President Trump's nominee for Surgeon General recently advocated for exploring unverified psychedelic therapies in her book, and suggested in a newsletter that mushroom use facilitated her finding a romantic partner.

Dr. Casey Means' suggestion to explore supervised psilocybin-assisted therapy warrants attention, particularly given psilocybin's status as a Schedule 1 controlled substance under federal legislation, categorised as having "no currently accepted medical use and a high potential for abuse." Despite Oregon and Colorado legalising psychedelic therapy, some Oregonian cities have subsequently prohibited it.

The Surgeon General's mandate is to furnish the US populace with cutting-edge scientific insights, empowering them to optimize their well-being and mitigate vulnerability to disease and trauma; historically, occupants of this office have leveraged their platform to enlighten citizens on critical public health issues, ranging from AIDS awareness to suicide prophylaxis, with the landmark 1964 warning regarding the perils of smoking demonstrably altering the trajectory of American public health.

While certain 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, others faded into obscurity.

Means's selection exemplifies a trend initiated by Trump: prioritizing candidates with established public profiles, sometimes at the expense of demonstrable policy expertise, as evidenced by his admission that the nomination stemmed from a sole endorsement, despite his unfamiliarity with the nominee.

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 listed as inactive; she declined to provide any on-the-record statement when contacted.

In her 2024 publication, “Good Energy,” co-authored with her brother, Calley Means—an entrepreneur currently serving as a health advisor in the Trump administration and a known investor in biopharmaceutical firms specializing in psychedelic compounds—she advocated for the therapeutic potential of psychedelics.

A significant portion of the book delves into metabolic health, which Casey Means terms "good energy," proposing various strategies to mitigate the stressors, traumas, and cognitive patterns that impede well-being and contribute to compromised metabolic function.

One potential avenue to explore is "psilocybin-assisted therapy," referencing the active compound inherent in psychedelic fungi, a rationale she elaborates upon in a comprehensive 750-word exposition.

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

Despite preliminary research indicating potential advantages of psychedelic substances, a conclusive demonstration that these benefits supersede the inherent risks remains elusive. Psilocybin's capacity to induce extended hallucinatory episodes, ranging from euphoric to profoundly disturbing, necessitates caution. While its therapeutic application in conjunction with psychotherapy for psychiatric disorders and substance dependence is under investigation, empirical data concerning its effects on healthy individuals are conspicuously scarce. Furthermore, adverse physiological reactions, such as elevated heart rate, nausea, and cephalalgia, are documented side effects. Unsupervised consumption poses significant hazards, as drug-induced perceptual distortions could precipitate perilous behaviors, including accidental self-harm.

Means posited that the stigmatization of psilocybin and other psychedelic substances has been unwarranted, highlighting the potential benefits of MDMA, commonly known as ecstasy, in the treatment of post-traumatic stress disorder (PTSD), despite the Food and Drug Administration's recent decision to withhold approval for its therapeutic application due to concerns regarding research integrity and potential risks.

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

She expressed feeling intrinsically connected to an unbroken lineage of mothers and children stretching back to the dawn of life, stating that, in her perception, "psilocybin offers a portal to an alternative reality, unfettered by the constraints of ego, emotions, and individual experience."

In an October newsletter, Means disclosed her use of psychedelics to facilitate personal growth, specifically to "find love at 35." Elaborating, she mentioned engaging in "plant medicine experiences with trusted guides" to cultivate receptiveness to a relationship, adding a mushroom emoji for emphasis, while clarifying that this was not a blanket recommendation for others.

In a recent commentary outlining her desired White House health policy initiatives, Means advocated for improved school nutrition, proposed mandatory warning labels on heavily processed foods, urged scrutiny of vaccine safety protocols, and expressed a desire to eliminate conflicts of interest; while not explicitly mentioning 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 drug use, recounting in a 2021 blog post his initial psilocybin experience during a period of adversity, which he declared "the single most meaningful experience" of his life across personal, professional, and spiritual dimensions; furthermore, in 2022, he divulged having liquidated his entire 401k to invest in the stock of two psychedelic drug development and research firms, and subsequently remained unresponsive to requests for comment.

The confirmation hearing for Casey Means remains unscheduled, following Trump's selection of Means after scrutiny surrounding the credentials of his initial nominee for surgeon general, ex-Fox News medical contributor Janette Nesheiwat, ultimately led to her withdrawal.