Casey Means and the Deathly Kakistocracy

kak·i·sto·cra·cy /kakəˈstäkrəsē/ noun

• a state or society governed by its least suitable or least competent citizens.
  “the modern regime is at once a plutocracy and a kakistocracy.”
  Oxford English Dictionary.

Kakistocracy was always a funny word to me. It seemed impossibly cynical outside the context of a monarchy, where children clung to their parents’ power with ever-increasing deformity and feeblemindedness after generations of fucking their own first cousins. There was just no way that could ever happen in a democracy.

Or at least, that was what I thought until 2025.

It’s only been a year, but I am tired of being more qualified than appointees to positions intended for genuine experts who are trusted with the health of every man, woman, and child in the nation. Dr. Oz hasn’t practiced medicine in over a decade thanks to TV stardom. Jay Battacharya has never practiced medicine, as he never did a residency. And of course, RFK Jr. never attended a single day of scientific, medical, or nutritional training in his surprisingly long life, which is why he rose to the top.

In the case of Casey Means, I have her beat on every metric not because I’ve done anything special, but because I have done the minimum required to be a practicing physician in good standing, and I have successfully avoided grifting to move product to make up for a failed medical education.

I -like many others, will tell you that she is fundamentally unqualified to be the next Surgeon General because she failed to complete her basic training as a physician:

• Means completed medical school, which makes her a physician by way of an earned MD. But no graduate can practice medicine at this point.

• 1-3 years of residency is mandatory in order to qualify for a generalist’s license to practice medicine, which she could obtain by way of her partial ENT residency (but bear in mind that 4 years of ENT residency is not going to make anyone a competent general practitioner -that’s a specialized surgical program).

• Because she never finished her residency, she can NEVER be board certified, which is the minimum amount of training that you would demand for someone to diagnose and treat your raging case of amoebic dysentery or to take your kid’s tonsils out.

Means on dropping out: “My professional history is a feature. It’s not a bug.”

Bold words from someone who failed, and importantly -never recovered as a physician. This would be an important mantra for her to internalize to guard against emotional collapse in the face of emotionally devastating defeat, but it is nothing to be publicly proud of. It’s certainly not a qualification, even though her confident delivery is convincing. Apply her reasoning to any other intellectually demanding field with respect to the goal of doing something well:

In deploying a satellite into orbit do you seek the assistance of:

1. a team of formally educated astrophysicists and rocket scientists, or

2. a YouTuber who launches model rockets?

In wiring your new home, do you recruit:

1. a licensed journeyman electrician, or

2. an unlicensed free agent who dropped out of their apprenticeship?

The answers to these questions are obvious, and it is intellectually dishonest for anyone to say that they would prefer the care of an incompletely-trained failure than a fully trained physician. In 25 years of practice, I have never had anyone tell me they wanted someone less experienced or less educated. People are picky about their own health.

Wait… did I say “failure?” Yes, because that is the bug that Means touts as a feature. While she states that she left of her own accord after becoming “disillusioned with mainstream medicine,” that is pure bullshit. Absolutely no one willingly abandons eight and a half years of education between medical school and residency (only a few months shy of completion) unless they are going to be embarrassingly terminated in lieu of quitting. She was almost certainly encouraged to resign in a manner that was confidential but remains transparently obvious to those of us who have seen it -and every physician has seen a few of their co-residents wash out after a long struggle against poor performance.

Even if Means hadn’t dropped out of her residency -she would still be the worst possible candidate to serve in the 154 year history of the position.

When Casey Means states that she has “treated thousands of patients,” she has only done so independently as a functional medicine practitioner -which is quite frankly not a thing. You don’t need a license to practice functional medicine because:

1. you don’t need to go to school to learn functional medicine (there are no functional medical schools), because

2. it’s a marketing designation, not a specialty of medicine. While some physicians choose to “practice” it, so do chiropractors, fitness gurus, and supplement salespeople. Your plumber can practice functional medicine the moment he finishes reseating your toilet -without breaking any laws (but he still needs a license to be a plumber).

Means audaciously claims that the experience of pretending to practice medicine outside of its true legal definition, establishes medical credibility. It does not.

Her claim is no different campaigning to lead the United States Special Operations Command, on the grounds that even if someone washes out of boot camp, by virtue of being an elite Call of Duty player, they remain as qualified to run that organization as any Army Ranger or Navy SEAL that they would command. This would obviously be disastrous for the military, and it should be just as obvious that Means has no legitimate educational or vocational claim to being Surgeon General.

