Credentials, Charisma, and the Cost of Nominating Casey Means

Incompetent people, who do not perceive their incompetence, will surround themselves with like-minded incompetents

Years ago, while living with my parents and attending a local community college, I was hired and began working for a business I referred to as “the machine shop”. In reality, it was an aerospace parts factory. It housed industrial-grade milling machines, programmed to craft specially designed metal bolts and slips which were then sold to companies that would use them to build planes and jets.

Complex and technical as it sounds, my job was simple grunt work. The machines did all the heavy-lifting. For guys working the floor, our job included replacing chipped cutting instruments, washing oil off prepared parts, removing burrs from threaded screws, and taking measurements to make sure the parts were in spec. As a young man, it was a pretty sweet gig; most coworkers were friends, the pay was exceptionally good, and every day we ate either Chinese food or Subway.

At some point, demand for operations reached a fever pitch, so the owners decided to hire a floor supervisor to buttress operations. I was uninterested, but several of my friends vied for the role. The person they selected was Jason* (*not his real name). To all of us, Jason seemed like a reasonable choice. He was a smooth talker, experienced with different jobs on the factory floor, and was well regarded by most everyone at the shop.

However, that all seemed to change shortly after his promotion. Jason, to our befuddlement, was fairly inept in his role as floor supervisor. He would fumble important tasks, workflow became more complicated, and anytime something went wrong he was consistently, oddly, never responsible. At least, that’s what he told us.

Jason went from being capable, to incompetent, and a bit of a jerk when confronted with his ineptitude. What happened? Well, to provide a simple answer, Jason was promoted past his level of competence, displaying a classic example of the “Peter Principle” in action.

The Peter Principle was a term coined by Canadian psychologist Dr. Laurence Peter who in 1969, wrote and published a book called The Peter Principle: why things always go wrong. Removed from the banal managerial texts of the time, the work was a piece of satire that explored dysfunctions within organizational hierarchies, especially when it came to leadership.

In his book, he explains how people are easily promoted based on performance in a current role, rather than on abilities that are required or relevant to a new role. If not moored in principled hiring practices, incompetence may be advanced just as quickly as a career. A once capable person quickly becomes incapable, because the skills required for success in one role will not by necessity grant success in the new role. The new role may require different and more complex skills, and once confronted with a new challenge, the mismatch becomes apparent.

Now that we’re all familiar with the Peter Principle and its effort to explain the promotion of incompetence, we can turn our sights to the latest relevant case study found in one Casey Means, nominated to the role of Surgeon General.

The Call to Arms

Last week, Google search engines saw a sharp uptick in the phrases, “Who is Casey Means” and “What does the Surgeon General do?”, the trigger point for these online search phrases being Trump’s nomination of Casey Means for the office of the Surgeon General.

At the time of her appointment, Trump himself admitted to never having met Means, and that he relied entirely on the advice of his Health and Human Services Secretary, Robert F. Kennedy Jr. (RFK Jr):

“Bobby really thought she was great. I don’t know her… I listened to the recommendation of Bobby. I met her yesterday and once before. She’s a very outstanding person. A great academic, actually. So I think she’ll be great.”

Many healthcare individuals, both those who are inside and outside of President Trump’s favorable social circle, were critical of nomination. To get a brief glimpse of Means, here is a condensed timeline of her career:

2009-2014 - Means earned her medical degree from Stanford University.

2014-2018 - Means begins residency in Otolaryngology Head and Neck Surgery at Oregon Health & Science University, but leaves six months before completion due to what she described as “disillusionment with the healthcare system”.

2019 - A big year for Means. She sets up a functional medicine practice in Portland Oregon, and months later, co-founds Levels, a health technology company aimed at providing continuous glucose monitoring to people without diabetes. This same year, her medical license shifts to inactive status.

2024 - She co-authors the book "Good Energy: The Surprising Connection Between Metabolism and Limitless Health" with her brother, Calley Means.

My first introduction to the Means siblings was the senate roundtable hearing back in September of 2024. At the time, I don’t recall being impressed by what Means presented, though you could certainly argue she was passionate on the subject of chronic illness.

Passions aside, Means is utterly inept for the role she was offered. The office of the Surgeon General may not offer much in terms of legislative power, but it is a highly influential position.

The Nation’s Doctor

The Surgeon General is colloquially referred to as “the nation’s doctor”, so right off the bat, Means dispossession of an active medical license comes across as a federal faux pas. While being a medical doctor is not a necessity, the office has typically been filled by people with extensive experience in the healthcare field. In reverse chronological order, the role has seen a nurse officer, a physician and founder of Doctors for America, a nurse practitioner, an anesthesiologist and vice admiral, a nurse officer and rear admiral, and a physician with dual residency in family medicine and dermatology.

