Dr. Casey Means, a wellness influencer who rose to prominence by lambasting traditional medicine and accusing pharmaceutical companies of corruption, bore little resemblance to her online persona Wednesday when she appeared before the Senate.In measured comments before the Senate Health, Education, Labor and Pensions Committee to discuss her nomination for surgeon general, Means sidestepped questions on vaccines, birth control and pesticides — subjects she has often depicted as dangerous to human health — at times visibly frustrating lawmakers on both sides of the aisle.“Do you believe that there is evidence that the flu vaccine prevents serious disease or that it prevents hospitalizations or death in children?” Sen. Tim Kaine, D-Va., asked.“I believe that all patients should talk to their doctor,” Means said.After Kaine pressed several times for a clearer answer, Means eventually replied: “At the population level, I certainly think it does.”“This is not a hard question,” Kaine said. “Three minutes in, you answered a question that has a very simple ‘yes.’”If Means is confirmed, she would become the nation’s top doctor, with the power to issue health advisories for the entire country. Despite having a medical degree, she did not complete a surgical residency program and her medical license lapsed in January 2024. She told the Senate on Wednesday that she does not plan to reinstate her license because, as surgeon general, she would not see patients.Means has amassed nearly a million followers on social media by emphasizing real barriers to Americans’ health — such as sedentary lifestyles or diets that are high in ultra-processed foods — while also espousing unproven claims about children receiving too many vaccines and the alleged benefits of dietary supplements.“Our health is plummeting, for our children, ourselves and our parents. We are getting sicker. We are getting heavier. We are getting more depressed,” she told podcaster Dhru Purohit in 2024. “We’re waiting for people to get sick and then we’re jumping in with costly interventions that don’t actually get at the root cause of the problem.”Means’ views have gained more attention thanks to the election of President Donald Trump and his appointment of Robert F. Kennedy Jr. as health secretary. Many of her key messages are now the main planks of Kennedy’s “Make America Healthy Again” agenda. Means is a close ally of Kennedy’s and served as a campaign adviser during his presidential bid. Trump nominated her for surgeon general on Kennedy’s recommendation.Like Means, Kennedy also softened his rhetoric when appearing before the Senate for confirmation. At a hearing last year, Kennedy said vaccines played a critical role in health care and that he would “do nothing as HHS secretary that makes it difficult or discourages people from taking anything.” As health secretary, however, Kennedy has overhauled the childhood vaccine schedule to have fewer universal recommendations, downplayed the role of measles shots during an unprecedented outbreak and slashed funding for mRNA vaccine research.On Friday, the medical journal The Lancet published an editorial on Kennedy’s “one year of failure,” writing: “The destruction that Kennedy has wrought in 1 year might take generations to repair, and there is little hope for US health and science while he remains at the helm.”Like Kennedy, Means said Wednesday that vaccines are “an important part of public health” but stopped short of recommending flu, measles or hepatitis B shots and declined to rule out vaccines as a contributor to autism.“We do not know as a medical community what causes autism,” Means said. “Until we have a clear understanding of why kids are developing this at higher rates, I think we should not leave any stones unturned.”Jeff Niederdeppe, associate director of the Cornell Health Policy Center, said in a statement that it is difficult to know whether to take Means at her word about priorities and agendas.“As we have seen with RFK Jr., Senate confirmation hearings by no means bind candidates to how they will act in the position,” he said.However, Andrew Nixon, a spokesperson for the Department of Health and Human Services, said Means “made clear her commitment to following the best available data and gold standard science, which is exactly the approach Americans should expect from a Surgeon General.”Means did not respond to a request for comment.Watered down comments on vaccines and birth controlPrior to the hearing, Means had suggested without evidence that the cumulative effect of childhood vaccines may be contributing to autism — a theory that is not supported by scientific evidence.“I bet that one vaccine probably isn’t causing autism. But what about the 20 that they’re getting before 18 months?” she said on “The Joe Rogan Experience,” one of the world’s most popular podcasts.Means had also been vocal in her belief that most newborns shouldn’t receive hepatitis B shots. She wrote on X in 2024 that it was “absolute insanity” to administer the vaccines to newborns if their parents tested negative for hepatitis B, adding that “the disease is transmitted through needles and sex exclusively.”Hepatitis B can be transmitted from mother to child during delivery and can lead to liver disease, cancer and death. It can also be transmitted through contact with household objects like toothbrushes and earrings. Not all pregnant women get tested for the virus, so experts say delaying the shots for newborns could lead to more infections.When questioned about her comments on hepatitis B vaccines, Means said at the hearing that families were looking to have nuanced conversations with their doctors “about specific vaccines that their children may not be as seriously at risk for.”“This is not a condemnation of the vaccine generally, which I am very supportive of,” she said.Means also qualified her past remarks on birth control pills, which she described in a podcast interview with conservative commentator Tucker Carlson as “a disrespect of things that create life,” since the pills suppress hormones that facilitate pregnancy and childbirth. Means also wrote on her website about “horrifying health risks of hormonal birth control on the female mind and body,” but did not provide specifics.At the hearing, Means said some of the “horrifying” side effects she was referring to include blood clots and strokes among women who smoke or have clotting disorders.“I absolutely believe these medications should be accessible to all women,” she told Sen. Patty Murray, D-Wash. “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.”Blood clots and strokes are well-established, though rare, risks associated with some types of birth control. Doctors already do not recommend combination birth control pills, which contain synthetic versions of the hormones estrogen and progestin, for patients with certain risk factors, such as a history of blood clots, stroke or heart disease, or being older than 35 and a smoker. However, they may still recommend the mini pill, which does not contain estrogen.Shifting stances on magic mushrooms and pesticidesIn one of the standout moments at the hearing, Sen. Susan Collins, R-Maine, questioned Means on her past use of psychedelic mushrooms.Means wrote in her 2024 book “Good Energy” about taking psilocybin — a hallucinogen found in magic mushrooms — describing it as “a doorway to a different reality that is free from the limiting beliefs of my ego, feelings, and personal history.” She also encouraged readers to “explore intentional, guided psilocybin therapy.”Psilocybin is illegal across the U.S., with the exception of Oregon and Colorado, which allow supervised treatment for adults 21 and over. Scientists are still studying whether it may be a potential treatment for mental health conditions, but the Justice Department currently states that psilocybin has no legitimate medical purpose.“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,” Means told Collins at the hearing. “When it comes to psychedelic therapy for mental health issues, I think science is still emerging, and so it would certainly not be a recommendation to the American people to do that, under no circumstances.”In another exchange, Means was asked about her views on pesticides, which she has previously referred to as “invisible poisons being sprayed on us largely by foreign-owned companies.” On Wednesday, however, she said pesticides were part of a “complex” issue, echoing a recent pivot by Kennedy.“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 and 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,” Means said.Kennedy, too, has crusaded against the harms of pesticides and spent much of his legal career pushing for stricter regulations. In 2024, he called on Trump to “revisit pesticide and other chemical-use standards,” noting that 72 pesticides approved in the U.S. were banned or in the process of being phased out in the European Union.However, Kennedy’s “MAHA report,” released last year as a road map to improving children’s health, stopped short of cracking down on pesticides. And this past weekend, Kennedy backed Trump’s executive order to ensure a continued supply of glyphosate-based herbicides in the U.S. Glyphosate is a weed killer that Kennedy has said is linked to a range of diseases including cancer. The evidence itself is mixed.