chairman, I've got a lot of questions in a short period of time. I enjoyed your opening remarks and I think you're right that this is a country that is sick in many ways. We need to focus on disease prevention rather than spending a huge amount of money on tertiary care. And I've enjoyed and appreciated some of the remarks you have made in the past. So let me just see if we're on the same page here. When I was sitting where Senator Cassidy is now, I fought hard to have much more substantive labeling on junk food. In fact, it's my view that we should not have food manufacturers selling junk TV ads. My understanding is you have come out against junk food ads on television. Is that correct?

Yes.

Can you just take 30 seconds to elaborate that? Would you use your position to ban junk food TV ads?

Thank you so much, Senator Sanders. And I agree with you completely. I think there is so much that we agree on on these issues. Just to be clear, the Surgeon General's office does not have the purview to ban this...

But you have a voice.

Absolutely. And that's a voice I would absolutely lend to talking about the dangers of ultra-processed foods and getting these advertisements off TV. This has long been a part of my message. I talk about it in my book.

Senator Marshall mentioned earlier the crisis we have in obesity, childhood obesity. And you have these manufacturers selling sugar-laden products that cause obesity. So you will speak out and do I correct... do I understand your view is you would fight to ban TV ads of junk food? ...Marshall mentioned earlier about the crisis we have in obesity, childhood obesity. And you have these manufacturers selling sugar-laden products that cause obesity. So you will speak out and do I understand your view is you would fight to ban TV ads of junk food?

I think you will be frustrated by how much I will be talking about ultra-processed food.

Good. I won't be frustrated. I'd be delighted. All right, let me ask you another area that we may have some agreement. As you know, the United States and New Zealand are the only two countries in the world that allow the pharmaceutical industry to advertise on TV. I believe we should ban those ads. How do you feel?

I agree with you. I mean, just to elaborate, as you know, but for anyone who might be listening, about 65 to 70 percent of the calories that our children are eating are ultra-processed Frankenfoods made in factories that are so disconnected from their origin source and nutritional value that we're putting just nutritionally devoid food in our children. And then we wonder why we have an obesity crisis in children and why chronic diseases are rising as early as toddler years. So my vision in this role is to get more whole healthy foods on American plates.

And we spend a fortune.

A fortune.

We make people sick and then we spend a fortune trying to keep them alive. All right, those are important areas of agreement and I appreciate that. But I want to pick up on an issue that the chairman raised and it's a terribly important one and that deals with vaccines. And I think the answers you gave us were a little bit political and not to the point. The American Medical Association, I don't know if you're a member of it or not, is the largest professional association of physicians representing over 270,000 doctors. And they wrote in November that, quote, "an abundance of evidence from decades of scientific studies shows no link between vaccines and autism," end quote. In contrast, Secretary Kennedy has said, quote, "I do believe that autism does come from vaccines," end of quote. Dr. Means, who is right? Is the AMA right? Is the scientific community right? Or is Secretary Kennedy right?

As I said to Senator Cassidy, we have a situation where autism is rising.

It is.

This is a huge problem.

It is. But we don't want conspiracy theories to be...

Absolutely. I 100 percent agree with you. And also, as a biomedical researcher and physician, I am not going to sit here and say that we should not study something in the future. It's not a political answer.

We should study everything.

We should study the different factors that may be causing...

I agree. But you have scientific evidence, the overwhelming body of scientific evidence says vaccines do not cause autism.

I'm not... so just to be very clear, vaccines, vaccine advocacy has never been a part of my message. I don't mention the word vaccine in my book. This is not a part of my core message. I am not here to complicate the issue on vaccines. And also, I as a physician am very careful with my words and I don't think it's responsible to say that we're not going to study when kids are getting many medications. I think it's important to just keep it on the table.

Last question. I'm sorry, running out of time. We are the only major country on earth that does not guarantee healthcare to all people as a human right. Dr. Means, is healthcare a human right? Should the United States join every other major country and say to everybody, whether you're young, old, rich or poor, you are entitled to healthcare as a human right? Yes, no, maybe?

My focus is on ensuring that Americans have access to the best healthcare in the entire world, which as you talked about, as I talked about, as everyone who has spoken is talking about, is pretty much the opposite of what we have right now. We spend 2x every other country in the world and we have the worst health outcomes.

I agree. But is healthcare a human right? Will you join me in fighting for a national healthcare program?

I will be by your side trying to get Americans access to the best healthcare in the world.

Thank you very much.

Senator Mullin.

Thank you, Mr. Chairman. My green light was on, I thought my mic was on. I want to address a couple things. During the ranking member's opening statement, he talked about misinformation coming from this administration. And I just want to point out that the Biden Surgeon General, Dr. Murthy, was actually... a court actually ruled against him in 2023, the Fifth Circuit Court, for trying to censor free speech on social media. That's misinformation. And so for us to just throw out an accusation like that with no evidence when the ranking member was completely silent when that took place is really some hypocrisy there. When we start talking about healthcare not being affordable, ranking member and I actually agree on that. The problem is you supported the same tools that got us to where healthcare is unaffordable because ACA, affordable healthcare, which is completely unaffordable, has risen three times faster than inflation itself. Yet we still support it. Not we, you, the Democrats.

I support a national healthcare program which would cut the cost of healthcare... I'm sorry, it's my time. But you're attacking me. You're going to attack me, I'm going to respond.

No, I'm pointing out facts. You can say what you want, I'm just pointing out facts.

No, you're pointing out lies.

The fact is that it is rising three times faster and we know it. Yet we still want to sit here and defend it. The ranking member wants us to talk about all the death that is supposedly going to be happening because of President Trump and Secretary Kennedy because how dare they look at a healthcare system that is broken and unaffordable and try to make changes. But the definition of insanity is what? Doing the same thing expecting different results. So we should just sit here and accept it? And how dare we look into vaccines to just simply look to see if maybe vaccines may be a partial cause to autism when it's rising at a rate faster than any country in the nation? How dare us look at science? Oh my goodness. Science is supposed to be perfect? I thought science was always supposed to be studied. I'm for looking into it. As a father of six kids, yeah, I want to look into it. I want to know what's causing it. And I will turn over every stone. And so Dr. Means, thank you for saying I want to turn over every stone. Good on you. I'm not a doctor, I'm not sitting here trying to say we shouldn't do something. I'm saying let's go after it, let's look at it, let's question what we're doing. Let's look at the healthcare system. We can agree on that one, I just don't want to socialize it. But we can agree that it is absolutely not affordable. 100 percent not affordable. Yet it was supposed to be affordable. That's what we were sold by Obamacare. So how about we work together and say, hey, scrap ACA, admit it doesn't work, admit you guys made a mistake, and let's work at something with President Trump to make affordable healthcare healthy and affordable for everybody. But there's zero chance you guys could do that. Zero chance. Yet everybody we bring up here you guys chastise for trying to make changes. God forbid we change and go after and try to fix our broken system. Anyways, I ranted too long. Let's talk about some...

Yes, you did.

I'm sorry, I didn't ask your opinion on that. And if I cared about your opinion, I would ask you, but I don't care about your opinion. You're part of the system, you're part of the problem. You've been sitting here longer than I've even been alive. This is your problem. You should have fixed this a long time ago. You've been rail on it so long, what have you been doing?

I decided not to run for Surgeon General. You're the nominee, I've decided not to accept that nomination.

That is definitely something we would never accept. Ma'am, what's your passion about healthcare? What brought you into this?

Thank you, Senator Mullin. For all of us, I'm just going to take a deep breath. My vision for Surgeon General and for the future of America is to get more healthy whole food on Americans' plates and to work to systematically encourage our healthcare system to focus on the root causes of why we are sick and not just reactive sick care. This is my passion. This is why I was put on this earth. We have an incredible healthcare system. It's amazing. It's produced miracles. If we have an acute issue, absolutely you want to be in America to get that fixed. But 90 percent of healthcare costs are now going to chronic disease. And frankly, having practiced, seen thousands of patients, worked in this system for almost a decade in clinical medicine, it's not the focus of what we as doctors are incentivized to spend our time on. It's not what's reimbursed. And this is a problem. Medical education doesn't focus on these modifiable root causes of diseases. The science is showing us through amazing emerging work in systems biology and network biology that the physiologic causes of the vast majority of diseases that are taking American lives and torturing and shortening our lives, even in our children, are connected by shared physiology and shared root causes. We need to upgrade the paradigm of the American healthcare system to educate and treat in that way. It is by far the most efficient way to treat, of course, because if we're addressing shared root causes, we're going to be able to stop the whack-a-mole medicine that's not working for us and that is so costly. And so my passion is to help work with, work with the AMA, work with medical schools, work with Democrats, Republicans, all sorts of agencies across the government to ensure that we really move the needle on shifting the American healthcare system towards root causes. I know we can do it, there's political will, it's what Americans want, even the medical schools are on board, but we need a vision to get there.

Thank you.

Senator Murray.

Thank you, Mr. Chairman. Thank you, Dr. Means, for being here. Let me start with this. You called birth control pills, and I'm going to quote, "a disrespect of life," and you said Americans, quote, "use birth control pills like candy." You also claimed, contrary to established science, that hormonal birth control has, quote, "horrifying health risks for women." Now, here are the facts. There are 18 FDA-approved contraceptive methods, both hormonal and non-hormonal, and there are decades, decades of evidence showing that every one of these birth control methods is safe and effective. So I wanted to ask you, help me understand, should women trust the FDA, which approved all 18 methods of birth control after a very rigorous look at the evidence, or should they trust your statement that there are horrifying health risks to birth control, which contradicts that evidence?

Thank you, Senator Murray, for your question. I'm curious if you're aware of what the side effects of hormonal contraception are.

I'm curious if you are with the FDA that went through all of these and rigorously looked at them, or as Surgeon General if you're going to tell the truth to the American people.

