Bulwark Takes - BREAKING: Trump Ditches MAHA Surgeon General, Bashes GOP Senator, Nominates Fox Contributor

Episode Date: April 30, 2026

Sam Stein and Jonathan Cohn are going live to cover Trump's newest Surgeon General nominee, Dr. Nicole Saphier, a Fox News contributor. After pulling Casey Means' nomination, Trump bashed GOP Senator Bill Cassidy for opposing Means.Exclusive $25-off Carver Mat at https://on.auraframes.com/BULWARKTAKES. Promo Code BULWARKTAKESTickets for our Bulwark Live shows in San Diego and Los Angeles in May: https://thebulwark.com/events

All right, hey, everyone. We got an emergency podcast here with my man, Jonathan Cohn, because just about 30 minutes ago, Donald Trump, through a series of bleats, announced, I think he announced, it's sort of insinuated, if not outwardly announced that his Surgeon General nominee, Casey Means, is no longer the Surgeon General nominee. Where she's going, we don't know. He said something akin to, she'll continue to serve the Mahal movement, but made no indication of in what capacity you could see it right there. And instead, he is nominating Dr. Nicole B. Sapphire, who is an actual doctor, unlike Casey Means. I believe she works at Sloan Kettering, but I may be wrong about that.

I'll get that in a second. But she's also a Fox News contributor, has been since 2018. Yeah, she is a radiologist and director of breast imaging at Memorial Sloan Kettering. So she's an actual doctor, which is an upgrade. But for now, let's focus on Casey Means, because John, you've been doing extensive writing, reporting analysis of that nomination. And it was doomed pretty much from the start. Why did he pick her in the first place, Casey, that is?

Well, I mean, you know, he picked her because she was very much in the spirit of the RFK Jr. Maha imperative, right? I mean, she now she had gone to medical school. Let's be clear. She had a, you know, a medical degree from Stanford, you know, smart, very knowledgeable. But she'd kind of taken a detour off the traditional medical. path and basically become a wellness influencer. And she very much embodied what I think is the sort of, you know, the guiding principle

of Robert F. Kennedy Jr. is that the medical establishment is wrong. Whatever they say, do the opposite. And that was sort of, you know, she was very much a part of that. But, you know, she got into trouble right away. I think there was a lot of worrying it about having somebody be the surgeon general. I mean, this is the nation's most important doctor who's not a practicing doctor. I mean, that's, that's, you know, that really got people's attention. And then you remember her confirmation hearings. Yeah. You know, she was, she was kind of all over the place and she wouldn't take a, you know, it wasn't clear what she said. She was dodging questions. And, you know, this all came at a moment, I think, when we've seen a backlash to Kennedy in his

politics. Right. And they got caught up in that. Let's talk about the confirmation hearing. So she goes before Senate help committee. She's asked about vaccinations. And I forget if it was specifically to the measles vaccine. Do you remember precisely what it was that tripped her up? Oh, gosh. What was the exact question? I mean, there were a couple of questions.

The one that I remember most was, and we kind of pulled this just because we had pulled this out, among other things. She got a question from Tim Cain about whether she agreed with the science, you know, with the research showing that the flu vaccine. vaccine, you know, was effective and reduced hospitalization, which is very well documented. This is, you know, we can argue about, you know, how effective it is. But, I mean, this is very well documented effect. And she wouldn't answer the question. She dodged and she weaved. And she finally said she would agree with this statement.

And it was sort of a shocking moment because it wasn't even asking her whether to recommend the vaccine, which is, you know, you can get to the question of who should get it when and whatever. It gets slightly more complicated, I suppose. This was how do you read the research, which is not ambiguous? And she wouldn't say, you know, answer that. And you didn't know, is this because she has her views on it? And she's afraid that those views will be politically toxic to the country. She has her views and she's afraid they won't align with Kennedys.

