February 26, 2026—Almost-a-Dr. Casey Means (more on her title at the end) sat for Senate questioning yesterday to decide whether she should or should not be confirmed as US Surgeon General.

Means was appointed by President Trump on the recommendation of Secretary of Health and Human Services, Robert F. Kennedy, Jr. Kennedy is in the process of dismantling vaccine protections for the country that have kept us healthy for decades. I have a lot to say about that, but not today.

There is some question whether Means would further threaten US health on the subject of vaccines.

I want to focus on one statement she made in the hearing: “Until we have a clear understanding of why kids are developing [autism] at higher rates [than once was the case], I think we should not leave any stones unturned.”

The problem with the anti-vaxxer’s view on the relation between vaccines and autism is that the anti-vaxxers seem to want to keep turning over the same stone.

Many studies have debunked the connection between vaccines and autism. The famous study that found a connection was discovered to be fraudulent. But we seem to be having the same conversation over and over and over again.

Aren’t there other stones to turn over?

Of course there are. There could be environmental toxins related to new industries that have contributed to an increase in autism. There could be an undiscovered pathogen that was released as a result of global climate change. Our modern diet could be a contributing factor, either as consumed by children or as consumed by their mom’s during pregnancy. Or it could just be genetic.

I’m not advocating for or against any of these, of course. I’m a lawyer and a writer, not a medical expert. (On the other hand, those credentials don’t seem to keep RFK, Jr. from advocating as if he were a medical expert.)

Before I drop the idea of alternate hypotheses for the cause of the increasing incidence of autism, let me add one more. It’s important.

Maybe autism hasn’t increased at all.

I have no personal knowledge about this hypothesis either—except that I was a kid when autism was not particularly talked about (1950s and 60s) and I’m still around. And my kids went through the school system in the aughts and teens when autism had become known to the general public, particularly school-age kids and their parents.

Anti-vaxxers don’t like where I’m headed with this one because autism was first described scientifically by the psychiatrist Leo Kanner in 1943. By the time I was a kid in school, presumably, pediatricians were aware of the diagnosis and able to identify kids who fit the description. By the 1950s, we should have had good data on the number of autism cases in the country.

Obviously, this was a first step. But pediatrician knowledge can’t be the whole story. Pediatricians aren’t going to make a diagnosis unless parents bring their kids in with a complaint.

I wasn’t a parent in the 1950s and 60s. I was a kid. But, as a kid, I was certainly aware that kids who were what we now call neurodivergent were not treated well. They were called the r-word. Some didn’t even come to school. Others might have sat in special ed classes, segregated from the rest of us normies.

Now, when I use the word “normie,” I’m including myself. I was a high achiever academically, but not so much socially. And my social difficulties have persisted one way or another for life. Could I have been “on the spectrum,” if they had such a thing when I was in school? All they cared about in those days was that I got good grades. Kids who didn’t get good grades and kids who were disruptive in some way didn’t get the good treatment that I got.

In 1990, the Americans with Disabilities Act was passed (I was long out of school). This created a right, based on disability, to fair and nondiscriminatory treatment in employment, in public accommodations—and in schools. Could it be that parents of kids who would formerly be tracked for failure in schools sought to get diagnoses that might get the help the kids needed to do better?

The answer to that question is yes. I specifically saw this happen in my kids’ schools.

There are three related research questions that come from this. The first question is how many kids sought help by getting diagnoses of neurodivergence (I only saw a handful of cases). The second question is how many kids were left behind before these diagnoses became widely used. The third question is whether the difference between these two numbers can fully explain the increase in autism diagnoses.

And I’m not even going to get into how the diagnostic criteria for autism and “the spectrum” have changed during these years. I don’t even know if the “spectrum” terminology is valid today. Things have changed over the years.

The point is that anti-vaxxers say that autism has increased. They correlated this to the increase in vaccine usage over the last half century and more. But correlation is not causation, as they say.

But even before you get to the causation question, I think it’s fair to ask whether autism has increased at all—or if the increase can entirely be explained by social factors that made it valuable for parents to get diagnoses for their kids.

That’s a stone that needs to be turned over. I mentioned other stones above: new pathogens, environmental toxins, different diets. Undoubtedly there are other possibilities.

So let’s turn over these stones Almost-a-Dr. Casey Means! You are absolutely right that “we should not leave any stones unturned.” So let’s turn over those other stones—not just that favorite pretty stone that caught your eye. There’s nothing under that stone so far as we’ve been able to detect.

And refusing to turn over other stones is kinda obsessive—and not very scientific.

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Now for a word about the title “Almost-a-Dr.” that I used when describing Surgeon General nominee Casey Means.

If you’ve ever been in the hospital, you probably encountered a medical resident. Yes, they are technically doctors. But, no, they are not really ready to practice on patients without supervision. That’s why residencies often go on for more years than medical school. As I understand it, Dr. Means’ residency was a 5-year commitment. She almost finished it, but not quite. She wanted to be a social media influencer—whatever that is—or she was dissatisfied with the residency, or both.

So, she did become an influencer. She is presumably very smart. She got through a great medical school and almost 5 years of a residency. But she made a peculiar decision to quit when her residency was very close to the end. Almost, but not quite. Almost like the appearance of being a doctor was more appealing to Dr. Means than actually being one.

And now she’s trying to get the job of Surgeon General.

Remember the commercial where the actor Chris Robinson from the soap opera General Hospital said: “I’m not a doctor, but I play one on TV”? That was all about selling Vicks Formula 44 cough syrup, not about science.

Or truth.

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