Takeaways from AP's report on the business interests of Trump's surgeon general pick

PROVIDENCE, R.I. — President Donald Trump's pick to be U.S. surgeon general has repeatedly said the nation's medical and food systems are corrupted by special interests and people out to make a profit at the expense of Americans' health. Yet as Dr. Casey Means has criticized scientists, medical schools and regulators for taking money from the food and pharmaceutical industries, she has promoted dozens of products in ways that put money in her own pocket.

The Associated Press found Means, who has carved out a niche in the wellness industry, set up deals with an array of businesses. In some cases, she promoted companies in which she was an investor or adviser without consistently disclosing the connection, the AP found.

Means, 37, has said she recommends products that she has personally vetted and uses herself. Still, experts said her business entanglements raise concerns about conflicting interests for an aspiring surgeon general, a role responsible for giving Americans the best scientific information on how to improve their health.

Here are some takeaways from the AP's reporting.

Growing an audience, and selling products

Means, 37, earned her medical degree from Stanford University, but she dropped out of her residency program in 2018, and her license to practice is inactive. She said she saw firsthand how ''broken and exploitative the healthcare system is" and turned to alternative approaches to address what she has described as widespread metabolic dysfunction driven largely by poor nutrition and an overabundance of ultra-processed foods.

She co-founded Levels, a nutrition, sleep and exercise-tracking app that can also give users insights from blood tests and continuous glucose monitors. The company charges $199 per year for an app subscription and an additional $184 per month for glucose monitors. Though scientists debate whether continuous glucose monitors are beneficial for people without diabetes, U.S. Health Secretary Robert F. Kennedy Jr. has promoted their use as a precursor to making certain weight-loss drugs available to patients.

With more than 825,000 followers on Instagram and a newsletter that she has said reached 200,000 subscribers, Means has a direct line to an audience interested in health, nutrition and wellness.

Many companies, including Amazon, have affiliate marketing programs in which people with substantial social media followings can sign up to receive a percentage of sales or some other benefit when someone clicks through and buys a product using a special individualized link or code shared by the influencer.

Means has used such links to promote various products sold on Amazon. Among them are books, including the one she co-wrote, ''Good Energy"; beauty products; cardamom-flavored dental floss; organic jojoba oil; sunglasses; a sleep mask; a silk pillowcase; fitness and sleep trackers; protein powder and supplements.

She also has shared links to products sold by other companies that included ''affiliate'' or ''partner'' coding. The products include an AI-powered sleep system and the prepared food company Daily Harvest, for which she curated a ''metabolic health collection.''

On a ''My Faves'' page that was taken down from her website shortly after Trump picked her, Means wrote that some links ''are affiliate links and I make a small percentage if you buy something after clicking them.''

It's not clear how much money Means has earned from her affiliate marketing, partnerships and other agreements. Daily Harvest did not return messages seeking comment, and Means said she could not comment on the record during the confirmation process.

Disclosing conflicts

Influencers who endorse products in exchange for something of value are required by the the Federal Trade Commission to disclose it every time. But most consumers still don't realize that a personality recommending a product might make money if people click through and buy, said University of Minnesota professor Christopher Terry.

While Means did disclose some relationships like newsletter sponsors, the AP found she wasn't consistent. For example, a ''Clean Personal & Home Care Product Recommendations'' guide she links to from her website contains two dozen affiliate or partner links and no disclosure that she could profit from any sales.

Means has said she invested in Function Health, which provides subscription-based lab testing for $500 annually. Of the more than a dozen online posts the AP found in which Means mentioned Function Health, more than half did not disclose she had any affiliation with the company. Though the ''About'' page on her website discloses the affiliation, that's not enough, experts said. She is required to disclose any material connection she has to a company any time she promotes it.

Representatives for Function Health did not return messages seeking comment.

While the disclosure requirements are rarely enforced by the FTC, Means should have been informing her readers of any connections regardless of whether she was violating any laws, said Olivier Sylvain, a Fordham Law School professor, previously a senior advisor to the FTC chair.

''What you want in a surgeon general, presumably, is someone who you trust to talk about tobacco, about social media, about caffeinated alcoholic beverages, things that present problems in public health,'' Sylvain said, adding, ''Should there be any doubt about claims you make about products?''

Potential conflicts pose new ethical questions

Past surgeons general have faced questions about their financial entanglements, prompting them to divest from certain stocks or recuse themselves from matters involving their business relationships for a period of time. Means hasn't yet gone through a Senate confirmation hearing and has not yet announced the ethical commitments she will make for the role.

Emily Hund, author of ''The Influencer Industry: The Quest for Authenticity on Social Media,'' said as influencer marketing becomes more common, it is raising more ethical questions — like what past influencers who enter government should do to avoid the appearance of a conflict.

''This is like a learning moment in the evolution of our democracy,'' Hund said. ''Is this a runaway train that we just have to get on and ride, or is this something that we want to go differently?''

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Swenson reported from New York.