Means

NEW YORK — Wellness influencer Dr. Casey Means’ nomination to be U.S. surgeon general is stalled a month after senators of both major political parties grilled her on vaccines and other health topics during a tense confirmation hearing, deepening doubts about her ability to secure the votes she needs for the role.

The nomination has languished despite ongoing efforts from the White House and Make America Healthy Again activists, revealing how intractable rifts over health policy can be even when Congress has shown deference to President Trump. It’s become the latest snag in Health Secretary Robert F. Kennedy Jr.’s agenda after two legal setbacks last week.

Means, a 38-year-old Stanford-educated physician who became disillusioned with traditional medicine and did not finish her surgical residency program, has faced scrutiny for her lack of experience and potential conflicts. Another sticking point has been her close alignment with Kennedy, whose efforts to dramatically pull back vaccine recommendations have been slammed by lawmakers and medical groups.

To advance to a full Senate vote, Means likely needs every Republican on the Senate Health, Education, Labor and Pensions Committee to support her nomination. But after last month’s hearing, two of them — Sens. Lisa Murkowski of Alaska and Susan Collins of Maine — told reporters they still had questions for her.

Murkowski told reporters Tuesday that “I’m just in the same spot” when it comes to those hesitations. Collins and Republican committee chairman Sen. Bill Cassidy, a physician from Louisiana who interrogated Means about vaccines during the hearing, didn’t respond to multiple inquiries about the delay.

White House spokesman Kush Desai said in a statement that the Trump administration has been having “productive conversations with the Senate” to advance Means. He added that her “elite academic credentials, research background and advocacy on America’s chronic disease epidemic will make her a critical asset for President Trump’s push to Make America Healthy Again.”

Kennedy spokesman Andrew Nixon reinforced the Republican administration’s support for Means and praised her message calling for healthier lifestyle choices rather than “sick care.”

Contentious hearing set the stage for a tough path to confirmation

Means promotes ideas popular with the MAHA movement, including that Americans are overmedicalized and that diet and lifestyle changes should be at the center of efforts to end widespread chronic disease.

But she’s been criticized for having an inactive medical license, for sometimes failing to disclose financial relationships with brands she promotes and for some of her past health-related comments.

Senators asked her during her hearing about how she would speak to the public about vaccines.

Murkowski and Cassidy pressed Means about her past doubts about the birth dose of the hepatitis B vaccine, which the U.S. Centers for Disease Control and Prevention stopped recommending for all children late last year in a move later temporarily blocked by a federal judge. Means called the hepatitis B vaccine important and lifesaving but said parents should make their own decisions with their doctors.

Cassidy also asked Means whether she would advise Americans to vaccinate against the flu and measles amid outbreaks across the country. She didn’t make that commitment, instead emphasizing the importance of informed consent.

Collins asked Means about her past advocacy for the therapeutic use of psychedelic mushrooms. Means, who has spoken positively of her own experience with the drugs, said she wouldn’t recommend psychedelics for the American public.

Kennedy’s supporters put pressure on hesitant senators

Once it appeared Murkowski and Collins were undecided, MAHA activists orchestrated a push to support Means’ bid by surging phone calls to the two senators.

“Please call both of them. Call them time after time. Get your friends to call them,” Tony Lyons, head of the Kennedy-aligned group MAHA Action, told supporters earlier this month.

Others have loudly opposed Means’ nomination. Dr. Jerome Adams, Trump’s first-term surgeon general, has repeatedly called her unqualified for her lack of an active medical license. He said in an interview that Republicans in Congress and in the Trump administration have told him they disapprove of the pick but see it as Kennedy’s choice.

“What I keep hearing from folks is, ‘This is what Bobby wants,’” he said.

While surgeons general aren’t mandated by law to have an active medical license, they are required to be part of the U.S. Public Health Service Commissioned Corps, a group of health professionals that says members should have up-to-date licenses.

Means said during her confirmation hearing that she had voluntarily made her Oregon medical license inactive, and that Adm. Brian Christine, who runs the Commissioned Corps, had testified that she was eligible to serve.

