Casey Means has, to say the least, modified her tone. When she testified today in front of the Senate’s health committee, the nominee for surgeon general didn’t, as she is normally wont to do, delve into her experiences with psychedelics or endorse raw milk. She also did not rail at length against birth control. Instead, the longtime health entrepreneur and influencer emphasized her medical degree from Stanford—even though she does not have an active medical license—and sought out common ground with the senators cross-examining her.Before her nomination last spring, Means—who dropped out of her surgical residency in 2018—embraced some unconventional theories about wellness. As Rina Raphael wrote for The Atlantic last month, Means has talked to trees, implied that natural disasters are a “communication from God,” and dubbed the nation’s health “a spiritual crisis.” When she appeared on Tucker Carlson’s podcast in 2024, she denounced seed oils and suggested that the widespread use of hormonal birth control was indicative of a cultural “disrespect of life.” She has also questioned the universal birth dose of the hepatitis-B vaccine.[Read: America’s would-be surgeon general says to trust your ‘heart intelligence’]In her 2024 book, Good Energy—which Means co-wrote with her brother, Calley, who is now a senior adviser to Health and Human Services Secretary Robert F. Kennedy Jr. and also a key figure in the MAHA movement—she advises readers to avoid tap water and conventionally grown food, and to trust themselves rather than their doctors. She recommends getting “one cumulative hour of very hot heat exposure” each week and says that people should optimize their health by using a glucose-monitoring device, which is, helpfully, available through Levels Health, a company she co-founded.Means, who didn’t respond to a request for comment, wrote in her September ethics filing that she would resign from Levels and forfeit or divest all stock options in the company. But she is still listed on Levels’ blog as the company’s chief medical officer. She said today during her hearing that she has spent “the last several months working with the Office of Government Ethics to be fully compliant” with rules regarding conflicts of interest. Senator Chris Murphy also pressed Means on her financial relationships with companies whose products she has promoted in her newsletter, citing an analysis that found that she’d frequently failed to make proper disclosures to her readers. “I have a strong feeling that the way in which they gathered this data is done intentionally to create these claims that you’re making,” Means testified.Today, Means was far less outwardly anti-establishment than she has been in her book, her newsletter, and podcast appearances. For example, when Senator Patty Murray asked Means to explain her previous anti-birth-control comments, Means said that she was referring not to birth control generally but to particular women whose medical history might increase risk from taking birth control. She also avoided explicitly besmirching immunizations. “I believe that vaccines are a key part of any infectious-disease public-health strategy,” she told Senator Bill Cassidy.Means had reason to tone it down. Health leaders, including former surgeons general, have questioned her qualifications for the position. Dozens of health and advocacy organizations have opposed her nomination. Peter Lurie, the president and executive director of the Center for Science in the Public Interest, called Means “a virtual PEZ dispenser for RFK, Jr.’s misinformation” in a statement yesterday.Means’s confirmation hearing also comes at a pivotal moment for the MAHA movement. In the run-up to the midterm elections later this year, Kennedy appears to be shifting his focus from undermining the childhood-vaccine schedule—his least popular priority, according to one recent poll—to battling the food industry, which enjoys broad support. (The New York Times has reported that the White House wants Kennedy to downplay vaccines ahead of the midterms. The White House and the Department of Health and Human Services did not immediately respond to requests for comment.)Means’s stance on vaccines today was measured, by MAHA standards. She said that “vaccines save lives” but hesitated when asked whether she agreed with Kennedy’s assertion that there’s no evidence that the flu vaccine prevents serious illness or death in children. “At the population level, I certainly think that it does,” she said finally. (CDC data indicate that the flu vaccine prevents death across all age groups, including children.) Notably, Means said that “I absolutely am supportive” of the measles vaccine, but—against prevailing medical advice—declined to recommend it to parents, possibly hoping to avoid alienating the anti-vaccine wing of MAHA. “There’s a nuanced conversation that American families are looking to have about shared clinical decision making with their doctors about specific vaccines,” she told Senator Angela Alsobrooks—less of an endorsement than is customary for a surgeon general or any other public-health expert, but more mainstream than her earlier suggestions to follow one’s own intuition over expert medical advice.[Read: RFK Jr.’s next move is what anti-vaxxers have been waiting for]She also sought to be a unifying voice on pesticides, which have recently caused a fissure between MAHA and MAGA. Last week, President Trump issued an executive order to boost the domestic production of the weed killer glyphosate, which Kennedy has long insisted causes cancer, on the grounds that the compound is essential to the United States’ food security. Key leaders in the MAHA movement regarded the move as a betrayal. Not that long ago, Means might have also been quick to criticize the decision: Last March, she posted on X that “pesticides are a slow-motion extinction event.” In her testimony, though, Means was far more conciliatory, telling senators that the issue is complicated and that “changes need to be made thoughtfully, with full respect for American farmers and the constraints that they’re under.”Over the past several weeks, leaders in the MAHA movement and the GOP have been fighting over how to win the midterms without angering the factions that make up MAHA. Anti-vaccine activists won’t be satisfied until Kennedy follows through on long-favored plans to do away with the childhood-vaccine schedule. But at least for now, the secretary seems to be leaning into more broadly popular priorities, such as condemning ultra-processed food (he’ll be the keynote speaker at an “Eat Real Food” rally tomorrow in Austin). If she is confirmed, Means will find herself at the center of a movement that is in the midst of an identity crisis.