Part the First: Casey Means, MD, Awaits Her Moment in the Spotlight. Some time ago, we delved into Dr. Casey Means, the Surgeon General nominee, during a review of her book, Good Energy. Her confirmation hearing in the U.S. Senate is reportedly still pending. Dr. David Gorski offers updates at SBM, Surgeon General Nominee Dr. Casey Means and Functional Medicine: Legitimizing Quackery. I couldn’t find a prior Surgeon General who transitioned from practicing medicine to promoting what many consider quackery, specifically a concept dubbed Functional Medicine. Historically, each Surgeon General has been a distinguished physician with strong, often controversial, views. Yet, here we find ourselves in the early days of the Trump administration, version 2.0.
Good Energy is recognized as a seminal text within the MAHA movement. Its initial sections, particularly those discussing the biochemistry of nutrition, are straightforward and engaging. However, the book seems to conform to the misleading expectations set by its subtitle: The Surprising Connection Between Metabolism and Limitless Health. The relationship between metabolism and health is not unexpected; rather, it is crucial to acknowledge that there is neither limitless health nor a valid foundation for Functional Medicine:
With RFK Jr. now serving as Secretary of Health and Human Services, the implications of allowing him to steer health policies—“going wild on health,” “on food,” and “on medicines,” as Trump pledged during his campaign—are concerning, particularly regarding vaccines, a topic I’ve extensively covered. However, I’ve been less vocal about how the unscientific and vibe-based philosophies surrounding MAHA could alter medical practice. Setting aside the pronounced anti-vaccine stance of our HHS Secretary, whose commitment to anti-vaccine ideologies cannot be overstated, one notable aspect of MAHA resembles a form of alternative medicine dubbed “functional medicine.” This approach is closely associated with Dr. Casey Means, a physician who is Donald Trump’s nominee for Surgeon General.
Functional Medicine seems poised to establish its own certifying board for physicians. However, this task genuinely falls under the purview of one of the boards affiliated with the American Board of Medical Specialties. Dr. Gorski notes that Functional Medicine exemplifies the problematic fusion of conventional and alternative medicine:
Over time, I have frequently described “functional medicine” as the “ultimate misnomer” in medicine and the “worst of both worlds.” In essence, it merges the detrimental elements of conventional medicine, such as excessive testing and overtreatment with countless dubious lab tests, with equally questionable alternative treatments, including naturopathy and acupuncture. One can humorously refer to Functional Medicine as consisting of “reams of useless tests in one hand and an enormous bill in the other.” Notably, Dr. Means proposes examining over 100 biomarkers biannually, which mirrors a similar test panel of 100+ assessments offered by long-time FM advocate Dr. Mark Hyman, who frequently appears on this blog. Interestingly, Dr. Hyman is well-connected with RFK Jr. and actively promotes Functional Medicine as part of MAHA.
But what exactly is Functional Medicine? It is a “specialty” that was largely envisioned—more or less fabricated—by Dr. Jeffrey Bland, co-founder of IFM, and subsequently championed by others like Dr. Mark Hyman…
We have explored the definition of FM numerous times, with Wally Sampson’s posts critiquing FM as quackery from years ago remaining relevant. His characterization resonates: FM often appears as an “indecipherable babble and descriptive word salad.” Essentially, FM promotes a “systems” approach to create an illusion of being more “holistic” than conventional medicine. Ironically, when Dr. Hyman previously discussed systems biology in relation to autism, it was incoherent, and the science was misrepresented; and the same applies to cancer.
While Systems Biology is a credible science today, the term can also serve as a catch-all for a variety of views, sometimes even among serious biologists. My understanding of the term traces back to the work of theoretical biologist Ludwig von Bertalanffy (1901-1972):
Systems thinking, a transformative paradigm, originates from the remarkable insights of theoretical biologist Ludwig von Bertalanffy, whose pioneering work alongside computer scientist Jay Forrester and other scholars laid the groundwork for this revolutionary framework. This evolved in the 1990s when Peter Senge published the insightful The Fifth Discipline, which shared these principles with a global audience.
Remarkably intriguing! However, Ernst Mayr, who actively observed this period, remarked that those writers often lacked practical experimental abilities. A hint: when terms like “systems” or “holistic” are introduced within scientific domains, be alert. Dr. Gorski has provided comprehensive coverage on this topic; a quick glance at his SBM post will reveal most of what you need to understand. The myriad rabbit holes within Functional Medicine are intentional.
Part of me is curious to witness how this interplay of politics and medicine unfolds. Yet, a greater part is relieved I won’t be here to see it in all its inflated glory. Unfortunately, my children and grandchildren will have to endure it. Although troubling, the key takeaway remains: Functional Medicine is essentially a subset of Alternative Medicine. While there may be a fragment of truth hidden within the word salad of each, effective Alternative Medicine is simply known as Medicine.
