Pressure is mounting on Food and Drug Administration Commissioner Dr. Marty Makary on multiple fronts, as the White House seeks to remold its healthcare agenda before the midterm elections this November.
Makary has reportedly had multiple clashes with President Donald Trump and White House staff in recent weeks over a variety of troubles, with several inside reports suggesting he may be on his way out.
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Makary, who left a surgical post at Johns Hopkins University to join the Trump administration, rose to prominence outside of medical academia for his criticism of the Biden administration’s handling of the COVID-19 pandemic. But the FDA has been at the center of many of the administration’s health policy headaches since Makary was appointed as the agency’s head.
Tensions between Makary and Trump have come to a head in recent days, with anonymous administration officials saying the FDA chief is on “thin ice,” according to NOTUS.
Health and Human Services Secretary Robert F. Kennedy Jr. also reportedly considered late last year delegating major responsibilities to other officials at the agency, reducing Makary to a figurehead.
Here are some of the reasons why Makary might be the next Cabinet official on the chopping block.
White House pressure on vapes
Trump appears to have come out on top in a skirmish with Makary regarding fruit-flavored vape products that critics say will entice children and teenagers to take up nicotine.
Trump promised on the 2024 campaign trail to “save” vaping, but Makary has been slow to take action on approving new flavored vape and nicotine products.
The Wall Street Journal reported on Tuesday afternoon that Trump scolded Makary over the weekend for not moving quickly enough on vapes. Within hours of the outlet’s report, the FDA officially announced the approval of four new vape flavors, including, for the first time, two fruit-flavored products, blueberry and mango.
The FDA’s news release on the approval said the products underwent “rigorous, scientific review.” The agency also said the age verification requirements, coupled with the FDA’s stringent marketing rules, will minimize illicit use from youth under 21.
White House spokesman Kush Desai in a statement to the Washington Examiner characterized Makary’s work at FDA as “trailblazing leadership,” adding that the commissioner “will continue to make evidence-based decisions that rectify the Biden administration’s missteps and that are in the best interest of the American people.
“The only factor guiding the Trump administration’s health policymaking is Gold Standard Science,” Desai said.
GOP pressure on abortion pills
The FDA has also been at the epicenter of the ideological rift within the GOP over abortion politics in the aftermath of the Supreme Court’s overturning of Roe v. Wade.
Anti-abortion advocates, including members of Congress, have expressed intense frustration that Makary has not reimplemented regulations on the abortion pill mifepristone that would require that the drug be dispensed only during an in-person doctor’s visit.
The FDA removed the in-person requirements on mifepristone in 2023, allowing abortion medications to be bought and sold online, including in the 13 states that entirely prohibit elective abortions.
Makary and Kennedy both promised that the agency would conduct a comprehensive safety review of mifepristone following a 2025 insurance data study that found nearly 11% of women experience complications following at-home abortions.
Conservative Republicans in Congress and the anti-abortion lobby slammed the Trump administration in October when, under Makary’s leadership, the FDA approved a new generic version of mifepristone.
SBA Pro-Life America president Marjorie Dannefelser this week renewed her call to terminate Makary.
“FDA Commissioner Makary should be fired immediately,” Dannefelser said in a Monday press release. “Indifference is completely unacceptable to millions of pro-life voters expecting the administration to act to save lives.”
Opinion polling commissioned by Dannefelser’s group in February found that a third of GOP voters report being less enthusiastic to support Republican candidates who do not support tightening restrictions on abortion pills.
Another third of Republican voters who typically volunteer to go door-to-door in their communities ahead of off-year elections report feeling less motivated to do so this cycle because the administration has not taken a hard stance on mifepristone.
“The GOP cannot win without its base and simply will not get the enthusiasm that drives turnout without leadership from the top,” Dannefelser said.
Pharmaceutical industry pressure on consistency and drug approvals
Pharmaceutical industry leaders have also complained about personnel and procedure at FDA, saying that the Trump administration has made it harder to ensure that drugs make it to market.
In particular, the industry has clashed with Vinay Prasad, whom Makary appointed as the agency’s head of vaccines and gene therapies.
Prasad, who has been characterized as confrontational by industry leaders, briefly left the agency last summer following intense disputes with other administration officials. He returned to the agency shortly thereafter, following Makary’s intervention with the White House.
But the administration announced earlier this spring that Prasad would leave the agency again, his last day slated for Thursday, May 7.
During his time, Prasad had high-profile disagreements over safety trial data at gene therapy companies for Huntington’s disease, which critics said contradicted the Trump administration’s promises to rapidly advance treatments for rare diseases. He also came under fire when he refused to approve Moderna’s new flu vaccine, citing flawed methodology, despite the company following instructions set by Biden administration officials.
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Tim Hunt, head of the Alliance for Regenerative Medicine, told Bloomberg earlier this week that the biotech community “wants to see Marty Makary be successful” but that many within the sector are frustrated by the agency’s “toxic methodological purity.”
FDA’s drug center and several lower-level appointments have also caused headaches for both the administration and industry leaders, who say the unpredictability at the regulatory agency has disrupted the flow of getting products to market.
