President Donald Trump announced Thursday that he is nominating Dr. Nicole Saphier, a breast-imaging radiologist and former Fox News contributor, for U.S. surgeon general, after Dr. Casey Means' confirmation bid collapsed under bipartisan Senate resistance. It marks Trump's third attempt to fill the post in his second term, and it arrived with pointed criticism of the Republican senator who chairs the committee that never brought Means to a vote.
Means, a 38-year-old Stanford-educated physician, author, and entrepreneur, had been nominated last May. Her confirmation hearing came in late February, but the months since produced no committee vote. The Associated Press reported that exchanges with lawmakers during and after the hearing raised serious doubts about whether she could secure enough votes to advance out of the Senate health committee chaired by Sen. Bill Cassidy of Louisiana.
Means told the AP in an interview Thursday that her nomination fell apart after what she called a "yearlong smear campaign against me." She said she would continue to "help with progress on this movement how I can."
The central fault line was vaccines. Senators grilled Means in February about Health Secretary Robert F. Kennedy Jr.'s broader effort to pull back vaccine recommendations. Means had posted on social media in 2024 that giving the hepatitis B vaccine to a newborn whose parents don't have hepatitis B was "absolute insanity", a statement that drew sharp attention on Capitol Hill.
She told the AP she "wasn't coming in with any agenda to impact the vaccine conversation" and suggested there had been "some talking past each other" with senators. But the votes weren't there. Means acknowledged that Sen. Lisa Murkowski of Alaska was not going to support her and that Sen. Susan Collins of Maine had "serious reservations."
Both Murkowski and Collins are Republicans. With Democrats already opposed, losing even two GOP members on the health committee would have been enough to sink the nomination before it ever reached the full Senate floor.
The White House and its allies placed blame squarely on Cassidy. Trump, in a social media post, called Means "a strong MAHA Warrior" and attacked the "intransigence and political games" of the Louisiana senator. Calley Means, Casey's brother and a health adviser to the Trump administration, claimed Cassidy's "constant delay tactics" sank the nomination by refusing to bring it to a committee vote.
Kennedy went further. The health secretary posted that Cassidy "did the dirty work for entrenched interests seeking to stall the MAHA movement." Cassidy did not respond to a request for comment from the AP.
This is not the first time Trump has publicly singled out Cassidy. The president has previously branded the senator as "very disloyal" and urged Louisiana voters to find a replacement.
Means is the second surgeon general pick Trump has had to withdraw in this term. His first nominee, Dr. Janette Nesheiwat, a Fox News medical contributor, was pulled after questions arose about her academic credentials. Now Saphier, also a former Fox News contributor, becomes the third attempt.
The pattern is not confined to the surgeon general post. Trump also recently withdrew Ed Martin's nomination for U.S. attorney for the District of Columbia after that confirmation stalled in the Senate, as National Review reported, replacing him with former Fox host Jeanine Pirro as interim U.S. attorney.
The common thread is a Senate confirmation process that has repeatedly failed to move Trump's picks forward on a reasonable timetable. Whether the obstacle is Democratic opposition, wobbly Republican votes, or committee chairs who drag their feet, the result is the same: qualified nominees languish while the posts they were chosen to fill sit empty.
Means did not finish her surgical residency program and does not currently hold an active medical license, facts that gave skeptics ammunition. But her supporters in the Make America Healthy Again movement saw her as exactly the kind of outsider voice needed to challenge a public-health establishment they believe has failed the country on chronic disease.
The new nominee brings a more conventional medical résumé. Saphier serves as director of breast imaging at Memorial Sloan Kettering Monmouth. Her profile lists fellowships at the Mayo Clinic and a doctor of medicine degree from Ross University School of Medicine in Barbados.
Trump called her "a STAR physician who has spent her career guiding women facing breast cancer through their diagnosis and treatment." Kennedy described Saphier as "a long-time warrior for the MAHA movement."
That label may raise eyebrows, given that Saphier has shown a willingness to push back against the administration's own messaging on health topics. In September, she told the AP that Trump's cautions about pregnant women taking Tylenol were oversimplistic and "patronizing."
In an email to the AP last year, Saphier elaborated on her view. She said the president's press conference on the subject was "full of hyperbole" and "really painful to watch."
"For decades, women have endured a paternalistic tone in medicine. We've moved past dismissing symptoms as 'hysteria.' The President's recent comments on Tylenol in pregnancy are a prime example. Advising moderation was sound; delivering it in a patronizing, simplistic way was not."
That kind of candor from a nominee about the president who picked her is unusual. It suggests Saphier is not simply a loyalist willing to echo talking points, she is a physician with her own professional judgments. Whether that independence helps or hurts her confirmation prospects remains to be seen.
The broader dynamic of personnel shakeups and pressure around Trump-aligned figures has become a recurring feature of this administration's second term.
On the question that torpedoed Means' nomination, vaccines, Saphier has staked out a position that is cautious but not absolutist. On a podcast in September, she said she did not "necessarily think it's necessary" to give every newborn the hepatitis B vaccine at birth.
"My opinion is if a woman recently tested negative for hepatitis B and they're living a low-risk lifestyle, no IV drug use, not a sex worker, they don't have a hepatitis B positive person living in the home, then the newborn probably doesn't need this vaccine and we can have a conversation about whether or not they should get the vaccine later in life."
She also criticized COVID vaccine booster requirements on a radio show that same month. Those positions place her within the orbit of the MAHA movement's vaccine skepticism, though her framing is more measured than Means' "absolute insanity" post.
The CDC itself stopped recommending the birth dose of the hepatitis B vaccine for all children late last year, a move criticized by scientific and medical groups nationwide. That change is currently blocked during a lawsuit, which means the policy terrain Saphier would step into as surgeon general is already contested ground.
Saphier did not respond to a request for comment from the AP. Nor did Cassidy.
Saphier wrote a book in 2020 titled "Make America Healthy Again", years before the phrase became a Trump-era rallying cry. Whether that early adoption of the slogan signals deep alignment with the movement or simply a shared concern about American health outcomes, it will certainly feature in her confirmation hearings.
Trump has not been shy about publicly targeting high-profile figures he believes have let him down, and the surgeon general saga fits the pattern. Two nominees withdrawn. One committee chairman called out by name. And the post still empty.
Several unknowns hang over Saphier's path forward. The AP did not report whether she holds an active medical license, a question that dogged both prior nominees. Her vaccine positions, while more carefully framed than Means', will still face scrutiny from senators who watched the last hearing turn into a referendum on Kennedy's health agenda.
And then there is the Cassidy problem. If the committee chairman remains skeptical of the MAHA movement's nominees, even a more credentialed pick could face the same procedural wall that blocked Means. The White House has made clear it views Cassidy as an obstacle, not a partner. Whether that pressure produces cooperation or deeper resistance is the central question for Saphier's confirmation.
The administration's willingness to push through Washington's institutional resistance on multiple fronts suggests it will not back down easily on this fight.
Three nominees in one term for a single post. At some point, the Senate has to decide whether it wants a surgeon general or just wants to run out the clock.
