What The Hell America!

So what does Casey Means actually stand for? One place to look is the 2024 book Good Energy, which she coauthored with her brother. The title is both somewhat misleading and typical of her style. While the book’s good energy/bad energy framework may conjure Marianne Williamson and crystals, it actually refers to metabolic health — and the foods, activities, and lifestyles Means thinks support or impair it.

Whether or not one accepts the specific health claims made throughout the book (a full analysis of which would require sifting through the footnotes — perhaps worthwhile, but not undertaken here), the overall picture is neither especially objectionable nor earth shattering. Means thinks we would all benefit from more nutrient-dense foods, movement, sunlight, and sleep. She is, perhaps surprisingly, clear-eyed about the root of the problem — not individual choices, but the systemic conflict between human well-being and profit seeking. “Patients are being crushed,” she writes, “by the devil’s bargain between the $6 trillion food industry (which wants to make food cheap and addictive) and the $4 trillion health care industry (which profits off the interventions on sick patients and stays silent about the reasons they’re getting sick).”

That last line hints at Means’s broader critique of the medical system — a system in which she was, for many years, deeply embedded. These reflections, a sort of ethnography of the surgical labor process, form one of the more compelling elements of the book. Means talks about her frustration with performing surgical interventions to treat ailments that were clearly downstream of more systemic, immune-related conditions. She points out how limiting this bureaucratic organization of the body can be — the mismatch between medical specialties and the messy reality of the human form.

Some reporting on Means has suggested she has obscured the real reason she left her residency. Journalists have interviewed other doctors who knew her at the time, and who suggest she just couldn’t hack it, too overwhelmed and stressed out to successfully complete her training. To her credit, Means is actually pretty transparent about this, and she weaves her own experience of exhaustion, panic, and depression into a broader discussion of the way the grueling labor conditions in hospitals may make doctors less able to perform their jobs and, ultimately, sick themselves.

So what does Means suggest we do about these enormous, deeply structural problems? Well, naturally, she says we all need to buy wearables to track our health data in real time and pay out of pocket for lab work to become informed, empowered, bio-decision-makers. Don’t trust your doctor, she says — trust yourself. Or rather, trust the devices and apps helpfully listed in the book. Specifically, she wants everyone wearing a Fitbit Inspire 2 and suggests we might also consider the continuous glucose monitor sold by her company Levels Health, which offers subscription-based health monitoring on an “AI-powered” platform. Means cofounded the company with former SpaceX engineer Josh Clemente, Department of Government Efficiency (DOGE) consultant Sam Corcos, and two Google engineers.

“What if we treated humans like rockets” she muses, discussing Clemente’s contributions to the start-up, “equipping them with sensors before systems fail. . . ?” This turn is a little jarring at first, given that the book begins with a critique of the anti-holistic bias in medicine and estrangement of humans from nature. That is until one recalls the long history of fraternization between back-to-the-landers, hi-tech evangelists, and the military-industrial complex — the cybernetic utopian milieu surrounding Stewart Brand and his proto–Silicon Valley set.

At first, Means’s vision seems to demand that everyone become their own doctor. But somehow, she arrives at something bleaker: a world where the doctors are AI and the patients are outfitted with an arsenal of digital devices. Not quite “machines of loving grace,” but tiny electric scolds and spies, perpetually harvesting the secrets of our bodies to sell to the highest bidder.

For all her concern about the profit motives of the food, medical, and pharmaceutical industries, Means seems untroubled by the implications of opting into large-scale, privately run biosurveillance. A quick search for one such platform — an AI-powered therapy platform called BetterHelp  — reveals that it was recently fined $7.8 million by the Federal Trade Commission for selling users’ private data.

Also missing from the book is any real discussion of the obstacles people might encounter in attempting to pursue her “Good Energy” plan. Means does, rather ruthlessly, suggest that anyone whose sleep is disturbed by a pet jumping on their bed should consider rehoming said pet. But her discussion of how to become a “counterculture circadian warrior,” bucking the contemporary lifestyle habits that keep us up staring at screens late into the night, concludes without any mention of the expansion of nonstandard and unstable work schedules across the US economy in recent decades. Though Means reflects at some length on how the fragmented work schedule and high-stress environment in the hospital affected her and her colleagues, she fails to extend that insight to workers outside the medical field.

In Good Energy, what begins as a structural indictment ends as a shopping guide — directed to the savvy health “consumer” with time and income to spare. Though the problems Means identifies are rooted in the economic system, she is wholly committed to a purely market-based solution — a point she drives home when she assures the reader, “I am a huge believer in personal choice and individual freedoms.” That commitment renders Means’s prescriptions wholly inadequate to addressing the problems she identifies. She advocates for a “bottoms-up [sic] revolution,” but inaccessibility makes this revolution a dystopian one. Some may be able to buy their way out of the squalor of “modern industrial life,” but everyone else will be left to wade through the wreckage.