But the point was the surge in general, if you want anything from the surgeon general, is you want someone who will at least tell you what the research shows. And if she's not willing to take that stand publicly, you know, what's she going to do inside the room? And moments like that, there were a bunch of moments like that. And she just, well, let's, we actually have the video of it. I think it was Cassidy actually who asked her it. Let's play this video because it's actually quite pertinent to what happened today. Blue season this year, would you as past surgeon generals have encourage Americans to get vaccinated with the flu vaccine?

At the risk of sounding repetitive, I do think it's very important as a physician and to rebuild trust in public health. to make sure that patients are encouraged to have informed consent with their doctor before getting any medication. I believe vaccines save lives. I believe they're an important part of public health. I also do not want to not encourage patients to have a conversation with their doctor. I think it's incredibly important.

And informed consent is going to be part of building trust in public health. So you could see there it's a classic two-step, right? Have informed consent. Oh, by the way, I also believe vaccines are good. are good, but never once saying, yes, you should get the flu vaccine. It's just a workaround. And that clearly bothered a lot of centers. Now, I'm summarizing your piece on this, but, you know, as much as it was problematic from a medical perspective, it was problematic from a political perspective, too, not just because it hurt her with the votes in the Senate, but because

the whole crux of the surge in general position is that you have to be able to withstand political pressure to tell inconvenient truths to the public, whether it's about the flu vaccine, whether it's about AIDS, whether it's about smoking. You have to withstand political pressure as past Surgeon General's have. And right there, she failed the test, more or less. She did fail the test. She did. And it really misunderstands the role of the Surgeon General as if, you know,

is just there to kind of, the Surgeon General, we don't have a Surgeon General to sort of instruct you to go onto, you know, Google Health and figure out your own health information. The whole reason we have a Surgeon General. That's why we have Claude and Chad GPT. Yeah. Hey, you know, I mean, that's, I mean, Dr. Claude. But, you know, that might be where we're going.

Yeah. I mean, the Surgeon General has a number of duties, but a really important role historically, as you said, is to give guidance, is to give advice. Say, look, I'm appointed by the government as a scientific officer of the government to make my best judgment based on what the evidence is. And here is what the evidence shows. Here's what I recommend that you do. I mean, you know, the flu vaccine is a great example. It's not like anyone's mandating, you know, we're forcing, you know, civilians to get the flu vaccine. I mean, we're saying, is the surgeon general going to urge people say, hey, this is a good idea.

I think you should do it. And the fact that she wasn't willing to do that is sort of shocking. But again, very much in line with Kennedy's sort of, you know, where Kennedy would like to see this go. I mean, you know, he presumably long. No one's going to be in the next day. We'll talk about the Kennedy element in a second. I will just note that, like weeks after that exchange, Pete Higgs-F did pull the mandatory flu vaccine from the U.S. Armed Forces.

So we're having that. You notice I said civilians very deliberately. I did notice. That was my key. I picked up what you dropped, Jonathan. Years of working together. I finally pick it up. All right.

The senator asking that question was Bill Cassidy, Senator from Louisiana. Now, a little political history for those who don't remember. Cassidy is in this kind of interesting position. He voted for Trump's impeachment after January 6th, one of painstakingly few Republicans who was still around, who did so, and he's running for re-election this cycle.

Now, in order to ingratiate himself with Trump, I suppose, but it's probably true, he voted for Robert F. Kennedy Jr.'s nomination to the cabinet, to HHS Secretary, even though it was very clear that he disagreed with Robert F. Kennedy Jr. on a host of fronts, and he insisted that RFK Jr. had given him assurances that, among other things, major changes to the vaccine schedule would be passed by or screened by his office before they were announced or made, things like that. That hasn't happened. RFK Jr.

basically is given him the middle finger and just gone and decimated some of the main institutional vaccine structures at HHS. And Cassidy's been there holding the back. And as we understand it, I mean, it seems pretty clear. Cassidy was not a fan of Casey Means. He was questioning her aggressively. And from all contemporaneous reporting, Cassidy was not going to vote for her nomination. But he wasn't the only one.

