Marty Makary’s tenure as FDA commissioner ended Tuesday in the manner it was conducted — amid competing pressures from every direction, with no single constituency satisfied and the White House confirming his departure in the blunt shorthand of a president who had grown tired of the arrangement.
“Marty is a terrific guy, but he’s going to go on, and he’s going to lead a good life,” Trump told reporters when asked whether he had fired the FDA commissioner. He later posted what appeared to be Makary’s resignation text on Truth Social, thanked him for doing “a great job” and described him as “a hard worker, who was respected by all.” Kyle Diamantas, previously the agency’s top food official, will serve as acting commissioner.
The gap between Trump’s warm send-off language and the circumstances of Makary’s exit is considerable. He lasted just over a year at the helm of an agency that oversees vaccines, medicines and food for the world’s largest economy — and in that time managed to antagonize pharmaceutical executives, tobacco lobbyists, anti-abortion activists, public health leaders and ultimately the White House itself, an achievement of comprehensive alienation that is difficult to accomplish accidentally.
The proximate pressure that accelerated his departure was the administration’s push to approve flavored e-cigarettes. Makary had voiced concern about fruit-flavored vapes and their appeal to young people. The administration forged ahead regardless, and the friction that produced appears to have been the final weight on a scale already loaded with accumulated grievances.
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Conservatives who have spent years targeting the abortion pill mifepristone accused him of moving too slowly on a review of the drug, which has been FDA-approved for 25 years. Pharmaceutical executives said his attempts to reshape the drug review process had introduced confusion and delay rather than the efficiency he promised. Public health leaders accused him of capitulating to anti-vaccine sentiment after the FDA published an unsupported memo claiming deaths linked to the COVID-19 vaccine — a document that had no scientific basis and that critics said reflected the broader ideological atmosphere at the Department of Health and Human Services under Robert F. Kennedy Jr.
Makary had arrived at the FDA with the biography of a reformer and the reputation of a contrarian. A surgeon and former Fox News contributor, he built his public profile during the COVID-19 pandemic as a critic of the medical establishment and the public health measures that defined it. Trump found that posture useful. The FDA, however, is an institution that runs on the trust of the pharmaceutical industry, the medical community, international regulators and the public — constituencies that a reflexive contrarian approach tends to erode rather than rebuild.
His departure is the latest in a sequence of leadership vacancies accumulating across the health department that critics say reflects something more systemic than personnel management. The CDC also lacks a confirmed director. The surgeon general position is in flux. The FDA now has an acting commissioner rather than a permanent one.
Peter Lurie, president of the Center for Science in the Public Interest, did not soften his assessment of what the pattern represents. “When you don’t have a CDC Director, an FDA Commissioner, or a Surgeon General, the obvious question is: Why do you have this HHS Secretary?” Lurie said. “Robert F. Kennedy Jr. is the cause of much of the chaos that has resulted in these job vacancies. HHS is rotting from the head.”
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Kennedy, a noted vaccine skeptic who has spent decades outside mainstream public health and whose Senate confirmation was itself contested, now oversees a department where the three most prominent scientific and regulatory positions are either vacant or filled on an acting basis. The nomination processes that might resolve those vacancies have moved slowly, reflecting either deliberate selection difficulty or the reality that credentialed public health professionals are reluctant to serve in an environment defined by Kennedy’s ideological priorities and Trump’s tolerance for institutional disruption.
Makary’s departure does not resolve any of the substantive questions his tenure left open — the mifepristone review remains incomplete, the flavored vape policy remains contested and the FDA’s relationship with the pharmaceutical industry it regulates remains strained. Diamantas takes over an agency operating without settled leadership for the third time in recent months, in a department that its own former officials are now describing as institutionally damaged.
The terrific guy is gone. The chaos, by most accounts, is not.