Coffee Break: Casey Means MD and MAHA, Health Insurance, Coffee Scat, and Big Brother at the Home of the Free Speech Movement

Part the First: Casey Means MD Is Still Awaiting Her Closeup.  We discussed the Surgeon General in waiting some time ago in a review of her book, Good Energy.  Her confirmation hearing in the US Senate is apparently still in the works.  Dr. David Gorski has an update at SBM, Surgeon General nominee Dr. Casey Means and functional medicine: Legitimizing quackery.  I have been unable to identify a previous Surgeon General who gave up the practice of medicine for, well, quackery, this time as something called Functional Medicine.  Many previous Surgeons General have had strong views that elicited excitement, but each was an accomplished physician.  And here we are in the first year of Trump v.2.0.

Good Energy is one of the leading texts of the MAHA movement.  The first section on the biochemistry of nutrition is very good.  She hits the highpoints in accessible language.  But after that, Good Energy lived up to the preconceived nonsense in its subtitle: The Surprising Connection Between Metabolism and Limitless Health.  There is no surprise in the connection of metabolism to health, but there is no such thing as limitless health, or Functional Medicine:

Now that RFK Jr. is Secretary of Health and Human Services, we have seen the consequences of letting RFK Jr. “go wild on health,” “go wild on the food,” and “go wild on the medicines,” as Trump promised during the campaign, and it’s not good, particularly for vaccines, as I’ve written about extensively. However, what I haven’t written about so much is how the other vibes-based, unscientific ideas behind MAHA could end up reshaping medicine. For example, leaving aside the extreme antivax views of our HHS Secretary—and, make no mistake, he is antivax to the core and coming for your vaccines—one aspect of MAHA is its embrace of a form of alternative medicine known as “functional medicine” (FM), as embodied in one of RFK Jr.’s key allies in MAHA, previously little-known physician named Dr. Casey Means, who is Donald Trump’s nominee for Surgeon General.

It appears that Functional Medicine will soon have its own board that certifies physicians as FM physicians.  No, not really.  That is the job of one of the boards under the auspices of the American Board of Medical Specialties. As Dr. Gorski points out, Functional Medicine combines the worst of conventional and alternative medicine:

Over the years, I’ve frequently referred to the kludge that is known as “functional medicine” as the “ultimate misnomer” in medicine and “worst of both worlds.” What I mean by that is that FM combines the worst elements of conventional medicine, overtesting and overtreatment involving reams of questionable lab tests and imaging studies (many not reimbursed by health insurance), with the worst elements of alternative medicine, specifically embracing quackery like naturopathy and acupuncture and “integrating” them with medicine. Indeed, I’ve often riffed a major punchline in a famous Mitchell & Webb comedy sketch about homeopathy and referred to FM as “reams of useless tests in one hand, a huge invoice in the other.” Even if you don’t know anything about FM, you can get the feeling that overtesting is a key component of it just from realizing that Means’ plan offers to look at 100+ biomarkers drawn twice a year. Unsurprisingly (to anyone who knows anything about FM) this sounds very similar to a panel of 100+ tests offered by one of the longtime gurus of FM, Dr. Mark Hyman, who himself was (prepandemic, at least) a frequent topic of this blog. Unsurprisingly, Dr. Hyman is himself tight with RFK Jr., a longtime buddy, and promoting FM as part of MAHA.

But what is functional medicine itself? It is a “specialty” that was “pioneered”—actually more or less made up of whole cloth — by Dr. Jeffrey Bland, who co-founded IFM, and then championed by people like Dr. Mark Hyman…

We’ve asked (and tried to answer) the question of what FM is many times on this blog going way, way back to Wally Sampson’s posts explaining why FM is quackery. (Even 17 years later, I like his characterization of FM as an “indecipherable babble and descriptive word salad.“).  Basically, FM invokes “systems” thinking in order to make it seem as though it is more “holistic” than conventional medicine. Oddly enough, however, when Dr. Hyman used to discuss the systems biology of autism, he made no sense and mangled the science; ditto for cancer.

Systems Biology is a legitimate science these days, but the term is also a catch-all, sometimes trope, even for serious biologists.  In my reading, the term goes back to the work in general systems theory of Ludwig von Bertalanffy (1901-1972):

Systems thinking, a transformative paradigm, owes its genesis to the profound intellect of theoretical biologist Ludwig von Bertalanffy, whose pioneering collaboration with computer scientist Jay Forrester and other luminaries laid its foundational bedrock. This revolutionary framework, born from their collective genius, flourished in the 1990s with the publication of Peter Senge’s enduring masterpiece, The Fifth Discipline, which illuminated its principles for a global audience.

That is downright breathtaking!  Ernst Mayr, who was there at the time and paying attention, characterized these writers as scientists who could not do an experiment or even think of one.  Pro tip: When you hear terms like “systems” and “holistic” applied to any scientific discipline, your antennae should go up immediately.  Dr. Gorski has covered this well, and a quick read of his SBM post will tell you everything you need to know.  The various rabbit holes are too many to count, however.  Which is intentional among practitioners of Functional Medicine.

