President Trump's nominee for surgeon general recently advocated for exploring the therapeutic potential of unverified psychedelic drugs in a book, and in a newsletter, she implied that her consumption of mushrooms facilitated her finding a romantic partner.

Dr. Casey Means' suggestion to explore supervised psilocybin-assisted therapy warrants attention, given the federal prohibition of psilocybin as a Schedule 1 drug, characterized by its "lack of accepted medical utility and a significant risk of misuse." Despite Oregon and Colorado legalizing psychedelic therapy, certain Oregonian municipalities have subsequently reversed this stance.

Tasked with furnishing the American populace with cutting-edge scientific insights on optimizing well-being and mitigating susceptibility to disease and injury, the Surgeon General's office has historically leveraged its platform to raise public awareness regarding pressing health crises such as AIDS and suicide prevention; indeed, the landmark 1964 Surgeon General's warning concerning the perils of smoking demonstrably altered the trajectory of public health in America.

While figures such as Dr. C. Everett Koop, who served as surgeon general under President Ronald Reagan, achieved widespread recognition and exerted considerable influence on policy, others faded into relative obscurity.

Means's appointment reflects a broader trend under Trump, prioritising individuals with prominent public profiles over those with demonstrable policy expertise; in this instance, the president admitted his selection of Means stemmed solely from Secretary Kennedy Jr.'s endorsement, confessing a complete lack of personal acquaintance.

Means, a Stanford University alumna with degrees in both undergraduate studies and medicine, commenced a medical residency in Oregon, which she ultimately abandoned, and her medical license is currently inactive; when reached for comment, Means declined to provide an official statement.

Her endorsement of psychedelics appeared in her 2024 publication, “Good Energy,” co-authored with her brother, Calley Means, an entrepreneur currently serving as a health advisor in the Trump administration, who has disclosed investments in biopharmaceutical firms specializing in psychedelic compounds.

The book largely addresses metabolic health, or what Casey Means terms "optimal bioenergetics," proposing strategies to mitigate stressors, traumas, and cognitive patterns that undermine metabolic function and overall well-being.

One potential avenue is the exploration of psilocybin-assisted therapy, referencing the active compound in psychedelic fungi, a rationale she elaborates upon in a substantial 750-word exposition.

"Should you feel so inclined, I would also urge you to investigate intentional, clinically-supervised psilocybin therapy," she stated. "Compelling scientific data indicates that this psychedelic-assisted therapy can constitute a profoundly significant life experience for certain individuals, as has been the case for myself."

While preliminary research indicates potential therapeutic applications for psychedelics, a comprehensive risk-benefit analysis remains inconclusive. Psilocybin-induced hallucinations, lasting several hours, can range from euphoric to profoundly disturbing experiences. Although investigated in conjunction with psychotherapy for psychiatric disorders and substance dependence, particularly alcoholism, research on healthy individuals remains limited. Adverse effects may include elevated heart rate, nausea, and headaches. Unsupervised consumption poses considerable risks, as hallucinatory states could precipitate hazardous behaviours, such as inadvertently stepping into traffic.

Means asserted that psilocybin and other psychedelic substances have been unfairly stigmatized, and she extolled the potential benefits of MDMA, commonly known as ecstasy, in alleviating symptoms of post-traumatic stress disorder (PTSD), despite the Food and Drug Administration's recent rejection of its use as a therapeutic intervention for PTSD, following concerns raised by an advisory panel regarding methodological flaws in the supporting research and the identification of significant risks associated with its administration.

In her book, Means employs the term "plant medicine" when referring to psychedelics, recounting her inaugural experience with psilocybin mushrooms around January 1, 2021, prompted by what she describes as "an internal voice that whispered: it's time to prepare."

She articulated a sensation of being embedded within an endless, seamless lineage of maternal figures and infants stretching back to the genesis of life, further stating that, in her perception, "psilocybin may furnish access to an alternate plane of existence, unconstrained by the ego's inherent limitations, subjective emotions, and individual past."

In an October newsletter, Means disclosed her use of psychedelics as a catalyst for personal growth, stating that these experiences, undertaken with experienced facilitators, helped her cultivate the emotional availability necessary to pursue a relationship at 35, clarifying that this was not an endorsement for others to follow suit.

In a recent commentary outlining her desired White House health policy reforms, Means advocated for improved nutritional standards in schools, proposed mandatory warning labels on ultra-processed foods, urged rigorous investigations into vaccine safety, and emphasized the need to eliminate conflicts of interest; while not explicitly mentioning psychedelics, she noted the limited impetus for researchers to explore "generic, natural, and non-patentable drugs and therapies," arguing that a dedicated proportion of research funding should be allocated to alternative healthcare modalities.

Means has also championed the therapeutic potential of psychedelic drugs, recounting in a 2021 blog post that his initial experience with psilocybin during a period of personal turmoil proved transformative – "the single most meaningful experience of my life – personally, professionally, and spiritually." Further underscoring his conviction, he stated in 2022 that he had liquidated his entire 401k to invest in the burgeoning psychedelic research and development sector, purchasing stock in two companies engaged in this field; he did not respond to requests for comment.

Casey Means' confirmation hearing remains unscheduled, her nomination arising after Trump rescinded his initial choice for Surgeon General, Janette Nesheiwat, a former Fox News medical contributor, amidst scrutiny of her credentials.