Even if Means advances out of committee, she might have difficulty securing confirmation by the full 100-member Senate. Republican Sen. Thom Tillis of North Carolina, who isn’t seeking another term, told the Associated Press that he’s leaning against voting for Means.

“Her resume already puts me on alert — and then I don’t think she did herself any favors in the hearing,” Tillis said.

Means’ confirmation delay is unusually long

At nearly 300 days since her nomination in May, Means’ confirmation process has taken almost twice as long as the average presidential pick in Trump’s second term, according to data from the nonprofit Partnership for Public Service. The group found that in the first 400 days, the average time between nomination and confirmation for Trump’s nominees was 157 days.

Sometimes the process has gone far more quickly. Markwayne Mullin, the new Department of Homeland Security secretary sworn in Tuesday, had his confirmation hearing, floor vote and swearing-in all within a weeklong period.

One reason for Means’ drawn-out nomination is the birth of her son, which happened last October on the day of her initially scheduled confirmation hearing.

But Chris Piper, manager of public policy and stakeholder engagement at the Partnership for Public Service, said the length of time that has passed since Means’ rescheduled confirmation hearing also is unusual. He said candidates are often voted out of committee within a week of their hearing.

“A monthlong delay following a hearing is atypical for most nominations, particularly at this level of position,” he said.

Swenson writes for the Associated Press. AP writers Joey Cappelletti and Stephen Groves in Washington contributed to this report.

For years, Beirut’s southern suburb has been spoken about as though it were a world apart: A Hezbollah bastion, a target, a warning, or a battlefield. But in Arabic, the word “dahiyeh” simply means “the suburb”.

The word itself is ordinary. What makes it extraordinary in Lebanon is its history.

When the Lebanese speak of Dahiyeh, they do not mean any suburb of their capital city. They mean southern Beirut in particular – a dense belt of neighbourhoods that grew from villages, fields, informal housing and municipal edges into a major extension of the city.

Dahiyeh – in size nearly as big as municipal Beirut – has been shaped by migration and displacement in the past 50 years. While many moved there in search of work or housing, most of the others were pushed there by wars, political unrest, evictions and a general sense of being neglected by the Lebanese state.

The social geography of Lebanon, which gained independence from French colonisers in 1943, began to be transformed in 1948 when Israel’s establishment saw the expulsion of more than 700,000 Palestinians from their land in what is commonly referred to as the Nakba. After Israel’s further occupation of Palestinian lands in 1967 and the expulsion of Palestinian fighters from Jordan in 1970, southern Lebanon and parts of Beirut became increasingly bound up with the Palestinian national movement.

Beirut’s ‘belt of misery’

Dahiyeh’s growth, however, accelerated after 1975, when the Lebanese civil war broke out. People displaced from other parts of Beirut moved south. The subsequent Israeli attacks and invasions in 1978 and 1982 drove more people to the edge of the capital. In that sense, Dahiyeh was not just a destination for “migrants”. It was also a refuge for the uprooted, the poor, and those repeatedly forced to start over.

Studies by scholars such as Mona Harb, professor of urban studies and politics at the American University of Beirut (AUB), show how a common noun – Dahiyeh – gradually evolved into a distinct political space: A stigmatised periphery marked in the Lebanese imagination as Beirut’s “belt of misery” that hardened into a territory with its own social and political significance. Today, it is part of Greater Beirut, woven into the capital geographically, economically and socially, even if the country’s politics may have treated the area as an outlier.

Harb’s work explicitly frames the southern suburb as a politically produced urban territory rather than just a space outside Beirut. To understand how that happened, one has to begin with the making of modern Lebanon.

Under the French Mandate, and later through the political order consolidated at independence in 1943, power in Lebanon was distributed through a sectarian system that heavily favoured the established elites, especially the Maronite Christians, who dominated the presidency and other key positions. The system not only created inequality, but also formalised and reproduced it.

Rural Lebanon, especially the south and the Bekaa Valley, remained underdeveloped and politically neglected for decades. Among those most affected were Lebanon’s Shia community, who were disproportionately concentrated in the poorer agricultural regions and had less access to state investments, infrastructure and patronage than the more privileged urban and mountainous centres. Scholars say it was not simply a temporary developmental gap, but a long history of marginalisation that defined the country’s politics.

