FDA Commissioner Dr. Marty Makary is out.

The resignation was confirmed on Tuesday after weeks of mounting pressure and reports that President Donald Trump had already approved a plan to remove Makary from the post. The departure caps a turbulent stretch at the Food and Drug Administration that saw clashes over vaping policy, drug approvals, and the broader Make America Healthy Again agenda.

President Trump confirmed the news outside the White House and struck a gracious tone about the outgoing commissioner.

“He was having some difficulty. He’s a great doctor,” Trump said. “He’s a terrific guy… everybody wants that job. He’s gonna go on and lead a good life.”

The departure did not come out of nowhere. Just one day before Makary’s resignation moved publicly, CBS News reported that Trump had approved a plan to fire him.

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CBS News reported:

On Monday, May 11, President Trump had approved a plan to fire FDA Commissioner Dr. Marty Makary, according to two sources familiar with the matter. At that point, the move had not yet been carried out publicly, and CBS said the timing was still uncertain, with room for Trump to change course if he chose. At that stage, Makary had not yet been notified, according to a senior Health and Human Services official, who said Makary still had support inside HHS.

CBS added several signals that the pressure around Makary was real. He did not appear in the Oval Office on Monday alongside other top federal public health officials when President Trump highlighted his administration’s work on maternal health. He was also still expected to testify before the Senate Appropriations Committee, according to the panel. CBS tied the friction to disputes over the FDA agenda, including the May 6 approval of flavored e-cigarettes after pressure from Trump and reporting that advisers viewed Makary as blocking a priority for the administration.

So the writing was on the wall. By Tuesday, the private pressure had become a public exit.

According to the AP, Makary is stepping down after just over a year leading the FDA. The agency’s food chief, Kyle Diamantas, is expected to step in as acting commissioner while the White House works on a permanent replacement, who would need Senate confirmation.

AP News reported:

On May 12, Dr. Marty Makary was resigning as FDA commissioner after just over a year leading the agency. The exit followed months of pressure from several directions: health industry executives, anti-abortion activists unhappy with the pace of the mifepristone review, vaping interests pressing for action on flavored e-cigarettes, and Trump allies who wanted the FDA moving faster on key priorities.

AP also laid out the machinery of what happens next. Kyle Diamantas, the FDA’s chief for foods, is expected to take over as acting commissioner, while any permanent replacement would have to be nominated by President Trump and confirmed by the Senate. The same account pointed to leadership churn inside the FDA, tension over drug-review decisions, and uncertainty around Makary-era initiatives that had not been locked into federal regulation before his departure. The personnel move also gives the administration a chance to reset one of the most powerful regulatory agencies in the country.

Makary came into the job with a strong resume as a Johns Hopkins surgeon and public health researcher. But running a federal regulatory agency with thousands of employees, a sprawling policy portfolio, and powerful outside interests pulling in every direction is a fundamentally different challenge than practicing medicine or writing books.

The fact that Trump handled this publicly with respect and well wishes says something about how the president manages these transitions. He acknowledged the difficulty, praised Makary as a person and a physician, and made clear the job will attract serious candidates. That is how a confident executive operates.

Now comes the next chapter. The FDA commissioner seat is one of the most consequential appointments in the federal government, touching everything from food safety to pharmaceutical approvals to the health freedom agenda that millions of Americans voted for. Whoever Trump picks next will need to hit the ground running, and the Senate will need to move quickly on confirmation. The Make America Healthy Again mission is too important to leave on autopilot.

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