Casey Means, President Trump’s nominee for surgeon general, will appear before the Senate Health Committee on Wednesday and is likely to face scrutiny over her qualifications for becoming the country’s top doctor.

Though Means holds a medical degree from Stanford Medical School, she dropped out of her medical residency and holds no active medical license. Instead, she has pursued a career as a wellness influencer, embracing “functional” medicine, an ill-defined form of alternative medicine. She co-founded a company called Levels, which promotes intensive health tracking, including the use of continuous glucose monitoring for people without diabetes or prediabetes, which is not backed by evidence.

Last year, an analysis by The Washington Post found that Means earned over half a million dollars between 2024 and 2025 from making deals with companies described as selling “diagnostic testing,” “herbal remedies and wellness products,” and “teas, supplements, and elixirs.”

But Means is best known as an ally to anti-vaccine Health Secretary Robert F. Kennedy Jr. and a popular influencer among Kennedy’s Make America Healthy Again (MAHA) followers.

In 2024, Means and her brother Calley Means—also a close Kennedy ally and Trump administration official—wrote a book some consider MAHA’s bible: Good Energy: The Surprising Connection Between Metabolism and Limitless Health. The book provides dietary and lifestyle advice, including a recommendation to avoid processed foods, seed oils, fragrances, a variety of home care products, fluoride, unfiltered water, bananas (when eaten alone), receipt paper, and birth control pills. It includes a chapter titled “Trust Yourself, Not Your Doctor.”

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“Damning”

Overall, a lack of updated data can make it more difficult, if not impossible, for federal and state health officials to identify and rapidly respond to emerging outbreaks. It can also prevent the identification of communities or demographics that could benefit most from targeted vaccination outreach.

In an accompanying editorial, Jeanne Marrazzo, CEO of the Infectious Disease Society of America and former director of the National Institute of Allergy and Infectious Diseases, stated the concern in starker terms, writing: “The evidence is damning: The administration’s anti-vaccine stance has interrupted the reliable flow of the data we need to keep Americans safe from preventable infections. The consequences will be dire.”

The study authors note that the unexplained pauses could be direct targeting of vaccine-related data collection by the administration—or they could be an indirect consequence of the tumult Kennedy and the Trump administration have inflicted on the CDC, including brutal budget and staff cuts. But Marrazzo argues that the exact mechanism doesn’t matter.

“Either causative pathway demonstrates a profound disregard for human life, scientific progress, and the dedication of the public health workforce that has provided a bulwark against the advance of emerging, and reemerging, infectious diseases,” she writes.

Marrazzo emphasizes that the lack of current data not only hampers outbreak response efforts but also helps the health secretary realize his vision for the CDC.

Kennedy, “who has stated baldly that the CDC failed to protect Americans during the COVID-19 pandemic, is now enacting a self-fulfilling prophecy. The CDC as it currently exists is no longer the stalwart, reliable source of public health data that for decades has set the global bar for rigorous public health practice.”

Emily Hilliard, a spokesperson for the Department of Health and Human Services, sent Ars Technica a statement saying: “Changes to individual dashboards or update schedules reflect routine data quality and system management decisions, not political direction. Under this administration, public health data reporting is driven by scientific integrity, transparency, and accuracy.”

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For these people, regardless of what state they are in, getting the vaccine would mean a pharmacist or doctor would have to go “off-label” to provide it.

“It’s very gray on how a pharmacist may proceed in that scenario,” Groves told Ars. Going off-label could open pharmacists up to liability concerns, she said. And even if a patient can obtain a prescription for an off-label vaccine, that still may not be enough to allow a pharmacist to administer the vaccine.

“Pharmacists have something called ‘corresponding responsibility,’ Groves explained. “So even if a physician, or a nurse practitioner, or whomever may send a prescription over for that vaccine, that pharmacist still has that responsibility to ensure this is the right medication, for the right patient, at the right time, and that they’re indicated for it,” she said. So, it would still be going outside what they’re technically authorized to do.

Doctors, on the other hand, can administer vaccines off-label, which they might do if they choose to follow guidance from medical organizations like AAP and ACOG, or if they think it’s best for their patient. They can do this without any heightened professional liability, contrary to some suggestions Kennedy has made (doctors prescribe things off-label all the time). But, people may have to schedule an appointment with their doctor and convince them to provide the shot—a situation far less convenient than strolling into a local pharmacy. Also, since pharmacies have provided the vast majority of COVID-19 vaccines so far, some doctors’ offices may not have them on hand.

Pregnancy

It’s unclear if pregnancy still falls under the FDA’s criteria for a high-risk condition. It was included in the list that FDA officials published in May. However, the agency did not make that list official when it changed the vaccine labels last month. Some experts have suggested that, in this case, the qualifying high-risk conditions default to the CDC’s existing list of high-risk conditions, which includes pregnancy. But it’s not entirely clear.

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