The newly nominated Surgeon General under President Donald Trump has courted controversy following revelations that her recent publication advocated for the exploration of empirically unsupported psychedelic therapies, while her personal newsletter alluded to the facilitative role of psilocybin ingestion in the consummation of a romantic liaison.

Dr. Casey Means' advocacy for judicious exploration of guided psilocybin-assisted therapy warrants significant consideration, particularly given the ongoing federal proscription of psilocybin as a Schedule I controlled substance—a classification predicated on its purported lack of accepted medical utility and demonstrable propensity for abuse—notwithstanding the burgeoning legalisation of psychedelic-assisted therapies in Oregon and Colorado, a trend tempered by subsequent municipal-level retrenchment in certain Oregonian localities.

The Surgeon General's remit encompasses the dissemination of cutting-edge scientific data to the American populace, empowering them to optimise their well-being and mitigate morbidity and injury risks; historically, occupants of this office have leveraged their platform to spearhead public health education initiatives addressing critical issues ranging from AIDS awareness to suicide prophylaxis, with the watershed 1964 warning regarding the deleterious effects of tobacco use serving as a pivotal inflection point in the trajectory of American public health.

While luminaries such as Dr. C. Everett Koop, the erstwhile Surgeon General under President Reagan, indelibly imprinted themselves on the collective consciousness and exerted a palpable influence on policy, others, despite their contributions, faded into the mists of historical oblivion with disconcerting ease.

Means's ascendancy epitomises a discernible Trumpian modus operandi: the prioritisation of candidates distinguished by prominent public profiles over those with demonstrable expertise in substantive policy, a predilection exemplified by his avowal that Means's selection hinged exclusively upon the endorsement of Health Secretary Robert F. Kennedy Jr. – "Bobby thought she was fantastic" – despite Trump's concomitant admission of personal unfamiliarity.

Means, a Stanford alumna (both undergraduate and Doctor of Medicine degrees), commenced a residency in Oregon, which she ultimately relinquished; her medical license is currently designated as inactive, and she demurred from providing any on-the-record commentary when contacted.

In her 2024 treatise, "Good Energy," co-authored with her sibling, Calley Means—an entrepreneur now ensconced within the Trump administration as a health advisor and avowed investor in biopharmaceutical entities specializing in psychedelic compounds—she proffered a series of recommendations concerning the therapeutic potential, and inherent risks, of psychedelic substances.

A significant portion of the book is dedicated to metabolic health, conceptualised by Casey Means as "good energy," wherein she posits a range of interventions designed to facilitate the management and amelioration of stressors, traumas, and ingrained cognitive schemata that constrain individual potential and contribute to suboptimal metabolic function and overall wellbeing.

One potential avenue lies in the consideration of psilocybin-assisted therapy, referencing the active constituent of psychedelic fungi, a line of reasoning she expounds upon in a 750-word excursus.

"Ergo, should the siren call of self-exploration resonate within, I would further commend a deliberate foray into the realm of intentional, guided psilocybin therapy," she elucidated. "Substantial empirical data intimates that this specific instantiation of psychedelic intervention may burgeon into a profoundly consequential existential juncture for certain individuals, mirroring its transformative impact upon my own lived experience."

While preliminary investigations intimate potential therapeutic avenues for psychedelics, a comprehensive risk-benefit analysis remains conspicuously absent, particularly given the capacity of psilocybin to induce protracted hallucinatory states ranging from euphoric to profoundly anxiogenic. Its adjunctive application in psychotherapy for recalcitrant psychiatric disorders and alcohol use disorder warrants further scrutiny, yet the paucity of research within normative populations necessitates circumspection. The attendant physiological sequelae, encompassing but not limited to elevated heart rate, emesis, and cephalalgia, coupled with the inherent perils of unsupervised administration – potentially precipitating perilous behavioural dyscontrol via hallucinogen-induced perceptual distortions – underscore the critical imperative for rigorous clinical oversight.

Means, in her discourse, posited the unwarranted stigmatisation of psilocybin and cognate psychedelic compounds, further valorising MDMA, colloquially known as ecstasy or molly, for its putative therapeutic efficacy in mitigating the debilitating sequelae of post-traumatic stress disorder (PTSD), notwithstanding the Food and Drug Administration's recent circumspection, evidenced by their declination to sanction MDMA-assisted therapy for PTSD, predicated on a panel of advisors' concerns regarding methodological lacunae and the potential for iatrogenic exacerbation.

Means, deploying the nomenclature of the burgeoning psychedelic renaissance, characterizes psychedelics within her treatise as "plant medicine," recounting her inaugural psilocybin experience circa the advent of 2021, catalyzed by what she elucidates as an "internal voice" imbuing her with the imperative: "it's time to prepare."

"She articulated a sensation of osmotic assimilation into an unbounded, serially embedded continuum of ancestral maternal dyads, originating, in essence, from the very genesis of biological sentience," she penned, further postulating that, "in her experiential framework, psilocybin may function as a liminal portal, facilitating ingress to an alternative ontological domain, emancipated from the prescriptive strictures imposed by the egoic construct, affective proclivities, and the idiosyncratic trajectory of one's personal narrative."

In her October missive, Means averred that psychedelic interventions had been instrumental in cultivating the requisite psychic topography for amorous congress at the age of thirty-five, elaborating that she had undertaken "plant medicine experiences with trusted guides" to achieve partnership readiness, an assertion she punctuated with a whimsical mushroom emoji, appending a caveat that this was not necessarily a universally applicable prescription.

In her recent exegesis on desiderata for White House health policy, Means advocated for improved nutritional standards in scholastic settings, the implementation of mandatory advisory labelling on ultra-processed comestibles, and rigorous inquiry into the probity of vaccine protocols, whilst simultaneously articulating a desire to eliminate conflicts of interest; although eschewing explicit mention of psychedelics, she posited that the prevailing paradigm furnishes scant impetus for researchers to investigate "generic, natural, and non-patentable drugs and therapies," advocating for a dedicated tranche of research funding to be earmarked for alternative modalities of healthcare.

Means, an outspoken proponent of psychedelic therapeutics, has proselytized on the transformative potential of such substances, most notably in a 2021 blog entry where he recounted his inaugural psilocybin experience amidst a period of personal crisis, characterizing it as "the single most meaningful experience of my life — personally, professionally, and spiritually"; further underscoring his conviction, in 2022 he avowed to have liquidated his entire 401k to acquire equity in two biotech firms engaged in the development and investigation of psychedelic compounds, and has remained conspicuously unresponsive to requests for elucidation.

The scheduling of Casey Means' confirmation hearing remains pending, her nomination having arisen following the withdrawal of Janette Nesheiwat, a former Fox News medical contributor, whose curriculum vitae prompted scrutiny and ultimately led to the retraction of her initial nomination by the Trump administration for the post of Surgeon General.