All is not well in the world of MAHA. The announcement of Donald Trump’s second nominee for surgeon general, Casey Means, has sparked considerable outrage within and beyond the MAHA/MAGA universe. Mainstream commentators have largely focused on her lack of qualifications — she did not complete her medical residency and no longer holds a license to practice medicine — as well as her promotion of dubious or unproven health claims.

The internal dispute within the movement is more complicated and reveals growing fissures between the administration and its adherents. Some media outlets have framed the conflict as a schism between MAGA and the Make America Healthy Again (MAHA) movement. The Means siblings — Casey and her older brother Calley, a former lobbyist who now serves as a senior health advisor for the Department of Health and Human Services — are generally seen as aligned with the MAHA faction. On the MAGA side, Laura Loomer has emerged as a vocal critic, attacking them on several fronts: Casey Means’s woo-woo inclinations (tree hugging, psychedelic mushrooms) and a children’s book, written by their father, called The Adventures of Felix the Flamingo, which Loomer believes has a “trans-friendly” subtext. Calley has vociferously rejected this criticism, insisting that the book was addressed to a gay friend and reaffirming that both he and his sister are staunchly anti-trans.

Another fault line within MAHA largely centers on vaccines. Casey Means has, on the whole, indicated that she is at the very minimum a vaccine skeptic, questioning the number, necessity, and composition of required childhood vaccines. Whatever her position, many within the MAHA fold find her opposition insufficient or unconvincing, spawning a line of Means-centric conspiracy theorizing: that she is actually a diversion, a Big Pharma plant, a globalist with Rockefeller ties, or a Manchurian Candidate. Her brother’s role in connecting Trump with RFK Jr has only added fuel to the fire.