Trump's surgeon general pick won't commit outright to vaccines, and other key takeaways

Democratic and Republican lawmakers peppered US President Donald Trump's nominee for surgeon general with hours of questions at a confirmation hearing on Wednesday, asking Casey Means about her stands on vaccines and more.

Means - a doctor, entrepreneur, and health influencer - was also questioned heavily about her qualifications and possible conflicts of interest.

Unlike past surgeons general, who lead the 6,000-person US Public Health Service, the 38-year-old Stanford-trained doctor does not have an active medical licence.

She currently is considered a leader in the Make America Healthy Again (Maha) movement championed by Health Secretary Robert F Kennedy Jr, and has published the book Good Energy that advocates natural foods, exercise, and lifestyle changes to achieve strong health.

The committee is expected to vote on her nomination soon, and, if it is approved, send it to the full chamber.

Here are our key takeaways from Wednesday's hearing.

A few senators pressed Means on the kinds of products she has promoted as a health influencer.

Senator Chris Murphy, a Democrat of Connecticut, accused her of violating Federal Trade Commission policies dozens of times, by allegedly failing to disclose she received compensation from companies while promoting their products.

Murphy cited financial data outlining her corporate sponsorships that was provided to the committee ahead of the hearing, and argued Means was undermining Americans' trust in the medical profession and raising ethical concerns over conflicts of interest.

Means responded by saying Murphy's documentation was "incorrect" and a "false representation", and accused his staff of gathering data "intentionally to create these claims".

She repeatedly told the hearing that, after a months-long process, she was fully cleared by the Office of Government Ethics and signed a letter committing to divest from her business interests while in office.

Means graduated from Stanford University's medical school and completed most of her residency training to be a surgeon, but quit before she was finished.

"I walked out of the hospital and embarked on a journey to understand the real reasons why people get sick," she wrote in Good Energy.

Since then, she has promoted some controversial health views, including scepticism of the childhood vaccination schedule. She also co-founded a company to help people monitor their blood glucose, and has sold other products - including teas and dietary supplements - on social media.

At the hearing, Means was pressed about lacking an active medical licence and said she had only allowed her licence to lapse into "inactive" status because she was not currently seeing patients. She added she wouldn't see patients as surgeon general and does not have plans to re-activiate it.

An active medical licence is not required to become surgeon general. However, in the role Means would oversee public health officers who must maintain "active and unrestricted" licences.

If confirmed, Means would be responsible for issuing national health advisories and would report to Kennedy.

Since taking office, Kennedy has made sweeping changes to the nation's health agencies as well as vaccine recommendations. Most recently, the Centers for Disease Control and Prevention (CDC) slashed the longstanding number of vaccines recommended for children by about a third - from 17 to 11.

When asked many times if, as surgeon general, she would advocate for everyone in the US to be immunised against a number of illnesses, including measles, Hepatitis B, and the flu, Means often would not commit.

At one point, she did not directly answer a question about whether she would encourage mothers to vaccinate their children against measles, saying instead: "I believe vaccines save lives. I believe that vaccines are a key part of every public - of any infectious disease public health strategy."

When pressed further, Means added: "I do believe that each patient, mother, parent, needs to have a conversation with their pediatrician about any medication they're putting in their body or their children's body."

She repeated the theme about autonomy in medical decision-making throughout the hearing, especially when discussing Hepatitis B vaccinations, which she described as "life-saving".

After several minutes of tense questioning, she said Hepatitis B immunisation is important at some point in a child's life, but not necessary for all children at birth.

The American Association of Pediatrics advises giving the first Hepatitis B jab within 24 hours of a baby's birth, saying the disease is particularly risky for infants' health and can lead to long-term problems.

The CDC, meanwhile, advises that individual parents should decide when to vaccinate their children against the disease, because many infants are not at risk of contracting it.

Means had previously said giving the vaccine to newborns born to parents who do not have Hepatitis B was "absolute insanity".

Senator Bill Cassidy, a Republican of Louisiana, asked Means if she believed vaccines cause autism, as the health secretary has said in the past.

Recently, under Kennedy, the CDC updated its guidance to say that a link between vaccines and autism cannot be ruled out, going against major health groups.

The American Medical Association, the largest professional association of physicians in the US, has said "an abundance of evidence from decades of scientific studies shows no link between vaccines and autism".

Means answered that the "autism crisis" is "devastating" families and added that "until we have a clear understanding of why kids are developing this at higher rates, I think we should not leave any stones unturned".

She also said she accepted the scientific evidence that vaccines do not cause autism, but added "science is never settled".

Senator Patty Murray, a Democrat of Washington, questioned Means about her past statements that contraceptive pills are "a disrespect of life", Americans use them "like candy", and they pose "horrifying health risks".

Murray has often said contraception approved by the Food and Drug Administration is safe.

Means told the hearing she believed contraceptive pills and mifepristone, commonly referred to as "the abortion pill", should be widely accessible, adding that all medications have risks and benefits.

But, again, she said using medication was an individual's decision and contraceptive pills can have "horrifying" side effects such as blood clots and stroke in certain women, such as those who smoke.

She added that she believed doctors often did not have time for a "thorough, informed consent conversation" with patients about risks.

Cassidy, a former doctor, asked Means if she thought mifepristone should be prescribed without an in-person physician visit.

Whether the doctor's visit can be in-person or online is outside the purview of the surgeon general's office, she said. While every patient needs to have a conversation with their doctor before taking any medication, too often that does not happen, she added.