Marty Makary out as FDA commissioner?

Marty Makary faces potential removal amidst controversial FDA decisions by 2027. As the 27th Commissioner of Food and Drugs since April 1, 2025 ^[1], he could be removed before January 2027 due to upcoming FDA decisions on highly controversial topics: mifepristone and e-cigarettes ^[1][7][8][9]. His tenure has already involved reported friction with the White House over policy directions, particularly concerning flavored e-cigarettes ^{[10][11][12][13]}. Regarding mifepristone, the U.S. Supreme Court is currently reviewing a Fifth Circuit Court of Appeals decision from May 1, 2026, which temporarily reinstituted in-person dispensing rules ^{[1][8][2][14][15]}. The Supreme Court temporarily halted this decision until May 11, 2026, and is expected to issue a final ruling by that date on whether mail dispensing can continue ^[2]. The FDA is also reviewing mifepristone's safety data and its Risk Evaluation and Mitigation Strategy (REMS) program, with a status report due by October 7, 2026 ^[8][16][17]. Despite acknowledging he would act if new data emerged, Makary stated in April 2025 that he had "no plans to take action" to restrict mifepristone, a position that drew criticism from some Republicans ^[18][19][20].

E-cigarette regulation, especially flavored products, is another highly scrutinized area. Makary has reportedly encountered pressure from the Trump administration on this issue ^{[3][6][10][11][12][13]}. A significant policy shift occurred on May 5, 2026, when the FDA authorized the first fruit-flavored vapes for adults ^[3][4][5][6]. This decision followed reports of President Trump pressuring Makary, who some advisers initially viewed as an "obstacle" ^{[3][6][10][11][12][13]}. Should this authorization lead to a notable increase in youth vaping or a strong public health backlash, Makary could face accountability and calls for his removal ^[3][21]. The FDA also issued draft guidance on March 11, 2026, for flavored e-cigarette premarket applications, with the public comment period ending May 11, 2026 ^[22]. In September 2025, Makary encouraged retailers to cease selling illegal flavored vapes, highlighting that many products sold are unauthorized ^[23].

HHS Secretary RFK Jr. voiced significant concerns about Marty Makary's FDA leadership. Discussions reportedly involved potentially limiting Makary's role and appointing a day-to-day operational lead, effectively making him a figurehead ^[2][3][4]. These considerations stemmed from reported internal dysfunction, infighting among Makary's appointed directors, and difficulties in reaching the FDA commissioner ^[2][3][4]. News reports from May 2026 indicated Makary was on "thin ice" with the White House due to "friction among staff and leadership, industry frustration and a general dysfunction in the agency" ^[1]. Sources familiar with internal deliberations cited concerns about Makary's inability to effectively run the FDA, his failure to "wrangle the bureaucracy and move quickly," and not being "responsive enough" to White House and agency concerns ^[1]. Despite these reported internal issues, Kennedy publicly defended Makary's record, suggesting that criticism of the FDA Commissioner stemmed from "industry anger over tougher evidentiary standards" ^[8].

Anti-abortion advocates heavily criticized Marty Makary for alleged mifepristone safety review delays. Key anti-abortion advocates primarily alleged that Makary deliberately delayed a comprehensive safety review of mifepristone until after the 2026 midterm elections for political reasons ^[5][6]. SBA Pro-Life America specifically criticized Makary for his "indifference" to abortion drugs, citing reports that he privately expressed not "thinking about" urgent safety regulations on these drugs ^[7]. This alleged stance fueled accusations that the FDA is "doing NOTHING while every day abortion drugs take the lives of children, put women & girls at serious risk, empower abusers, & trample state pro-life laws" ^[5]. Critics further argued that Makary's actions or inaction were "severely undermining President Trump and Vice President Vance's pro-life credentials" and their position on states' rights, particularly by allowing the continuation of "Biden's Covid-era mail-order abortion drug rule" ^[5]. Senator Josh Hawley (R-MO) accused the FDA of misleading Congress regarding the mifepristone review and urged Makary to "stop dithering [and] reinstate the mifepristone safety guardrails" ^[5].

