By MICHELLE R. SMITH and ALI SWENSON, Associated Press

PROVIDENCE, R.I. (AP) — President Donald Trump’s pick to be the next U.S. surgeon general has repeatedly said the nation’s medical, health and food systems are corrupted by special interests and people out to make a profit at the expense of Americans’ health.

Yet as Dr. Casey Means has criticized scientists, medical schools and regulators for taking money from the food and pharmaceutical industries, she has promoted dozens of health and wellness products — including specialty basil seed supplements, a blood testing service and a prepared meal delivery service — in ways that put money in her own pocket.

A review by The Associated Press found Means, who has carved out a niche in the wellness industry, set up deals with an array of businesses.

In her newsletter, on her social media accounts, on her website, in her book and during podcast appearances, the entrepreneur and influencer has at times failed to disclose that she could profit or benefit in other ways from sales of products she recommends. In some cases, she promoted companies in which she was an investor or adviser without consistently disclosing the connection, the AP found.

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Means, 37, has said she recommends products that she has personally vetted and uses herself. She is far from the only online creator who doesn’t always follow federal transparency rules that require influencers to disclose when they have a “material connection” to a product they promote.

Still, legal and ethics experts said those business entanglements raise concerns about conflicting interests for an aspiring surgeon general, a role responsible for giving Americans the best scientific information on how to improve their health.

“I fear that she will be cultivating her next employers and her next sponsors or business partners while in office,” said Jeff Hauser, executive director of the Revolving Door Project, a progressive ethics watchdog monitoring executive branch appointees.

The nomination, which comes amid a whirlwind of Trump administration actions to dismantle the government’s public integrity guardrails, also has raised questions about whether Levels, a company Means co-founded that sells subscriptions for devices that continuously monitor users’ glucose levels, could benefit from this administration’s health guidance and policy.

Though scientists debate whether continuous glucose monitors are beneficial for people without diabetes, U.S. Health Secretary Robert F. Kennedy Jr. has promoted their use as a precursor to making certain weight-loss drugs available to patients.

The aspiring presidential appointee has built her own brand in part by criticizing doctors, scientists and government officials for being “bought off” or “corrupt” because of ties to industry.

Means’ use of affiliate marketing and other methods of making money from her recommendations for supplements, medical tests and other health and dietary products raise questions about the extent to which she is influenced by a different set of special interests: those of the wellness industry.

A compelling origin story

Means earned her medical degree from Stanford University, but she dropped out of her residency program in Oregon in 2018, and her license to practice is inactive. She has grown her public profile in part with a compelling origin story that seeks to explain why she left her residency and conventional medicine.

“During my training as a surgeon, I saw how broken and exploitative the healthcare system is and left to focus on how to keep people out of the operating room,” she wrote on her website.

Means turned to alternative approaches to address what she has described as widespread metabolic dysfunction driven largely by poor nutrition and an overabundance of ultra-processed foods. She co-founded Levels, a nutrition, sleep and exercise-tracking app that can also give users insights from blood tests and continuous glucose monitors. The company charges $199 per year for an app subscription and an additional $184 per month for glucose monitors.

Means has argued that the medical system is incentivized not to look at the root causes of illness but instead to maintain profits by keeping patients sick and coming back for more prescription drugs and procedures.

“At the highest level of our medical institutions, there are conflicts of interest and corruption that are actually making the science that we’re getting not as accurate and not as clean as we’d want it,” she said on Megyn Kelly’s podcast last year.

But even as Means decries the influence of money on science and medicine, she has made her own deals with business interests.

During the same Megyn Kelly podcast, Means mentioned a frozen prepared food brand, Daily Harvest. She promoted that brand in a book she published last year. What she didn’t mention in either instance: Means had a business relationship with Daily Harvest.

Growing an audience, and selling products

Influencer marketing has expanded beyond the beauty, fashion and travel sectors to “encompass more and more of our lives,” said Emily Hund, author of “The Influencer Industry: The Quest for Authenticity on Social Media.”

