Donald Trump has reportedly signed off on firing FDA Commissioner Marty Makary. It’s a move that feels both inevitable and chaotic. After only 14 months on the job, the Johns Hopkins surgeon who was supposed to "refocus" the agency is on the verge of being out of a job.
If you’ve been watching the FDA lately, you know it’s been a mess. But this isn't just about a personality clash or a bad boss. It’s about a fundamental breakdown between a "disruptor" commissioner and the reality of running a massive federal regulator. Trump reportedly approved the ouster on Friday, May 8, 2026, though he played it cool with reporters later that evening, claiming he "knows nothing about it." Don't buy that. The writing has been on the wall for weeks.
The mifepristone breaking point
You can't talk about Makary’s downfall without talking about the abortion pill. For months, anti-abortion activists have been screaming for blood. They wanted Makary to use the FDA’s power to effectively ban mifepristone or, at the very least, roll back every expansion of its use from the last decade.
Instead, the FDA under Makary did something that drove the hardline right crazy: it allowed a new generic version of the pill to hit the market. It didn't reinstate the strict in-person dispensing requirements they were hoping for. By Friday, the pressure reached a fever pitch. Senior White House staffers were literally scheduled to meet with anti-abortion leaders the same evening the news broke. It looks like Makary was the sacrificial lamb offered to keep that voting bloc happy before the midterm elections.
A revolt from the pharmaceutical industry
It wasn't just the social conservatives who wanted him gone. The pharmaceutical industry—usually the biggest influence on the FDA—has been in a state of open revolt.
Makary prided himself on "methodological purity." In plain English, that meant he and his hand-picked team were rejecting drugs that the industry thought were shoo-ins. During his short tenure, the agency issued a string of "shocker" rejections:
- RP1: An advanced melanoma therapy from Replimune.
- Deramiocel: A treatment for Duchenne muscular dystrophy.
- Bitopertin: A rare disease drug that had already been given a priority voucher.
Biotech CEOs were livid. They accused Makary of "moving the goalposts" mid-game. When you spend hundreds of millions on a clinical trial based on agreed-upon rules, and then the regulator changes those rules at the finish line, you don't just get mad—you call your friends in the White House.
The Vinay Prasad shadow
Then there's the Vinay Prasad factor. Makary brought in Prasad, a vocal skeptic of the medical establishment, to run the vaccine division (CBER). It was a disaster for agency morale. Prasad spent his time fighting with career scientists and, in one instance, refused to review Moderna’s mRNA flu vaccine because he didn't like the trial design.
Trump actually had to summon Makary to the White House to tell him to get the vaccine review back on track. Prasad finally left the agency last month, but the damage was done. Veteran regulators like Richard Pazdur, the longtime oncology chief, quit because they felt the "wall" between politics and science had been smashed.
What happens to the FDA now
The agency is currently a ghost town at the top. If Makary leaves, there's no permanent commissioner, no permanent head of the CDC, and no Surgeon General. It’s a leadership vacuum that leaves the world’s most important drug regulator rudderless.
For the average person, this means uncertainty. If you’re waiting on a new therapy for a rare disease, the "consistency" the industry is begging for might sound like a good thing. But the political churn at the top makes it harder for the FDA to do its actual job: making sure your medicine works and won't kill you.
If you're following this, watch the next few days closely. Trump could still change his mind—he's done it before. But with the pharmaceutical lobby and the anti-abortion groups finally agreeing on one thing (that Makary has to go), his chances of surviving the weekend are slim. Keep an eye on who is named as "acting" commissioner; it’ll tell you exactly whether the administration is moving back toward a conventional approach or doubling down on the "MAHA" (Make America Healthy Again) agenda.