I absolutely believe these medications should be accessible to all women. And also, all medications have risks and benefits. And in our current medical climate, with the burden on doctors, we do not have... doctors do not have enough time for thorough informed consent conversations. Some of the horrifying side effects of birth control that I have mentioned include blood clots and stroke risk in women who have clotting disorders, who are smokers, who have obesity... No, it's not general. I'm speaking... I'm very careful with my words. And when I say those comments, which are taken out of context, I'm speaking about particular women that can be hurt if there is not informed consent about their medical history, their lifestyle exposures, and their family history. I want those women, and I know you do too, to be able to have a thorough conversation with their doctor and know whether they are at higher risk for side effects when prescribed the medication.

Saying that is one thing, but saying on different shows that birth control pills are a disrespect of life is very different.

I am passionate about women's health, and I think it is disrespectful to women—

Saying that people use birth controls like candy is very different than what you just said.

...we prescribe a huge amount of hormonal contraceptive, and I do not believe most of those conversations have informed consent because of the pressures that doctors are under because of our broken healthcare system. I want what's best for women, as do you, and I want every woman who could be at risk for a side effect...

Dr. Means, I need, I just have two minutes left and I have other questions. Let me move on. Thank you.

If a woman died from a stroke or a blood clot because they did not have a thorough conversation...

Dr. Means, thank you for your answer. You made that clear. Let me go to another question. Tracy Beth Hoeg, she's an anti-vaccine skeptic. She was elevated by the Trump administration to serve as the top drug regulator at FDA. She made comments last week casting doubt on the safety of RSV vaccines for baby. As you're sure know, RSV can be deadly even for healthy full-term infants. Do you believe that Dr. Hoeg is wrong to question the safety of RSV vaccines?

I have not read that article or seen that quote. I would need to know what she said before I commented on that.

Well, you do know that RSV is the leading cause of hospitalization for infants.

I do. I have a 17-week-old and I'm very aware of that.

If you hear her statement as Surgeon General, would you contradict it?

I certainly have absolutely no issue having very frank conversations with anyone in the administration if I believe that their statements are misguided in some way or not fully informed. That's not a conversation I would have publicly first. I would have a private and direct conversation with anyone in the administration if I felt that patients were at risk because of...

All right. And I also want to ask you about maternal health. Mental health conditions are the leading cause of maternal death in the U.S., including suicide and overdose deaths. In her comments last week, Dr. Hoeg, same woman, also expressed concern about the safety of the antidepressants during pregnancy. Specifically, she called out SSRIs, the most commonly prescribed type. Do you believe that SSRIs are dangerous for pregnant women?

I don't want to be a broken record here, but I do believe that every medication has risks and benefits, and you need to have a nuanced conversation with your doctor before starting a medication. That is, I think, the most responsible position for any doctor to share.

Well, strong evidence has shown that SSRIs are safe in pregnancy. Most do not increase the risk of birth defects.

Certainly. Certainly.

But untreated depression in pregnancy puts women at risk.

And I agree with you, but I still think a patient, I don't think it's responsible to make a blanket statement for all Americans.

Okay. Well, if confirmed as Surgeon General, it will be your job to give accurate and up-to-date health information to the American people. I assume you will take that responsibility seriously.

I will. I absolutely do. And I also believe that the American people are looking for a more nuanced conversation about health, and I believe that that will help restore trust in public health.

Thank you.

Coach Tuberville.

Thank you, Mr. Chairman. Dr. Means, thanks for being here. Congratulations on expanding your family, and I know it's exciting time for you. Also want to thank Assistant Secretary Health, Dr. Bryant Christine, for being here. Thank you for your service. Dr. Means, I've listened to you and your brother Calley, and I know he's here today on I don't know how many tens and tens of podcasts I've listened to. I learned a whole lot because I grew up in the health business. I was a coach 35 years. It's all about nutrition. So the question I want to ask you is how do we get around this? I talk to people in the healthcare business and in the medical field. When we train our doctors, we don't teach anything about nutrition. Everything's about a priority, and those priorities are fine, but we need to teach our doctors and nurses about nutrition, about what to put in their body. This epidemic we have going on, chronic disease, as we've all talked about, is out of control and getting worse. So how do you prioritize that?

Thank you so much, Coach. And I really, really enjoyed getting to know you throughout this process. Thank you. This is so key, what you're talking about, reforming medical education to focus on root causes. And one of the key root cause modifiable factors of chronic disease is nutrition, as we all know. There has been incredible momentum already in the administration towards making this possible, starting with the Dietary Guidelines for America, which came out about a month ago. This is the first time we've had a full-throated denunciation of ultra-processed food, and I think this is historic. It's historic when the federal government says that out loud. What that is going to do is impact medical education. It's going to impact procurement regulations for billions of meals served and paid for by federal dollars every year. We're going to see real food, more real food, less ultra-processed food going into the National School Lunch Program, prisons, hospitals, and other federally funded organizations. This, I think, it's a point that gets lost a little bit, that by just changing the dietary guidelines, it is going to trickle down into billions and billions of healthier meals for Americans. So I think that's step one. I think, secondarily, we've got Dr. Marty Makary, an absolute hero, who is approaching the GRAS loophole, the Generally Recognized as Safe loophole through the FDA. So this is a program where companies have essentially been self-reporting the safety of the ingredients that they're putting in their foods with very, very little oversight, which has led to literally thousands of chemicals in our food system that we don't know what they are or what they are doing to our body. By addressing this loophole and starting to be have much more scrutiny about what's going into our food, this is going to trickle down to affect medical education, affect culture, affect what companies are putting in the food. The zeitgeist is going to shift about a lot of this because we're going to start to have transparency about what is even in our food system. Additional things are happening that are just incredible around food. There was just $700 million put forward towards regenerative agriculture. So we're going to have more investment in research and studying of soil health, water quality, nutrient density of food, and how that's affecting our health. That's going to trickle into medical education. There's a whole person health initiative at the NIH that's being put forward by Dr. Jay Bhattacharya, who is doing an incredible job. That's going to study this systems biology perspective of the body, not isolated silos, but the whole body health. And when you look at the body as a system like that, nutrition has to play into it. So this is just, you know, four or five of some of the the stones that are being moved right now that all will lead to nutrition being a bigger part of our healthcare system. I think where I can help on that is elevating the work that's being done, having conversations, again, across the whole medical community to to help us in a really positive and unifying way move towards a more root cause approach to health.

Do you think that will be a hard item to push in our medical schools about nutrition?

I've had conversations with a number of deans of medical schools who are very, very passionate about this issue. They want to change. It feels hard because we have this behemoth healthcare system that operates a certain way. But right now, there's cultural momentum, there's political will, and I think the time is now to make generational changes that are going to have a huge impact on all Americans. And I also think it's an issue that all of us can work on together. It's non-controversial. It's positive. It's unifying. And I think that's what we need right now for Americans.

It's all about educating people, and sometimes people don't want to be educated. But I think the Surgeon General and our whole Department of Health and Human Services, I think everybody's on board with that. And if we do that, what Senator Sanders was talking about about the $5 trillion a year we spend, we can't afford to do that anymore. I mean, we have to stop, and the root cause is education. We have to educate people. Thank you very much.

Senator Baldwin.

Thank you, Mr. Chairman, and thank you, Dr. Means, for being here today. You spoke in your opening statement about building trust, building trust in public health. And you also made, I think, a passing reference to conflicts of interest within agencies in HHS. So I want to ask you a few questions on that point. Dr. Means, you've promoted a lab testing company, Genova Diagnostics, which is backed by private equity and may charge customers several hundred dollars for its services. Before you began promoting their tests on social media, the company agreed to pay $43 million to resolve allegations that it had billed for medically unnecessary lab tests and violated the False Claims Act. You personally accepted $10,000 from this company, and I want to ask you whether you were aware of Genova Diagnostics' prior violations and the settlement when you started promoting their services.

Thank you, Senator Baldwin, and also thank you so much for meeting with me beforehand. I really enjoyed our conversation. Frankly, I was not familiar with that settlement. There's a particular test that they make about nutrient quality that I find very compelling because I do think we need to understand a little bit more transparently about how the nutrients from our food are affecting our health. And I would just highlight that I have worked extremely closely with the Office of Government Ethics over the last several months and taken this process very seriously, signed a letter that outlines how to rectify any potential conflicts and—

And I know you're going to divest your stocks in all sorts of health-related and non-health-related entities. But it's troubling because the Surgeon General must be someone that the public can trust and someone who does their homework before accepting money or lending credibility to a company. And for me, this raises questions about your judgment. It does not inspire confidence that you're here to make Americans healthy when you accept money to promote a company who's had to pay a settlement because of violating the False Claims Act. Dr. Means, you have also promoted a range of supplements, including those that claim to promote longevity and detoxification. You made at least 325,000 dollars from promoting supplements since the beginning of 2024, according to information provided to this committee. This includes nearly 135,000 dollars for a so-called longevity supplement and 46,000 dollars for wellness teas and elixirs, both of which can cost upwards of 100 dollars a month for somebody consuming them. Your company, Levels Health, offers continuous glucose monitoring and AI-driven health insights. And a full membership, and I'm not sure what all a full membership involves, but costs 1,500 dollars a year. And that's about a whole month's average rent for a one-bedroom apartment in Milwaukee, Wisconsin. Do you really believe that most Americans can afford to spend upwards of 1,500 dollars a year on your supplements and programs? And is that one of your solutions to our nation's health problems?