Marty Makary's FDA tenure faced significant public friction with the White House. Makary, who was sworn in as FDA Commissioner on April 1, 2025 ^[1][2], was publicly scolded by President Trump in May 2026 for slow approvals of vape products, particularly fruit flavors ^[6][7]. Following this incident, internal reports suggested Makary was on "thin ice" and the "chopping block," even though the FDA approved the vapes shortly thereafter ^[6][8][7][9]. Makary also reportedly experienced internal clashes with staff and promoted a deputy against the White House's expressed preferences ^[6][8][9].

In stark contrast, Scott Gottlieb maintained a notably positive relationship with the Trump administration. Gottlieb resigned as FDA Commissioner in March 2019, citing personal family reasons ^[3][4][5]. His departure was met with praise from President Trump, who publicly tweeted that Gottlieb had performed an "absolutely terrific job," and the Department of Health and Human Services also commended his work ^[3][4][5]. During his time as commissioner, there were no reports of Gottlieb being fired or experiencing any significant public clashes with the White House ^[3][4][5].

Gottlieb's relationship evolved, becoming critical of administration interference in later years. He continued to advise President Trump on COVID-19 matters post-resignation ^[10]. However, in 2020, Gottlieb, alongside seven other former commissioners, issued broader criticism, accusing the Trump administration of interfering with the FDA's independence ^[11].

FDA Commissioners typically lack a fixed term length for their service. Historically, Commissioners appointed during a president's first term have served an average tenure of approximately 4 years and 0 months, which totals 1464 days ^[1].

Marty Makary assumed office as 27th FDA Commissioner in 2025. He was confirmed as the 27th Commissioner of Food and Drugs on March 25, 2025, following his nomination by President Donald Trump. Makary officially assumed office on April 1, 2025 ^{[2][3][4][5][1]}. It is worth noting that appointments for this position can sometimes face delays due to controversies, which may result in periods with acting commissioners ^[1].

Marty Makary secured FDA Commissioner role with bipartisan and administrative backing. Marty Makary was confirmed as the 27th Commissioner of the Food and Drug Administration (FDA) on March 25, 2025, following his nomination by President-elect Donald Trump ^{[1][2][3][4][5][6][7][8][9]}. During his 2025 Senate confirmation, he received support from all Republican Senators and Senator Dick Durbin (D-Ill.), with Durbin also voting to advance his nomination out of committee ^{[1][6][7][8][9][10][11][12][21][22]}. President Donald Trump praised Makary's expertise, and Secretary Kennedy Jr. welcomed him to the FDA, expressing pleasure in his leadership. Further support came from organizations including the American Cancer Society Cancer Action Network (ACS CAN) and the NCPA ^{[2][4][6][8][13][12]}.

Commissioner Makary maintained strong administrative and continued bipartisan engagement through 2026. Secretary Kennedy Jr. publicly defended Makary's record and commended his leadership, with a spokesperson for HHS affirming Kennedy's "full trust and confidence." The White House also reiterated "total confidence" in Commissioner Makary ^{[13][14][15][16]}. Makary continues to operate under the Trump administration, as demonstrated by his testimony before Senate committees on the FDA's fiscal year 2026 budget, indicating ongoing administrative backing for his role ^{[3][11][17][18]}. Additionally, Senator Durbin, alongside Senator Susan Collins (R), engaged with Commissioner Makary in May 2026, sending a bipartisan letter urging the FDA to reconsider draft guidance on flavored e-cigarettes ^[19][20]. The American Cancer Society Cancer Action Network's 2025 statement further implies continued functional engagement with Makary in his capacity as FDA head ^[2][4].

Martin A. (Marty) Makary was confirmed as the 27th FDA Commissioner on March 25, 2025, and is still treated as in-role by the agency in the retrieved FDA profile ^[1][2]. A recent report from 2026-05-05/06 states that Makary is on "thin ice" with the White House, and anonymous officials suggest potential movement, though there were no immediate plans for his ouster ^[3][4].

The market for Makary's tenure indicates resolution if he leaves before Jun 1, 2026, implying that market liquidity likely clusters around events in the run-up to that cutoff ^[5]. Reporting links leadership instability to FDA personnel and process turmoil, including the Prasad succession context and broader internal challenges; such successor and churn dynamics are the kinds of catalysts that typically change "will he leave by date X" probabilities ^[6][7][4].