The departure of Marty Makary as FDA commissioner removes a lightning rod from the Trump administration's health team, but it does little to resolve the structural pressures that made his tenure so turbulent. The next person to lead the agency will inherit the same headwinds: political interference from the White House and Health and Human Services Secretary Robert F. Kennedy Jr., shrinking budgets, and the challenge of balancing the populist “Make America Healthy Again” (MAHA) agenda with the demands of a MAGA-aligned administration.
Pressure Points Remain
Kennedy is actively pushing for unregulated access to experimental peptides, while anti-abortion lawmakers continue to press the FDA to restrict mifepristone. President Trump himself has weighed in directly: after meeting with executives from Reynolds American, he reportedly pressed Makary to approve flavored electronic cigarettes. The resulting internal friction culminated in Makary's exit, which was triggered largely by his reluctance to greenlight those products.
Lawrence O. Gostin, a Georgetown University law professor and public health expert, said Makary failed to resist political pressure from both the White House and Kennedy, and at times actively undermined the agency's scientific credibility. “The problem at FDA is not just one commissioner or one controversy. It’s the growing perception that scientific expertise is being subordinated to politics, instability and ideology,” Gostin told The World Signal. “While there have been periods of trust gaps with other agencies at HHS, the FDA is the oldest scientific agency. It’s the most revered and venerable, and yet there is profoundly eroding public trust in the institution.”
A Politicized Agency
For decades, the FDA was considered a nonpartisan, technocratic body led by career scientists or experienced administrators. Under Trump, that tradition has been upended by a top-down governing style that leaves little room for independent scientific judgment. Public health advocates worry the next commissioner will be even more pliable. “Our concern is that although Marty Makary really did offend just about everybody, the reason why he lost his job seems to have been focused on a few decisions,” said Diana Zuckerman, president of the National Center for Health Research. “We want a more scientific-based, evidence-based FDA, and not one that has to change according to the whims of political appointees and also perhaps donors and friends of the White House.”
Kennedy, in a social media post Tuesday, said the search for a successor is proceeding “with urgency.” He praised Makary for taking on “entrenched interests” and advancing the MAHA mission. But the MAHA faction has increasingly found itself at odds with the administration: Trump sided with big agriculture over Kennedy on weedkiller production, and he dropped the MAHA-backed surgeon general nominee when she lacked Senate support. Still, the food-focused MAHA agenda is expected to remain a priority, especially ahead of the midterms.
Industry vs. MAHA
Chris Meekins, a Raymond James analyst and former senior HHS official, described the next commissioner’s task as a tightrope walk. “We expect the Trump Administration to take some time in choosing a nominee for the role. Finding someone industry welcomes and MAHA does not despise, may be a bit of a challenging channel to navigate,” he wrote in an investor note. The administration has already tapped Kyle Diamantas as acting FDA chief while the search continues.
Before resigning, Makary approved mango and blueberry flavored e-cigarettes for marketing, reversing an earlier decision to override agency scientists who had recommended approval. In what anti-tobacco groups called a last-ditch effort to save his job, the FDA then issued a final guidance that effectively allows the sale of e-cigarettes and nicotine pouches that haven’t been formally approved, as long as they clear certain regulatory hurdles. Brian King, a former FDA tobacco chief now at the Campaign for Tobacco-Free Kids, said White House interest in tobacco policy is not new, but the current level of interference is. “What’s different here is that you actually have pressure to influence agency decisionmaking, which has occurred following sizable political donations and closed-door meetings between the tobacco industry and the administration,” King said.
The broader erosion of trust in the FDA, experts warn, could have lasting consequences for public health. The agency’s next leader will have to navigate not only the immediate political crossfire but also the deeper damage to its reputation as an impartial scientific regulator.