Thank you for the question. I certainly don't think every American needs to be wearing a glucose monitor. I think that we have a monumental blood sugar problem in this country that underlies most of the leading causes of death in this country. Dementia, cancer, diabetes, heart disease, stroke are all connected by metabolic dysfunction and elevated blood sugar. And my work on using entrepreneurship as a tool to bring and study new tools that can help us understand our blood sugar better, I believe I'm very proud of. And as I mentioned in my opening statement, research—

Thank you for that statement and those observations. Dr. Means—

And that research that we've done with the company is meant to benefit all Americans. It does not necessarily—

And that's what I wanted to tie up in my remaining 12 seconds. Dr. Means, you say you want to address chronic disease, but one-third of low-income adults have two or more chronic conditions. They need an affordable solution. Groceries are too expensive, healthcare is too expensive, health insurance premiums have skyrocketed because of Republicans' refusal to extend the tax credit and cuts to Medicaid. 15 million Americans are losing their health insurance. People cannot afford their prescription drugs. So you've said that our healthcare system is broken, but it seems to me that you've spent your career sort of making money off the flaws in the system, and I'm left wondering how the American people are supposed to trust you to put their health and safety first, not profits.

Those are incorrect characterizations. I appreciate your comments and I do look forward to working with you and on your priorities. And I absolutely am committed to giving Americans the best public health information possible. And like the comments I made prior, I think some of the movement in our administration towards making healthy food more accessible are going to impact all Americans in a very positive way, and I look forward to helping on that and many other issues that make healthcare accessibility much easier for all Americans.

Senator Husted.

Thank you, Mr. Chairman. Dr. Means, thanks for being here today. I'm going to try to get through pesticides and mental health for our children if I could. I want to thank you for what you're trying to do to raise awareness about healthy eating, healthy foods. And since your nomination, though, I've had a lot of questions from farmers in the agriculture community in Ohio about your comments on pesticides. And you will not regulate pesticides in your role, but your views will impact American consumers and what they believe about what's healthy and good for them. What is a pesticide? And I'll just put a little poster up here, and why do we use them? Because this is the kind of thing we try to prevent. This is an earworm. This is the kind of thing that destroys our crops in all across the country: corn, wheat, soybeans, fruit, and vegetables. If you have, if we fail to use proper pesticides, it will drive down yields of 20 to 50 percent, even more for fruits and vegetables, the very things we want people to eat more of, which will restrict the supply chain, make food less accessible and more expensive if we can't have proper crop yields and use more land, more resources, etc. And so given all those facts and given what the concerns are, please just share your views on pesticides for what they mean to the average consumer of food in our grocery stores.

Thank you, Senator Husted. And thank you so much for meeting with me prior to this hearing. This is a very complex issue. And what I would just want to start by saying is that I have the utmost respect for the American farmer. And I think just like doctors, farmers are in an impossible situation right now where we have developed an agriculture system that is dependent on chemicals that are toxic to have an affordable food supply. And that's not good for farmers, it's not good for consumers. It's a complex issue. And obviously, changing anything overnight would be devastating to the American farmer and the American consumer. With that said, this administration is committed to understanding what's in our food and how it's affecting our bodies and how cumulative exposures to various chemicals in our environment is affecting us. And that is a core, profound, long-term deep passion of mine as someone who thinks about how our environments and the system that we live in is affecting our health in the midst of this monumental chronic disease epidemic. And certainly pesticides, herbicides, insecticides is something we need to look into as part of that cumulative exposure. So it's a complex issue. It's very sensitive for farmers and for American consumers, especially mothers, because we want to have the safest water and the safest food supply in terms of what's on it. But I understand the nuance of these issues and that changes need to be made thoughtfully with full respect for American farmers and the constraints that they're under. And also, eventually, we are going to need to move towards a more sustainable way of growing our food that decreases our reliance on toxic chemicals that are hurting human health. I think there are incredible movements happening within the administration, like I mentioned, the $700 million going towards regenerative agriculture transitions, precision agriculture, and the private sector collaboration that may be using technology to help be more precise with pesticide spraying. And I think those are all positive developments. But at the end of the day, we do need to understand how these chemicals are affecting our bodies and work towards creating the safest food system possible.

Great. I have one more, three quick questions for you. It's on mental health of our children. And I'm going to ask all three of them and give you a chance to respond. Do you believe that smartphones and social media are negatively impacting the health of America's children? What age should a child have access to a smartphone and social media? And what would you recommend, would you recommend banning smartphones in America's schools?

I believe that the research is showing that the impact of social media on children is profound and negative, and we need to take great efforts to protect children from premature use of technology that is associated with mental health issues and depression. And it's a strong concern of mine.

And what age would, does the research say that we should give a child access to a smartphone?

I don't have the answer to that question. I don't know if that exact number is known. But I think in light of how quickly things are moving with technology and social media and how rapidly things are changing, we need to, as parents, communities, schools, and a government, exert an abundance of caution and be very proactive about making sure we're protecting children and their mental health.

I hope you'll spend some time talking about this issue in your role as Surgeon General because if you go to a school that's banned smartphones, they will tell you it has a profound difference on the mental health and the educational environment in those schools. So thank you.

Thank you.

We'll now go to Senator Murphy. And for the awareness of the members, after Senator Murphy, we'll take a 15-minute break for the benefit of Dr. Means, and more importantly, the benefit of her child, and then we'll return 15 minutes as said.

Thank you, Mr. Chairman. Good morning, Dr. Means. Dr. Means, are you familiar with FTC policy that requires those who are recommending products online to disclose their financial connection to those companies? In particular, the document from the FTC says this: "If you endorse a product through social media, your endorsement message should make it obvious when you have a relationship with the brand." Are you familiar with that, Dr. Means?

Certainly.

So, as you know, there is a pending complaint regarding your failure to adhere to those guidelines. That basically makes the contention, and this committee has verified the data that underlies their complaint, that you routinely violated this policy, and that in fact, in the majority of your posts for many of the products you recommend, you did not transparently reveal your financial connection. Let me give you an example.

That's false.

Well, let me give you, well, I'll give you an example. So, there's a prenatal vitamin called WeNatal. Your filings before this committee show that you started receiving compensation in the spring of 2024. And yet in September of 2024, you posted a video saying that you had no financial relationship to the company, just a big fan. And then in October, you said, "Not sponsored, just love these." But in fact, you have documentation before this committee that showed when you said those things, you had a financial relationship. You had already started receiving money from that company. So, you weren't telling the truth when you said you were just a fan. You were actually receiving money, correct?

If I, in any post where I said I am not receiving money, I had not been receiving money at that time.

But you had received partnership fees for this particular prenatal vitamin. In fact, prior to September and October, you had posted partnership links in which you get compensated based upon click-throughs, correct?

I'm happy to look at whatever documentation you're talking about, but I do not, this is incorrect, and it's a false representation. And just to be very clear, I've spent the last several months working with the Office of Government Ethics to be fully compliant with this process. I take it very seriously. Before, during, and after, if I am in office, I will be in full compliance with the Office of Government Ethics. I think, as I've talked about, conflicts of interest are incredibly important to rectify if we're in public service, and I am fully committed to continuing to work with them.

Absolutely. So let me give you some other examples. Function Health, which is your lab testing platform, data shows that you disclosed your partnership with them less than a third of the time that you recommended their services online. Genova Diagnostics, you disclosed your sponsorship in only two of the nine times that you promoted Genova. Daily Harvest, you disclosed your sponsorship in only three of the 14 posts recommending that product. Zen Basel seeds, you disclosed your partnership only two out of the 13 times that you recommended the product. This seems systemic. It seems that in the majority of instances in which you were, as a medical professional, recommending a product, you were hiding the fact that you had a financial partnership. You seem to be in regular willful violation of the FTC rules. That is concerning as someone who agrees with Senator Cassidy that our focus has to be on restoring trust in the medical profession, and yet over and over again, you seem to be at scale recommending products without telling your followers. And you have 200,000 newsletter subscribers, you have almost a million Instagram followers, and in only three out of 14 times on Daily Harvest, when you were promoting Daily Harvest, you disclosed that you're getting paid by them.

It sounds like you have a lot to say about this issue, and I would be very interested to see how your staff looked at this data. I have a strong feeling that the way in which they gathered this data is done intentionally to create these claims that you're making.

Well, I have the backup here. I mean, will you acknowledge that in many instances when you were promoting these products, you did not disclose that you had a financial relationship?

I don't think that's true. And if it has happened, if it inadvertently has happened, I would rectify that immediately. However, I would be interested to see how your staff gathered this data.

I'll be happy to send it to you. I'll send it to all the committee members. I mean, it's pretty incontrovertible evidence.

I take conflicts of interest incredibly seriously. I've worked diligently with the Office of Government Ethics to make sure that conflicts are addressed thoroughly.

The committee will stand in recess for 15 minutes.

Thank you.

Thank you for everybody being back. Senator Marshall defers to Senator Collins.

Thank you, Mr. Chairman. Welcome, Dr. Means. Addiction and drug overdoses are a major problem for families and communities in my state of Maine and across the nation. I'm concerned that in your book on Good Energy, that you urge readers to consider psilocybin-assisted therapy. You also said that you were inspired to try psychedelics in what I can only describe as an internal voice that whispered, "It's time to prepare." Illicit drug use remains a huge problem in this country, and this didn't happen in your teen years. According to your book, in 2021, you began using illicit psychedelic mushrooms. So my questions to you are twofold. One, do you stand by what you said in your book encouraging people to try psychedelics? And second, as Surgeon General, should you be confirmed, how would you speak to the American people about the use of illicit drugs?

Thank you so much, Senator Collins, and I also thank you sincerely for engaging so deeply with my work and learning about me. This is a very important question, and I would start by just saying that I believe what I would say as a private citizen is in many cases different than what I would say as a public health official, joining a team where the purpose of this role is to communicate absolutely the best evidence-based science to the American people to keep them safe, thriving, and healthy. And when it comes to psychedelic therapy for mental health issues, I think the science is still emerging. And so it would certainly not be a recommendation to the American people to do that under no circumstances. I do believe that there is exciting work being done in this area that needs to continue on psychedelic therapies for PTSD and veterans, for mental health issues, and some of the researchers who are doing this work have said it's some of the most promising and exciting of their entire career. So I look forward to following that, but to be very clear, under no circumstances would I recommend that to the American people in this role. Our illicit drug use problem in our country is monumental and severe, and I look forward to working with you on these issues that are so important.