Part of me wants to live long enough to see how this politico-medical discursion plays out.  The larger part of me is happy I will not live to see it in all its vainglory.  But my children and grandchildren will have to live through it.  Alas.  The take-home message is that Functional Medicine is a form of Alternative Medicine.  There is a little bit truth lurking in the word salad of each.  But Alternative Medicine that works is simply called Medicine.

Part the Second: Yes, Health Insurance Is Just Another Category Mistake of Neoliberalism.  The federal government is still shut down, ostensibly because of a game of chicken over health insurance costs.  The question is not which wing of the Uniparty bird of prey will win.  The question is how are businesses and individuals going to survive:

Premiums for employer-provided health insurance spiked by more than double the rate of inflation this year, driving the cost of a family plan to almost $27,000, a new survey finds.

KFF’s annual survey of more than 1,800 small and large employers found family premiums grew 6% in 2025, compared with a 7% increase in each of the previous two years. That’s compared with general inflation of 2.7% and wage growth of 4% over the past year.

While KFF’s report doesn’t provide insight into 2026 costs, other large surveys have cited premium hikes of 9%. Newly released individual and small-group market premiums that show steep increases don’t bode well for large-group employer plans, either.

“There is a quiet alarm bell going off,” KFF CEO Drew Altman said in a statement. “With GLP-1s, increases in hospital prices, tariffs and other factors, we expect employer premiums to rise more sharply next year.”

While KFF’s report doesn’t provide insight into 2026 costs, other large surveys have cited premium hikes of 9%. Newly released individual and small-group market premiums that show steep increases don’t bode well for large-group employer plans, either.

“There is a quiet alarm bell going off,” KFF CEO Drew Altman said in a statement. “With GLP-1s, increases in hospital prices, tariffs and other factors, we expect employer premiums to rise more sharply next year.”

Roughly 154 million Americans under age 65 get their health insurance through employers, so KFF’s snapshot, which includes employers covering 3.6 million people, illuminates the experiences of a broad swath of the population. Family premiums spiked by 26% over the past five years, outpacing inflation, which was 23.5%. Wage growth was 28.6% over the same period.

The average total premiums for employer coverage for a family was just shy of $27,000 this year, $1,408 higher than in 2024. Of that, $6,850 gets paid by the employee and $20,143 by the employer, on average.

I remember thinking when I was much younger than I am now that the United States would figure out this healthcare funding thing by the time I was an old man and thinking about what comes next, after my employer-funded health insurance ends.  Silly me.  As Lambert put it, the attitude of our neoliberal betters can be summed up as, “Because markets, go die.”  And that is exactly what will happen, especially when ObamaCare (sic) premiums for those in the “marketplace” spike into the stratosphere.  For the rest of us, this will take a little longer.  We are not a serious polity.

The category mistake?  Insurance is for events that are unlikely to happen: automobile accident, fire, flood, theft, early death of the breadwinner.  Insurance is not for events that are certain to happen, such as illness.  Shortly after health insurance was used to lure workers from one job to another in the United States during World War II, Aneurin “Nye” Bevan started the National Health Service in the United Kingdom.  From plan to implementation took less than two years.  For more than fifty years the NHS was real crown jewel of Great Britain.  The bell of neoliberalism tolls for the NHS now.  We are not serious people.

Part the Third: Coffee Scat.  Would you drink coffee from beans that passed through the digestive system of a civet?  Apparently many rich people do:

Civets enrich coffee beans they eat and excrete with two fatty acids often used in dairy products. It has been described as nutty, chocolatey, earthy and even fishy: a wildly expensive coffee that can sell for more than 100 times the price of regular brews, made from beans eaten and excreted by civet ‘cats.’

Scientists have long wondered what lies behind civet coffee’s unique flavor. A team now says that the digested beans contain high levels of two compounds commonly used as flavoring agents in dairy products — and these might contribute to the coffee’s distinctive taste.

Good to know.

Civet coffee is produced across Asia. Called Kopi Luwak in its origin country of Indonesia, it grabbed international attention after being featured in the 2007 film The Bucket List. Asian palm civets (Paradoxurus hermaphroditus) eat the fruit or cherries of coffee shrubs, and the seeds (commonly called beans) can be picked from their scat. These are then roasted to make coffee with a unique flavor; the resulting beans can cost more than US$1,300 per kilogram, and the coffee up to $75 per cup.

An analysis using gas-chromatography-mass spectrometry found one notable difference: a higher concentration of caprylic acid and capric acid in the civet-processed beans. These fatty acids are known for their goat-like flavor in dairy products. The difference, the team says, is probably caused by digestion and fermentation in the civet guts, with Gluconobacter gut bacteria and their enzymes playing a key role.

Another nod to the importance of the gut microbiome.  But I do wonder three things: (1) how do the “scat-pickers” describe their jobs, (2) how does Kopi Luwak go with Casu Marzu, and (3) how long before the food chemists figure out how to ultra-process their way to a cheaper, unpassed but passable, Kopi Luwak?  I’ll wait to hear the answers from others and then take their word for it.  My underdeveloped palate strikes again!