With more than 825,000 followers on Instagram and a newsletter that she has said reached 200,000 subscribers, Means has a direct line into the social media feeds and inboxes of an audience interested in health, nutrition and wellness.

Affiliate marketing, brand partnerships and similar business arrangements are growing more popular as social media becomes increasingly lucrative for influencers, especially among younger generations. Companies might provide a payment, free or discounted products or other benefits to the influencer in exchange for a post or a mention. But most consumers still don’t realize that a personality recommending a product might make money if people click through and buy, said University of Minnesota professor Christopher Terry.

“A lot of people watch those influencers, and they take what those influencers say as gospel,” said Terry, who teaches media advertising and internet law. Even his own students don’t understand that influencers might stand to benefit from sales of the products they endorse, he added.

Many companies, including Amazon, have affiliate marketing programs in which people with substantial social media followings can sign up to receive a percentage of sales or some other benefit when someone clicks through and buys a product using a special individualized link or code shared by the influencer.

Means has used such links to promote various products sold on Amazon. Among them are books, including the one she co-wrote, “Good Energy”; a walking pad; soap; body oil; hair products; cardamom-flavored dental floss; organic jojoba oil; a razor set; reusable kitchen products; sunglasses; a sleep mask; a silk pillowcase; fitness and sleep trackers; protein powder and supplements.

She also has shared links to products sold by other companies that included “affiliate” or “partner” coding, indicating she has a business relationship with the companies. The products include an AI-powered sleep system and Daily Harvest, for which she curated a “metabolic health collection.”

On a “My Faves” page that was taken down from her website shortly after Trump picked her, Means wrote that some links “are affiliate links and I make a small percentage if you buy something after clicking them.”

It’s not clear how much money Means has earned from her affiliate marketing, partnerships and other agreements. Daily Harvest did not return messages seeking comment, and Means said she could not comment on the record during the confirmation process.

Disclosing conflicts

Means has raised concerns that scientists, regulators and doctors are swayed by the influence of industry, oftentimes pointing to public disclosures of their connections. In January, she told the Kristin Cavallari podcast “Let’s Be Honest” that “relationships are influential.”

“There’s huge money, huge money going to fund scientists from industry,” Means said. “We know that when industry funds papers, it does skew outcomes.”

In November, on a podcast run by a beauty products brand, Primally Pure, she said it was “insanity” to have people connected to the processed food industry involved in writing food guidelines, adding, “We need unbiased people writing our guidelines that aren’t getting their mortgage paid by a food company.”

On the same podcast, she acknowledged supplement companies sponsor her newsletter, adding, “I do understand how it’s messy.”

Influencers who endorse or promote products in exchange for payment or something else of value are required by the Federal Trade Commission to make a clear and conspicuous disclosure of any business, family or personal relationship. While Means did provide disclosures about newsletter sponsors, the AP found in other cases Means did not always tell her audience when she had a connection to the companies she promoted. For example, a “Clean Personal & Home Care Product Recommendations” guide she links to from her website contains two dozen affiliate or partner links and no disclosure that she could profit from any sales.

Means has said she invested in Function Health, which provides subscription-based lab testing for $500 annually. Of the more than a dozen online posts the AP found in which Means mentioned Function Health, more than half did not disclose she had any affiliation with the company.

Means also listed the supplement company Zen Basil as a company for which she was an “Investor and/or Advisor.” The AP found posts on Instagram, X and on Facebook where Means promoted its products without disclosing the relationship.

Though the “About” page on her website discloses an affiliation with both companies, that’s not enough, experts said. She is required to disclose any material connection she has to a company anytime she promotes it.

Representatives for Function Health did not return messages seeking comment through their website and executives’ LinkedIn profiles. Zen Basil’s founder, Shakira Niazi, did not answer questions about Means’ business relationship with the company or her disclosures of it. She said the two had known each other for about four years and called Means’ advice “transformational,” saying her teachings reversed Niazi’s prediabetes and other ailments.

“I am proud to sponsor her newsletter through my company,” Niazi said in an email.

