If you close your eyes and imagine an up-from-the-bootstraps embodiment of boomer triumphalism—the ambitious young technocrat of a systems novel by Don DeLillo or Thomas Pynchon, sprinting toward his fully vested stake in the American Century—you might see a man like Grady Means, whose daughter, Casey Means, is now President Trump’s nominee for U.S. Surgeon General. Grady was born in the Los Angeles area in 1946, and received scholarships at Stanford, where he studied economics and engineering and excelled at track-and-field. He worked for Fairchild Semiconductor, one of Silicon Valley’s seminal ventures, and for the Northrop Corporation, an avatar of Southern California’s then flourishing aerospace industry. “This was a state,” Joan Didion wrote of California, in 1993, “in which virtually every county was to one degree or another dependent on defense contracts”—including “billions upon billions of federal dollars that flowed into Los Angeles County,” until the cutbacks of the early nineteen-nineties. The idea that the military-industrial complex could continue to nurture communities of happy, landowning citizens, Didion went on, “was a sturdy but finally an unsupportable ambition, sustained for forty years by good times and the good will of the federal government.”
But the federal government did continue to sustain Grady Means. He worked, under President Nixon, at the forerunner agency of today’s Department of Health and Human Services (H.H.S.), and, later, as an aide to Vice-President Nelson Rockefeller. He joined a consulting-and-accounting firm that, beginning in the eighties, guided troubled but resource-rich Latin American countries through the process of privatizing their state assets. (Grady’s icy brand of Realpolitik is apparent in an editorial that he wrote for the conservative Washington Times, in which he offered conditional praise for the Chilean tyrant Augusto Pinochet.) His firm merged with another to form the financial behemoth PricewaterhouseCoopers; in 2002, the consulting wing was sold to I.B.M. for $3.5 billion. By that time, Grady and his wife were raising Casey and her brother, Calley, then teen-agers, in Washington, D.C.
The Means siblings, in their way, also aim to balance private enterprise and public service. Casey, who is thirty-seven, is a graduate of Stanford School of Medicine and a founder of Levels, a health-tracking and wearables company. (The co-founder and C.E.O. of Levels, Sam Corcos, is a top adviser at the Department of the Treasury and has led the effort to dismantle the Internal Revenue Service on behalf of Elon Musk’s Department of Government Efficiency.) Calley, thirty-nine, is a onetime food and pharma consultant; a top adviser to the H.H.S. secretary, Robert F. Kennedy, Jr.; and a co-founder of Truemed, a platform for spending H.S.A. and F.S.A. dollars on life-style interventions such as cold plunges, red-light therapy, and Levels. Together, the siblings are the authors of the best-seller “Good Energy: The Surprising Connection Between Metabolism and Limitless Health” (2024), which includes chapters such as “Trust Yourself, Not Your Doctor” and “Your Body Has the Answers: How to Read Your Blood Tests and Get Actionable Insights from Wearables.”
The book and the publicity blitz behind it—including interviews with Joe Rogan and Tucker Carlson, the latter of whom told Casey that she is poised to “change the world”—put the Meanses at the forefront of Kennedy’s Make America Healthy Again (MAHA) movement. In fact, their rise to fame seemed so abrupt—and their views on vaccines so relatively mild—that it led to some suspicious clucking within MAHA. Nicole Shanahan, who was Kennedy’s running mate during his 2024 Presidential bid, posted on X that “there is something very artificial and aggressive about them, almost like they were bred and raised Manchurian assets.”
This callback to vast mid-century power structures is both ludicrous and oddly apt, considering the Meanses’ pedigree. In the acknowledgments section of “Good Energy,” Casey and Calley thank their father for “being our inspiration of how to live the principles outlined in this book: exercising, writing, sailing, bodysurfing, hiking, laughing, growing, gardening, learning, and practicing gratitude at seventy-seven.” Casey told Carlson, “We were raised with spirituality. We were reading, you know, sacred texts and the Bible and Rumi and Ayn Rand.” She has also conceded that her family provided a “financial backstop” when she dropped out of a prestigious residency in otolaryngology, after more than eight years of medical schooling and hundreds of thousands of dollars in tuition. (In “Good Energy,” Casey, the principal author, explains that she quit because conventional medicine did not permit her “to generate foundational, vibrant health for my patients”; a former chair of her program told the Los Angeles Times that she quit because she “did not like that level of stress.”)