There was a lot of Republican senators who were concerned about the nomination. Before I get into Trump's knock on Cassidy today, do you have any other reporting or insights to add on her on the politics of her nomination? Yeah, only that, you know, obviously he's the chairman of the help committee. So he, you know, he's not just another Republican, right? I mean, he's the guy who schedules the vote. You know, I wouldn't schedule the vote. And he made very clear, I mean, you know, he would, it put this, like, we know, basically to, you know, certainty that if, if, if he had wanted her nomination to go forward,

it would have happened. He was the guy. He was the, he was the, he was the, sort of the choke point. And he was the choke point, you know, also in the sense that he is a physician and he's, he's recognized. He's a, you know, someone who cares about public health, talks a lot about it. Sure. How he went on this was going to influence any Republicans on the fence. I mean, probably not Susan Collins, probably not Lisa Murkowski.

They were more likely to vote on their own. But pretty much everyone else in the caucus was going to do. But she's got to get out. So Means had to get out of the committee. And that was the first step. And she was stuck. So clearly something came to her head, I don't know, today, maybe the day before, sometime recently.

Because out of nowhere today, Trump put up this bleat going hard at Cassidy. Let's put it up. For months, Senator Bill Cassidy to the great state of Louisiana, a very disloyal person whose Trump endorsement got him elected, but later voted to impeach Trump, who on what was now proven to be a total hoax and scam, here we go, has stood in the way of Robert F. Kennedy Jr.'s nominee Casey Means for the important position of the officer general. I nominated Casey strong maha warrior at the recommendation of Secretary Kennedy, who understands the Mahmovement better than anyone with perhaps the possible exception of meat. Nevertheless, despite Senator Cassidy's transdiction and political games,

Casey will continue to fight from a high many important months, yada, yada, yada. There was a second one that he then issued later in the day. Here it is. Hopefully all the great Republican people of Louisiana, which I won big three times, will be voting Bill Cassidy out of office in the upcoming Republican primary, President Donald J. Trump. So there you go. Trump clearly blaming Cassidy for this, and a lesson learned that you can.

that you can bend over backwards and put perhaps the most irresponsible man ever to hold a hs secretary post in that post and it will do you no good with trump if you cross him on one additional thing and that's where we end up yeah and and what a devastating load of cassidy who again as you said you know who knows how dangerous kennedy is has had you know when he's had gotten chances to question kennedy in testimony he's made very clear he's not happy with the changes that Kennedy? I mean, you said, you know, doing the middle finger to me. To me, the classic example of this is there was supposedly a guarantee he wouldn't change, you know, language, you know, official CDC language about links between vaccine and autism. If you go today to the CDC

website, right now, it was last time I checked, there's language there that says there, you know, we don't know for sure if there's a link between vaccines and autism because scientists haven't thoroughly, you know, investigated it, which is not true. And it actually appears, you know, there's still the old language that says there is no link. And the technicality here is basically, well, we didn't take down the old information. We just added this new one. Obviously, you know, it's such a middle finger. Is that what they did?

Yeah, I mean, the old language is clear. At least it was last time I checked. It's been lost. Maybe it's gone. I don't know. But I mean, now originally that's how it was. And, you know, it's just, it's so clear that he just, you know, Whatever guarantees were or were not made, you know, you and I weren't in the room, who knows.

Whatever guarantees were or were not made, Kennedy has not done what Cassidy said he was going to do. And Cassidy's just gotten to sit there and take it. And, you know, now he's running in Louisiana primary where he could lose anyway. Yeah. And I'm curious, you talked about guarantees. I am curious if Cassidy got any guarantees. Like, for instance, from the White House, hey, if I support RFK- junior, will you at least, like, sit out? Because you have to imagine that was a calculus

after all these are politicians. Look, we're going to get into the new Surgeon General nominee in the state of the Maha movement itself. But first, we have actual sponsors for our program because people like our program and want to advertise on it. If you're an advertiser out there looking to reach a really well-informed populace and a growing one, think about advertising on the show. Here is an ad from one of my favorite gifts for my mother-in-law, I give to her a Mother's Day, ORAFraM's, let's play it. Where you want to get caught flat-footed. Trust me, I've been there.