While the disclosure requirements are rarely enforced by the FTC, Means should have been informing her readers of any connections regardless of whether she was violating any laws, said Olivier Sylvain, a Fordham Law School professor who was previously a senior adviser to the FTC chair.

“What you want in a surgeon general, presumably, is someone who you trust to talk about tobacco, about social media, about caffeinated alcoholic beverages, things that present problems in public health,” Sylvain said, adding, “Should there be any doubt about claims you make about products?”

Potential conflicts pose new ethical questions

Means isn’t the first surgeon general nominee whose financial entanglements have raised eyebrows.

Jerome Adams, who served as surgeon general from 2017 to 2021, filed federal disclosure forms that showed he invested in several health technology, insurance and pharmaceutical companies before taking the job — among them Pfizer, Mylan and UnitedHealth Group. He also invested in the food and drink giant Nestle.

He divested those stocks when he was confirmed for the role and pledged that he and his immediate family would not acquire financial interest in certain industries regulated by the Food and Drug Administration.

Vivek Murthy, who served as surgeon general twice, under Presidents Barack Obama and Joe Biden, made more than $2 million in COVID-19-related speaking and consulting fees from Carnival, Netflix, Estee Lauder and Airbnb between holding those positions. He pledged to recuse himself from matters involving those parties for a period of time.

Means has not yet gone through a Senate confirmation hearing and has not yet announced the ethical commitments she will make for the role.

Hund said that as influencer marketing becomes more common, it is raising more ethical questions, such as what past influencers who enter government should do to avoid the appearance of a conflict.

Other administration officials, including Homeland Security Secretary Kristi Noem and Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz, have also promoted companies on social media without disclosing their financial ties.

“This is like a learning moment in the evolution of our democracy,” Hund said. “Is this a runaway train that we just have to get on and ride, or is this something that we want to go differently?”

Swenson reported from New York.

By CHRISSIE THOMPSON and COLLIN BINKLEY, Associated Press Education Writers

WASHINGTON (AP) — A federal judge has temporarily blocked a proclamation by President Donald Trump that banned foreign students from entering the U.S. to attend Harvard University.

Trump’s proclamation was the latest attempt by his Republican administration to prevent the nation’s oldest and wealthiest college from enrolling a quarter of its students, who account for much of its research and scholarship.

Harvard filed a legal challenge on Thursday, asking for a judge to block Trump’s order and calling it illegal retaliation for Harvard’s rejection of White House demands. Harvard said the president was attempting an end-run around a previous court order.

A few hours later, U.S. District Judge Allison Burroughs in Boston issued a temporary restraining order against Trump’s proclamation. Harvard, she said, had demonstrated it would sustain “immediate and irreparable injury” before she would have an opportunity to hear from the parties in the lawsuit.

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Burroughs also extended the temporary hold she placed on the administration’s previous attempt to end Harvard’s enrollment of international students. Last month, the Department of Homeland Security revoked Harvard’s certification to host foreign students and issue paperwork to them for their visas, only to have Burroughs block the action temporarily. Trump’s order this week invoked a different legal authority.

If Trump’s measure were to survive this court challenge, it would block thousands of students who are scheduled to go to Harvard’s campus in Cambridge, Massachusetts, for the summer and fall terms.

“Harvard’s more than 7,000 F-1 and J-1 visa holders — and their dependents — have become pawns in the government’s escalating campaign of retaliation,” Harvard wrote Thursday in a court filing.

While the court case proceeds, Harvard is making contingency plans so students and visiting scholars can continue their work at the university, President Alan Garber said in a message to the campus and alumni.

“Each of us is part of a truly global university community,” Garber said Thursday. “We know that the benefits of bringing talented people together from around the world are unique and irreplaceable.”

Harvard has attracted a growing number of the brightest minds from around the world, with international enrollment growing from 11% of the student body three decades ago to 26% today.

As those students wait to find out if they’ll be able to attend the university, some are pursuing other options.