Means, for all intents and purposes, is an entrepreneurial wellness influencer.

Surgeon Generals are spokespersons. Nobody actually knows what they do, but everyone has heard of the role. The Surgeon General advises the government and the public on urgent health issues and shares evidence-based information to help people live healthier lives. They are vocal on everything that affects health, from chronic disease prevention, to mental health, to pandemics, to vaccinations.

They are also in charge of the U.S. Public Health Service Commissioned Corps, a team of about 6,000 public health professionals. This is the president’s personal medical army, deployed during natural disasters, disease outbreaks, and other emergencies to support community health efforts across the country.

You don’t know the Surgeon General, but you have probably heard their work.

In 1964, Dr. Terry released the first official report linking smoking to cancer and heart disease, which led to the use of cigarette warning labels.

In 1986, during the height of the AIDS crisis, Dr. Koop sent a public information pamphlet on HIV/AIDS to every American household, something that had never previously been done.

In 2016, Dr. Murthy published a massive report on addiction which attempted to frame the nature of addiction outside of moral failure. He’s the same man who in 2023 discussed effects of social media on youth, calling for better protections and more research.

The office does not write law, but it is significant. You want someone who is a good communicator, but, that communication needs to be evidence-based.

Unfit for Office

Consider the following from Casey Mean’s book, Good Energy:

There is a better way, and it starts with understanding that the biggest lie in health care is that the root cause of why we’re getting sicker, heavier, more depressed, and more infertile is complicated. (Means, 2024, IX) [Italics added]

More on that comment about “the biggest lie” in a minute. She also wrote:

Depression, anxiety, acne, infertility, insomnia, heart disease, erectile dysfunction, type 2 diabetes, Alzheimer’s disease, cancer, and most other conditions that torture and shorten our lives are actually rooted in the same thing. And the ability to prevent and reverse these conditions — and feel incredible today — is under your control and simpler than you think. (Means, 2024, IX)

You could cover a circus tent with the red flag required when any medical professional attributes all human suffering to one thing. I cannot for the life of me understand how anyone earns a medical degree and carries on with a perception that the human body is that simplistic.

Worse than this however, is the practice of morally condemning the entire medical profession; decrees of personal escapes in order to “tell the truth”. RFK Jr. seems completely on board with this sentiment, as he publicly expressed:

The attacks that Casey is unqualified because she left the medical system completely miss the point of what we are trying to accomplish with MAHA. Casey is the perfect choice for Surgeon General precisely because she left the traditional medical system—not in spite of it.

Said another way, Means and RFK Jr. do not claim experience and practice as their professional qualifiers. Rather, they rely on a self-asserted quasi-virtue. Unfortunately, this self-proclaimed virtue is grey, fuzzy in its distinction, and relies entirely on collective dismissal and condemnation.

In other words, it’s not virtue. It is immoral, useless pablum whose only achievement is grandstanding the official from which it originates.

But here’s the rub. Means is clearly an intelligent woman. She is clearly a good communicator. She has the ability to foster sentiments that somehow sound both independent and obsequious. She knows enough about human physiology to sound educated and experienced. She is resourceful, capable of launching a successful business brand. She’s also a talented story-teller.

According to Means, she left medicine when she perceived the healthcare system to be broken and exploitative.

According to her former residency chair, Dr. Paul Flint, who offered Means a three month leave of absence during her residency, it was stress and burnout:

She was under so much stress… She did that [took the leave of absence], came back and decided she wanted to leave the program. She did not like that level of stress.

If that is the case, Means managed to successfully reinvent her residency dropout, as it has now put her front and center for a big promotion. But as we learn from Dr. Laurence Peter, your ability to excel with a specified skillset will not necessarily afford you success in another arena.

A final word on this, and the Peter Principle. For all its pervasiveness, incompetence in hiring is not an inevitability. Rather, it highlights the need for skills-based promotion. As people are naturally promoted it should be fueled by a track record of success, and supported through a system of mentorship, professional development, and performance evaluation.

Following the logic of the Peter Principle, you can quickly see how any organization can quickly become top-heavy with incompetence over time. I still remember a quote from undergraduate that stated, “Mediocrity knows nothing beyond itself, but talent instantly recognizes genius.” Incompetent people, who do not perceive their incompetence, will surround themselves with like-minded incompetents.

A fellow dietitian on LinkedIn noted this irony behind Mean’s nomination:

The irony of this administration saying they are doing away with DEI and going based on merit, when not a single person has the merit for the position they hold.

Hiring and rewarding incompetence did not start with the current administration, but at present, it is leading towards ill-advised destinations. Casey Means seems charismatic, a good communicator, and quite convicted in her positions.

Even assuming best intentions, that is not good enough. Our nation needs, desperately, competence in practice.