Dr. Casey Means, the president’s nominee for surgeon general, appeared in front of the Senate for her long-awaited confirmation hearing on Wednesday. Much to the chagrin of Democrats, Means confirmed that she will not make vaccine policy a priority should she be appointed. Here is a closer look at what was revealed during the lengthy confirmation hearing.

About Trump's Pick for U.S. Surgeon General

What do we know about Dr. Casey Means? President Donald Trump has nominated the 38-year-old for the role of the nation's top doctor. This role guides public health initiatives and policy while also overseeing the U.S. Public Health Service Commissioned Corps. Means was questioned extensively by senators from both sides of the aisle on Wednesday, testifying for over two hours in front of the Senate Health, Education, Labor, and Pensions Committee.

Means is best known as a best-selling author and wellness influencer. The Stanford medical graduate has been a supporter of the U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and his controversial "Make America Healthy Again" campaign. Her brother Calley currently serves as an adviser to Kennedy at HHS. Means has been vocal about her support for limited pharmaceutical influence, alternative medicine, and healthy eating.

In addition to being an influencer and author, Means is also a co-founder of Levels, a health technology company that connects glucose monitors to smartphones. The confirmation hearing was pushed back nearly four months from the original date after Means gave birth last fall.

During her opening remarks on Capitol Hill, Means noted what she called the “unraveling” of mental and physical health” in this country and “a society losing its mind” to dementia and depression. Means expressed her commitment to addressing the root triggers of chronic illness by leaning on nutritional principles.

Opponents of Means' nomination are concerned that Means has no clinical experience after dropping out of her medical residency program before finishing. Her Oregon medical license is currently inactive, meaning that she cannot write a prescription. Means confirmed on Wednesday that she does not plan on reactivating her license.

Critics of the nominee also raised concerns about potential conflicts of interest. As a wellness author and influencer, Means has previously endorsed several products, including smoothies and supplements. Means continues to defend these partnerships, saying that she is working with government ethics officials to eliminate conflicts of interest.

Means' Views on Vaccines

The most controversial segment of the hearing revolved around vaccines. Both Democrats and Republicans grilled Means on her views on the childhood vaccine schedule, specifically some of the immunizations that have come under scrutiny by Kennedy.

Means and Virginia Democratic Sen. Tim Kaine engaged in an intense discussion over the benefits of the flu vaccine. Kaine pressed the nominee on whether she would agree that the flu vaccine reduces the chance of hospitalization and death. Means would not directly answer the question, instead just deferring to the guidance from the U.S. Centers for Disease Control and Prevention (CDC). However, the CDC recently modified the flu vaccine recommendations for children, saying that the decision to vaccinate should be made after consulting their health care provider for the decision.

The nominee fielded questions from Republicans Bill Cassidy, chairman of the committee, and Lisa Murkowski about her stance on the hepatitis B vaccine. This is another immunization that was recently removed from the CDC childhood vaccination schedule. Means acknowledged that it is a lifesaving vaccine but went on to say that "parents’ autonomy needs to be respected.”

Issue of Abortion Pill Mifepristone

Abortion also took center stage at Wednesday's hearing. Means did not take a firm stance on contraception and the abortion pill Mifepristone. At issue is a decision during the Biden era that paved the way for the pill to be prescribed through telehealth, allowing doctors to send Mifepristone through the mail. Critics of this policy note that this is a loophole to allow patients in states with abortion bans to receive the pill.

Sen. Cassidy asked Means whether she believes that the pill should be prescribed remotely. Means deflected the direct question by saying that the policy surrounding the controversial pill was outside the jurisdiction of the surgeon general.

Democrats pressed Means on her overall views on birth control in light of previous comments that she thought contraception could be detrimental to long-term health. The nominee responded by saying that while she believes that birth control should be widely available, patients should be proactive about discussing the risks with their health care providers.

Use of Alternative Medicine and Psychedelic Drugs

Means has recently come under fire for her past comments about psychedelic drugs. A passage in Means' book, "Good Energy," details how she used psychedelic mushrooms known as psilocybin during her mother's battle with pancreatic cancer. Maine GOP Sen. Susan Collins grilled Means about these alternative therapies.

Means responded by saying that the science surrounding psychedelic therapies for mental health issues is still emerging, noting that she will follow the evidence in her role as surgeon general. Collins was the most concerned about how Means' views on these types of alternative medicine could lead to more illicit drug use. Like Means, Kennedy has also signaled that he is open to the potential of psychedelic therapies.

As of Thursday, Means does not have the votes that she needs for confirmation. Both Collins and Murkowski said that they have not decided how they will vote. The voting committee is comprised of 12 Republicans and 11 Democrats. This means that it will just take one Republican to derail the nomination should all the Democrats vote against Means.

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