But what goes unmentioned—what stands in opposition to the siblings’ code of self-optimization and principled bodysurfing—is that their father’s success grew from the soil of an extraordinary season of public investment. We are now in an equally extraordinary moment of divestment from the public good, set in motion by the Administration that the Means siblings wish to serve. The story that the siblings tell about our health and well-being is that you are your own backstop—you and your apps and wearables.
Casey Means does not have an active medical license, and appears to lack a background in public health, which won’t necessarily preclude the Senate from confirming her as Surgeon General. Assuming her nomination sails through, it’s uncertain how much will be left of American public-health infrastructure once her term is underway. In March, H.H.S. announced it would claw back more than eleven billion dollars in federal grants to state health departments, which had been allocated for distributing vaccines, tracking and controlling infectious diseases, and providing mental-health and substance-abuse assistance, among other services. (After a coalition of twenty-three Democratic states and the District of Columbia sued, a federal judge temporarily blocked the decision in their jurisdictions.) A Senate minority staff report from this month stated that, throughout the first three months of the Trump Administration, the National Institutes of Health (N.I.H.) rescinded eight hundred and fifteen million dollars in grants that were intended to fund research, training, and treatment related to cancer, Alzheimer’s, cardiovascular and infectious disease, and other conditions. Over all, the full-time staff at H.H.S. has shrunk by more than twenty per cent since January.
The decimation of government agencies and programs may not trouble the Means siblings. Calley has said that the Affordable Care Act was “probably the deadliest law passed in recent history,” that Medicaid is a “disaster” for “single moms trying to make ends meet,” and that, if it were up to him, he would fire every nutrition scientist in the government’s employ. Casey, who espouses “functional medicine”—an alternative to alternative medicine, more or less—often talks about how financial conflicts of interest have compromised the work of thousands of N.I.H. grantees in recent years (this is true) and claimed that “medical error and medications are the third-leading cause of death in the U.S.” (this is highly disputed).
The siblings often have a point. They are not wrong when they attack our medical system for prizing billables over outcomes, or when they condemn government subsidies for corn and soybeans which spur the production of unhealthy food. But, even in these moments of truth, they’re often tempted to reach for some startling but dubious statistic—as when Casey asserted, at a Senate roundtable last year, that every serving of ultra-processed food increases “early mortality” by eighteen per cent (almost certainly untrue). And although the siblings bemoan the crushing cost of health care, they minimize the culpability of the insurance industry. On their Tucker Carlson appearance, Calley belittled supporters of Obamacare for embracing what he called “this populist idea of, like, taking on the insurance companies”—an idea that miserably failed—but he offered little critique of the insurance companies themselves. When “Good Energy” cites the high percentage of bankruptcies in which medical bills are a major contributor, it’s not to excoriate the likes of Aetna and UnitedHealthcare but to admonish the reader to invest in fresh, organic food, or else: “You will either pay for healthy food up front,” she writes, “or you will pay for preventable medical issues and lost productivity in the future.”
“Good Energy” is at once a memoir, a quasi-anti-establishment screed, and an orthorexic diet guide, advancing along the way three core MAHA positions. The first is that Big Food and Big Pharma are incentivized to make and keep us sick. The second is that many conventional medicines and interventions do little to improve our health, and often worsen it; these include, per the Meanses, “several antibiotics, chemotherapy drugs, antiretroviral drugs, statins, beta-blockers, and high blood pressure medications.” And, third, that most maladies can be prevented or treated through one’s own ascetic diet and life-style choices.
Because few of the credentialed participants in the system can be trusted, an individual can serve as her own doctor by way of an ongoing self-audit of her biomarkers: fasting insulin, fasting glucose, triglycerides, and so on. (“Glucose as a molecule has caused more destruction of the human mind and body than any other substance in human history,” Casey posted on Twitter in 2021.) She recommends wearing a continuous glucose monitor—these devices are at the center of her Levels program—along with trackers that measure heart-rate variability, step count, and sleep quality, plus apps for food intake and breath work. Writing in 2013, the political scientist Corey Robin observed that the complexities of Obamacare epitomized the “neoliberal utopia,” in which “all of us are forced to spend an inordinate amount of time keeping track of each and every facet of our economic lives.” In “Good Energy,” the utopia has come for your blood sugar.
