The latest nominee for Surgeon General, hand-picked by President Trump, has recently courted controversy with assertions in her published work advocating for the exploration of unsubstantiated psychedelic therapies, and furthermore, disseminated anecdotal claims in a newsletter suggesting that her own psilocybin use facilitated a romantic connection.

Dr. Casey Means's advocacy for exploring guided psilocybin-assisted therapy warrants meticulous consideration, particularly given the Schedule 1 classification of psilocybin under federal statute, which proscribes its use due to its ostensible lack of therapeutic application and perceived propensity for abuse, notwithstanding the nascent legalisation of psychedelic therapy in Oregon and Colorado, a development subsequently tempered by municipal prohibitions within Oregon.

Entrusted with disseminating cutting-edge, evidence-based insights into proactive healthcare strategies and the mitigation of morbidity and mortality risks, the Surgeon General's remit encompasses a pivotal role in shaping public health discourse, as exemplified by previous incumbents who leveraged their office to spearhead national awareness campaigns addressing critical issues ranging from AIDS to suicide prevention, culminating in landmark interventions such as the 1964 Surgeon General's advisory on the deleterious effects of smoking, which demonstrably reconfigured the trajectory of American public health.

While luminaries such as Dr. C. Everett Koop, Surgeon General during the Reagan administration, indelibly marked the politico-medical landscape, wielding considerable influence on policy, others, despite their contributions, faded into relative obscurity.

Means's nomination, emblematic of a broader Trumpian praxis, prioritized individuals distinguished by their prominent public personae over those possessing demonstrable policy acumen; indeed, her selection, ostensibly secured solely on the imprimatur of Health Secretary Robert F. Kennedy Jr. ("Bobby thought she was fantastic," Trump averred, confessing his unfamiliarity), underscored a disinterest in substantive expertise, favoring instead the cachet of celebrity endorsement and the capricious whims of influential advisors.

Means, a Stanford alumna (both undergraduate and M.D.), commenced a residency in Oregon which she ultimately relinquished, her medical license currently bearing the status of inactive; she demurred when reached for comment.

Her 2024 treatise, "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 psychedelics—contained her pronouncements regarding the therapeutic potential of psychedelic compounds.

The book substantively grapples with metabolic health, or what Casey Means evocatively terms "good energy," proffering a suite of sophisticated strategies intended to facilitate the meticulous management and amelioration of those multifarious stressors, traumas, and entrenched cognitive patterns that insidiously constrain individual potential and actively undermine robust metabolic function and comprehensive well-being.

One potential avenue, she posits, lies in the consideration of psilocybin-assisted therapy, referencing the active constituent of hallucinogenic fungi, an exposition of her rationale meticulously detailed within a 750-word excursus.

"She penned, 'Should an inner imperative resonate, I further exhort you to consider intentional, clinically-supervised psilocybin therapy; the robust corpus of scientific evidence intimates that this form of psychedelic intervention can constitute a profoundly significant, even transformative, life experience for certain individuals, as it has demonstrably proven to be for myself.'"

Despite burgeoning scholarship tentatively indicating potential therapeutic applications of psychedelics, a definitive risk-benefit analysis remains conspicuously absent; whilst psilocybin may induce protracted hallucinatory states, oscillating between euphorigenic and profoundly distressing experiences, and is undergoing investigation, adjunctively with psychotherapy, in the context of refractory psychiatric disorders and chronic alcohol dependence, the paucity of research involving euthymic individuals is patent, particularly given that adverse effects may encompass tachycardia, emesis, and cephalalgia, and that unsupervised ingestion carries considerable hazard, including the potential for reality disjunction precipitating perilous behaviours, such as involuntary exposure to vehicular traffic or other imprudent actions.

Means posited that psilocybin and other psychedelic compounds have been unjustly stigmatized, further extolling the purported therapeutic virtues of MDMA, colloquially known as ecstasy or molly, in the mitigation of post-traumatic stress disorder (PTSD), notwithstanding the Food and Drug Administration's recent declination to sanction its use as a PTSD therapy, predicated on a panel of advisors' findings of methodological deficiencies and attendant risks inherent in its application.

Means, within the ambit of her monograph, designates psychedelics as “plant medicine,” recounting her inaugural psilocybin experience circa the commencement of 2021, subsequent to an internalised imperative, an almost oracular locution, enjoining her to initiate preparations.

"She elucidated, articulating a sensation of consubstantiality with an unbounded, serially nested continuum of maternal-infant dyads stretching back to life's primordial instantiation, further postulating that her experiential encounters intimate that psilocybin may constitute a liminal portal, affording ingress to an alternative ontological domain, transcendently liberated from the circumscribing strictures of egoic constructs, affective dispositions, and idiosyncratic biographical contingencies."

In her October newsletter, Means averred that psychedelic experiences, undertaken with reputable facilitators, had catalysed a personal paradigm shift, enabling her to cultivate the requisite emotional architecture for romantic partnership at the age of 35 – a point she underscored with a whimsical mushroom emoji, while disclaiming any endorsement of such practices for others.

In her recent exegesis on desiderata for White House healthcare policy, Means advocated for the provision of more salutary comestibles in scholastic settings, mooted the implementation of cautionary labels on ultra-processed victuals, demanded inquiries into the probity of vaccine regimens, and articulated a desire to mitigate conflicts of interest, stopping short of explicitly referencing psychedelics, but nonetheless lamenting the paucity of incentives for researchers to investigate "generic, natural, and non-patentable drugs and therapies," further postulating that a discrete tranche of research funding be earmarked for unorthodox approaches to healthcare.

Means, a proponent of psychedelic therapeutics, has publicly avowed the transformative impact of psilocybin on his personal and professional trajectory, recounting in a 2021 online disquisition its singular significance during a period of existential adversity; furthermore, he disclosed in 2022 a substantial reallocation of his investment portfolio, liquidating his entire 401k to acquire equity in two biotechnology firms pioneering psychedelic research and development, remaining, however, conspicuously reticent in response to requests for further elaboration.

The scheduling of Casey Means's confirmation hearing remains outstanding, her nomination having arisen following the withdrawal of Janette Nesheiwat – a former medical contributor for Fox News – whose initial selection by Trump as Surgeon General was compromised by concerns surrounding the veracity of her presented qualifications.