Part the Second: The Fallacy of Health Insurance in Neoliberalism. The federal government remains in a standstill, ostensibly due to contention over rising health insurance costs. The central issue is not which faction of the Uniparty prevails, but rather how individuals and businesses will weather the storm:
Premiums for employer-sponsored health insurance have surged at more than double the inflation rate this year, pushing the average family plan cost close to $27,000, a recent survey reveals.
KFF’s annual survey, encompassing over 1,800 small and large employers, indicated a 6% increase in family premiums for 2025, compared to a 7% rise in each of the preceding two years. This is in stark contrast to general inflation, which recorded a rate of 2.7%, and wage growth at 4% over the past year.
Although KFF’s report does not speculate on 2026 costs, other significant surveys have reported projected premium increases of 9%. The newly released individual and small-group market premiums show draconian hikes, foreshadowing ominous prospects for large-group employer plans.
“A subtle alarm bell is sounding,” remarked KFF CEO Drew Altman in a statement. “With GLP-1s, rising hospital prices, tariffs, and other contributing factors, we’re anticipating a sharper increase in employer premiums next year.”
Roughly 154 million Americans younger than 65 acquire their health insurance through employers, making KFF’s analysis, which encompasses employers serving 3.6 million people, a revealing snapshot of a significant demographic. Over the past five years, family premiums have soared by 26%, surpassing inflation’s 23.5% rise, while wage growth stood at 28.6% during the same timeframe.
This year’s average total premiums for employer-sponsored family coverage approached $27,000, reflecting an increase of $1,408 from 2024. Of that total, employees contribute approximately $6,850, while employers cover around $20,143 on average.
Reflecting on my younger days, I used to believe the United States would resolve its health care funding issues long before I reached old age, especially as I contemplated life post-employer insurance. How naïve! As Lambert succinctly noted, the perspective of our neoliberal leaders can be summed up as, “Because markets, go die.” This mentality is precisely what we face, notably as ObamaCare premiums for those in the “marketplace” leap to astronomical heights. For many, the delay in these outcomes may be longer, but it showcases our unserious political climate.
The fundamental misconception? Insurance is designed for unpredictable events: car accidents, fires, floods, theft, or untimely demises. It is not intended for assured occurrences, such as illness. Shortly after health insurance was used as an incentive for workers during World War II, Aneurin “Nye” Bevan established the National Health Service in the UK, turning plans into reality in under two years. For over five decades, the NHS represented a true jewel for Great Britain, yet the neoliberal agenda jeopardizes this legacy. It’s disheartening to witness our lack of seriousness.
Part the Third: The Enigma of Coffee Scat. Would you enjoy coffee produced from beans that have traversed the digestive system of a civet? Apparently, many affluent individuals do:
Civets enhance the coffee beans they consume and excrete by enriching them with two fatty acids commonly found in dairy products. This rarefied coffee has been characterized as nutty, chocolatey, earthy, and occasionally fishy; it can cost over 100 times more than standard brews, sourced from beans consumed and expelled by civet cats.
Scientists have long been intrigued by the distinctive flavor profiles of civet coffee. Recent studies suggest that the digested beans possess elevated levels of two compounds frequently used as flavoring agents in dairy products, possibly contributing to the unique taste of this beverage.
Good information to have.
Civet coffee is produced throughout Asia, distinguished as Kopi Luwak in Indonesia, its country of origin. The coffee gained international recognition following its appearance in the 2007 film The Bucket List. The Asian palm civet (Paradoxurus hermaphroditus) consumes the fruit or cherries from coffee plants, and the seeds, referred to as beans, can be extracted from their excrement. Following roasting, this unique coffee flavor emerges; the resulting beans can be valued at over $1,300 per kilogram, while the coffee itself can retail for up to $75 per cup.
Gas-chromatography-mass spectrometry analysis has identified a notable difference: civet-processed beans exhibited higher concentrations of caprylic acid and capric acid. These fatty acids are renowned for imparting a goat-like flavor in dairy products. The variation likely results from digestion and fermentation occurring in the civet’s digestive tract, with Gluconobacter gut bacteria and their enzymes playing a crucial role.
This brings attention to the significance of the gut microbiome. However, I do ponder a few things: (1) how do the “scat-pickers” describe their work, (2) what pairing options exist between Kopi Luwak and Casu Marzu, and (3) how long before food chemists develop a synthetic alternative to Kopi Luwak? I’ll await answers from others on these questions and take their word for it, as my palate leaves much to be desired!