Israeli attacks on Palestinian positions inside Lebanon repeatedly hit the surrounding Lebanese communities as well, mainly in the south. For the Shia in southern Lebanon, these attacks sharpened a bitter awareness: They were living on the front lines of a bitter regional conflict, while they were also being denied equal economic rights and meaningful political inclusion in Lebanon itself.

Out of that reality emerged a new form of Shia political mobilisation centred not only on identity, but also on deprivation, dignity and state neglect. That mobilisation found its earliest expression in Harakat al-Mahroumin, the Movement of the Deprived, founded by Imam Musa al-Sadr in the 1970s. Al-Sadr became a towering figure of modern Lebanese Shia politics because he gave social, religious and political forms to grievances building up for decades. That movement later grew an armed wing: Amal.

Al-Sadr’s mysterious disappearance during a 1978 trip to Libya remains unresolved and politically contested to this day. What is not contested is his historical importance. He helped turn the Shia of Lebanon from a neglected rural underclass into an organised political constituency demanding equal rights, representation, and a defining national presence.

The rise of Hezbollah

The 1982 Israeli invasion of Lebanon changed the Shia political landscape yet again. Israel’s siege of Beirut, the departure of Palestinian icon Yasser Arafat and his Palestine Liberation Organization forces, and Syria’s desire to dominate Lebanon all intensified divisions within Lebanese society.

Amal, which meanwhile had grown closer to Damascus to get weapons, money and political backing, remained a major force. But new Islamist movements emerged from within and around it, shaped by the Israeli occupation, disillusionment with older leaderships, and increasing support from Iran’s Islamic Revolutionary Guard Corps, especially in the Bekaa region.

Over time, these currents crystallised into Hezbollah. The split within the Shia movement was less theological and more about political strategy, defined by questions over aligning more closely with Syria, solidarity with the Palestinians, and general resistance against the Israeli occupation. Differences between Amal and Hezbollah over these questions turned violent in the 1980s, an intra-Shia fighting that Lebanese often recall as “a war among brothers”.

As Hezbollah grew stronger, Dahiyeh became much more than a residential belt. It turned into an urban heartland of a social and political force. Hezbollah built institutions there: Offices, schools, clinics, welfare networks and media infrastructure. Amal also had a presence, but the common shorthand that reduces Dahiyeh to a “Hezbollah stronghold” always conceals more than it reveals.

Today, Dahiyeh hosts a Shia majority, but also has a small minority of Palestinians and other Lebanese communities, including Christians. It bleeds physically into what is known as Greater Beirut, including its Christian and mixed areas. So when the suburb is bombed, it is not some isolated military island that is hit, but a deeply inhabited part of urban Beirut.

That is precisely why Dahiyeh is so central to the Israeli military’s thinking. During the 2006 war, large sections of the southern suburb, especially Haret Hreik, were devastated by Israel. The destruction became so emblematic that Israeli military strategists came up with what came to be known as the Dahiyeh Doctrine: Use of overwhelming force and large-scale destruction of areas associated with an armed group, with the aim of generating deterrence and putting pressure on residents supporting the group. Rights activists and legal scholars say the doctrine violates international humanitarian law, as civilian neighbourhoods and infrastructure do not become legitimate targets simply because an armed group is embedded among the population.

That Israeli pattern, however, has intensified since October 2023, when a genocidal war on Gaza and attacks on Lebanon began. Meanwhile, the killing of Hezbollah leader Hassan Nasrallah in an Israeli strike in late 2024 eroded Dahiyeh’s resistance. That erosion is more visible in the ongoing Israeli attacks on Beirut and southern Lebanon, where more than a million people have registered as displaced since March 2. The old formula – that Dahiyeh was the principal red line and that any strikes there could be deterred by Hezbollah’s threats of retaliatory strikes on several Israeli cities – no longer holds.

