President Donald Trump's nominee for surgeon general recently authored a book suggesting individuals explore the therapeutic potential of unverified psychedelic drugs, and in a newsletter, she implied that her use of mushrooms facilitated finding a romantic partner.

Dr. Casey Means' suggestion to explore supervised psilocybin-assisted therapy warrants attention, given psilocybin's federal illegality as a Schedule 1 drug, characterized by "no currently accepted medical use and a high potential for abuse;" despite Oregon and Colorado's legalization of psychedelic therapy, some Oregonian cities have subsequently prohibited it.

Charged with furnishing the American populace with cutting-edge scientific insights into health optimisation and the mitigation of disease and injury risks, the Surgeon General's role has historically been leveraged to spearhead public health awareness campaigns addressing critical issues such as AIDS and suicide prevention; indeed, the seminal 1964 warning regarding the perils of smoking demonstrably altered the trajectory of the nation's health.

Figures such as Dr. C. Everett Koop, who served as surgeon general under President Ronald Reagan, achieved widespread recognition and significantly influenced policy, whereas others faded into obscurity.

Means' appointment exemplifies a recurring trend under Trump's administration: prioritising candidates with prominent public images over those with demonstrable policy expertise, as evidenced by the President's admission that his selection of Means was based exclusively on Secretary Kennedy Jr.'s endorsement, despite lacking any prior acquaintance with her.

Means, a Stanford University alumna holding both undergraduate and medical degrees, commenced a residency in Oregon but ultimately abandoned it, her medical license currently listed as inactive; reached by telephone, Means demurred from providing an on-the-record statement.

Her advocacy for psychedelics, articulated in her 2024 publication "Good Energy" co-authored with her brother, Calley Means—an entrepreneur currently serving as a health advisor within the Trump administration and a known investor in biopharmaceutical firms specializing in psychedelic compounds—has garnered significant attention.

The book largely addresses metabolic health, or what Casey Means terms "optimal energy," advocating various strategies for individuals to mitigate and rectify the stressors, traumas, and cognitive frameworks that impede their potential and undermine robust metabolic function.

One potential avenue, she suggests, is "psilocybin-assisted therapy," referencing the active compound in psychedelic fungi, a proposition she elaborates on at length in a 750-word exposition.

"She added that those who feel so inclined should consider exploring intentional, guided psilocybin therapy, citing compelling scientific evidence that suggests this psychedelic treatment can constitute a profoundly significant and transformative experience for certain individuals, as it has proven to be for her personally."

Despite preliminary research indicating potential advantages of psychedelic substances, a definitive determination of whether these benefits surpass the inherent risks remains elusive. Psilocybin, for instance, can induce protracted hallucinatory states, which may range from euphoric to profoundly disturbing. While its therapeutic application in conjunction with psychotherapy is being explored for psychiatric disorders and alcohol dependence, the paucity of research involving healthy individuals is a significant limitation. Furthermore, adverse effects such as elevated heart rate, nausea, and cephalalgia have been documented. Unsupervised consumption poses considerable hazards, as drug-induced hallucinations could precipitate perilous behaviors, such as inadvertently stepping into oncoming traffic or engaging in other imprudent actions.

Means asserted that psilocybin and related psychedelic substances have been unjustly stigmatized, further advocating for the therapeutic potential of MDMA, commonly known as ecstasy or molly, in alleviating post-traumatic stress disorder (PTSD). However, the Food and Drug Administration (FDA) recently rejected the approval of MDMA-assisted therapy for PTSD, following concerns raised by an advisory panel regarding methodological deficiencies in the supporting research and the presence of considerable risks associated with its utilization.

In her book, Means employs the term "plant medicine" when referencing psychedelics, recounting her inaugural experience with psilocybin mushrooms around January 1, 2021, an event she attributes to an "internal voice" that impelled her to prepare.

She articulated a sense of interconnectedness, perceiving herself as an integral link in an unbroken lineage of mothers and infants stretching back to the dawn of life, further noting that, in her experience, "psilocybin can serve as a portal to an alternate reality, unconstrained by the ego's inherent limitations, subjective emotions, and individual history."

In an October newsletter, Means disclosed using psychedelics to cultivate the emotional availability needed to "find love at 35," specifying that she undertook "plant medicine experiences with trusted guides" to prepare for a relationship, an assertion playfully emphasized with a mushroom emoji, while explicitly stating she wasn't advocating similar practices for others.

In a recent commentary outlining her desired White House health policy initiatives, Means advocated for improved nutritional standards in schools, proposed mandatory warning labels on ultra-processed food products, demanded rigorous inquiries into vaccine safety, and expressed a desire to eliminate conflicts of interest; while not explicitly mentioning psychedelics, she argued that researchers lack motivation to investigate "generic, natural, and non-patentable drugs and therapies," suggesting that a segment of research funding should be allocated to alternative healthcare methodologies.

Means has also championed psychedelic drug use, recounting in a 2021 blog post that his initial psilocybin experience during a period of personal difficulty proved profoundly impactful – "the single most meaningful experience of my life – personally, professionally, and spiritually." Further, in 2022, he stated he had liquidated his entire 401k to invest in the burgeoning psychedelic research and development sector, purchasing shares in two relevant companies; he has not yet responded to requests for comment.

Casey Means' confirmation hearing remains unscheduled, following her nomination by Trump after the withdrawal of Janette Nesheiwat, a former Fox News medical contributor, whose suitability for the Surgeon General post came under scrutiny.