Part the Fourth: The Diminishing Relevance of Health Insurance Despite being categorized as a misstep, most of us will rely on health insurance at some point. However, for the Governor of Florida, Ron DeSantis: downplaying the value of health insurance amidst the prolonged government shutdown:
Florida Governor Ron DeSantis (R) provided a stark contrast between the attitudes of political parties regarding health insurance, downplaying the significance of comprehensive coverage in his recent comments.
It is worth noting that the two factions of this misguided Uniparty do not have massively different views on health insurance. Full coverage information is available at Florida Politics without the need for a subscription:
“Most individuals, particularly those under 50, actually need affordable catastrophic plans, enabling them to manage expenses via health savings accounts,” stated DeSantis, now 47, in a fireside conversation at the Hoover Institution.
Having served in the Navy, DeSantis and his family can access taxpayer-funded healthcare. Since the 2012 election, he and his family have also benefited from government-subsidized health insurance. DeSantis represented Florida in Congress for three terms from 2013 to 2018 and later became Governor.
Yet, from DeSantis’s perspective, these benefits seem excessive.
“For most people, outside of insurance premiums, the routine medical expenses they incur are quite low,” DeSantis mentioned to interviewer Condoleezza Rice.
It’s noteworthy that First Lady Casey DeSantis has faced her own battle with breast cancer in recent years. While specific details surrounding her treatment expenses remain ambiguous, the First Couple does have access to a state employee health insurance plan likely covering a significant portion of the costs.
As the Governor makes these claims, policymakers estimate that more than one million Floridians may soon lose their health coverage this year.
Indeed, the refrain remains, Because markets, go die, you expendable entities!
Part the Fifth: The Pervasive Watch of Big Brother. Even (or particularly) amid the heart of the Free Speech Movement: University of California faculty resist an intrusive cybersecurity mandate:
Faculty and administration at the University of California (UC) find themselves in a standoff, embroiled in a conflict over privacy and academic freedom. For over a year, faculty members have loudly protested against a cybersecurity protocol that critics argue grants administrators and federal entities access to their research and communications. Last month, they were informed that the UC president’s office would cease further communication on the matter, a decision that amplifies their frustration regarding insufficient dialogue surrounding the mandate, which began to take effect last May.
The conflict centers on Trellix, the cybersecurity software mandated for all university-owned and even personal devices accessing specific university resources. UC officials justify its implementation, citing a spike in digital threats. However, faculty raise concerns that Trellix’s invasive design empowers administrators to spy on, or possibly manipulate, nearly all activities on their devices. Trellix’s participation in the federal Joint Cyber Defense Collaborative, which centralizes “rapid information sharing” between private firms and government agencies, further fuels these concerns. Faculty fear that the software could expose sensitive research, regulated health data, and high-value innovations to an administration that is already skeptical of higher education.
“Installing this type of software on our machines completely demolishes our capacity for free speech and thought within our academic environments,” articulates Lilly Irani, a communication scholar at UC San Diego. “It feels distinctly as if Big Brother is observing every individual at the University of California,” adds Mia McIver, the executive director of the American Association of University Professors, which recently communicated their “grave concerns” regarding this policy to UC officials.
There’s no ambiguity here: that seems to be the objective. Yet, anyone—including faculty from what I consider to be (or was) the world’s preeminent educational institution across numerous fields (excepting medicine, which is on the other side of the Bay)—believing for a moment that the administration (both Berkeley and beyond) is not monitoring your computer activities is quite naive. This leads to another important point:
Trellix’s elevated access rights could permit administrators or governmental agents to monitor and scrutinize anything on faculty computers at any time without needing a warrant, asserts Kevork Abazajian, a cosmologist at UC Irvine. In response to inquiries from Science, a Trellix spokesperson affirmed that the company “will not divulge any data from UC or other clients unless compelled to do so by law or a valid government request. In such scenarios, we will inform the client of this demand and grant them an opportunity to contest, unless prohibited by law.”
The objections have precipitated numerous letters, petitions, and resolutions. Recently, the UC Academic Senate—which shares authority with the administration over issues impacting teaching, research, and academic policy—passed a resolution with an 82% majority demanding an immediate halt to Trellix. Last June, over 1,000 faculty members signed a petition opposing its rollout, followed by a letter in August urging its suspension. However, on September 15, Academic Senate Chair Ahmet Palazoglu conveyed that the UCOP would not respond to the August letter nor issue further communications concerning Trellix.
Forcefully articulated letters…but it remains uncertain what further actions faculty can take. Unfortunately, these communications will likely have as much effect as symbolic gestures. Nonetheless, it is a disheartening situation. On a lighter note, I appreciate the photo of the Berkeley campus at the source. Additionally, in the area known for its beautiful architecture near the former LeConte Hall, premium parking spaces were once marked by signs stating, “This Space Reserved for Nobel Prize Winners,” making for a humorous element among us mere mortal scientists when I last visited.