Rising international enrollment has made Harvard and other elite colleges uniquely vulnerable to Trump’s crackdown on foreign students. Republicans have been seeking to force overhauls of the nation’s top colleges, which they see as hotbeds of “woke” and antisemitic viewpoints.

Garber says the university has made changes to combat antisemitism. But Harvard, he said, will not stray from its “core, legally-protected principles,” even after receiving federal ultimatums.

Trump’s administration has also taken steps to withhold federal funding from Harvard and other elite colleges that have rejected White House demands related to campus protests, admissions, hiring and more. Harvard’s $53 billion endowment allows it to weather the loss of funding for a time, although Garber has warned of “difficult decisions and sacrifices” to come.

But cutting off students and visiting scholars could hamstring the university’s research and global standing.

The Associated Press’ education coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

By LEAH WILLINGHAM, Associated Press

BOSTON (AP) — Democratic state attorneys general on Friday will seek to block President Donald Trump’s proposal for a sweeping overhaul of U.S. elections in a case that tests a constitutional bedrock — the separation of powers.

The top law enforcement officials from 19 states filed a federal lawsuit after the Republican president signed the executive order in March, arguing that its provisions would step on states’ power to set their own election rules and that the executive branch had no such authority.

In a filing supporting that argument, a bipartisan group of former secretaries of state said Trump’s directive would upend the system established by the Constitution’s Elections Clause, which gives states and Congress control over how elections are run. They said the order seeks to “unilaterally coronate the President as the country’s chief election policymaker and administrator.”

If the court does not halt the order, they argued, “the snowball of executive overreach will grow swiftly and exponentially.”

Trump’s election directive was part of a flurry of executive orders he has issued in the opening months of his second term, many of which have drawn swift legal challenges. It follows years of him falsely claiming that his loss to Democrat Joe Biden in the 2020 presidential election was due to widespread fraud and an election year in which he and other Republicans promoted the notion that large numbers of noncitizens threatened the integrity of U.S. elections. In fact, voting by noncitizens is rare and, when caught, can lead to felony charges and deportation.

President Donald Trump attends a meeting with the Fraternal Order of Police in the State Dinning Room of the White House, Thursday, June 5, 2025, in Washington. (AP Photo/Alex Brandon)

Trump’s executive order would require voters to show proof of U.S. citizenship when registering to vote in federal elections, prohibit mail or absentee ballots from being counted if they are received after Election Day, set new rules for voting equipment and prohibit non-U.S. citizens from being able to donate in certain elections. It also would condition federal election grant funding on states adhering to the strict ballot deadline.

The hearing Friday in U.S. District Court in Boston comes in one of three lawsuits filed against the executive order. One is from Oregon and Washington, where elections are conducted almost entirely by mail and ballots received after Election Day are counted as long as they are postmarked by then.

The provision that would create a proof-of-citizenship requirement for federal elections already has been halted in a lawsuit filed by voting and civil rights groups and national Democratic organizations.

In that case, filed in federal court in the District of Columbia, the judge said the president’s attempt to use a federal agency to enact a proof-of-citizenship requirement for voting usurped the power of states and Congress, which at the time was considering legislation that would do just that. That bill, called the SAVE Act, passed the U.S. House but faces an uncertain future in the Senate.

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Trump’s executive order said its intent was to ensure “free, fair and honest elections unmarred by fraud, errors, or suspicion.” The Justice Department, in arguing against the motion by the attorneys general for a preliminary injunction, said the president is within his rights to direct agencies to carry out federal voting laws.

The order tasks the U.S. Election Assistance Commission with updating the federal voter registration form to require people to submit documentation proving they are U.S. citizens. Similar provisions enacted previously in a handful of states have raised concerns about disenfranchising otherwise eligible voters who can’t readily access those documents. That includes married women, who would need both a birth certificate and a marriage license if they had changed their last name.

A state proof-of-citizenship law enacted in Kansas more than a decade ago blocked the registrations of 31,000 people later found to be eligible to vote.

The two sides will argue over whether the president has the authority to direct the election commission, which was created by Congress as an independent agency after the Florida ballot debacle during the 2000 presidential election.

