President Donald Trump on Thursday withdrew his nomination of Casey Means, a wellness influencer, for surgeon general after key Senate Republicans declined to support her.

Means, a doctor without an active medical license, had been poised to elevate Trump’s vague but politically potent message to “Make America Healthy Again” and alternative forms of medicine. Pulling her nomination represents a defeat for the president and Health and Human Services Secretary Robert F. Kennedy Jr., who had recommended her for the job.

Trump announced Dr. Nicole Saphier, a radiologist, director of breast imaging at Memorial Sloan Kettering Monmouth and a frequent Fox News commentator, as his new nominee in a Truth Social post.

Trump highlighted Saphier’s background in cancer treatments.

“She is also an INCREDIBLE COMMUNICATOR, who makes complicated health issues more easily understood by all Americans,” he added.  

Means’ nomination seemed to grind to a halt after her February confirmation hearing, where senators questioned her past criticisms of birth control pills and routine childhood vaccines. Means’ vague answers did not seem to assuage members of the health committee tasked with reviewing her credentials, and a handful of Republicans stalled for weeks over whether to advance her confirmation to a full chamber vote.

Recently, Trump had publicly indicated waning support for Means. When asked by reporters in late March about the nomination, he did not rule out considering another person for the job.

“Well, we’re looking at a lot of different things. I don’t know how she’s doing in the nomination process. I’m more focused on Iran,” Trump said. “But, you know, something like that would be possible. We certainly have a lot of great candidates.”

In a separate Truth Social post, Trump accused Republican Sen. Bill Cassidy, a licensed physician, of derailing Means’ nomination.

“I nominated Casey, a strong MAHA Warrior, at the recommendation of Secretary Kennedy, who understands the MAHA Movement better than anyone, with perhaps the possible exception of ME! Nevertheless, despite Senator Cassidy’s intransigence and political games, Casey will continue to fight for MAHA on the many important Health issues facing our Country, such as the rising childhood disease epidemic, increased autism rates, poor nutrition, over-medicalization, and researching the root causes of infertility, and many other difficult medical problems,” the president wrote.

Means — and, if confirmed Saphier — would have been among just a handful of women to serve in the role, a position within the federal government that has existed in some capacity since the late 1800s. Known as the “nation’s doctor,” the surgeon general has limited authority but can issue advisories and reports on health that could sway public opinion. Still, that platform could have proven critical for the Trump administration ahead of the midterm elections, in which health care access and affordability are expected to be key voting issues.

Means focuses on “functional medicine,” a growing alternative medical field that emphasizes finding the root cause of chronic health conditions — at times by trying untested methods that aren’t always covered by insurance. Kennedy has staked his own tenure on addressing what he describes as the root causes of chronic disease, particularly in children.

Unlike Kennedy, Means has formal medical training. She graduated from medical school but later dropped out of a surgical residency program. Her medical licence, issued in Oregon in 2018, is listed as inactive because she does not currently treat patients.

Sen. Andy Kim, a Democrat from New Jersey, raised the issue during the hearing, noting recent surgeon generals have had active medical licenses. (Trump’s surgeon general during his first term has also questioned Means’ credentials.) Means defended a career trajectory that has included co-founding a health company that promotes glucose monitoring, college-level teaching, editing a medical journal and co-writing a diet book about metabolic health.

Means has a massive online presence, with large followings on social media accounts, a newsletter and dozens of appearances on podcasts — including on shows hosted by Joe Rogan and right-wing media personality Tucker Carlson.

Means made remarks on both podcasts about subjects like birth control, IVF and vaccines that were points of contention for lawmakers during her Senate hearing. Means told Carlson, in an episode that aired in August 2024, that she questioned the use of birth control pills, which she said is prescribed “like candy.”

“It is one of the key barometers of female health, ‘How is your cycle doing? Is it regular? Is it heavy? And — we just shut it down and say there’s no repercussions for that, which I think gets to a larger issue, which is a disrespect of life,” she said back then.

Though hormonal birth control can have side effects, it is safe for most people. 

Cassidy asked Means if birth control is safe and should be widely accessible, including without a prescription. Means replied that patients should have a conversation with their doctors about risks and benefits about taking any medication — a similar response she gave Cassidy when he asked her if she believes the abortion medication mifepristone is safe and should be made available. 

Means was also asked about her views on IVF after she told Carlson in 2024 that people facing infertility could address it by changing their diet. She made the same point on her website. Trump has committed to making IVF more affordable, though his early actions on the issue have been scant.

Means told lawmakers that IVF is “miraculous” and said that it should be widely accessible. She added: “I also think we need to give patients the best public health information about what is impacting these conditions that are plaguing our population.”

Democrats asked Means whether she would encourage parents to vaccinate their children against measles, hepatitis B and annual flu strains. Means repeatedly declined to specify support for any specific vaccine, instead telling lawmakers that she believes vaccines save lives, are a key part of any infectious disease public health strategy and parents should consult their doctors about them. Means has previously questioned the need for a newborn hep B vaccine shot by claiming to Carlson in the same podcast episode that disease is only spread through sexual contact or drug use — even though it can spread through saliva and in other cases.

Means tried to steer her Senate hearing remarks on a bigger picture view of health. She said she wanted to nudge the American health care system toward a less reactive form of medicine while also focusing on nutrition that avoids ultra-processed foods. She also said she wants to understand how man-made changes across food, water, air and soil are impacting health.

“It’s environmental exposures that are making us sick, and we have not prioritized studying that, and the NIH and the MAHA movement is focused on looking at this, and I think this is going to be a rapid accelerant of understanding why we’re sick and how to how to heal,” she said.