What did you mean by saying that you heard an internal voice whispering to you saying, "It's time to prepare"?

Yeah, in that passage of the book, I'm referring to my mother's passing, which happened, she got a diagnosis of pancreatic cancer about a week after that experience. And in my meditations and prayers at that time, I was having a deep sense that something ominous was coming. And so that's what that's referring to. I think when I speak of spirituality and you know, I do believe Americans are ready to hear about spirituality as it pertains to medicine. 80 percent of Americans are spiritual or religious. There's amazing evidence coming out of Columbia University, the lab of Dr. Lisa Miller, that spirituality has a large impact on health outcomes. And you know, so certainly that's a personal anecdote, but again, I'm committed to sharing only the best solid science with Americans on how to be healthy.

I understand totally what you're saying about spirituality, and I'm sorry about the loss of your mother. It's the link to illicit drugs that I'm having a hard time with. But I have very little time left, so I want to go to another issue, and that is in the staff interview when you were talking about wasteful spending, you referred specifically to money that NIH spent on Alzheimer's research that quote, "proved to be fraudulent." And you were referring to the amyloid plaque research replication issue that was discussed in the New York Times. That story, however, has been largely debunked and countered. So I just want to make sure that I know for certain whether you are for vigorous research looking at a wide variety of factors when it comes to Alzheimer's disease and other dementias.

Unquestionably, full-throatedly, yes. This is one of the most devastating diseases facing Americans today. It's one that I'm very passionate about, particularly in light of research showing that early-onset Alzheimer's dementia in as early as the 50s is starting to rise at a significant rate. I believe that we need to be studying, like you said, all the different medical, genetic, lifestyle, environmental factors that can be contributing to this. And when I look at the research that, you know, some of the research that I'm very excited to elevate in the conversation if I'm confirmed, I'd point to the Lancet study from 2024 about the modifiable risk factors for Alzheimer's dementia, which I'm sure you're familiar with, which showed that with 14 modifiable factors, we could reduce 45 percent of Alzheimer's dementia cases. This is incredible. This isn't really the type of research that we've been hearing from the medical community. We hear a lot about drugs, we hear a lot about interventions that slow decline once we're sick, but that's the type of research, like from the Lancet, major medical journal, that I really look forward to elevating, supporting further research like that that can really help Americans be empowered to prevent this disease when we can.

Thank you.

Senator Kim.

Thank you, Chairman. Thank you for coming and congratulations on the new baby. I wanted to just ask you about the role of the Surgeon General, you know, the different aspects of it. So one of it is about issuing public health advisories, is that correct?

Yes.

I wanted to just ask, are you currently able to write prescriptions for patients?

I have not been seeing patients over the last several years, and so I currently, with the status of my license that I voluntarily put on inactive status, which I'm sure is what you're getting at, cannot prescribe a prescription right now. However, if I were to work with the Oregon Medical Board to reinstate that, it's very possible to do and just to give you...

Is that something you're planning to do?

I'm not planning on prescribing prescriptions for Americans.

No, I mean, are you planning to reactivate your license?

My path in medicine, you know, I spent four years doing surgeries and seeing patients in clinics, and that one-to-one medicine, it's valuable, but my path took me down a different road to have a one-to-many approach to affect the root cause of why we're sick in America and I've had a very successful...

So you're saying you're not going to pursue reactivating your medical license in taking this job, is that correct?

I do not plan to reactivate because I'm not going to be seeing patients in this role. It would not make sense to do that. In fact, for physicians, if I could just clarify because this has been a point of severe misinformation from the media, for any doctor in a state where you are required to put your license on inactive if you're not seeing patients, I would imagine that many, many physicians in public health service who aren't seeing patients would have to put their license on inactive status because they are not seeing patients, unless they choose to continue to do so while in office.

So another important role here, I just want to kind of clarify because you're saying, you know, you're not currently able to practice medicine, you're not currently able to write prescriptions because you're saying you're not going to be seeing patients in this job.

And I do have a medical license.

Another big role, another big role of the work that you're doing is to be a leader of the Commissioned Corps, is that correct? So I guess I wanted to just dive into this because with the Commissioned Corps, it's saying as a Commissioned Corps officer of the U.S. Public Health Service, keeping professional licensure and certification up to date is mandatory. So I guess I just wanted to get a sense of how you're squaring this here.

Well, I do have a medical license right now. It is voluntarily placed on inactive status because I'm not actively seeing patients at this time. The HHS and Admiral Brian Christine have testified in front of this committee that I am eligible to serve as the Medical Director of the HHS and as the President's nominee for Surgeon General.

But how does that square with saying here it says professional, keeping a professional licensure and certification up to date is mandatory. Is yours up to date?

I have an active medical, I have a medical license that is unexpired right now. Admiral Christine has testified that I'm eligible to serve in this role. I'm the President's nominee for Surgeon General, and further questions about that will have to go to them.

So if we were to expand that, would you say that like with the others in the Commissioned Corps, do you think we should remove the mandatory licensure for them to be able to participate in the Corps?

That's not a question that I've considered. I don't think it's actually relevant to this particular hearing.

Well, it's relevant insofar as I'm just trying to think through if you're in this job, you know, how are you going to be proceeding, you know, and what kind of advice you're going to be able to give to the American people and the credibility that they will have in understanding what your advice is. Also in terms of, you know, if you are a leader of the Commissioned Corps, I'm trying to get a sense, are you going to deprioritize having an active license in the same way that, you know, you believe that you can do the job of a Surgeon General without having an active license? Do you believe that that is the case for others in the Commissioned Corps that they can do their job without having an active license?

Senator Kim, I'm a medical doctor. I graduated from Stanford University School of Medicine. I have a medical license. My professional history is a feature, it's not a bug. I have had a unique history that has merged entrepreneurship, public health advocacy, faculty course direction at Stanford University, as well as being an editor of a medical journal and a biomedical researcher. And in these complex times for American healthcare, that type of multidisciplinary history is going to be extremely valuable for the American people.

I don't discount your accomplishments and your education. But what I'm trying to get a sense of here is your ability to be able to engage with our current medical professionals, to show respect to...

I practiced medicine, I owned my own medical practice, and I've seen thousands of patients, and I did over four years of surgical training, which is more than many of our past Surgeon Generals completed who did medical specialties. I have completed extremely thorough medical training, and I have the ability through these experiences to communicate excellent public health information. And I really look forward to working with the Commissioned Corps. This is an incredible group of people, 5,000 uniformed officers who are committing their lives to helping the American people. And personally, just to share a little bit of a vision for that...

I agree with that, but I think the signal that is being sent is one that I think we have to look at. And with that, I'll yield back.

Could I...

Yes, ma'am.

This incredible group of officers has traditionally been deployed for public health emergencies like natural disasters and infectious disease. And I think there's a huge opportunity to actually work with these members who are interested in approaching the chronic disease epidemic, which has not traditionally been part of their role. And I think that bringing that perspective and the demonstrated history of work in this area is actually going to be a really positive development for the Commissioned Corps. And I thank you for your questions.

Thank you.

Dr. Means, I should have said this earlier. Is your family behind you?

Yes.

Would you please introduce?

I'd be happy to. This is my stepmom, Kathy, my dad, Grady, my incredible better half and husband, Bryan Nickerson, my best friend of 20 years, Fiona Biles, my sister-in-law, Leslie Voorhees, and somewhere in here is my brother, Calley. And also my cousin, Fleet White, and his wife, Adrienne, I don't think is here, but yes.

Well, I couldn't help noticing how proud the people looked behind you, so I said, you know, let's put two and two together. So anyway, thank you and thank you all for being here.

Thank you. Thank you very much, Senator Cassidy.

Senator Marshall.

All right. Thank you, Chairman. Before I begin my questioning, Mr. Chairman, I ask unanimous consent to submit this statement from Stanford School of Medicine supporting Dr. Means' nomination and recognizing her as an outstanding student to the record.

...of work in this area is actually going to be a really positive development for the Commissioned Corps. And I thank you for your questions.

Thank you. Dr. Means, I should have said this earlier. Is your family behind you?

Yes.

Would you please introduce?

[Laughter.] I'd be happy to. This is my stepmom, Kathy. My dad, Grady. My incredible better half and husband, Bryan Nickerson. My best friend of 20 years, Fiona Biles. My sister-in-law, Leslie Voorhees. And somewhere in here is my brother, Calley. And also my cousin, Fleet White, and his wife, Adrienne. I don't think she's here, but yes.

Well, I couldn't help noticing how proud the people looked behind you, so I said, you know, let's put two and two together. So anyway, thank you, and thank you all for being here.

Thank you. Thank you very much, Senator Cassidy.

Senator Marshall.

Right. Thank you, Chairman. Before I begin my questioning, Mr. Chairman, I ask unanimous consent to submit this statement from Stanford School of Medicine supporting Dr. Means' nomination and recognizing her as an outstanding student to the record.

Without objection.

Dr. Means, do you have a medical license?

I do.

Thank you. Just wanted to make sure we cleared that up as well.

I've had one for 11 years.

Exactly. Dr. Means, there's so many things that you could focus on. Narrow it down to what would be, if you could accomplish one thing, what might it be? And it's hard not to get into two and three, but just share a little bit what's on your heart and your goals. What's your mantra going to be?

