The Surgeon General Debacle: When Wellness Influencers Almost Ran Public Health
Medical News of the Week: Polio warnings, measles returning, GLP-1 surprises, and why trust in medicine is falling
The Surgeon General Fiasco — and a Week of Medical Reality
Reports this week suggest that Casey Means may not have the votes needed to become Surgeon General.
If that turns out to be true, it may be one of the more encouraging pieces of public-health news we’ve heard in a while.
The Surgeon General of the United States is not supposed to be a wellness influencer.
Historically, it is one of the most respected medical posts in the country, held by physicians with deep clinical and public-health experience.
Consider a few of the people who have held that office.
C. Everett Koop, a pediatric surgeon, confronted the AIDS epidemic in the 1980s with clarity and courage when many politicians preferred silence. His national HIV education campaign saved lives and helped push the country toward evidence-based policy.
David Satcher served both as Surgeon General and Director of the CDC and used the office to address health disparities and mental health.
Vivek Murthy, a practicing physician and public-health expert, has used the office to confront loneliness, addiction, and the mental-health crisis affecting young people.
These were physicians who had spent years practicing medicine, leading institutions, and grappling with real public-health problems.
The Surgeon General is supposed to be the nation’s doctor.
Instead, we were presented with a candidate who:
Did not complete a surgical residency
Has not practiced clinical medicine for years
Built her public profile largely through wellness media, podcast appearances, and a bestselling book
That alone should raise eyebrows.
But the problem goes deeper.
During a Senate hearing, Senator Tim Kaine asked a simple question:
Do influenza vaccines reduce hospitalization and death?
This is not a trick question.
The answer is yes. Decades of epidemiologic data show that influenza vaccination reduces severe disease, hospitalizations, and mortality.
Instead of answering, Means spent three minutes avoiding the question, circling around it even while Kaine had the statistics in front of him.
When someone seeking the nation’s top public-health position cannot clearly state that influenza vaccines reduce hospitalizations and deaths, that is not nuance.
That is evasion.
And evasion on basic public-health questions is disqualifying.
This is not a serious public-health professional.
This is a wellness influencer.
Someone whose business model includes promoting continuous glucose monitors to healthy people alongside her brother, despite the fact that most of those consumers do not medically need them.
That is not clinical medicine.
That is the wellness industry.
And it reflects a larger problem.
Under the orbit of Robert F. Kennedy Jr., qualified scientists have been removed from advisory panels while a loose ecosystem of influencers and contrarians has been elevated.
For those of us who have spent decades practicing medicine, teaching medicine, and working in public health, it is not merely frustrating.
It is insulting.
Public health is not a hobby.
It is the quiet infrastructure that keeps water clean, food safe, and infectious diseases from killing millions of people.
You only notice it when it breaks.
And when it breaks, the reminder tends to arrive in the form of outbreaks.
Which, if you look at the rest of this week’s medical news, may already be happening.
Trust in Medicine Is Falling
A new survey from the Annenberg Public Policy Center found that Americans are losing trust in federal health agencies.
Confidence in the CDC, FDA, and NIH dropped between five and seven percentage points over the past year.
Interestingly, Americans say they trust professional medical organizations more, with 73% saying they trust the American Medical Association.
That finding makes sense.
People trust doctors.
But here is the irony.
Much of the science physicians rely on comes from the very agencies people say they trust less.
The NIH funds the research.
The FDA evaluates the drugs.
The CDC tracks the diseases.
Those institutions are the backbone of American public health.
We need them to function well.
But at the moment they are being hollowed out.
Under the current RFK Jr. orbit, many serious experts have been pushed aside while advisory panels are filled with contrarians and influencers.
Instead of the quiet competence that public health requires, we are increasingly getting performative skepticism.
We are drifting toward a system where some of the loudest voices in health policy make Gary Brecka sound like the adult in the room.
That should concern anyone who cares about science.
Polio Is Showing Up Again
The CDC issued a Level 2 travel advisory after poliovirus was detected in multiple regions over the past year.
Countries where the virus has appeared include:
Germany
Israel
Spain
The United Kingdom
Several African nations
Travelers are advised to make sure their polio vaccinations are up to date.
Most Americans received the full childhood series and remain well protected.
Routine boosters are not necessary for most adults, but the CDC recommends one lifetime booster for people traveling to areas where poliovirus is circulating.
For younger generations, polio is something found in history books.
Older physicians remember it very well.
Children in iron lungs.
Hospital wards filled with paralyzed patients.
Vaccination nearly eliminated it here.
But viruses do not respect borders.
Measles Is Back
The United States has already recorded more than 1,100 measles cases this year.
About 96% of those cases occurred in people who were not vaccinated.
More than 80% are in children and teenagers.
Epidemiologists often call measles “the canary in the coal mine.”
It is one of the most contagious diseases known.
When vaccination rates fall even slightly, measles is usually the first disease to return.
And when it does, other vaccine-preventable diseases often follow.
Flu Has Overtaken COVID This Winter
For the second winter in a row, influenza has caused more illness in the United States than COVID-19.
COVID continues to circulate year-round, but widespread immunity from vaccination and prior infection has reduced its severity.
Influenza remains seasonal and unpredictable because the virus evolves each year.
GLP-1 Drugs Continue to Surprise Researchers
GLP-1 medications are quickly becoming one of the most important therapeutic classes in modern medicine.
This week’s research suggests they may:
Reduce risk of substance-use disorders
Maintain benefits even with less frequent dosing
Dramatically lower cardiovascular risk when combined with healthy lifestyle habits
I’ll go through the studies in more detail in the paid section below.
Artificial Intelligence Is Not Ready for the ER
A study published in Nature Medicine tested an AI triage system using 60 real-world clinical scenarios.
The AI under-triaged emergency cases more than half the time, recommending routine care when patients should have gone to the emergency room.
Artificial intelligence will absolutely play a role in medicine.
But for now it occasionally behaves like a first-year medical student who stayed up all night reading WebMD.
The Microbiome Testing Industry Is Still the Wild West
Researchers sent identical stool samples to 21 direct-to-consumer microbiome tests.
The results varied wildly between companies.
In some cases even tests from the same company disagreed.
The microbiome is a fascinating field of science.
But the commercial testing industry has gotten far ahead of the evidence.
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