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Do you want to get an orrame? I was actually thinking buying one for my dad. because he has an old version of one. So very good pitch. I got a future as a pitch, man. All right, let's talk about Nicole Sapphire. Let me just say, we mentioned that she is a doctor. She's a Fox News contributor.

She is an author. She is of the Maham movement. I mean, she's very much of that mind. She wrote a book, I believe, on the Mahal movement. You've done all of about, you know, 30 minutes of research, more or less. What did you find? So she is legit. You know, she's at Sloan Kettering, and she does, it looks like imaging.

She's, you know, MD does, you know, among, you know, oncology imaging at Sloan Kettering, which, you know, first of all, number one, she's a practicing physician. So right off the bat, right, something, you know, we couldn't have said, you know, about means. So, you know, that roots her in medical practice, which, you know, is the first box you want to check on surgeon general. Her, you know, she did write a book called, you know, Make America or Making America Healthy Again, or make them make America. Make the very helpful.

Yeah, the original, I don't know if that's the original original original, but, you know, one of the original uses of that acronym. And you can see, you know, it's, you know, she's got on the one hand, she's of this world.

I mean, she definitely is sort of a promoter of, you know, individual behavior can make you much healthier. This is the secret, you know, of that. And her second book, uh,

is a panic attack? Is that the name of it? Yeah, panic attack, um, which is very critical. of the public health establishments reaction in COVID. And if you watch some of her segments on Fox News over the years, I mean, she's got the tone,

she's got the attack, you know, Fauci is terrible, you know, there was this tremendous overreaction that did all this damage. Now, what's not clear to me at this point, I'd have to really sit down. I imagine we'll all be sitting down and looking at what she's written and said. I mean, obviously, there's a, there's a very wide range of opinion on when you look back like the COVID reaction, you know, and there's a very, I think lots of very serious people have a very, there's a lot of, you know, reasonable debate here about, you know, what was too much, what mistakes were made, you know, without sort of tipping over into the sort of far, you know,

right conspiracy land. And, you know, we're on that spectrum she is. I don't know. I mean, look, there's lots of, I think, important debate to have about, you know, everything from schools to, you know, the early reaction, you know, all of that. So where she, you know, she, know, she has the tone down. It's not clear to me how much of it is. That's how she sounds because she's on Fox News and what, you know, how much where she really believes. And kind of the same with vaccines. I mean, we'll have to, you know, I'm sure we'll all be combing over her statements on vaccines. She's definitely talked about, you know, some of the COVID shot, you know, recommendations went too far. She's against mandates. But, you know, where in the spectrum she is, you know, there's a kind of

what I would consider a reasonable version of some of those, you know, is she, you know, where in that spectrum, I don't know. It's hard to tell right now. Well, it's like, there's like a line of demarcation somewhere in the Maha movement between people who care about eating healthier exercise who, you know, may be critical of the medical establishment, maybe a little bit contrarian about things, maybe anti-lockdown and may have real criticisms of what happened around COVID. And those who, like, believe in Wiccans and want to drink and pasteurizing. is milk, right? Like, I feel like there's, you know, one has more science-based than the other one is like really just vibes. And like they want to go back to like the 1840s because they think, you know, when we just ate protein all the time and, you know, ate what we shot and, you know, that, that, you know, that was great.

