FDA leadership in flux: Commissioner Makary resigns after rocky tenure

U.S. Food and Drug Administration Commissioner Marty Makary, M.D., M.P.H., resigned Tuesday after a rocky tenure of just over a year.

A surgeon and researcher, Makary drew sustained complaints from pharmaceutical executives, anti-abortion activists and other allies of President Donald Trump, according to reports from multiple news outlets. Politico first reported the resignation; that site and other outlets have cited a number of unnamed sources discussing the situation.

Kyle Diamantas, J.D., the FDA's deputy commissioner for food, is expected to assume the role of acting commissioner and testify before Congress in Makary's place. Makary had been scheduled to appear before the Senate Appropriations Committee on Wednesday to discuss the agency's proposed budget.

Makary was sworn in as the 27th Commissioner of Food and Drugs following a bipartisan Senate confirmation vote in March 2025. A surgical oncologist and health policy researcher, he spent more than two decades at Johns Hopkins University, where he authored more than 300 peer-reviewed articles and founded the Johns Hopkins Surgery Center for Outcomes Research.

His tenure was marked by persistent instability. Virtually all of the FDA's senior career officials resigned, retired or were forced out in the first year of the second Trump administration, leading to a steady stream of leaks and negative stories cataloging low morale, dysfunction and frustration among staff.

A dispute over flavored e-cigarettes proved to be a breaking point. According to The Wall Street Journal, the FDA's May 6, 2026, approval of some flavored e-cigarettes came only after Trump pressured Makary to approve the fruit-flavored vapes, which he had been refusing to do. One source said Makary's departure stems from that dispute.

Anti-abortion groups added to the pressure. In June 2025, U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. asked Makary to review mifepristone to examine real-world outcomes and evidence related to the drug's safety and efficacy. By December, reports emerged that he had slow-walked the study, prompting Susan B. Anthony Pro-Life America and other conservative groups to call for his firing.

On May 12, the president declined to discuss details but called Makary “a great guy” and “a friend of mine,” according to CBS News.

"Marty's a terrific guy, but he's going to go on, and he's going to lead a good life," Trump said per the CBS News report. "He was having some difficulty. You know, he's a great doctor. And he was having some difficulty. But he's going to go on, and he's going to do well."

More than a half-dozen initiatives from Makary aimed to speed up or streamline FDA drug reviews, including dropping certain study requirements, incorporating artificial intelligence into drug evaluations and offering expedited reviews to medicines that support national interests. But pharmaceutical executives rely on the predictability and consistency of FDA decisions, even more than speedy reviews, and Makary's efforts were overshadowed by internal conflicts and upheavals.

Former FDA Commissioner Scott Gottlieb, M.D., who served during Trump's first term, told CBS News' "Face the Nation" on Sunday that the FDA upheaval has been detrimental, noting that political appointees had taken over what are typically career leadership positions running the medical product centers.

Makary's resignation leaves Trump with yet another vacancy in the HHS top ranks. The administration already lacks a permanent leader at the Centers for Disease Control and Prevention and a permanent surgeon general.

Hungry for change

Diamantas, the acting replacement for Makary, brings a legal and regulatory background to the commissioner's role rather than a clinical one, according to his official FDA biography. As deputy commissioner for food, Diamantas leads the agency's Human Foods Program (HFP), overseeing all FDA nutrition and food safety activities, including resource allocation, risk-prioritization strategy, policy initiatives and major response activities involving human foods, according to the agency’s official description.

Diamantas holds a juris doctor from the University of Florida Levin College of Law and a bachelor's degree in pre-law political science from the University of Central Florida. He has extensive experience working with federal and state agencies, scientific organizations, consumer advocacy groups and industry stakeholders, with wide-ranging background on regulatory, compliance, investigative, enforcement, rulemaking and legislative matters.

In his role atop the Human Foods Program, Diamantas serves as a liaison between FDA, HHS and the White House, and represents the agency on food-related matters in dealings with foreign governments and international organizations. That portfolio now expands to encompass the full breadth of FDA's regulatory authority over drugs, medical devices, vaccines and tobacco products.

The Human Foods Program that Diamantas has led is a substantial undertaking in its own right. The program oversees all FDA activities related to food safety and nutrition, with a stated vision of ensuring that food is a source of wellness for all U.S. consumers. Its day-to-day work focuses on preventing foodborne illness, reducing diet-related chronic disease and ensuring that chemicals in food are safe — priorities organized across three parallel tracks covering microbiological food safety, food chemical safety, and nutrition.

MAHA vs. food

Diamantas's food safety background takes on added significance in the context of the broader policy agenda he now inherits.

Kennedy has argued that ultraprocessed foods are driving the nation's chronic disease epidemic, calling on federal agencies to act boldly to eliminate the root causes of chronic illness and improve the health of the food supply. The FDA has identified the United States as facing a growing epidemic of preventable diet-related chronic diseases, such as cardiovascular disease, Type 2 diabetes and obesity, and has noted that researchers have linked consumption of ultraprocessed foods to a range of negative health outcomes, including certain cancers.

The agency estimates that 70% of the U.S. food supply is comprised of foods commonly considered ultraprocessed, and that children get more than 60% of their calories from such foods. The FDA's Human Foods Program describes its 2026 mission as playing a critical role in implementing Kennedy's Make America Healthy Again agenda, noting that for the first time, there is a dramatic and determined focus across the federal government on the importance of food and nutrition in improving the health of all Americans.