The Surgeon General is the people’s doctor: strong in evidence and committed to delivering medical advice that serves the health of all citizens. The Surgeon General does not serve any political party or corporate interest (because let’s face it, neither corporations nor political parties struggle with advocating for their own interests). So while the office of the Surgeon General has historically had bouts of controversy over statements that conflicted with either entity (which confirms that they were doing their job to serve the people), it has no record of significant ethical scandals, like say… plugging your own company at a senate confirmation hearing.

Means was able to promote her own company, Levels Health, several times during her confirmation hearing. Senator Marshall (R-KS) also fawningly brought it up as he introduced her. While not illegal, it certainly constitutes an appearance of impropriety, given that the Surgeon General is supposed to provide non-conflicted, evidence-based advice on public health, rather than orchestrating brand placement ads in the Upper Body of the Legislature.

Means is a MAHA appointee, but does she faithfully represent MAHA’s principles?

Short answer is: No

MAHA fiercely holds the following positions:

1. There is too much conflict of interest in medicine and medical research.

2. Disease is overmedicalized by mainstream medicine.

3. Insufficient effort is made in addressing the root causes of disease, and too much effort is made in treating the symptoms of disease.

4. There are vast flaws and omissions in medical education.

How does Casey Means stack up against these? Worse than you might think.

On conflicts of interest:

Means proudly claims to have founded an industry-sponsored research consortium to study glucose dysregulation. She cited this as an accomplishment, but it’s really just a shocking admission of conflict since industry-funded research is exactly what yields conclusions that are deliberately wrong in order to sell product. Historical examples include:

• Tobacco-sponsored research determined that cigarettes don’t cause cancer.

• Sugar companies funded research to demonstrate that fat (not sugar) causes coronary artery disease. In truth, they both do, but there was no dedicated fat industry to push back against that.

• ExxonMobil funded research that asserts that burning fossil fuels doesn’t contribute to climate change. While >99% of independent research shows that human combustion of fossil fuels drives climate change, the fraction of a percent that says otherwise is directly or indirectly tied to industry funding that desperately wants to deny it.

• GM, Standard Oil, and DuPont sponsored research to suggest that leaded gasoline was totally safe -because they held a patent for tetra ethyl lead -allowing them to collect royalties on every gallon of gas sold. Lead reduced engine-knock, but so did ethanol -which could not be patented. I am going to assume that no one reading this doubts the existence of lead toxicity.

So it should be no surprise that Means’ own corporate-sponsored and non-peer-reviewed research found that non-diabetics benefit from continuous glucose monitoring -even though independently conducted research has found no value in using it to lose weight or stave off diabetes (despite being fantastic for diabetics).

Sales-driven corporate research is demonstrably tied to false conclusions no matter one’s political stance, but MAHA specifically views this exact behavior as the primary source of “corporate capture” in health. Where is the outrage over this hypocrisy?

On overmedicalization:

While Means explicitly states that she is against “overmedicalization,” she paradoxically advocates for universal use of continuous glucose monitors on people who do not suffer from diabetes of any type -which is around 85% of the entire fucking population. That seems a lot like… overmedicalization. What could be the difference between calling the treatment of things like depression or hyperlipidemia overmedicalization while believing that invasive and unnecessary blood glucose monitoring is mission-critical to healthcare? Oh, wait… I know this one! It’s because she owns the company that sells said glucose monitors!

Thus, according to Dr. Means, overmedicalization is only acceptable when you simultaneously have a massive conflict of interest. Do two wrongs make a right? Is this a MAHA principle or the logic gleaned from Means’ Good Energy? I can’t answer that, but it looks like astounding hypocrisy and grift to me.

On treating the root causes of disease, instead of managing symptoms:

An opportunity was missed by the senators who grilled her. They asked about influenza, and Hep B, and MMR vaccines -but no one asked about HPV, a real hot potato amongst the religious right who see vaccination against genital warts as failing a purity test, instead of seeing it for what it really is: a vaccine against cancer.

I cannot speak to Casey Means’ religious inclinations, but I also cannot find an instance of her expressing an opinion on HPV vaccines. This is particularly fascinating for someone who did a few years of ENT residency, where much of their operative efforts are spent pruning the faces and orifices of those who in silent HPV infection, have cultivated nightmarish facial cancers. There is an entire fellowship -1 to 2 years of extra training- that ENT’s can pursue treat devastating and disfiguring head and neck cancers mostly caused by HPV, which affect over 15,000 Americans each year, killing 2-3,000.

