Takeaways from AP's report on the business interests of Trump's surgeon
general pick
[June 09, 2025]
By MICHELLE R. SMITH and ALI SWENSON
PROVIDENCE, R.I. (AP) — President Donald Trump’s pick to be U.S. surgeon
general has repeatedly said the nation’s medical and food systems are
corrupted by special interests and people out to make a profit at the
expense of Americans’ health. Yet as Dr. Casey Means has criticized
scientists, medical schools and regulators for taking money from the
food and pharmaceutical industries, she has promoted dozens of products
in ways that put money in her own pocket.
The Associated Press found Means, who has carved out a niche in the
wellness industry, set up deals with an array of businesses. In some
cases, she promoted companies in which she was an investor or adviser
without consistently disclosing the connection, the AP found.
Means, 37, has said she recommends products that she has personally
vetted and uses herself. Still, experts said her business entanglements
raise concerns about conflicting interests for an aspiring surgeon
general, a role responsible for giving Americans the best scientific
information on how to improve their health.
Here are some takeaways from the AP's reporting.
Growing an audience, and selling products
Means, 37, earned her medical degree from Stanford University, but she
dropped out of her residency program in 2018, and her license to
practice is inactive. She said she saw firsthand how “broken and
exploitative the healthcare system is" and turned to alternative
approaches to address what she has described as widespread metabolic
dysfunction driven largely by poor nutrition and an overabundance of
ultra-processed foods.
She co-founded Levels, a nutrition, sleep and exercise-tracking app that
can also give users insights from blood tests and continuous glucose
monitors. The company charges $199 per year for an app subscription and
an additional $184 per month for glucose monitors. Though scientists
debate whether continuous glucose monitors are beneficial for people
without diabetes, U.S. Health Secretary Robert F. Kennedy Jr. has
promoted their use as a precursor to making certain weight-loss drugs
available to patients.
With more than 825,000 followers on Instagram and a newsletter that she
has said reached 200,000 subscribers, Means has a direct line to an
audience interested in health, nutrition and wellness.
Many companies, including Amazon, have affiliate marketing programs in
which people with substantial social media followings can sign up to
receive a percentage of sales or some other benefit when someone clicks
through and buys a product using a special individualized link or code
shared by the influencer.
Means has used such links to promote various products sold on Amazon.
Among them are books, including the one she co-wrote, “Good Energy";
beauty products; cardamom-flavored dental floss; organic jojoba oil;
sunglasses; a sleep mask; a silk pillowcase; fitness and sleep trackers;
protein powder and supplements.
She also has shared links to products sold by other companies that
included “affiliate” or “partner” coding. The products include an
AI-powered sleep system and the prepared food company Daily Harvest, for
which she curated a “metabolic health collection.”
On a “My Faves” page that was taken down from her website shortly after
Trump picked her, Means wrote that some links “are affiliate links and I
make a small percentage if you buy something after clicking them.”
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Dr. Casey Means, a wellness influencer, left, and journalist Megyn
Kelly, attend a confirmation hearing for Robert F. Kennedy Jr. for
the Secretary of Health and Human Services post, at the Capitol in
Washington, Jan. 29, 2025. (AP Photo/Ben Curtis, File)
 It’s not clear how much money Means
has earned from her affiliate marketing, partnerships and other
agreements. Daily Harvest did not return messages seeking comment,
and Means said she could not comment on the record during the
confirmation process.
Disclosing conflicts
Influencers who endorse products in exchange for something of value
are required by the the Federal Trade Commission to disclose it
every time. But most consumers still don’t realize that a
personality recommending a product might make money if people click
through and buy, said University of Minnesota professor Christopher
Terry.
While Means did disclose some relationships like newsletter
sponsors, the AP found she wasn't consistent. For example, a “Clean
Personal & Home Care Product Recommendations” guide she links to
from her website contains two dozen affiliate or partner links and
no disclosure that she could profit from any sales.
Means has said she invested in Function Health, which provides
subscription-based lab testing for $500 annually. Of the more than a
dozen online posts the AP found in which Means mentioned Function
Health, more than half did not disclose she had any affiliation with
the company. Though the “About” page on her website discloses the
affiliation, that’s not enough, experts said. She is required to
disclose any material connection she has to a company any time she
promotes it.
Representatives for Function Health did not return messages seeking
comment.
While the disclosure requirements are rarely enforced by the FTC,
Means should have been informing her readers of any connections
regardless of whether she was violating any laws, said Olivier
Sylvain, a Fordham Law School professor, previously a senior advisor
to the FTC chair.
“What you want in a surgeon general, presumably, is someone who you
trust to talk about tobacco, about social media, about caffeinated
alcoholic beverages, things that present problems in public health,”
Sylvain said, adding, “Should there be any doubt about claims you
make about products?”
Potential conflicts pose new ethical questions
Past surgeons general have faced questions about their financial
entanglements, prompting them to divest from certain stocks or
recuse themselves from matters involving their business
relationships for a period of time. Means hasn't yet gone through a
Senate confirmation hearing and has not yet announced the ethical
commitments she will make for the role.
Emily Hund, author of “The Influencer Industry: The Quest for
Authenticity on Social Media,” said as influencer marketing becomes
more common, it is raising more ethical questions — like what past
influencers who enter government should do to avoid the appearance
of a conflict.
“This is like a learning moment in the evolution of our democracy,”
Hund said. “Is this a runaway train that we just have to get on and
ride, or is this something that we want to go differently?”
___
Swenson reported from New York.
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