Updated at 1:20 p.m. ET on March 5, 2026<\/p>\n
The surgeon general may be the nation\u2019s doctor, but she\u2019s not your doctor. At least that\u2019s the view of Casey Means<\/a>, the physician turned wellness influencer who is vying for the role. When asked during her recent Senate confirmation hearing whether she would encourage parents to vaccinate their children against measles\u2014hardly a theoretical question, given the country\u2019s ongoing outbreak\u2014Means delivered an elliptical response. She supported vaccines as a public-health tool but wouldn\u2019t necessarily encourage someone to get them. \u201cI am not an individual\u2019s doctor,\u201d she said. (In fact, she is no one\u2019s doctor at the moment, because she lacks an active medical license.) \u201cAnd every individual needs to talk to their doctor before putting a medication into their body.\u201d<\/p>\n Means\u2019s nonanswer was more than a dodge. It represents a paradox in the Trump administration\u2019s approach to public health. Means, Health Secretary Robert F. Kennedy Jr., and their allies have consistently eroded confidence in the medical establishment\u2014even as they propose to solve the widespread mistrust of public health by encouraging Americans to talk to their doctor.<\/p>\n Kennedy and his subordinates have spent the past year infusing this approach into federal immunization policy. In October, the CDC announced<\/a> that it would no longer encourage universal COVID boosters for either adults or children. Instead, a process known as \u201cshared clinical decision-making,\u201d in which doctors engage their patient in a detailed conversation about the pros and cons of the vaccine without defaulting to an endorsement, was the recommended approach. Jim O\u2019Neill, the acting CDC director at the time, said in a press release that the previous guidance \u201cdeterred health care providers from talking about the risks and benefits of vaccination for the individual patient or parent.\u201d In January, the CDC went one step further, striking<\/a> several more vaccines\u2014those against rotavirus, influenza, meningococcal disease, and hepatitis A and B\u2014from the routine-childhood-immunization schedule. Shared decision making would be the preferred approach for these immunizations as well. On a podcast, Kennedy touted the move<\/a> as returning \u201cfreedom of choice to American mothers.\u201d<\/p>\n Who could argue against freedom of choice? The difficulty is that in medicine, shared decision making is not simply a synonym for allowing a patient to ask questions and decide for themselves. That sequence of events is covered by informed consent, a process that takes place before any medical intervention, including vaccination. Shared decision making, in contrast, is a somewhat nebulous term reserved for clinical borderlands: scenarios in which the trade-offs are nuanced or the best course of action is unclear.<\/p>\n Perhaps the most notable example of shared decision making in my area of medical practice is prostate-cancer screening. A handful of large, randomized studies have examined whether the prostate-specific-antigen blood test truly saves lives by detecting cancers earlier. These trials have yielded mixed results, suggesting that, at most, only a small number of men might avoid dying from cancer by getting checked. In contrast, the potential harms of treating an asymptomatic tumor that would not otherwise have been discovered\u2014lifelong urinary and sexual problems, for example\u2014are common. Given the intimate risks and modest benefits, prostate-cancer screening is not explicitly recommended by public-health or physician groups; instead, patients and their doctors are left to their own devices. I have heard from many urologists and primary-care doctors that this process can be baffling and unsatisfying for them and their patients alike. Patients may feel overwhelmed by the complexity of the scientific data, and doctors often feel that they are abandoning their responsibility to offer patients a clear recommendation.<\/p>\n Routine immunizations do not inhabit the sort of gray zone that would warrant such an elaborate discussion. Take the hepatitis-B shot. Everyone who doesn\u2019t get it is susceptible at some point in their life to infection with the virus, which, if it becomes chronic, commonly results in serious liver damage and liver cancer. The vaccine is highly effective at preventing this infection, and its potential harms are either very mild or extremely rare. Vaccination also benefits entire communities by reducing spread of the disease. What would a shared decision even look like in this case? On one hand, a doctor might tell her patient, a very safe immunization can effectively prevent a potentially deadly disease across your child\u2019s entire life. On the other hand, anti-vaccine activists have asserted, without convincing evidence, that vaccination comes with a host of possible dangers.<\/p>\n Shrouding established immunizations in the confusion of shared decision making does not add nuance; it introduces only ambiguity. The Department of Health and Human Services, the Office of the Surgeon General, and public health as a whole exist in large part to offer scientifically accurate advice that doesn\u2019t take a physician to understand. The system that Means seemed to be proposing for the measles shot during her confirmation hearing is so absurd that it left Senator Bill Cassidy\u2014a doctor himself\u2014apparently dumbfounded. At one point, Cassidy wondered<\/a> whether Means was likening immunizations to something as risky as a bypass surgery, which does require a doctor and patient to intensively discuss the risks and benefits. (Means did not directly answer the question, and instead responded, \u201cThe constraints on doctors are monumental, and many American parents are frustrated by what they feel like is lack of transparency on the issue of vaccines.\u201d) The comparison was clarifying. The risks of coronary-artery-bypass surgery, which involves cracking someone\u2019s chest open and stopping their heart, are hardly in the same league as a vaccine-induced sore arm or a mild fever\u2014or even the statistically minuscule risk of a serious side effect, such as anaphylaxis.<\/p>\n