Once again, Dahiyeh has become a focal point of the war, with repeated bombardment sending plumes of smoke over a place that many outsiders still describe as a world apart, but which is in fact woven into Beirut’s daily life. Built over decades by the poor, the migrants and the repeatedly uprooted – and shaped by the politics of marginalisation against those whom al‑Sadr once named “the deprived” – Dahiyeh has long served as both a refuge and a front line. Today, it is again being made to carry the costs of a conflict larger than itself.

As the media industry took stock of Paramount Skydance’s startling acquisition of Warner Bros. Discovery, one question lingered on the minds of many in the news business and beyond: what will this mean for CNN?

The iconic 24-hour cable news network is among the various Warner Bros. assets that would be scooped up by Paramount in a deal announced Thursday that could transform the media landscape.

Paramount has undergone a swift transformation under Chief Executive David Ellison following his family’s acquisition of the company last summer. These changes reached CBS News almost immediately with the appointment of Bari Weiss, the controversial Free Press co-founder, as its new editor in chief.

Bari Weiss moderated a town hall with Erika Kirk, widow of slain conservative activist Charlie Kirk.

(CBS via Getty Images)

Weiss’ tenure so far has been rocky.

Her decision to pull a “60 Minutes” story about conditions inside an El Salvador prison that housed undocumented Venezuelan migrants from the U.S. received widespread criticism and accusations of political motivation. The network said the story was held for more reporting, and the segment eventually aired.

There was more upheaval last week at the news magazine, when “60 Minutes” correspondent and CNN news anchor Anderson Cooper announced that he’d be leaving to spend more time with his family.

And earlier this year, a veteran producer at “CBS Evening News With Tony Dokoupil” was fired after he expressed disagreement about the editorial direction of the newscast.

Now, the concern is that similar changes could be in store for CNN, which has long been a target of President Trump’s ire. He has personally called for the ouster of hosts at the network who have questioned his policies.

CNN Worldwide Chief Executive Mark Thompson tried to quell some of those fears, particularly inside his own newsroom.

In an internal memo dated Thursday and obtained by The Times, Thompson urged employees not to “jump to conclusions about the future” and try to concentrate on their work.

“We’re still near the start of what is already an incredibly newsy year at home and abroad,” he wrote in the note. “Let’s continue to focus on delivering the best possible journalism to the millions of people who rely on us all around the world.”

Chairman and CEO of CNN Worldwide Mark Thompson and media editor for Semafor, Maxwell Tani, speak onstage.

(Shannon Finney / Getty Images for Semafor)

CNN declined to comment beyond Thompson’s memo.

Ellison has said his vision for a news business is one that is ideologically down the middle.

“We want to build a scaled news service that is basically, fundamentally in the trust business, that is in the truth business, and that speaks to the 70% of Americans that are in the middle,” he said during a Dec. 8 interview on CNBC, shortly after Warner said it had chosen Netflix as the winning bidder for its studios, HBO and HBO Max. “And we believe that by doing so that is for us, kind of doing well, while doing good.”

Ellison demurred when asked whether Trump would embrace him as CNN’s owner, given the president’s past criticisms of the network.

“We’ve had great conversations with the president about this, but … I don’t want to speak for him in any way, shape or form,” he said.

First Amendment scholars have raised concerns about press freedom and free speech rights under the Trump administration, particularly after last month’s arrest of former CNN journalist Don Lemon and the Federal Communications Commission’s pressure on late-night hosts like Jimmy Kimmel and Stephen Colbert.

Press freedom groups have long asked questions in other countries about how authoritarian regimes use their power and “oligarchical alliances to belittle, silence, and punish independent journalistic voices, or to steer media ownership toward … a preferred version of the truth,” said RonNell Andersen Jones, a 1st Amendment scholar and distinguished professor in the college of law at the University of Utah, in an email.

“We see them asking at least some of these questions about the U.S. today,” she wrote.

Apprehension about the merger also extends beyond its implications for CNN and the media business.

Lawmakers such as Rep. Laura Friedman (D-Glendale), Sen. Adam Schiff (D-Calif.) and Sen. Cory Booker (D-N.J.) have raised concerns about how the consolidation of two major Hollywood studios could affect industry jobs and film and television production — which has significantly slowed since the pandemic, the dual writers’ and actors’ strikes in 2023 and corporate cutbacks in spending.

