President Donald Trump’s nominee to be surgeon general faced intense questioning on Tuesday over her stance on mifepristone, the most widely used abortion pill in the United States.
During testimony before the Senate Health, Education, Labor, and Pensions Committee, Dr. Casey Means declined to answer whether she believes mifepristone should only be prescribed after an in-person visit with a healthcare professional. The federal standard was in place for decades before the Food and Drug Administration moved to drop the requirement in 2021. Louisiana, Florida, and Texas are involved in active litigation aimed at reinstating in-person requirements for mifepristone.
“The question of whether it should be an in-person visit is out of the purview of the surgeon general’s office, but I do believe that every patient needs to have a very thorough conversation with their doctor before taking any medication,” Means said, in response to repeated questioning from committee chairman Bill Cassidy (R-LA).
“Unfortunately, in our current healthcare system, because of how overburdened doctors are, this often doesn’t happen, whether it’s in person or online,” she continued. “I think that every medication has risks and benefits. I think that all patients need to have a thorough conversation with their doctor and have true informed consent before taking any medication.”
Health and Human Services Secretary Robert F. Kennedy Jr., who helps oversee the FDA, announced last year that the government is reviewing the safety of mifepristone.
“Recent studies — such as the study by the Ethics and Public Policy Center (EPPC), which you highlighted in your letter — indicate potential dangers that may attend offering mifepristone without sufficient medical support or supervision,” Kennedy and FDA Commissioner Martin Makary wrote in response to Republican attorneys general who had expressed concern about the abortion pill. “FDA’s own data collected between 2000 to 2012 indicated 2,740 adverse events, including 416 events involving blood loss requiring transfusions. Since then, safeguards for women regarding the administration of mifepristone have been significantly reduced.”
Sen. Patty Murray (D-WA) engaged in a heated line of questioning with Means over contraception medication, saying that Trump’s surgeon general nominee’s beliefs go against “decades of evidence showing that every one of these birth control methods is safe and effective.”
“We prescribe a huge amount of hormonal contraceptive, and I do not believe most of those conversations have informed consent because of the pressures that doctors are under, because of our broken healthcare system. I want what’s best for women,” Means replied. “I also believe that the American people are looking for a more nuanced conversation about health, and I believe that that will help restore trust in public health.”
Means said she “absolutely” believes contraception methods approved by the FDA should remain accessible. She said she does not believe that all women are at risk when they take contraception, but that doctors must identify at-risk individuals before prescribing such medication.
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“All medications have risks and benefits, and in our current medical climate, with the burden on doctors, doctors do not have enough time for thorough, informed consent conversation. Some of the horrifying side effects of birth control that I have mentioned include blood clots and stroke risk in women who have clotting disorders, who are smokers, obesity,” she said. “I’m speaking about particular women that can be hurt if there is not informed consent about their medical history, their lifestyle exposures, and their family history. I want those women, and I know you do too, to be able to have a thorough conversation with their doctor and know whether they are at higher risk for side effects when prescribed the medication.”
Means and her brother, Calley, were part of the Make America Healthy Again coalition led by Kennedy, which helped propel Trump to victory in 2024.