Part the Fourth: Health Insurance, Who Needs It? Notwithstanding that health insurance is a category mistake, nearly all of us depend on it at one time or another, but for the Bantam Governor of the Sunshine State:  DeSantis downplays importance of health insurance as the government shutdown drags on:

Florida Gov. Ron DeSantis (R) offered a reminder of the political parties’ starkly different attitudes toward health insurance when he downplayed the importance of comprehensive coverage last week.

No, the two wings of the same malignant Uniparty do not have “starkly different attitudes toward health insurance.”  Full coverage at Florida Politics without a paywall:

“Most people, particularly under 50, what they really need is a catastrophic plan that’s affordable, where then they can pay whatever they’re doing out of a health savings account,” DeSantis, now 47, said during a fireside chat at the Hoover Institution.

DeSantis was in the Navy, meaning he and his family have access to taxpayer-funded health care. Since the 2012 election, DeSantis and his family have also benefited from government-subsidized health care. DeSantis served three terms in Congress from 2013 through much of 2018, and then was elected Governor.

But to hear DeSantis tell it, the benefits are wasted on him.

“Most people, outside of paying insurance premiums, are not paying a lot for medical on a routine basis. I know in the Navy, they told me to take something, I would do it. But other than that, I never did,” DeSantis told interviewer Condoleezza Rice.

It’s worth noting, First Lady Casey DeSantis battled breast cancer in recent years. While it’s unclear how the First Couple financed her recovery, but the First Couple does have access to a state employee health insurance plan, which likely would have foot most of the bill.

The Governor’s comments come as policymakers estimate that more than a million Floridians are poised to lose health coverage this year.

And yes, once again, Because markets, go die, you useless breathers!

Part the Fifth: Big Brother Is Everywhere. Even (especially?) at the home of the Free Speech Movement: University of California faculty push back against Big Brother cybersecurity mandate:

Faculty and administrators at the University of California (UC) have settled into a bitter stalemate in a dispute over privacy and academic freedom. For more than a year, faculty members have voiced loud opposition to a cybersecurity mandate they say hands administrators and federal agencies access to their research and communications. Last month, they learned the UC president’s office would not issue any further statements on the issue, a decision faculty say underscores their frustration over limited dialogue about the mandate, which began going into effect in May.

The long-running dispute centers on Trellix, a cybersecurity software UC now requires on all university-owned computers used by faculty and even personal computers accessing certain online university resources. UC officials say it is essential for defending against a surge in digital threats. But faculty warn that Trellix is highly intrusive and effectively gives administrators the ability to view, or even remotely manipulate, nearly all activity on their devices. Trellix’s participation in the federal Joint Cyber Defense Collaborative, which aims for “rapid information sharing” between private companies and federal agencies, is stoking the concerns. Faculty fear the software could expose sensitive research, regulated health data, and high-value innovations to a presidential administration already hostile to higher education.

“Putting this kind of software on our machines completely obliterates our ability to speak and think freely in our academic communities,” says Lilly Irani, a communication scholar of technology at UC San Diego (UCSD). “It feels very much like Big Brother is sitting on the shoulder of every worker at the University of California,” adds Mia McIver, executive director of the American Association of University Professors, which sent a letter to UC officials today expressing “deep concern” about the policy.

Of course, it does.  That is the point.  But for anyone, including faculty at what in my view is (or was) the best university in the world across all academic disciplines (except medicine, which is across the Bay) to think for a moment that the Administration (at Berkeley and beyond) is not looking at your computer is just plain silly.  This is the other point:

Trellix’s root access privileges could also allow administrators or the government to view anything on faculty computers at any time, without a warrant, says Kevork Abazajian, a cosmologist at UC Irvine (UCI). In an email to Science, a Trellix spokesperson wrote that the company “will not disclose any UC or other customer data unless required to do so under law or a valid government order. In such an event, we would first give the customer notice of the demand and an opportunity to object, unless legally prohibited from doing so.”

The objections have sparked a flurry of letters, petitions, and resolutions. Most recently, in June, UC’s Academic Senate—which shares decision-making power with the administration on matters affecting teaching, research, and academic policy—passed a resolution with an 82% supermajority demanding an immediate halt to Trellix. That same month, more than 1000 faculty signed a petition opposing the rollout, followed by another 1 August letter calling for its suspension. But on 15 September, Academic Senate Chair Ahmet Palazoglu relayed that UCOP would not respond to the August letter or issue future UC-wide messages regarding Trellix.

Sternly worded letters…it is not clear what other responses from the UC faculty are possible.  But letters, petitions, and resolutions will have as much effect as No Kings day.  Anyway, a sad thing.  But I love the photograph of the Berkeley campus at the link.  Further up the street in the center right near the beautiful building formerly known as LeConte Hall is where premium parking places are (or were; that is probably offensive to someone now) marked with signs “This Space Reserved for Nobel Prize Winners” when I was there last.  We comparative scientific nonentities who were not from Berkeley took pictures.