So, yes, we need to distill a little bit here on what she has said and we don't really have much yet. I mean, we're going to have a lot that she's going to be combed over. But I will say, like, you know, people like Jerome Adams, who was Trump's first surgeon general nominee, I mean, they were out there and they wanted, they were very adamant that it was important than an actual practicing doctor be in this role. Now, why? Why? Because you want to have someone with authority of the gravitas who's actually treated patients and understands that. It seems like she at least clears that bar from the get-go. It does. It does. And again, you know, if you're at Sloan Kettering, I don't want to make a rule here, but if you're practicing in Sloan Kettering, you're probably legit.

Probably within the boundaries of, you know, let's hope for Sloan Kettering. We hope so for everyone at Sloan Kettering's take. And look, I mean, you know, we've said this all along. There was a version you could imagine if you could unwind the clock in an alternative universe where Robert F. Kennedy Jr. comes in and he, you know, he really focuses on let's, you know, let's get some of the. the you know there's something unhealthy you know let's let's encourage people to eat healthier and get the colors out of the gatories yeah i mean i mean i don't know how it's the food dies really matter but whatever fine you know get rid of the artificial food dyes and exercise i mean that's great and i you know i don't know anyone who studies public health who wouldn't say number one there's always good room question things and and there's times when you know the mainstream medical consensus turns out to be wrong so someone who's willing to kind of look at things from a different angle and say, hey, you know, maybe there are things we can do in healthy living that can help.

That's all great. And that's not HHS secretary. That's not HHS secretary. That's the Michelle Obama role in Obama White House, right? Yeah. I mean, you know, well, especially, you know, if you know, if it doesn't come with, you know, oh, and by the way, we're going to take away, you know, funding for the next generation vaccine. And we're going to tell people there's, you know, that the vaccines are dangerous and we're going to

prove, you know, we're going to push vitamin A as a sort of, you know, first line, you alternative to treating, you know, to preventing the measles, which are all things Kennedy has done. Although he says he's not anti-vaccination, I know. So yeah, I mean, there's a version of that, you know, where does she fall on the spectrum? I don't know. Well, we got, we got breaking news here from our producer, Matt Marshall. She does believe in the measles vaccine. I believe we have a video of that. So, hey, small victories. Let's play the video. She believes in the measles vaccine. Measles, unfortunately, is one of the most contagious viruses and one infected individual likely infects anywhere to 9 to 12 people. Largely because it lingers in the air for a large amount of time.

If one person in the household is infected, highly likely the entire household is going to be infected. And the best way to protect yourself against measles is by making sure that your community and your family are vaccinated. But the problem is this is a very emotionally charged topic. And unless you acknowledge both sides of the argument, both sides here saying that, you know, the measles vaccine has caused some adverse effects that have harmed children. There have been children who have died from the MMR vaccine. You have to acknowledge that when you have the conversation, which is why it is so important that we talk about benefits and risks with vaccines.

Okay. I mean, the last part, not great. I don't think you. She had to do that, I suppose, to be good to her Fox audience. she likes the vaccine. At least she believes in it, right? Isn't that a progress? Yeah, I mean, that's kind of a low bar, but I suppose. I mean, look, I mean, there's a separate conversation to be had about how you end back trust in the public health establishment from people who have lost trust. And, you know, that conversational- These are the people who caused us to, yeah,

but these are the people who caused us to lose trust. Right. I mean, there's, it's complicated because it's like, how did we get here and then how do you solve it? Like, you know, you know, these are the people who went, I mean, look, I mean, there's a lot. I mean, I mean, There's a lot of reasons why people lost trust. I do think, you know, what happened in COVID, lots of people lost trust, whether they should or not is another story, but whatever. It's a complex story. And figuring out how to reach these people is a complex story.

And, you know, there's a world, if I wanted to be an optimist, I'd say, hey, someone who comes from Fox News and maybe has a following and can maybe talk that language and get people's trust. You always want to be. I mean, you never want to, you know, no doctor should ever judge patients, you know, or should ever, you know, go and sort of, you know, be chastising people. That's, that's bad medicine. You want to meet people where they are and, you know, want to hear them out. You want to make sure that you understand them and, you know, convey that, you know, this is certainly true.

