The Food and Drug Administration may soon lose its commissioner before he has held the job for a full year. President Trump has signed off on a plan to remove Dr. Marty Makary from the agency’s top post, according to reporting by The Wall Street Journal, confirmed by Bloomberg, The Washington Post, and Politico.

The decision is not yet final, sources cautioned. But four independent news organizations agreeing on the core fact suggests the trajectory is set, even if the timing shifts.

The Vaping Spark

The immediate friction point was vaping. Trump reportedly scolded Makary last weekend for not moving fast enough to approve flavored nicotine products, according to the Journal — a key campaign promise the president has branded as “save vaping.” Makary had held up approval of menthol, mango, and blueberry vape flavors from Los Angeles manufacturer Glas out of concern that the flavors could entice young users. On Tuesday, the FDA authorized the products.

The sequence is telling. The commissioner was reprimanded for exercising the kind of caution his agency was designed to exercise, then approved the products anyway, and is now being shown the door regardless.

Paranoia and Dysfunction

Reports have described an atmosphere of turmoil and controversy pervading the FDA under Makary’s leadership. The agency has been pulled in multiple directions simultaneously: DOGE-directed budget cuts have hollowed out staffing levels, while politically charged fights over vaccine policy, gene therapy approvals, abortion pill oversight, and vape regulation have consumed leadership bandwidth.

Top administration officials told the Journal they view Makary as a manager who argues with fellow health officials and has drawn complaints from the pharmaceutical industry — a constituency the FDA is meant to regulate, not please. The White House has not yet decided who would serve as acting commissioner upon Makary’s departure, the Post reported.

A Health Bureaucracy in Freefall

Makary’s expected removal does not exist in isolation. Since Trump returned to office, senior leaders at the FDA, the Centers for Disease Control and Prevention, and the National Institutes of Health have departed in waves. The CDC currently has no director. The position of surgeon general sits vacant. The entire apparatus is overseen by Health and Human Services Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic whose appointment itself prompted an exodus of career officials.

At each agency, vacancies have accumulated faster than replacements can be vetted — a combination of political pressure, loyalty testing, and the sweeping cuts driven by Elon Musk’s Department of Government Efficiency initiative. The cumulative effect is a health regulatory infrastructure losing institutional knowledge faster than it can be replaced.

Governance or Purge?

The question is no longer whether the Trump administration is reshaping the federal regulatory state. It clearly is, and with considerable velocity. The question is whether anyone in the White House has a plan for what these agencies are supposed to do once the reshaping is finished — or whether the destruction of institutional capacity is itself the objective.

Makary, a Johns Hopkins surgeon and prominent author, was a contentious pick from the start. Reformers welcomed his willingness to challenge FDA orthodoxy on drug approvals and agency efficiency. Public health traditionalists warned that his skepticism of certain medical conventions aligned too closely with Kennedy’s worldview. He has now managed the rare feat of alienating both camps: not compliant enough for a White House that wanted flavored vapes approved on a weekend’s notice, too weakened by internal battles to retain the confidence of career staff.

If Makary is removed, he will leave behind an agency that authorized the very products he worried would hook teenagers — and was fired anyway. That collision of political expediency overruling professional judgment, then punishing the professional who eventually complied, is a remarkably clear signal about how the United States currently manages its regulatory infrastructure. The career scientists who remain are watching.

Sources