Thank you. Thank you, Senator Marshall. My dream for this role is first and foremost to help nudge, push, inspire our healthcare system towards focusing on root causes and the reasons why we're getting sick, moving towards a real healthcare system and not just a reactive sick care system, which is of course also going to lower costs monumentally and unburden, I think, American taxpayers and doctors. I want to see affordable, accessible, real, nutritious food for all Americans because we know that nutrition and food is one of the key, most important drivers of chronic illness or of health. And we're not eating real food. We're eating 70 percent ultra-processed food right now, and there are structural barriers to making that possible that good policy and reform in the healthcare system can fix, and I believe there's political will and cultural momentum to do so. And I look forward to being a leader in that. And I would say lastly, a key passion of mine is to understand how the cumulative burden of the exposures we have in our environment across food, water, air, soil, the products we're putting in and on our bodies, how these are affecting our health. We know that these diseases are going up rapidly, and of course genetics have not changed over the past 20, 30, 40, 50 years. It's environmental exposures that are making us sick. And we have not prioritized studying that. And the NIH and the MAHA movement is focused on looking at this, and I think this is going to be a rapid accelerant of understanding why we're sick and how to heal.

Thanks. Let's talk about nutrition for a second through your eyes. I think we all acknowledge that America needs to eat better, but not everyone can afford to go to Whole Foods.

Right.

Carbohydrates are cheap, processed foods are typically cheaper. But how do we help the masses?

This is the most important question because obviously if it's not the easiest and the most accessible choice, it's not going to be sustainable for all Americans, which is what we need. This is why I'm so supportive of some of these systemic changes that are happening. So the dietary guidelines for America, like I mentioned, just by changing that and calling out no more ultra-processed foods full-throatedly, which is what they did, this is going to feed into billions and billions of meals per year of changing procurement towards local, organic, whole foods for kids, military, prisons, hospitals, organizations that are getting federal dollars. So that's going to make billions of meals more accessible for people through federal dollars. Additionally, with the GRAS loophole that the FDA is addressing, Dr. Marty Makary, this is going to mean that we can't even necessarily put some of these chemicals in our food. And then at the NIH, they are going to be studying this more thoroughly. And so I think all together, this is going to trickle into a safer, healthier food system for Americans that's going to be more affordable. I would also just mention SNAP. The reforms to SNAP are making these federal dollars go towards healthier food, and I think that's going to have a huge impact on actually getting healthier food to low-income communities because if the dollars are flowing there towards healthier food, the brands and the companies are going to bring their food there.

Thank you, Dr. Means. I look forward to supporting your nomination. Thank you so much, Mr. Chairman.

Thank you, Mr. Chairman. And thank you so much, Dr. Means, for being here, for your family, and congratulations on the birth of your son. If you are confirmed, you know that you will be America's top doctor. And as such, people will be looking to you for scientifically accurate health guidance. So I wanted to drill down a little bit more to understand your views on vaccines and the science supporting Secretary Kennedy's vaccine vision. And I know you said earlier that this really isn't a part of your core message, but I know that you've talked about it before, whether it's on podcasts or in articles or tweets. And so again, I just wanted to drill down a little bit more on that. And I know previously you stated that hepatitis B vaccine, giving it to a baby born to hepatitis B negative parents is absolute insanity and think you did an analogy to it being criminal. I was really pleased to hear you say so strongly here today that vaccines save lives, that you support the vaccinations for children. And so my first question is, if a mother is hepatitis B positive, is providing the vaccine at birth the most effective way to prevent transmission to the baby? So again, if a mother is hepatitis B positive, is providing the vaccine at birth the most effective way to prevent transmission to the baby?

I believe certainly that is the most effective way. Again, I would just say, you know, obviously the patient should talk to their doctor, but yes, that's a pretty clear case where certainly that would have a huge impact.

Thank you for your response. It appears even as we're talking about the Secretary's vision for vaccines in this country, that he has basically searched the globe to find things to justify his harmful, unpopular vaccine policies. And just a few weeks ago, we had Dr. Bhattacharya here, the head of NIH, and we got into a dialogue even with the Chairman about using Denmark as our peer to make these kind of decisions. On December 18, 2025, the CDC announced funding for a study in Guinea-Bissau, a West African country with just over two million people. The CDC-funded study proposed withholding the hepatitis B vaccine birth dose from half of the newborn infants in the trial without screening all mothers for hepatitis B. And as you know as a doctor, that when babies are exposed to the virus at birth, they can face very high risk of liver damage or cancer later in life. So as a doctor and as a mom, would you agree that it is unethical and dangerous to withhold a life-saving vaccine from babies at risk of a preventable disease?

These are obviously extremely important issues. I am not familiar with the announcement that you just talked about.

But hypothetically, just as a scientist, is it unethical to withhold life-saving vaccine for a baby?

I think that in the case where standard of care is to give a vaccine and that's the gold standard, I have trouble imagining a scenario where a study would be able to withhold that treatment.

Right. Because when a safe, effective vaccine is available, I think not just as a doctor, but as a human, we want to make sure that

I don't believe that Dr. Jay Bhattacharya or the HHS would be interested in withholding

So we'll make sure you get the study because what's interesting is that there are the researchers are also Danish, which is kind of interesting to me.

And also sometimes the devil's in the details, and I think I would want to look into this myself.

But as Surgeon General, it would be your responsibility to act legally and ethically. So you might oversee comprehensive scientific reports and oversee the commission corps who will conduct research and care for patients throughout the world. Would you advise against a study or refuse to conduct a study with serious ethical implications, even if the Secretary or the administration pressured you to?

Certainly as a physician, as a person, as a mother, ethical concerns are of top priority to me, protecting patients, protecting children. I am a strong-willed person who has no problem having direct conversations with anyone, and I would not hesitate to have direct private conversations with anyone about ethical concerns. And also, I do not believe that the Secretary or anyone in the administration would ask me to do something unethical.

Well, we'll follow up with you on that particular study. I thank you so much for your indulgence, Mr. Chairman, and this is a vital kind of question for the foundation of this position. So thank you, and I yield back.

Senator Banks.

...also, I do not believe that the Secretary or anyone in the administration would ask me to do something unethical.

Well, we will follow up with you on that particular study. I thank you so much for your indulgence, Mr. Chairman, and this is a vital kind of question for the foundation of this position. So thank you, and I yield back.

Thank you, Mr. Chairman. Dr. Means, the Surgeon General is first and foremost the chief spokesperson for Americans' health. Wouldn't you agree? You would be the first MAHA Surgeon General. What is the public not hearing that you're uniquely qualified to communicate to them?

Well, first I would say that I think that for anyone who has not read the MAHA strategy that came out at the end of last year, it's a document that everyone should read because it outlines in unbelievably positive, comprehensive, forward-thinking way of addressing the root causes of why we're sick. It's a profound document. I think it's groundbreaking. And many of the pieces from that strategy document are already way out of the barn and wins are happening already that are going to make healthcare and food more affordable and accessible for all Americans. And so I'm just very supportive of the work that's being done, and I do think it's a huge sea change shift from what we've heard from prior administrations in my lifetime, or you know, at least since I became interested in the biomedical sciences, you know, when I was 20 years ago. I have not heard at the federal level this sort of just impassioned, brave approach to talking about busting through, you know, industry potentially conflicts, conflicts in our research, the corporate capture of our agencies and our health organizations and just saying we're not going to stand for this anymore. We're going to put American health first and not just in a reactive way but in a proactive way. So all that is to say that I think we're going to see monumental progress over the next several years, and my deep hope is to be a unifying, practical messenger that brings people together around issues that I think every family cares about. There's not a person in this room who doesn't have a family member or a friend or know a child who's dealing with a chronic health issue. And we know that our environment is contributing to these and we need to make it systemically and structurally easier for people to be healthy in this country. And that's what the MAHA strategy does.

When I read the MAHA strategy as articulated by President Trump and Secretary Kennedy, I mean, these aren't partisan themes or strategies. I mean, these are ideas that are broadly supported by the vast majority of Americans, right?

Yes.

Yeah. You've raised awareness about metabolic syndrome, how diabetes, stroke, heart disease, and their risk factors interact. What do people need to know about metabolic syndrome and why isn't our healthcare system preventing these diseases?

Thank you for that question. This is one of my favorite topics in the world. So metabolic dysfunction and metabolic syndrome is referring to, not to get too technical here, but fundamentally it's the way our cells make energy and power themselves. We have trillions and trillions of cells in our body, they all need energy to work properly. Without that, you know, we'd fall apart. Unfortunately, the vast majority of American adults now have metabolic dysfunction. By some studies, 93 percent of Americans adults have at least one biomarker of metabolic dysfunction, meaning there's this fundamental whole-body cellular energy production problem that we know is deeply related to our diet and our lifestyles that then underlies diseases emerging all over the body, things like dementia, cancer, chronic liver disease, diabetes, obesity, heart failure, heart disease, stroke, etc. And so this is this systems biology approach that I'm talking about that our healthcare system is not currently incentivized to look at the body as a whole system. We have over 100 medical and surgical subspecialties and they are incentivized to look at one small part of their body. We need to bust that open, look at the body as a system, take the latest research on this unified sort of approach to health and then start to transform clinical practice into that way. If we do that, we can help people earlier understand what's going on in their body and hopefully prevent some of these catastrophic diseases as people get older.

But there's nothing partisan about that, right?

No.

Yeah, I didn't think so. Something else I don't think is partisan, you've been outspoken about the infertility crisis in America. More and more couples have trouble conceiving and so many women struggle to have healthy pregnancies. Why is that?

Yeah. So infertility is going up in our country, male and female infertility, it's going up about 1 percent per year. Up to 26 percent of women globally have a type of condition that can lead to infertility called polycystic ovarian syndrome. This is a disease I'm very passionate about because it actually goes hand in hand with metabolic dysfunction. There's certainly genetic aspects to it, but many lifestyle features as well. Right now, the current standard of care for PCOS is to prescribe medications for the metabolic dysfunction and for the hormonal imbalances. But what the research has actually showed us, good research, is that very targeted interventions on our diet, for instance, there's a particular study I'm thinking of that did a ketogenic Mediterranean diet and in about 16 weeks, nearly all participants in the study reversed their PCOS markers just with a dietary intervention. That's one study. I'm not saying that should be the gold standard. However, this is not information we're hearing, it's not information we're giving to women in OB-GYN's office, and I think that's really something we need to change. We need to give people empowering information about how to take their health.