All, no, any, any medical intervention from, you know, I used to say taking a time on all, but now that always sounds, you know, tainted. So, you know, any medical, taking an ibuprofen or an antihis, whatever, there are side effects and very, very occasional, you know, more serious dangers. That's true for everything. And, you know, yes, you should acknowledge those. Also, these things work really well on the overwhelming, you know, majority of cases. And you want to be, you want to be urging that. And, you know, that first part, she was great. She sounded great. You know, she was very convincing, I thought. And, you know, to have somebody from the Trump administration, maybe that's what it'll take. You know, maybe there's a world where having a Trump

administration, a certain general, say that, which, you know, we didn't hear from means. She wouldn't say that in testimony. No, she wouldn't. You mentioned the value of having a Fox News person, maybe preaching to their choir. Maybe. They have a lot of Fox News people in the camera. I'm just going to give you a list. Pete Higseth, former Fox and Friends weekend host. Sean Duffy, Transportation Secretary, former Fox Business host, Telsie Gabbard, DNI, former Fox News contributor, Tom Holman, Bordersar, former Fox News contributor, Kimi, Gilfoyle, Mike Huckabee, Mike Walts, Dan Bongino, Janine Piro, Sebastian Gorka. Is he in there? the administration, I guess, a little bit. Tammy Bruce, they all had Fox News

contributorship, so she is part of a lengthy line of X Fox News personalities or Fox News personalities who are now in the administration. We have two minutes left before we say goodbye. Quick state of the Maha movement. How do they feel? I mean, there was some backlash going on because of a bunch of things that Kennedy himself didn't do or did do. Now Means gets the boot. We'll see if her brother sticks around. How do they feel? Yeah, I mean, they've had a string of defeats and they were all in on means. They were big fans of hers. And, you know, when she testified, one of the really big leaders of the Maha movement was sitting in the food babe. This is how people know are on the internet. You know, was sitting in the, if I remember correctly, it was actually there in the hearings.

So I don't know how they're going to take this. And it's been a rough, you know, they've taken a series of setbacks. Now, there was a meeting at the White House with a bunch of them where I think Trump, you know, trying to make clear, hey, I'm with you. I'm curious if those tweets against Cassidy were partly to kind of keep the Maha people in the tent and say, hey, it's not my fault. The guy who controls this Senate committee won't confirm her. And don't you worry, I'm going to go after him. So they've had a string of setbacks. Now, you know, at the end of the day, do they really, you know, A, do they abandon Trump and the Republicans? B, doesn't matter how big a force are that those are unknowns. Right. And even within Maha.

you have different groups and you have their hardcore anti-vaccination activists. And then, as you said, you have a lot of people who really, this is about, you know, healthy food, healthy living. And they're not necessarily, you know, they're not to say on board with, say, the anti-vaccination part of it. And maybe not that committed to the Trump camp in the first place. I have a prediction. She'll be given a special envoy status to the shield of the Americas alongside Christi, it's where they all go.

It's like sending your dog upstate. It's like you get to be a special envoy to the shield of America's if you get axed. I'm kidding, folks. All right, Colin, thank you so much. Everyone should be subscribing to his newsletter. It's fantastic. He covered this stuff. You get much more than that.

It's the breakdown. It comes out Sundays, Tuesdays, occasionally, mostly, regularly. If I have my way. And you should be subscribing to the bulwark YouTube, where you get great takes like this. By the way, before we leave your programming note, as we have noted multiple times, We are hitting the road, Sarah, myself, Tim Miller. We're going to be in San Diego and Los Angeles, May 20th, May 21st. You got all the details to getting tickets for those events at the bulwark.com

slash events. We will drop the link in the show notes as well. But if you are in and around the area, come and see us. It's a great show. All right, folks, Jonathan, thank you so much. Take care, buddy. Talk to you soon. See ya.