In this context, there is no specialty of medicine more committed to treating the symptoms, rather than the root causes of a disease than ENT’s -particularly fellowship trained ones. If Means is “committed to combating chronic disease” she should have thrown her full and unqualified support at universal vaccination against HPV, because it would reduce the national burden of head and neck cancers by over 70%.

Instead, she dodged questions about supporting vaccinations of any kind, hiding behind the statement of “patients should have a conversation with their doctor,” knowing full well that any such conversation with the MAHA faithful will end in vaccine refusal. Ironically vaccination is better at treating the “root cause” of disease than any vitamin or supplement used to treat symptoms once infected.

Preventing infection is the single most perfect case for treating a root cause of disease.

On addressing perceived problems medical education:

Means proclaimed that she wants “a mature and candid conversation about flaws in medical education” -as someone who flunked out of it.

When we make laws, do we seek the counsel of lawyers who dropped out of law school? No we fucking don’t. Which is why we don’t charge the least accomplished of all physicians to find deep insight in complex topics that they haven’t finished learning about. She can’t even do a tonsillectomy. She lacks a nuanced understanding of medicine, she is specifically disallowed from delivering healthcare, and thus she should especially be excluded from making statements on how Americans should best tend to their medical needs. She is a novice at best, but much closer to a failure.

Like a handful of rocks, her insights are worthless, but casting a handful of stones into the furious turning of the jet engine of healthcare will inevitably lead to catastrophic failure. So her opinions still carry value… as sabotage.

But what about eating and exercising?

As RFK Jr. proved in his own confirmation, speaking broadly about the scourge of chronic diseases and the lackluster diets of Americans is nothing more than a stealth package for delivery of anti-vax and anti-scientific health weapons of mass destruction.

Literally no one argues against eating better and exercising more in a developed nation of culinary abundance that lacks predators to chase us each day. Framing this as MAHA’s unique side of a debate is fallacious because no one was claiming that Doritos and Mountain Dew were the secret to health and longevity. No one needs continuous glucose monitoring to validate that either.

Ultimately the choice of what we eat and how much we move belongs exclusively to the individual. No policy short of despotism will take food off of the table. No decree short of forced labor will shed pounds via the perspiration of those who delight in a sedentary lifestyle.

Precisely no one is pro-chronic illness, and Means’ messaging that her passion for fighting chronic illness makes those who disagree with her an adversary to health is more than just a bad-faith argument: it is hypocrisy in the context of her cautiously lukewarm evasion of support for vaccines that prevent both acute and chronic disease at their very roots.

Put a fork in me: I’m done.

This isn’t a left-verses-right thing: Casey Means’ grossly inappropriate nomination is an across-the-spectrum what-the-fuck moment for all Americans with an IQ that tops 75.

In the hyper-polarized substrate of US politics, any opinion that opposes any aspect of the Trump administration is reflexively labeled leftist. It is sad that critical thinking has sunk to this depth, but it is an undeniable reality of societal interaction these days. This dynamic stifles meaningful discussions over what might be good for the country, and what might be good for the party -particularly when those two things are at odds.

To those who disagree and wrongfully call my deep disdain for Means politically-motivated, I can only offer this scathing rebuke of Means from Laura Loomer. I defy you to find a single argument in the universe that could paint her of all people, as a leftist.

Everyone from Bernie Sanders to Laura Loomer agrees that Means is a criminally unqualified choice for the office of Surgeon General (because it is against the law in every state to practice medicine without a license). There has never been an issue in modern memory with such widespread agreement between right and left, including the handling of the Epstein Files.

Republican senators must grow a spine on this issue, and resist the urge to simply rubber stamp an appointee out of fear of reprisals from the executive branch. This is exactly the reason that the forefathers saw fit to separate the powers of governance. While the President leads the country, senators represent the best interests of their respective constituents -none of whom will be well served by this nomination. While President Trump nominated Casey Means, he would never let her take care of him. I simply argue that she should not be put in a position to take care of the rest of us lowly citizens as well.

Anything other than a NO-vote on Means from any US senator is an assault on the integrity of American healthcare, and stark hypocrisy until such time that these senators publicly insist on only allowing unlicensed, non-board-certified physicians to care for them.

The Nation’s doctor cannot be the worst of all of us.