Thank you. My time is expired.

I'm so sorry.

No problem. And I'm just being a little heavy because we're running out of time. And for the record, what Blunt Rochester was bringing up was the CDC study by press reports which bypassed the career scientists but was pushed by the director's office. It was later suspended because Guinea-Bissau said it was unethical, at which point the Trump administration pulled it back. So just for the record. And next will be Senator Kaine.

Thank you, Mr. Chair. Thank you, Doctor. In a news report on January 7, just a month or so ago, Secretary Kennedy stated, quote, "there is no evidence, no evidence, that the flu vaccine prevents serious disease or that it prevents hospitalization or deaths in children." Do you agree with that statement?

Senator Kaine, as I've said, I believe vaccines save lives and are an important part of our...

But I'm not asking about the general. I heard that testimony earlier. But the statement is, there is no evidence that the flu vaccine, and I want to be scrupulous about this, prevents serious disease or that it prevents hospitalization or death in children. 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 personally seen that quote or that article. I would want to review it before I comment on that.

Okay, I'm going to set the quote aside. I'll introduce for the record an article CBS News, "RFK Jr. says it may be better if fewer children receive the flu vaccine," dated January 7, 2026.

Without objection.

Let me set aside the quote and set aside Secretary Kennedy and set aside the article. 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 their doctors...

I know, and so do I. And that's not what I'm asking you. Your qualifications have been much discussed. There is a mountain of evidence about this. Do you believe that there's no evidence that the flu vaccine has efficacy in reducing serious injury or hospitalization?

I...

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, ACIP, and the agencies...

So you believe it 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 vaccine.

Well, let me just say, do you think the flu vaccine reduces the risk of hospitalization or serious injury?

I've stated, I believe vaccines save lives. I believe they're an important part of our public health strategy.

The flu vaccine. Does it reduce the risk of injury or hospitalization?

At the population level, I certainly think that it does.

Let me introduce for the record if I can, Mr. Chair, CDC seasonal flu vaccine effectiveness studies dated May 30, 2025, from the CDC that goes into this in some detail.

Without objection.

This is not a hard question.

I answered your question.

I know it. After three minutes in, you answered a question that has a very simple yes or it had a very simple no to the proposition stated by the Secretary that there is no evidence. The Secretary said there is no evidence that this is effective. And yes, after three minutes you acknowledge that at a population level you would disagree.

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 were.

I'm not asking you about the quote. I'm asking you about something in your remit, the effectiveness of the flu vaccine. All right, let me ask you this. Do you believe it's important to continue to work to reduce youth smoking?

Certainly.

President Trump has said it's a priority to support moms, including supporting families that may need IVF. Do you support that position?

I know the administration is strongly in favor of IVF and I think people should have access to the best quality fertility treatments and also my core message has been about how we are missing the mark on our fertility conversation...

I just was asked about IVF. And finally, the Secretary and the President have talked about radical transparency in healthcare. Do you believe in that?

Yes.

Okay, then I'm very puzzled, not by you, but I'm puzzled about why the administration eliminated the CDC office on smoking and health. It was the only federal entity running the campaign to reduce to promote smoking cessation. They eliminated it. They've eliminated whole programs at the CDC working on maternal health, including the center tasked with publishing data on the effectiveness of IVF clinics. They've eliminated the CDC's Freedom of Information Act office. They've repealed the Richardson waiver, thus reducing public participation in the creation of HHS rules. I'm glad that you support smoking cessation. I'm glad you support work on IVF. I'm glad you support radical transparency. I'm puzzled by why the administration doesn't. I yield back.

Senator Hawley.

Thank you very much, Mr. Chairman. Dr. Means, good to see you. Congratulations on your nomination. Congratulations also on the birth of your child. I'm the father of three. If you're like me, I suspect you've had a tremendous career already, but I suspect it may be that your family will end up being the most significant thing you do. It certainly is for me. I was just thinking my, I have three as I said, my youngest is now five, Abigail. As I left the house the other day, she had our Labrador, not a very well-behaved dog, I will say. She had our Labrador there in the kitchen, had his paw stretched out and was painting his toenails pink. So anyway, you've got that to look forward to. Congratulations again. Can I just ask you from a health perspective, can we think about AI just for a second? I want to get your views on this. This is a sort of cutting-edge issue obviously that's evolving almost by the day. Data centers. We've got more data centers in this country, I think, than almost anywhere else. They're proliferating. They're needed, we're told, for AI development and so on. My question to you is about the health effect of data centers. Here's why I'm asking. When I am home in Missouri, I get asked a lot now by folks all across the state, maybe especially in rural areas like where I grew up, where there are more and more data centers, they say, we're worried about the health effects. We're worried about contaminants in our water. We're worried about a digital cancer alley. We've had some reports of migraines, vertigo, nausea, chronic sleep disruption from residents, not necessarily people who work at a data center, but just residents in the area. Now, all of this is anecdotal. I haven't seen any studies on it, but that's getting to my question to you. Is this something that we should be looking into? Should we be looking at the health effects, the wellness effects of data centers? I'm talking about these massive, massive centers for residents that live around the area. What do you think about this?

First of all, thank you so much for your question and your kind words about family. It's an interesting question and it's one that I'm so glad you're sharing. It's not one that I've actually thought much about in this specific context, but a core and passion of mine and what I hope to bring to the role is really advocating for understanding how our environmental exposures are affecting our health. It's been understudied and there's a huge commitment from the NIH, the Whole Person Health initiative, and through Dr. Jay Bhattacharya's work to look at how these cumulative environmental exposures are affecting our health and that's something that I hope to champion in this role. And so this would certainly fit squarely within that category and I'd love to chat with you more about this if I'm confirmed.

Good. I look forward to that. I'm glad to hear you say that. You have been just an incredible champion for looking at these environmental factors as well as diet and the other things that you've been talking about. And who knows? I mean, correlation is not causation, of course. You're a scientist and this is all what I'm hearing is anecdotal. I think what I read in the press is anecdotal. But maybe we do need a study on it. I mean, there's a significant, a sufficient number of these centers and they're not going to be fewer. There's going to be a lot more everywhere. And the level of concern I hear from working people, these are just normal people, they're showing up to work, they're trying to raise their families and they're concerned and they're concerned for their health. And they have their concerns about costs and so forth, but just putting those aside, they're concerned about their health and I don't know what to tell them because I'm not a physician, I'm not a scientist. But I do think maybe the time has come to say, well, we're going to take this seriously. I mean, we'll look at it and we'll figure out what the truth is and we'll figure out if there's things that we need to do to protect the health of our folks. So I'm glad to hear you say that that you would make that a priority and I look forward to working with you on that. Can I introduce you here in just the few seconds that I have remaining, 90 seconds or so, to a young man whose name was Adam Reine? I think we may have a poster of him behind me. Adam was 16 years old when he was groomed by an AI chatbot into committing suicide. I think do we have, yeah, there he is. Adam was just an incredible kid. I've gotten to know his parents. He was a rockstar athlete. He was a terrific student. And he started using an AI chatbot, ChatGPT in this case, it's all a matter of public record. He started using a chatbot to do homework and over time this chatbot introduced him to the concept of self-harm. He tried to commit suicide multiple times. The chatbot told him every time, don't tell your parents. He didn't. He was very close to his parents before this, I should say. I've met them. They're wonderful people. They've testified. Eventually, the chatbot instructed him on how to take his own life and he did it using precisely the method that the chatbot recommended. Now, I'm sad to say I've talked with too many parents whose stories parallel that one. My question to you is, is it time to study the effect of AI chatbot companions for minor children? Adam was 16, you know, he's not even a college student yet. He's a kid. Bright kid, great kid, but still a kid. Is it time to study the effects when it comes to mental health and wellness on these AI chatbot companions for minors? And please be quick with your answer because we're running late.

Yeah. Well, it's obviously a complex question and a tragic, tragic story that you're sharing and especially hits so hard as a new mother. I think that you and I are in complete alignment that children's health and protecting minors is of paramount importance. I think a country that doesn't protect its children, you know, has gone off course and it's a top priority of mine to do everything that we can to make sure children are healthy and safe.

Good. I look forward to working with you on this. Thank you, Mr. Chairman.

Senator Alsobrooks.

Thank you so much, Chair Cassidy, for hosting today's hearing. Dr. Means, welcome. Thank you so much for being at this hearing and congratulations again on your beautiful, beautiful baby. I want to first begin by the places where we agree. The industry, you agree that industry should not have undue influence over our health policies. In fact, you have written that when pharmaceutical companies have a direct line to network television through advertising, and I quote, you say, they can have influence over what messages are emphasized on the news and what is deemed misinformation or truth. Now, can you confirm that those are your words? I'm sorry? I'm sorry?

That sounds like something I would say.

Okay, perfect. And I also want to confirm again that you have been compensated, have you ever been compensated for platforming, spotlighting, or highlighting companies in your newsletters or podcast appearances?

Yes. Not for podcast, but in my newsletter I've had newsletter sponsors for my newsletter, yes.

Okay. For example, EnergyBits, have you received compensation from a company called EnergyBits?

Yes.

Okay. And in your newsletter, the very same one where you rail out against pharmaceutical advertising, you acknowledge that EnergyBits sponsored your newsletters. And I wonder, were you aware that the Better Business Bureau found that that company, EnergyBits, failed to provide substantiation for health-related and environmental claims and recommended that it discontinue doing so?