Sen. Elizabeth Warren (D-Mass.) called the deal an “antitrust disaster” that she feared could raise prices and limit choices for consumers.

“With the cloud of corruption looming over Trump’s Department of Justice, it’ll be up to the American people to speak up and state attorneys general to enforce the law,” she said in a statement.

Already, California Atty. Gen. Rob Bonta has said the merger isn’t a “done deal,” adding that he is in communication with other states attorneys general about the issue.

“As the epicenter of the entertainment industry, California has a special interest in protecting competition,” he posted Friday on X.

Ellison addressed some of these concerns in a statement Friday.

“By bringing together these world-class studios, our complementary streaming platforms, and the extraordinary talent behind them, we will create even greater value for audiences, partners and shareholders,” he said. “We couldn’t be more excited for what’s ahead.”

Times staff writer Meg James contributed to this report.

NEW YORK — Wellness influencer, author and entrepreneur Dr. Casey Means on Wednesday shared a vision for addressing the root causes of chronic disease instead of feeding into “reactive sick care” during her confirmation hearing to become the nation’s next surgeon general.

“Our nation is angry, exhausted, and hurting from preventable diseases,” the 38-year-old said in Washington before the Senate health committee Wednesday. “If we’re addressing shared root causes, we’re going to be able to stop the whack-a-mole medicine that’s not working for us and that is so costly.”

It’s a message that dovetails closely with that of Means’ ally Health Secretary Robert F. Kennedy Jr. and his “Make America Healthy Again” movement. It also has some bipartisan support, with a wide swath of both Democrats and Republicans agreeing that the rise in chronic disease is a problem that needs solving.

But Means also faced tough questions from senators about more inflammatory topics, such as vaccines and hormonal birth control, as well as about her qualifications and potential conflicts. The Stanford-educated physician’s disillusionment with traditional medicine drove her to a career in which she has promoted a wide range of products, at times without disclosing how she could benefit financially. She has no government experience, and her license to practice as a physician is not currently active.

“I have very serious questions about the ability of Dr. Means to be the kind of surgeon general this country needs,” Vermont independent Sen. Bernie Sanders, the ranking member of the Senate health committee, said Wednesday.

Senators grill Means on vaccines, birth control

As the nation’s doctor, the surgeon general is a leader for Americans and health officials on public health issues. If confirmed, Means would be empowered to issue advisories that warn of public health threats. She also would be tasked with promoting Kennedy’s sprawling MAHA agenda, which calls for removing thousands of additives from U.S. foods, rooting out conflicts of interest at federal agencies and promoting healthier foods in school lunches and other nutrition programs.

Surgeons general also have sometimes used the office to advocate on issues related to vaccination — though the office has no role in creating vaccine policy. Though Means has largely steered clear of Kennedy’s debunked views on vaccines, senators from both parties sought clear answers from her on how she would approach the issue if confirmed.

Sen. Bill Cassidy, the Louisiana Republican who chairs the Senate health committee, asked Means whether she would encourage Americans to vaccinate against flu and measles amid outbreaks across the U.S. She declined to make such a commitment, instead emphasizing the importance of informed consent between patients and their personal physicians.

Cassidy also asked Means whether she believes that vaccines may contribute to autism, a claim that Kennedy has embraced despite overwhelming research to the contrary.

““I do accept that evidence,” she said. “I also think that science is never settled.” She said she looked forward to seeing the results of the federal health department’s effort to study environmental contributors to the disorder.

Sen. Patty Murray, a Democrat from Washington, asked Means to address past comments on a podcast in which she said birth control pills were being prescribed “like candy” and showed a “disrespect of things that create life.”

Means said she thinks oral contraceptives should be available to all women but raised concerns about what she called “horrifying side effects” that can occur in certain populations.

“Doctors do not have enough time for a thorough informed consent conversation,” she said.

Means isn’t a traditional candidate for the role

Means in her hearing said her goal is to “get more whole, healthy foods on American plates.” It’s a worldview that she got from her own unconventional path in the medical field.