“Bites are opportunities, and you don’t want to waste any,” Casey writes. To this end, “Good Energy” unspools a list of foods to avoid entirely, “as strongly as if they were illicit drugs,” owing largely to their effects on insulin and glucose levels. This catalogue includes store-bought cookies, instant oatmeal, granola bars, crackers, packaged bread, packaged mac and cheese (even Annie’s), canned soup, bouillon cubes, ketchup, mayonnaise, Nutella, “jelly and jam,” peanut butter (if it has sugar added), deli meat, bacon, beef jerky, frozen pizza, frozen fish sticks, flavored yogurt, popsicles, ice cream, and Gatorade. Elsewhere in the book, Casey gives the evil eye to pretzels, pasta, Cheerios, and “whole grains.” Your fruits and vegetables should be organic, and ideally purchased from a farmers’ market or C.S.A. If those are not options for you, Casey says, you can go to Costco.
It goes on and on. You should not eat anything made with seed or vegetable oils—canola, sunflower, peanut. (Kennedy and MAHA adherents allege that these oils are “poison” and major drivers of obesity and chronic disease, contrary to evidence.) You should not drink unfiltered tap water, nor should you drink water from plastic bottles. You should not eat a banana on its own, although pairing it with a few almonds is O.K. You should eat your dinner on a metabolically optimized timeline: first vegetables, then protein, then starch. Beyond food and drink, “Good Energy” also shoos readers away from most household cleaners and personal-care items, and advises them to “stop touching receipts and thermal papers.” You should not use perfumes or scents of any kind. Your house should have a HEPA filter. Your toothpaste should be fluoride-free. On the “Good Energy Baseline Quiz,” under “Ingested Toxins,” one of the line items is “I do not take oral hormonal contraceptives.” The advent of the birth-control pill, Casey told Carlson, gave women the message that “these hormones don’t matter. Your ability to create the most miracle of any miracles, which is create life—just shut it down, there’s no impacts. That’s crazy to me.”
The book’s tone is, at times, almost apocalyptic. “We are animals in cages right now, surrounded by encroaching threats that are entering our homes and daily lives through technology, chemicals, and more,” Casey writes. She may not be as conspiracy-addled as our current H.H.S. Secretary, but what is squarely in the key of Kennedy is the hypervigilance bordering on paranoia.
A Surgeon General’s task is one of clear and effective communication to the public on matters that affect their health and well-being. A medical license or public-health credentials may not be as important as having a grasp of how most Americans live day to day and recognizing the challenges they face in finding affordable health care and healthy food. In a 2020 webinar organized by the Founder Institute, Casey—who can patter indefatigably about hemoglobin A1C thresholds and triglyceride-to-HDL ratios—gets banana-peeled by a straightforward question about finding holistic-medicine care if you lack good health insurance. (Her meandering answer concludes, “So, yeah, functional medicine, and, you know, wearables and trackers that can help you stay on track, so.”)
Recently, my ten-year-old daughter and I went to our perfectly fine local supermarket with a list of packaged grocery items that “Good Energy” says are safe to buy. We did not do well. The ingredients on a cauliflower-crust frozen pizza seemed O.K., maybe. None of the yogurt qualified. Only one of the seven hummus brands on offer was not contaminated by seed oils, and it was also the most expensive. The MAHA firmament would view this disappointing grocery run as an indictment of Big Food and, to a lesser degree, an indictment of me for not getting everything we needed for the week at a local farmers’ market. “I eat organic, unprocessed foods I buy at the farmers’ market, and I cook every single meal for my partner and I,” Casey told Carlson. “And, when I have children in the next few years, I am so deeply excited to cook every meal for them from scratch, because there’s nothing more important.”
Of course, it is easy to lose sight of the necessity of fresh food if you are one of roughly fifty-three million Americans living in a U.S.D.A.-designated food desert—but perhaps that, like your wearables, is on you. Americans, according to Casey, “need to get back to having a sense of pride and responsibility in our households to cook food.” We are in the throes of a “spiritual crisis,” she said. “We have lost sight of what really matters in our lives.”
By “we,” she means Mother, or maybe just Woman. “Feminism has a great side,” Casey told Joe Rogan, but it also sends a pernicious message: “Don’t cook, being a mother is second-class citizenship, it’s associated with, like, being property and slave.” Cultural pressure on women to prioritize careers over family has fomented depression and divorce, she went on. “Men are lost because basically women are saying, like, ‘Men don’t have a role anymore—you know, we got this,’ and kids are not being able to, you know, get that quality time with their family, to play, and wisdom to be passed down, and to have home-cooked meals.”
