Published: May 12, 2026

What Happened

Dr. Marty Makary, the commissioner of the U.S. Food and Drug Administration (FDA), resigned on Tuesday after weeks of mounting pressure and speculation that President Trump was preparing to remove him from the role.

According to four people familiar with the matter, Dr. Makary's departure came after he privately opposed the administration's decision to authorize fruit-flavored e-cigarettes. He told those close to him that he could not in good conscience approve flavored vapes, given their strong appeal to young people.

His resignation marks the end of a turbulent tenure leading one of the nation's most influential health agencies, which oversees medical treatments, vaccines, and much of the U.S. food supply.

A Reformer Who Faced Pushback From Many Sides

Dr. Makary arrived at the FDA with a reputation as a reformer. He launched numerous initiatives and became known for his "white board on wheels" covered in Post-it notes—tracking announcements he frequently promoted during television appearances.

But his efforts often put him at odds with powerful interests:
- Food and beverage companies
- Tobacco industry executives
- Pharmaceutical and biotech leaders
- Anti-abortion advocacy groups
- Some members of the Trump administration

"He has offended almost everyone involved in FDA issues, which is not easy to do," said Diana Zuckerman, president of the National Center for Health Research. "But it would still be a disaster if he is replaced by someone who appeals primarily to tobacco companies, anti-abortion activists, and pharmaceutical lobbyists."

Key Conflicts During His Tenure

Flavored E-Cigarettes: The Breaking Point

The most significant clash of Dr. Makary's time at the FDA centered on flavored vaping products. He resisted authorizing fruit- and candy-flavored e-cigarettes, concerned they would attract young people to addictive nicotine products.

Despite his objections:
- Two fruit-flavored vapes were approved earlier this month
- Last Friday, the FDA quietly issued a policy allowing broader marketing of these products
- The White House ultimately overruled his concerns

This disagreement appears to have been the final factor in his decision to resign.

Vaccine Policy and Public Health Criticism

Dr. Makary also drew criticism from public health experts for:
- Releasing an unsupported memo suggesting deaths were linked to COVID-19 vaccines
- Allowing renewed use of unproven injectable peptides, a policy favored by Health Secretary Robert F. Kennedy Jr.
- Restricting COVID vaccine eligibility criteria early in his tenure to people over 65 or with specific health conditions

"He rarely prioritized rigorous evidence on vaccines and mifepristone," said Lawrence O. Gostin, a Georgetown Law professor who studies the FDA. "Ironically, his one stand for high-quality science—on flavored vapes—created the friction with the White House that contributed to him losing his job."

Abortion Medication Debate

Abortion rights opponents repeatedly called for Dr. Makary's removal, accusing him of delaying a study on the safety of mifepristone, a medication used in medication abortions. They viewed the delay as potentially helpful to efforts to restrict the drug's availability.

Drug Approval Disputes

Dr. Makary and Dr. Vinay Prasad, his appointee to lead gene therapies and vaccines, rejected several new drugs for rare diseases, citing weaknesses in the research supporting approval. While Dr. Makary defended these decisions publicly, frustrated biotech executives and investors voiced complaints to the White House and Secretary Kennedy's office.

Dr. Prasad resigned under pressure last summer after being targeted by right-wing influencers, though he was later brought back before leaving the agency again in recent weeks.

Staffing Challenges and Agency Morale

Dr. Makary began his work at the FDA during a period of significant staff reductions led by Secretary Kennedy and the Department of Government Efficiency. Critical positions involved in reviewing medical devices, inspecting food facilities, and monitoring drug safety were eliminated.

Although some staff were later rehired, voluntary departures reduced the agency's workforce by more than 4,000 people—about 20 percent of its total staff.

Dr. Makary became an advocate for rebuilding the agency, pushing for authorization to hire approximately 3,000 new employees. However, the recruitment process has moved slowly, raising concerns among current staff and outside observers about the FDA's capacity to fulfill its mission.

What Comes Next

Acting Leadership

Kyle Diamantas, the FDA's top food regulator, has been named acting commissioner. Mr. Diamantas joined the agency from the law firm Jones Day, where he represented Abbott Nutrition, a major infant formula manufacturer. He has been a vocal advocate for removing certain chemicals from the food supply and increasing transparency about food ingredients.

Finding a Permanent Replacement

Experts say selecting a permanent FDA commissioner will be challenging.

"The new commissioner will have to walk a tight rope between what the administration wants—Trump and R.F.K. Jr.—and what federal law commands of the FDA," said Nathan Cortez, a Southern Methodist University law professor who studies the agency. "Historically, the expectation is someone with an M.D. or PhD and real scientific chops. It's a lot of pressure."

Public Statements

President Trump told reporters Tuesday afternoon that he wished Dr. Makary well and later posted a complimentary message on social media:

"So much was accomplished under his leadership. He was a hard worker, who was respected by all, and will go on to have an outstanding career in Medicine."

Why This Matters for Public Health

The FDA plays a critical role in protecting Americans by:
- Ensuring the safety and effectiveness of prescription and over-the-counter drugs
- Regulating medical devices, from bandages to heart pacemakers
- Overseeing the safety of the nation's food supply
- Evaluating vaccines before they reach the public
- Monitoring tobacco products and their marketing

Leadership changes at the agency can influence:
- Which new treatments and drugs reach the market
- How quickly health threats are addressed
- The balance between industry interests and public protection
- Public trust in health recommendations

What to Watch For

In the coming weeks and months, pay attention to:
- Who President Trump nominates as the next permanent FDA commissioner
- How the agency handles upcoming decisions on vaping products, food additives, and new medications
- Whether staffing levels stabilize and the agency regains capacity for complex reviews
- How the West Coast Health Alliance and state health departments respond to federal policy shifts

For More Information

FDA official website: www.fda.gov
CDC vaccine information: www.cdc.gov/vaccines
State health department resources for local guidance
Trusted medical news sources for ongoing coverage of FDA developments

Content provided by Crestwood General. We share clear, science-based health information to help our community stay informed and engaged with important public health developments.