After graduating from medical school at Stanford University with a doctor of medicine degree, Means dropped out of her surgical residency program at Oregon Health and Science University in 2018. She has cited her belief that the health care system was broken and exploitative as the reason for her withdrawal.

Means then turned to alternative approaches to address what she has described as widespread metabolic dysfunction driven largely by poor nutrition and an overabundance of ultraprocessed foods. Because she had completed enough postgraduate training to obtain a medical license, she did so and started her own functional medicine practice in Oregon, which later closed. She co-founded Levels, a nutrition-, sleep- and exercise-tracking app that also can give users insights from blood tests and continuous glucose monitoring.

Financial disclosures show she made hundreds of thousands of dollars promoting health and wellness products, including specialty basil seed supplements, teas and elixirs, probiotic products and a prepared meal delivery service. An Associated Press investigation found that while recommending these products, she at times failed to disclose that she could profit or benefit from the sales.

Senators on Wednesday questioned Means about several specific incidents in which they said she didn’t disclose a financial relationship while promoting a product. She said such claims were incorrect, and that she takes conflicts of interest seriously.

In an ethics filing, Means said that if she is confirmed for the post by the full Senate, she will resign from her position with Levels and forfeit or divest stock options and stock in the company. She also pledged to stop working for Rupa, a specialty lab work company for which she developed an online course. While she may continue receiving royalty payments from her book “Good Energy,” she will not promote it, the filing said.

The filing also noted she will “not acquire any direct financial interest in entities listed on the Food and Drug Administration’s prohibited holdings list.”

At least two previous surgeons general have publicly suggested Means is not fit for the job.

In an op-ed in The Hill last May, former Bush administration surgeon general Dr. Rich Carmona wrote that Means’ professional qualifications “raise significant concerns.” Later that month, President Donald Trump’s first-term surgeon general, Dr. Jerome Adams, wrote on the social platform X that the surgeon general’s traditional leadership of the U.S. Public Health Service Commissioned Corps requires a medical license.

Means is seeking to join an administration for which her brother, Calley Means, already works. As a senior adviser to the U.S. Department of Health and Human Services, he has helped promote the Republican administration’s message about the dangers of ultraprocessed foods.

The nomination for Trump’s first pick for surgeon general, former Fox News Channel medical contributor Janette Nesheiwat, was withdrawn after she came under criticism from the president’s allies.

Means was nominated to the role last May. Her confirmation hearing was rescheduled from last October, when she went into labor the day she was set to appear.

Swenson writes for the Associated Press.

Feb. 25 (UPI) — Dr. Casey Means is scheduled to appear before the Senate Wednesday to discuss her confirmation to become surgeon general.

Means, 38, a friend of Health and Human Services Secretary Robert F. Kennedy Jr., wellness influencer and Make America Healthy Again advocate, was scheduled to appear in October before the Senate Health, Education Labor and Pension Committee virtually because she was pregnant with her first child. But it was postponed because she went into labor.

Her brother, Calley Means, is a lobbyist and senior adviser to the Health and Human Services Department.

She attended Stanford University for undergrad and medical school. She published a 2024 book, Good Energy, in which she described quitting her residency at Oregon Health and Science University. She had completed almost all of the five-year residency but said she was disillusioned with modern medicine. She advocates for healthy eating, limited pharmaceutical use and alternative remedies.

Her medical license lapsed in January 2024.

Because of this, she has faced questions over qualifications for the job, which would give her the authority to issue warnings and advisories for Americans.

HHS spokesperson Emily Hilliard said that Means’ “credentials, research background, and experience in public life give her the right insights to be the surgeon general who helps make sure America never again becomes the sickest nation on Earth.”

Kennedy recommended Means to President Donald Trump, who nominated her in May. Trump had withdrawn his previous nomination, former Fox News medical contributor Dr. Janette Nesheiwat.

Means has said she is for “unbiased research” in the childhood vaccine schedule. She has specifically questioned the safety of the hepatitis B vaccine being given soon after birth.

“I bet that one vaccine probably isn’t causing autism, but what about the 20 that they’re getting before 18 months?” CNN reported she said on Joe Rogan’s podcast in 2024.

There is no evidence that vaccines cause autism.