Marty Makary resigned as Food and Drug Administration commissioner on Tuesday, ending a 16-month tenure that collapsed under simultaneous pressure from the anti-abortion movement, the flavored e-cigarette lobby, and Health and Human Services Secretary Robert F. Kennedy Jr. The departure lands one day before Makary was scheduled to testify in front of the Senate Appropriations Committee on May 14.
The Decision Trump Already Signed Off On
CNN reported last week that Trump had already signed off on a plan to fire Makary, framing the question as one of timing, not outcome. Tuesday morning the timing question got answered. AP and PBS first reported the resignation, with administration officials confirming that Kyle Diamantis, the FDA’s deputy commissioner for food, steps in as acting head while the search for a permanent replacement runs in parallel.
The White House framing was clinical. An administration official told reporters that the issue was “process at the FDA,” which is the standard Washington way to say everything and nothing at once. The reality, according to officials and outside groups speaking to multiple outlets, is that Makary failed three constituencies at once.
What He Did on Mifepristone
The first constituency was the anti-abortion movement, and the fight that defined his exit was the abortion pill mifepristone. Susan B. Anthony Pro-Life America President Marjorie Dannenfelser had been meeting with White House officials for months pressing the FDA to reverse Biden-era rules allowing the drug to be prescribed online and mailed to patients. Makary kept the rules. Worse, from the movement’s perspective, he approved a generic version of mifepristone under his own signature.
Lila Rose of Live Action put the line that ended up in the firing memo on the record: “President Trump and HHS Secretary Kennedy must end this now, remove Commissioner Makary,” followed by a demand to “pull these child-killing drugs from the market.” An anonymous administration official added that Makary’s conduct had shown “pro-life advocates their concerns are an afterthought.” The FDA sets the nationwide rules on how mifepristone is prescribed. Whoever replaces Makary inherits the authority to roll back access for every state at once, which is exactly why the anti-abortion movement wanted the seat.
For broader context on how the Kennedy era at HHS has reshaped the agencies underneath it, see our earlier coverage of RFK Jr.’s 2026 Senate testimony on measles outbreaks and the vaccine schedule fight, which set the pattern of HHS overriding career staff that played out again here.
What He Did on Vapes
The second constituency was the vaping industry. Trump pressed Makary directly on flavored e-cigarettes, and the FDA reversed course on the question last week, opening a path for products that had been in regulatory limbo since the first Trump administration. CNBC reported Tuesday that the reversal did not buy Makary cover. The lobbyists wanted more, faster. The commissioner had moved on their schedule for one fight and against it on others, which is, in this White House, worse than having opposed them outright.
What He Did to Kennedy
The third and most consequential constituency was the secretary he reported to. Robert F. Kennedy Jr. pushed the White House to seek Makary’s departure, according to officials briefed on the deliberations. The MAHA wing of the administration argued that Makary had slow-rolled their health agenda priorities, an accusation that in plain English means he refused to fast-track changes that career FDA scientists believed lacked evidence. Kennedy got the resignation. The career staff lost the firewall.
What Happens Next
Diamantis is a placeholder. The permanent commissioner is the appointment that matters, because the FDA’s next commissioner will face two binary tests in the first 90 days. The first is whether to reverse the mifepristone mail-prescription rules, an action that would land in federal court within hours and reshape abortion access nationwide while the litigation runs. The second is whether to ratify or partially reverse the flavored e-cigarette decision, with billions in industry revenue waiting on the answer.
Watch the names floated. The Heritage Foundation has a shortlist that prioritizes anti-mifepristone credentials over agency experience. The pharmaceutical industry has its own shortlist that prioritizes the opposite. Trump’s pick will tell us which faction won the post-Makary fight.
The Broader Pattern
The Makary exit fits a pattern visible across the second Trump administration: career agency leaders pushed out for being insufficiently aggressive in executing the policy priorities of organized outside groups. The FDA, the CDC, and the NIH have all seen this play out in slightly different forms. Each agency loses, with each turnover, another layer of staff willing to push back when scientific evidence and political demand point in opposite directions.
The question for the next commissioner is not whether to be loyal to Trump. That is settled. The question is whether the next commissioner will hold any line at all when an outside group with White House access asks the agency to act against the recommendations of its own career scientists. Makary held one line, on mifepristone. He is the one who left.
By the Live News Chat editorial desk. Reporting on federal agencies, health policy, and the intersection of regulatory power and political pressure since 2019.