In its filing, the Justice Department said Trump’s executive order falls within his authority to direct officials “to carry out their statutory duties,” adding that “the only potential voters it disenfranchises are noncitizens who are ineligible to vote anyway.”

By CHRIS MEGERIAN, Associated Press

WASHINGTON (AP) — Maybe it was always going to end this way, with two billionaires angrily posting about each other on social media, fingers flying across pocket-sized screens as their incandescent feud burned hotter by the minute.

But even if the finale was predictable, that didn’t make it any less shocking. After long months when Donald Trump and Elon Musk appeared united in their chaotic mission to remake Washington, their relationship imploded this week like a star going supernova.

FILE – Tesla and SpaceX CEO Elon Musk, left, and Republican presidential nominee former President Donald Trump attend a campaign event at the Butler Farm Show, Oct. 5, 2024, in Butler, Pa. (AP Photo/Alex Brandon, File)

It began with Musk complaining about the centerpiece of Trump’s legislative agenda, which the president at first took in stride. Eventually Trump let slip that he was disappointed in his former adviser, prompting Musk to unleash a flood of insults and taunts.

He accused Trump of betraying promises to cut federal spending, shared a suggestion that the president should be impeached and claimed without evidence that the government was concealing information about his association with infamous pedophile Jeffrey Epstein. Perhaps most viciously, Musk insisted that Trump wouldn’t have won last year’s election without his help.

Trump, not one to slouch from a fight, could hold back no longer. He posted that Musk had been “wearing thin,” that he had “asked him to leave” his administration, that the tech titan had “gone CRAZY.”

Maybe, Trump threatened, he should save taxpayer money by canceling government contracts and subsidies for Musk’s companies.

Bad blood with high stakes

On and on it went, as liberals savored the spectacle of their most despised political opponents clawing at each other’s digital throats and conservatives reeled at the prospect of having to pick sides. Laura Loomer, a right-wing provocateur and conspiracy theorist, saw an opportunity to position herself as the voice of reason.

“This fight should be taken offline,” she said — on social media, of course.

The question now is whether Trump and Musk find some way to step back from a battle that is tearing apart one of the most consequential relationships in modern American politics. If they don’t, there’s little telling how far the fallout could spread from a collision between the world’s most powerful man and its wealthiest.

At stake are the future of Musk’s companies, including electric automaker Tesla and rocket manufacturer SpaceX; government programs that rely on the billionaire entrepreneur’s technology; legislation for advancing tax cuts and Trump’s other priorities in Congress; Republican chances in next year’s midterm elections; and an entire political ecosystem that has orbited around Trump and Musk’s deteriorating partnership.

“It’s like India and Pakistan,” said Republican Rep. Ryan Zinke of Montana, referring to two nuclear-armed nations that recently skirmished along their border. “It just escalates and neither one of them seem to back down and understand the strength of each other.”

Opposites attracted (for a time)

Trump and Musk were always an odd pairing, with contrasting world views and deep generational and stylistic differences.

Trump, 78, comes from old-school New York real estate and never appears in public without a suit and tie unless he’s on the golf course. Before running for president, he became a household name as a reality television star.

President Donald Trump speaks during a news conference with Elon Musk in the Oval Office of the White House, Friday, May 30, 2025, in Washington. (AP Photo/Evan Vucci)

Musk, 53, is an immigrant from South Africa who struck it rich in Silicon Valley. In addition to running Tesla and SpaceX, Musk owns the social media company X. He’s fashioned himself as a black-clad internet edgelord, and his wealth vastly outstrips Trump’s.

But Trump and Musk are kindred spirits in other ways. They’re experts at generating attention who enjoy stirring the pot by riling up their opponents. Each has sought more power to accomplish existential quests. Trump assails the federal “deep state” that resisted him during his first term, while Musk warns about the country going bankrupt from excessive spending and promotes an interplanetary future powered by his rocket technology.

