President Donald Trump nominated a new candidate for the position of Deputy Surgeon General, who wrote in a recent book that unproven psychedelic drugs should be considered as a therapeutic option, and who suggested in a newsletter that mushroom use had helped her find a romantic partner.

Dr. Casey Means's recommendation to consider guided psilocybin therapy is particularly noteworthy given that psilocybin remains a prohibited substance under federal law, classified as a Schedule I drug, defined as having "no currently accepted medical use and a high potential for abuse," despite Oregon and Colorado having legalized psychedelic-assisted therapy, albeit with some cities in Oregon subsequently banning it.

The Deputy Surgeon General's role involves disseminating the most robust scientific data to the American public, empowering them to enhance their well-being and mitigate the risks of disease and injury; historically, predecessors have leveraged this platform to educate citizens on critical health issues, ranging from AIDS awareness to suicide prevention, with the 1964 warning regarding the perils of smoking representing a pivotal moment in reshaping American public health.

Figures such as Dr. C. Everett Koop, the Surgeon General under President Ronald Reagan, achieved lasting renown for their profound influence on policy, whereas others rapidly faded from public consciousness.

The nomination of Means, perceived as a Trump-era archetype, prioritizes public profile over substantive policy alignment; in Means' case, the Republican president reportedly based his selection solely on Health Secretary Robert F. Kennedy Jr.'s endorsement, stating, "Bobby thinks she's great," while admitting a lack of prior acquaintance.

Means, a Stanford University alumna holding both a bachelor's degree and a medical doctorate, commenced a medical residency in Oregon which she did not complete. Her medical license is currently listed as inactive. Reached by telephone, Means declined to comment on the record.

In her 2024 book, "Good Energy," co-authored with her brother Calley Means—an entrepreneur and current advisor in the Trump administration with ties to pharmaceutical companies specializing in psychedelics—she advanced recommendations regarding psychedelic substances.

The book predominantly explores metabolic health, which Casey Means terms "clean energy," proposing strategies to manage and heal from pressures, traumas, and limiting thought patterns that contribute to compromised metabolic well-being and impede personal growth.

One such strategy involves "contemplating psilocybin-assisted therapy," a reference to the compound found in hallucinogenic mushrooms, a topic she elaborated upon in a comprehensive 750-word essay.

She wrote, "Should you perceive a calling, I would also encourage you to deliberately explore guided psilocybin therapy. Robust scientific evidence suggests this psychedelic-assisted therapy can constitute one of life's most profound experiences for certain individuals, as it has proven to be for myself."

While some research suggests potential benefits from hallucinogenic substances, conclusive evidence demonstrating that these benefits outweigh the risks remains elusive. Psilocybin, in particular, can induce extended periods of altered perception, experiences that may range from euphoric to terrifying. Although it has been investigated, when integrated with psychotherapy, as a therapeutic intervention for certain mental health conditions and alcohol dependence, studies involving healthy individuals remain limited. Potential adverse effects encompass elevated heart rate, nausea, and headaches. Unsupervised consumption carries inherent dangers, as the resultant hallucinations may lead individuals to engage in hazardous behaviours, such as entering traffic or encountering other perilous situations.

Means posited that psilocybin and other hallucinogens have been unfairly stigmatized, and extolled the potential benefits of MDMA, commonly known as ecstasy or molly, in alleviating symptoms for individuals suffering from post-traumatic stress disorder (PTSD); however, the Food and Drug Administration (FDA) last year declined to approve MDMA-assisted therapy for PTSD, following an advisory panel's assessment citing significant flaws in the supporting research and substantial risks associated with its use.

In her book, the author euphemistically refers to hallucinogenic substances as "plant medicine," recounting her initial experience with psilocybin mushrooms around January 1, 2021, prompted by what she describes as "an inner voice whispering: it is time to prepare."

She wrote that she perceived herself as inextricably linked to an infinite, unbroken lineage, a cosmic nesting doll of millions of mothers and infants preceding her since the dawn of humanity, adding that, in her experience, "psilocybin can serve as a gateway to an alternative reality, liberated from the constricting tenets of ego, emotion, and personal history."

In an October newsletter, Means disclosed her experimentation with psychedelics to facilitate her pursuit of love at 35, stating she had "experienced plant medicine with trusted guides" to prepare for a relationship, followed by a mushroom emoji, while explicitly noting that she wasn't necessarily advocating this approach for others.

In a recent post outlining her healthcare policy priorities, Means advocated for improved nutritional standards in school meals, proposed mandatory warning labels on heavily processed foods, urged investigations into vaccine safety, and expressed a desire to eliminate conflicts of interest; while she didn't directly address hallucinogens, she argued that researchers lack incentives to study "non-patentable and non-proprietary natural medicines and therapies," suggesting that a portion of research funding should be allocated to alternative health approaches.

Calley Means has also advocated for the utilization of psychedelics, stating in a 2021 blog post that his initial experience with psilocybin during a period of personal adversity proved to be "the most meaningful experience of my life—personally, professionally, and spiritually." Furthermore, he disclosed in 2022 that he had "liquidated his entire 401k" to invest in the stock of two companies involved in the development and research of hallucinogenic substances; he did not respond to requests for comment.

The confirmation hearing for Casey Means remains unscheduled, following Trump's selection of her after scrutiny surrounding the initial nominee for deputy surgeon general, former Fox News medical contributor Janette Nesheiwat, prompted the withdrawal of her nomination.