Senator Alsobrooks, I take conflicts very seriously. I've worked diligently with the Office of Government Ethics to make sure we've looked at all potential conflicts of interest, have signed a letter, have been cleared, and have signed a letter stating my commitment to divestments and of course during my time if I am confirmed in office I would take no money from any company...

But let me, Dr. Means, let me just ask, add a little bit more here. I know the time is tolling. Were you aware that this same company was served notice under California's Proposition 65 law alleging that their products contain lead above the allowable levels? Were you aware of that?

Again, I just want to reiterate, in this office, I will not be taking any financial compensation from any companies. I will be complying with the Office of Government Ethics thoroughly before, during, and after my time in office and I'm very committed to that.

Okay, let me ask you about another company. Have you ever received compensation from a company called Pique?

Yes.

Okay. And in your newsletter number 33, you acknowledge that Pique has sponsored you. Now, were you aware that this company was served notice under California's Proposition 65 for containing and failing to disclose that lead above the allowable amounts, a carcinogen and reproductive toxin, was present?

I just want to repeat, I've worked with the Office of Government Ethics. I am not going to be taking any financial compensation...

Okay, but we're talking about the ones you've already, so this is an ethics...

We're talking about conflicts and I have been cleared by the Office of Government Ethics through an exhaustive process and have signed a letter that I will be fully compliant and this is before, during, and after the term. I take it very seriously and I'll work closely with them to make sure there are no conflicts.

The point here is that you've received compensation from these companies, including Daily Harvest, where this company was subject to an investigation by the Food and Drug Administration after hundreds became seriously ill after consuming the product. And these are companies that you have received money from. They've been investigated and you are railing out against pharmaceutical companies that you say are advertising these products that mislead the public and yet, you know, you've received compensation from companies and you have promoted them in your newsletter and you're doing the same thing the pharmaceutical companies are doing by advertising and influencing people for these products that have been deemed to be unsafe for the public. Now, let me just move on as well to vaccinations. I want to just, you tweeted that you believe the hepatitis B vaccine at birth is a crime. That is what you tweeted. Do you recall tweeting that?

That is not the full tweet.

I actually do have the tweet. I can provide it for you. I have a copy of it here where you say that vaccination, that you believe the hepatitis B vaccine is a crime. And I wonder if you believe that, how is it that vaccinating children against hepatitis could be a crime?

I support vaccines. I believe vaccines save lives. I believe they are a key part of our public health strategy. I also believe that this administration is committed to making sure we have the safest vaccine schedule in the world and that we are continually studying the vaccine schedule, vaccine injuries, making sure we're eradicating conflicts of interest in vaccine research and doing gold standard science on vaccines. These are all things that I support and I think there's a nuanced conversation that American families are looking to have about shared clinical decision-making with their doctors about specific vaccines that their children may not be as seriously at risk for. And I think that that is the nature and the thrust of my comments.

Well, let me just follow, I know my time has expired. You have spoke on this panel about neurotoxin metals in vaccinations. Yet you have promoted through a brief research...

Senator, you're over your time and I say it with reluctance.

Okay. Just this last sentence here. You through a brief search of the products that you've made money off of in your newsletters, many of them have been found to contain the same neurotoxins that you claim are in these vaccinations. I yield. Thank you.

Thank you, Mr. Chairman. Dr. Means, welcome to the committee here. I'm going to stick with vaccines here because I am on, I'm red. Is it better? Better, better, better? Yeah. Just too far away. Sorry about that. Sticking with vaccines, you've stated that there's, quote, growing evidence that the total burden of the current extreme and growing vaccine schedule is causing health declines in vulnerable children. And so I've heard your comments to several of my colleagues here today, so I want to drill down more specifically to the hepatitis B vaccine. My state of Alaska has had a very long history with this, including early childhood immunization campaigns that were targeted specifically to Alaska Native communities. We were seeing some just really startling issues with regards to liver disease in Native children and so it was a pilot project decades ago that allowed for critical timely vaccinations for these Native children in the outlying areas. It made a remarkable difference in Alaska and I think other states, other countries look to that as an example. You have expressed the skepticism about the Hep B vaccine for newborns and I need to try to understand your thinking on that given the medical consensus that this vaccine prevents the serious liver disease and liver cancer that we, again, were able to demonstrate in real time, real life with that recommendation and now the view that you seem to be taking on this is it is not necessary for newborn.

Thank you, Senator Murkowski, for being willing to want to clarify this with me and also thank you for meeting with me. I really enjoyed our conversation in October with you and your staff. I think these concerns and comments that you're sharing, I think they're incompletely representing my views and so I'll take the opportunity to share. I think this is an effective vaccine. I think it's a very important vaccine and I think it's a, I mean, obviously Senator Cassidy knows better than anyone given his work, this is a vaccine that has saved thousands, millions of lives. I don't know the exact number, but I do think that this administration is committed to making sure we have the safest vaccine schedule and that parents have the opportunity to have shared clinical decision-making on specific vaccines with their doctor so they can make the best decisions for their family. This is not a condemnation of the vaccine generally, which I am very supportive of. However, I do believe that the thrust towards parents wanting to have the ability to have shared clinical decision-making with their doctor is important when there are conditions like hepatitis B where there's differential risk amongst different populations. ...I do think that this administration is committed to making sure we have the safest vaccine schedule and that parents have the opportunity to have shared clinical decision-making on specific vaccines with their doctor so they can make the best decisions for their family. This is not a condemnation of the vaccine generally, which I am very supportive of. However, I do believe that the thrust towards parents wanting to have the ability to have shared clinical decision-making with their doctor is important when there are conditions like hepatitis B where there's a differential risk amongst different populations.

So you have said that the Hep B vaccine is, you stated this on a TV show, is for a sexually transmitted disease and an IV drug user disease, which of course babies are not going to be exposed to. And one of the things that we have certainly seen with Hep B, recognizing that it's a bloodborne pathogen, 100 times more infectious than HIV, not just contracted through sexual contact or drug use. And in Western Alaska, where we see Hep B as endemic, we find that it's being spread through mosquito bites where a child is itching an arm, ordinary household community contact, whether it's sharing food, toothbrushes, and minor injuries. And so this is where many in my state are looking at this and saying, we have been able to turn the corner on this. We're no longer seeing children with liver cancer, with this liver disease, and it is because the hepatitis B vaccine has been made available to them at birth. And so my hope is that as you are communicating the value of childhood vaccine, that demonstrated positive results of vaccines just like this would be communicated and not just everybody needs to consult with their doctor. But if you're in an Alaska Native population that has been systematically impacted in a way that we've now seen a marked difference, it seems to me that's where you should be directing it. I'm well out of time, sir. Thank you.

Senator Hickenlooper.

Dr. Means, congratulations on your birth. As I know from two experiences, that is about the most magical time you can ever have. We know that many Americans struggle with the issues around infertility. Medical intervention often is necessary. According to the American College of Obstetricians and Gynecologists, by the age of 30, fertility in women starts to decline and that rate of decline gets more rapid throughout the decade. For families like mine, where a childbirth would have been impossible without IVF, I think it's potentially damaging to widely spread a message that if only we made lifestyle changes, we too could conceive naturally. I think that the people that are struggling with infertility sometimes feel that if they only made lifestyle changes, the world would open up. And I guess my question then is, how much time should a woman of childbearing age take to self-reverse a fertility struggle that may ultimately serve as a further setback to them growing their family? And I again say this as someone who we did use IVF, as you're aware, and it was a transformational, it wouldn't have been possible without that. So how long should people wait before making that decision?

Thank you, Senator, for this very thoughtful question and also for meeting with me in October. I of course can't answer for a specific time period that someone should wait. But the broader message, which is I think one that we probably agree on, is that the American people deserve to and I think want to have information from medical authorities about what is possible and what the evidence shows in terms of what environmental factors are affecting these really important issues in our life like fertility. Like we've talked about earlier, infertility is going up about 1 percent a year in both men and women, male and female infertility. And the key medical conditions that are causing infertility, we know are lifestyle-related. Certainly that does not mean that all infertility cases can be reversed by lifestyle changes. And also, it is the onus is on our medical authorities to make sure Americans are seeing that information clearly and loudly and in an empowered way, and that we then use policy and medical education to make systemic changes that make those choices easier, more accessible, and affordable for Americans. And that's really my message. Patients deserve to know what the data is showing and not just a myopic view on technological or medical or surgical interventions. They deserve to know the breadth of the spectrum. And from working with thousands and thousands of both Levels members and also in my clinical practice, I believe that people don't feel discouraged by understanding what the evidence-based levers are for how they can impact their own health. I think they're looking for that right now. And it's a yes-and answer. I think IVF is miraculous, I think it should be widely accessible, and with that said, I also think we need to give patients the best public health information about what is impacting these conditions that are plaguing our population.

Let me switch tack here and talk a little bit about autism because obviously I don't think we definitively know what causes autism. I think we agree on that and certainly I applaud any fact-based effort to get a better understanding of that diagnosis. You've stated that the cause of autism is very likely to be multifactorial and anyone who claims to believe that it can be just only one factor is mistaken. So I guess the question then is, are those who believe autism is singularly caused by vaccines, including some of those currently serving at the Department of Health and Human Services, by that calculus, are they incorrect?

You know, I can't speak for every person who's made a comment about autism and vaccines. I know that people are in pain looking at the childhood chronic disease epidemic and the rising rate of childhood neurodevelopmental diseases and they're looking for answers. And I think that I certainly can't speak for anyone who's spoken out about vaccines and autism. However, I would assume that most people understand that health is there's multifarious things that impact every medical condition and are trying to understand if there's a contribution from a significant number of medications that our children are getting to this disease. I'm strongly supportive of the research that the administration is or the grants that the administration has recently enacted, I believe for about $50 million to study root causes of autism and specifically environmental factors. And I think we should all look forward to the results of those studies and hopefully we can help children through that.

I appreciate that and I look forward to that science being the North Star of those investigations. Thank you.

Thank you.

