The latest nominee for Surgeon General, hand-picked by President Trump, has recently courted controversy by advocating for the exploration of unorthodox psychedelic therapies in her published work, and further compounded concerns with a newsletter divulging that her ingestion of fungi facilitated the acquisition of a romantic liaison.

Dr. Casey Means' advocacy for judicious exploration of psilocybin-assisted therapy warrants particular attention, given the incongruity of its Schedule 1 classification under federal statutes as a substance devoid of accepted medical utility and exhibiting a proclivity for abuse, notwithstanding the nascent legalisation of psychedelic-assisted psychotherapy in Oregon and Colorado, offset by subsequent municipal prohibitions within the former.

Entrusted with disseminating cutting-edge scientific findings to the American populace, the Surgeon General's remit encompasses the enhancement of public health and the mitigation of morbidity and mortality; historically, incumbents have leveraged this office to effectuate substantive shifts in health consciousness, exemplified by seminal pronouncements on the AIDS epidemic, suicide prophylaxis, and the watershed 1964 advisory concerning the deleterious ramifications of tobacco consumption, which fundamentally recalibrated America's health trajectory.

While luminaries such as Dr. C. Everett Koop, Surgeon General during the Reagan administration, indelibly shaped policy and permeated the public consciousness, others succumbed to the inexorable oblivion of historical ephemera.

Means's ascendance to candidacy epitomises a Trumpian modus operandi: the prioritisation of high-profile figures over policy wonks, a proclivity exemplified by his own admission that Means's selection hinged solely on the imprimatur of Health Secretary Robert F. Kennedy Jr. – "Bobby thought she was fantastic," Trump declared, betraying a palpable ignorance of her substantive credentials.

Means, a Stanford alumna (both undergraduate and M.D.), commenced a residency in Oregon which she ultimately forwent; her medical license is currently designated as inactive, and she demurred from providing any on-the-record commentary when reached for comment.

In her 2024 opus, "Good Energy," co-authored with her brother, Calley Means—an entrepreneur presently ensconced within the Trump administration as a health advisor, and avowed investor in biopharmaceutical entities specializing in psychedelic compounds—she proffered a recommendation concerning the therapeutic potential of psychedelics.

Casey Means's treatise largely grapples with the intricacies of metabolic well-being, which she elegantly conceptualizes as "good energy," proffering a panoply of strategies aimed at empowering individuals to effectively navigate and remediate the multifaceted stressors, ingrained traumas, and pernicious cognitive schema that both circumscribe human potential and inexorably contribute to the deleterious erosion of metabolic equilibrium and holistic thriving.

One such therapeutic avenue lies in the consideration of psilocybin-assisted therapy, referencing the psychoactive compound inherent in fungi of the Psilocybe genus, with her rationale meticulously explicated in a 750-word excursus.

“If you feel called, I also encourage you to explore intentional, guided psilocybin therapy,” she wrote. “Strong scientific evidence suggests that this psychedelic therapy can be one of the most meaningful experiences of life for some people, as they have been for me.”

Despite a nascent body of research tentatively indicating potential therapeutic applications for psychedelic compounds, a definitive risk-benefit analysis remains elusive, particularly given the capacity of substances like psilocybin to induce protracted hallucinatory states ranging from the euphoric to the profoundly disturbing; while its adjunctive use with psychotherapy has been explored in the context of select psychiatric disorders and substance dependencies, its effects on healthy individuals remain largely unelucidated, and the potential for adverse events, encompassing cardiovascular excitation, emesis, and cephalalgia, necessitates rigorous clinical oversight, as unsupervised ingestion carries significant inherent dangers, including the potential for reality detachment leading to perilous behaviours such as involuntary exposure to vehicular trauma or other imprudent actions.

Means posited that the societal stigmatisation of psilocybin and other psychedelic compounds belies their therapeutic potential, valorising MDMA (3,4-methylenedioxymethamphetamine), colloquially known as ecstasy or molly, for its putative efficacy in mitigating the debilitating effects of post-traumatic stress disorder (PTSD), notwithstanding the Food and Drug Administration's recent demurral regarding its approval as a PTSD therapy, precipitated by an advisory panel's critique of methodological lacunae and the identification of substantive risks attendant to its administration.

Means, within the ambit of her monograph, denominates psychedelics "plant medicine," recounting her inaugural psilocybin experience circa New Year's Day, 2021, catalyzed, as she explicates, by an internal monition, a sibilant imperative: "it's time to prepare."

She articulated a sensation of being enfolded within an unbounded, serially recursive concatenation of maternal-infant dyads stretching back to the very genesis of sentient life, postulating that, experientially, "psilocybin precipitates a transliminal gateway to an ontologically distinct realm, liberated from the circumscribing doxastic frameworks of the ego, affective burdens, and the idiosyncratic accruals of personal history."

In her October newsletter, Means avowed that psychedelic adjunctive therapy had facilitated the creation of "psychic interstices amenable to cultivating amorous sentiment at the age of 35," elaborating that "plant medicine experiences under the aegis of accredited facilitators" had catalyzed her readiness for a committed partnership, an assertion playfully underscored with a mushroom emoji, whilst simultaneously disclaiming any endorsement of such practices for others.

In her desiderata for White House health policy, articulated in a recent communiqué, Means advocated for enhanced nutritional standards in scholastic alimentation, the implementation of cautionary labelling on heavily processed comestibles, rigorous scrutiny of vaccine safety protocols, and the eradication of conflicts of interest, omitting explicit reference to psychedelics whilst nonetheless lamenting the paucity of incentives for researchers to investigate "generic, natural, and non-patentable drugs and therapies," proposing the earmarking of research budgets for unorthodox therapeutic modalities.

Means, a proponent of psychedelic therapeutics, has publicly avowed the transformative impact of psilocybin, recounting in a 2021 communiqué the inaugural experience amidst a period of profound personal exigency which he subsequently characterised as "the single most meaningful experience of my life — personally, professionally, and spiritually"; furthermore, in 2022, he disclosed the liquidation of his entire 401k portfolio in favour of speculative investment in two nascent biopharmaceutical entities engaged in psychedelic drug development and research, while remaining conspicuously unresponsive to requests for elucidation regarding these assertions.

The scheduling of Casey Means' confirmation hearing remains outstanding, a consequence of her nomination as Surgeon General following the retraction of Janette Nesheiwat, the initial Trump administration appointee whose credentials, replete with prior associations as a medical contributor for Fox News, engendered considerable scrutiny.