Musk endorsed Trump after the Republican candidate was nearly assassinated in Butler, Pennsylvania, and he began spending millions to support him. His social media megaphone was a powerful addition to Trump’s comeback campaign, magnifying his efforts to court tech leaders and young, very online men.

Trump rarely tolerates sharing the spotlight, but he seemed enamored with his powerful backer, mentioning him in stump speeches and welcoming him onstage at rallies.

After the election, Musk was a fixture around Mar-a-Lago, posing for photos with Trump’s family, joining them for dinner, sitting in on meetings. Instead of growing tired of his “first buddy,” Trump made plans to bring Musk along to Washington, appointing him to lead a cost-cutting initiative known as the Department of Government Efficiency.

Cracks emerge

Musk tried to establish himself as the president’s omniscient and omnipresent adviser. He held court in Cabinet meetings, slept over in the Lincoln Bedroom and helped himself to caramel ice cream from the White House kitchen.

Elon Musk listens as President Donald Trump speaks during a news conference in the Oval Office of the White House, Friday, May 30, 2025, in Washington. (AP Photo/Evan Vucci)

The federal bureaucracy practically trembled before Musk, who oversaw layoffs and downsizing with his team of acolytes and engineers embedded in various agencies.

Musk appeared thrilled at his opportunity to tinker with the government and exulted in his bromance with Trump, posting on Feb. 7 that he loved the president “as much as a straight man can love another man.”

Trump returned the favor on March 11, allowing Musk to line up Tesla vehicles on the White House driveway as his company was struggling with declining sales. Trump made a show of choosing a cherry red electric car for himself.

But cracks were emerging, especially as Trump pursued tariffs that could raise costs for Musk’s businesses. Musk said Peter Navarro, the president’s trade adviser, was “truly a moron” and “dumber than a sack of bricks” on April 8.

The billionaire entrepreneur, who had never before worked in public service, seemed to be souring on government. He suggested there wasn’t enough political will, either in Congress or in the White House, to adequately reduce spending.

Trump started signaling that it was time for him to leave even though Musk said he would be willing to stay.

Shortly before announcing his departure, Musk said he was “disappointed” by legislation that Trump called the “big beautiful bill” because it would increase the deficit. The measure includes tax cuts, more money for border security and changes to Medicaid that would leave fewer people with health insurance.

“I think a bill can be big or it could be beautiful,” Musk said. “But I don’t know if it could be both.”

The criticism didn’t prevent Trump from giving Musk a send-off in the Oval Office, where he presented his outgoing adviser with a ceremonial key.

“Elon is really not leaving,” Trump said. “He’s going to be back and forth.”

Musk said, “I’ll continue to be visiting here and be a friend and adviser to the president.”

The implosion comes hard and fast

It’s hard to imagine that now.

Musk escalated his attacks on the legislation Tuesday, calling it a “disgusting abomination,” and Trump tried to fend off the criticism.

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“He hasn’t said bad about me personally, but I’m sure that will be next,” the president said Thursday in the Oval Office during a meeting with the German chancellor.

It was.

Musk quickly took to X to vent his anger at Trump, saying his tariffs “will cause a recession in the second half of this year” and accusing him of lying. He also said it was “very unfair” that the legislation would eliminate tax incentives for electric vehicles.

Trump fired back in real time as he tried to maintain momentum for his legislation, which faces a difficult debate in the Senate.

“I don’t mind Elon turning against me, but he should have done so months ago,” the president posted. “This is one of the Greatest Bills ever presented to Congress.”

Meanwhile, some of Trump’s allies plotted revenge.

Steve Bannon, a former Trump adviser who hosts an influential conservative podcast, said the president should direct the U.S. government to seize SpaceX. He also encouraged Trump to investigate allegations that Musk uses drugs and “go through everything about his immigration status” in preparation for potential deportation.

“We’ll see how good Elon Musk takes a little of that pressure,” Bannon said, “because I happen to think a little of that pressure might be coming.”

Associated Press writers Tom Beaumont, Kevin Freking and Michelle L. Price contributed to this report.