Senator Markey.

Thank you. Dr. Means, thank you for being here and congratulations. You have spoken extensively, including earlier in this hearing, about the root causes of chronic diseases and the harmful impacts of unhealthy foods and environmental toxins. And this is an area where you and I may have some common ground. Over a decade ago, I called on the EPA to review the safety of pesticides and their link to cancer. So yes or no, Dr. Means, do you agree with the scientific research that glyphosate, one of the key ingredients of the most widely used weed killer Roundup, is harmful to humans?

I certainly have significant concerns about many of the environmental chemicals that are used in our agriculture system, of which glyphosate is one of them, and I think they need to be significantly more robustly studied so that we can understand the cumulative impact on health. And that's a passion of mine.

Yeah, according to your blog post of August 19, 2024, and I have this here, you wrote, quote, "The World Health Organization has explicitly stated that glyphosate damages our DNA and probably causes cancer." So I request unanimous consent to submit the blog post.

Without objection.

Thank you. You also wrote that there are, quote, "billions of people impacted by the sublethal chronic impacts these are toxic substances," you wrote. So I agree with your concerns about glyphosate. We should prioritize protecting people from harmful chemicals, not pushing them. Yet last week, Donald Trump signed an executive order to promote production of glyphosate-based herbicides. Just a few months before, the Trump administration filed a brief with the Supreme Court arguing that Monsanto, one of the main producers of glyphosate, should be shielded from lawsuits from Americans who developed cancers from being exposed to glyphosate-containing Roundup, which is a weed killer. Instead of fighting for families with cancer, the Trump administration is fighting against them. So again, back to you. Yes or no, do you think President Trump's executive order promoting the production of glyphosate, which you yourself have said likely causes cancer, will put American families' health at risk?

Senator Markey, you and I both know that these issues around agriculture and health are extremely complex and are affecting farmers, consumers, food producers, food accessibility. My understanding of the executive order is that this the thrust of this has to do with national security and decreased resilience and reliance on foreign countries for tools that farmers are currently using right now.

But these are things, these are cancer-inducing chemicals according to your own statements.

We must as a country move away from using toxic inputs in our food supply and we must study these chemicals more to understand their effects. I am very gravely concerned about the health impacts of these chemicals.

I understand, Doctor. I'm just trying to help you to agree with yourself. You've already said it in the past, but Trump is contradicting you. He's signed an executive order.

Our food system is dependent currently on these chemicals. There is a good faith movement towards moving our food system towards regenerative agriculture and precision application of pesticides. I believe in good faith that is happening within this administration. I do also believe that we must do that for human health.

It's not good faith. He's immunizing, he's arguing that there should be an immunization of Monsanto against any lawsuits. That's not good faith. That's just siding with the chemical manufacturing company that is in fact causing the cancers. So again, don't you think it does put people, families at risk if these chemicals are in the system? That's been your position historically.

I think there's grave issues with these chemicals. I think that we are in a very complicated moment for agriculture and food. We cannot overturn the entire agriculture system overnight. That would hurt farmers, it would hurt food prices. This is a national security decision.

That's not what the Trump administration, that's not what the Trump administration...

And as a physician and as the Surgeon General, my focus would be on making sure that we are protecting American consumers and their health and making sure that we are having transparent, honest conversations about these issues.

Well, I'm disappointed to see you back away from your efforts on this issue.

I am not in any way backing away from this issue. It is a core passion of my life.

Secretary Kennedy has already backed away from his prior statements that glyphosate is a carcinogen and a "likely culprit" behind chronic diseases in the United States. That's a total U-turn on the health risks of glyphosate. Total U-turn by Kennedy, and you're in his agency. Thank you, Mr. Chairman.

Could I respond, Senator Cassidy? The administration has put down in very clear writing through the MAHA strategy that we are going to study the chemical inputs of our food supply. We're going to make sure American consumers are protected and that we are entering an era where we are going to prioritize helping farmers move to more sustainable farming practices. I think those are all good things. I think it's extremely important both for our planet and our health, and I'm going to be a champion on that issue.

The MAHA movement is not happy with the Trump executive order. Okay, that's the reality. Thank you, Mr. Chairman.

Taking the chairman's prerogative, I've listened obviously to everyone. I have a couple follow-ups. When you speak of shared decision-making as regards immunization, right now the doctor speaks with the mom or the dad as regards should the child be vaccinated. The doctor doesn't take the parent out of the room and give the child the shot. No, they discuss it and they give it. Are you speaking about something more than what is currently used?

I think, Senator Cassidy, I think that in our current landscape of our healthcare system, robust, thorough conversations about informed consent are lacking.

So that should happen. So are you speaking of a formal consent form?

No, I'm speaking of generally that we need to unburden our doctors to make sure we're having conversations that address all parent concerns, that don't shame parents, and that honor the ability to have robust and nuanced conversations about medical decisions for our children.

But that happens. So you're advocating for something different, I think. My pediatricians tell me they routinely have these conversations. Are you advocating for something different than what my pediatricians say they routinely have?

If these pediatricians are doing that, I commend them and I think that's fantastic and I think we need to support doctors in our broken medical system.

But are you advocating for something different than the doctor saying, "I think your child needs the hepatitis B vaccine when the child passes through the birth canal, they are exposed to the same secretions that they would be through intercourse. By the way, when they're a teenager, they may have intercourse with someone who's a chronic carrier. Now's the perfect time and it's safe." Now, would you ask for something more than that? I'm not quite clear because it seems as if status quo is not adequate, and that's what I'm trying to understand.

I support the CDC's recommendations on the vaccine schedule.

I get that, but I'm asking... what I'm trying to get at, are you asking for a formal informed consent as if somebody's going for bypass surgery or somebody's going for an appendectomy for an immunization?

I'm not necessarily advocating for that. I think that you and I both know from clinical practice that the constraints on doctors are monumental and many American parents are frustrated by what they feel like is lack of transparency on the issue of vaccines. And I think doing what we can as medical leaders to...

But what would that be?

It's encouraging a culture shift towards making sure that we're respecting parent questions, choices...

I don't see that culture lacking. And so that's where when I speak to the pediatricians, they emphasize that they spend a lot of time discussing immunizations.

I spoke to a physician leader of a major medical organization last week who in his morning clinic saw 28 patients. I think you know exactly what I'm talking about, that the physicians are very overburdened.

In that case, I'm sure the nurse extender or the physician extender would be having that conversation. I mean, we both know that there's other ways to communicate. And so I'm not sure I know what you're advocating for, which of course gives pause.

Broadly speaking, I am very supportive of what's been laid out by this administration in regard to vaccines, which is that we want to make sure that for all of our vaccines, we're pursuing gold-standard placebo-controlled trials, that we are robustly and transparently studying vaccine injury, that we're making sure that conflicts of interest in any of the research around vaccines are addressed and understood, that post-licensing data is transparent and shared with the American people, and that we work towards a healthcare system where doctors have more time and ability and incentive to spend more time with patients for the sake of both the doctors and the patients. Those are all common-sense things that I agree with.

Now, the Secretary has suggested that the fact that a pediatrician gets five bucks more for vaccinating a child reflects a conflict of interest that would incentivize them to vaccinate a child, and the conflict of interest being pejorative, if you will. Would that kind of outcomes measurement with the aligned incentive to promote immunizations be considered something negative?

Senator Cassidy, I want to just back up and broadly just reassure you that this is not an issue that I intend to complicate or bring an agenda on vaccines. This has not been the core of my issue. As I said, I support the initiatives that the administration is putting forward to hopefully restore trust in public health through increased transparency and through placebo-controlled trials.

One more thing, I'm sorry. And you've made that point, you've presented it very well, by the way. Let me just compliment you. It's clear that your concerns about metabolic disease are very important. And by the way, I agree with that totally. Do you agree with the need for universal hepatitis B immunization?

I think right now any parent in America can walk into their pediatrician's office and get access to the hepatitis B vaccine for their child if they want it, and my understanding is that all insurers have agreed to continue with cost-sharing on that vaccine.

I accept that, but is universal hepatitis B immunization, irrespective of what age the vaccine would be given, in your mind is that an important goal?

It is accessible to every American family right now.

That's not what I'm asking. Is it an important goal?

I think it is an important vaccine. It is a life-saving vaccine. I also think that parent autonomy and family autonomy should be respected.

No one's arguing that because no one forces the child... well, that universal and parent autonomy... but broadly speaking, I believe that parents want to have a good-faith conversation without shame with their doctors about vaccines and that we need to move toward a medical culture where that's possible. And I genuinely believe that will help restore trust in public health. Right now, that's not the current culture of medicine. One more time. Everything you say, I agree with. But the question is, because we want to support parents, the question is, is universal hepatitis B immunization an important goal?

I feel like we're going in a semantic loop here. Do you want to define for me exactly what you mean by universal?

Should we be promoting to parents that for the long-term safety of your child, she or he should be vaccinated for hepatitis B at some time in their youth?

At some time in their youth, I think that's an important recommendation, yes.

Okay, so universal... does that mean you agree that universal hepatitis B immunization is a goal we should be shooting for?

I think there are many parents and I think the administration question whether this vaccine is necessary for all children on the first day of life. And I think that certainly if we're talking more broadly about promoting universal vaccination in children at some point in childhood, I think that's a worthy goal.

Okay. And I'll just note that among some populations in Hawaii, up to 10 percent of the folks are chronically infected, and of course we know that one of those may eventually marry someone who's not. So if they're not immunized and they marry someone who's chronically infected, then you're more likely to have acute infection in the person married to the person who's chronically infected. And that's very Hawaii-specific, but it's of course going to occur anywhere. Thank you very much for your testimony.

Thank you, Senator Cassidy.

For any Senator wishing to ask additional questions, questions for the records will be due 5:00 PM Thursday, February 26. Thank you again for being here. The committee stands adjourned.