The Doctor Who Hates Medicine

Opinion|The Doctor Who Hates Medicine

Dr. Casey Means, President Trump’s nominee for surgeon general, graduated from the Stanford School of Medicine but abandoned her residency before completion, and has spent the past half-dozen years as a wellness influencer and tech company founder. She says she left medicine when she realized she was training to treat the complications of illness rather than the root causes.

“With a wall full of awards and honors for my clinical and research performance,” she writes in her book, “Good Energy,” “I walked out of the hospital and embarked on a journey to understand the real reasons why people get sick.”

As the nation’s top doctor, the surgeon general is meant to be a trusted voice guiding Americans on matters concerning their health, bolstered by professional credentials and experience. Dr. Means, whose Senate hearings for the position begin on Thursday, is a strange choice for the job. She is simultaneously boastful of her academic accomplishments and insistent on their uselessness. She references graduating at the top of her class at Stanford to establish her authority, only to then use that authority to argue that Stanford and institutions like it are fundamentally corrupt. She is an anti-expert expert, the doctor who believes doctors make people sicker. Her biography is typical of the leaders Robert F. Kennedy Jr., the secretary of health and human services, has elevated. In his eyes, this paradoxical relationship to expertise is exactly what qualifies her for the job.

“‘Trust the experts’ is not a feature of science or democracy; it’s a feature of religion and totalitarianism” is a maxim often repeated by Mr. Kennedy. Thus far, his efforts to oust the experts has more closely resembled regime change than democratization. Rather than attempt some novel way to honor diversity of opinion, Mr. Kennedy has simply shut one establishment out while creating another. He has installed a new ruling class at the Department of Health and Human Services and vested it with the authority to determine what ought to count as fact.

When faced with the possibility of dissent from within his ranks, he fires people, as he did with Dr. Susan Monarez, whom he appointed to head the Centers for Disease Control and Prevention, only to dismiss her when she told him she would not approve his handpicked advisory committee’s recommended changes to the vaccine schedule.

His new establishment — including Dr. Jay Bhattacharya at the National Institutes of Health, Dr. Marty Makary at the Food and Drug Administration and others — nonetheless leans heavily on signifiers of conventional prestige for legitimacy. When reporters and scientists questioned the Trump administration’s recent effort to link Tylenol and autism, administration leaders and defenders emphasized that one of the studies they relied on was conducted by a dean at Harvard (who, it turned out, had been paid to testify in lawsuits against the makers of Tylenol).