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

Dr. Casey Means' suggestion to explore supervised psilocybin-assisted therapy is noteworthy, given the federal prohibition of psilocybin as a Schedule 1 drug, a category reserved for substances deemed to lack any accepted medicinal application and carrying a substantial risk of misuse, despite Oregon and Colorado having legalized psychedelic therapy, a decision subsequently countered by bans in several Oregonian cities.

Charged with disseminating the most robust scientific findings to the American public, the Surgeon General plays a pivotal role in shaping health outcomes and mitigating risks of disease and injury; historically, occupants of this office have leveraged their platform to spearhead public health initiatives addressing critical issues ranging from AIDS awareness to suicide prevention, with the landmark 1964 warning on the perils of smoking demonstrably altering the trajectory of the nation's health.

Figures such as Dr. C. Everett Koop, who served as surgeon general under President Ronald Reagan, achieved considerable notoriety and exerted significant influence on policy, while others faded into obscurity.

Means's appointment aligns with a discernible trend under Trump's leadership of prioritizing candidates with established public profiles over demonstrable policy expertise, exemplified by his admission that the selection of Means was based exclusively on Health Secretary Robert F. Kennedy Jr.'s endorsement, despite Trump's own lack of familiarity with her.

Means, a Stanford University alumna with both undergraduate and medical degrees, commenced a medical residency in Oregon, which she ultimately abandoned, and her medical license is currently inactive; when contacted, she declined to provide any on-the-record statement.

Her 2024 book, "Good Energy," co-authored with her brother, Calley Means—an entrepreneur currently serving as a health advisor in the Trump administration and who has publicly acknowledged investing in biopharmaceutical firms specializing in psychedelics—contained her endorsement of psychedelic substances.

The book largely addresses metabolic health, or, in Casey Means's terminology, "good energy," outlining strategies for individuals to mitigate stressors, traumas, and ingrained thought patterns that impede well-being and contribute to impaired metabolic function.

One potentially beneficial approach involves "considering psilocybin-assisted therapy," a reference to the active compound present in psychedelic fungi, with her rationale elaborated upon in a detailed 750-word exposition.

"Should you feel so inclined, I would also advocate exploring structured psilocybin-assisted therapy," she stated. "Compelling scientific data indicates that this psychedelic intervention can represent a profoundly significant and enriching life experience for certain individuals, as it has proven to be for myself."

While preliminary research indicates potential therapeutic applications for psychedelics, a definitive risk-benefit analysis remains inconclusive. Psilocybin-induced hallucinations, which can range from euphoric to deeply disturbing, necessitate careful consideration. Although psilocybin-assisted psychotherapy has demonstrated promise in treating specific psychiatric disorders and alcohol dependency, its effects on healthy individuals are largely unexamined. Furthermore, adverse physiological reactions, such as elevated heart rate, nausea, and headaches, are documented. Unsupervised consumption carries inherent dangers, as hallucinatory states may precipitate hazardous behaviors, including impaired judgment and risk-taking.

Means asserted that psilocybin and other psychedelic substances have been unfairly stigmatized, while also highlighting the potential benefits of MDMA, commonly known as ecstasy or molly, in the treatment of post-traumatic stress disorder (PTSD); however, the Food and Drug Administration recently declined to approve MDMA-assisted therapy for PTSD, following concerns raised by an advisory panel regarding methodological flaws in the research and potential risks associated with its use.

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

She articulated a sense of interconnectedness, perceiving herself as an element within an unending lineage of maternal bonds stretching back to the genesis of life, further asserting that, in her perception, "psilocybin offers a conduit to an alternative reality, unconstrained by the habitual limitations of ego, emotions, and personal narrative."

In her October newsletter, Means disclosed using psychedelics to cultivate the emotional availability necessary "to find love at 35," specifying that she undertook "plant medicine experiences with trusted guides" to foster preparedness for a relationship, an assertion playfully emphasized with a mushroom emoji, while explicitly refraining from advocating similar practices for others.

In a recent commentary outlining her White House health policy objectives, Means advocated for improved nutritional standards in school meals, proposed mandatory labelling for ultra-processed foods, urged scrutiny of vaccine safety protocols, and aimed to eliminate conflicts of interest; while not directly addressing psychedelics, she noted the limited impetus for researchers to investigate "generic, natural, and non-patentable drugs and therapies," arguing for the allocation of research funds towards alternative healthcare modalities.

Means has also championed psychedelic drugs, asserting in a 2021 blog post that his initial psilocybin experience during a period of personal difficulty proved "the single most meaningful experience" of his life across personal, professional, and spiritual dimensions; furthermore, he stated in 2022 that he had liquidated his entire 401k to invest in the burgeoning psychedelic research and development sector, acquiring stock in two relevant companies, though he has remained unresponsive to requests for comment.

Casey Means' confirmation hearing remains unscheduled, Trump having nominated him following scrutiny of Janette Nesheiwat, the initial surgeon general candidate and former Fox News medical contributor, whose nomination was subsequently withdrawn.