The Prestige and Power of Leading the FDA
The role of FDA commissioner is one of the most respected and influential positions in American healthcare. At the helm of an agency that oversees 20% of every dollar spent in the United States, the commissioner has the power to shape the trajectory of modern medicine. From approving life-saving treatments to investigating dangerous products, the FDA commissioner leaves an indelible mark on public health. Few people outside of medical circles know the name David Kessler, the FDA commissioner during much of the 1990s, but his legacy includes the federal regulation of cigarettes—a monumental achievement that has saved countless lives. Now, a new commissioner, Marty Makary, is poised to take on this critical role under the Trump administration, with a nomination that has sparked both excitement and concern.
Marty Makary: A resume fit for the role
Marty Makary, a renowned surgeon at Johns Hopkins, best-selling author, and advisor to the World Health Organization, is undeniably qualified for the position of FDA commissioner. His credentials are impressive, and his election to the National Academy of Medicine underscores his expertise. Makary’s recent Senate confirmation hearing highlighted his hands-on experience in healthcare; he even mentioned performing a gallbladder removal the day before the hearing. While his frequent critiques of the medical establishment on Fox News have drawn criticism, many, including Kavita Patel, a physician and former Obama-administration official, believe he has the potential to be one of the greatest FDA commissioners in history. However, his alignment with Health and Human Services Secretary Robert F. Kennedy Jr. raises questions about how he will navigate the role.
A Clash of Visions: Makary and Kennedy
Makary’s scientific background and Kennedy’s penchant for conspiracy theories and radical ideas create an inevitable clash. Kennedy, now the HHS secretary, has promised to empower scientists but has also vowed to overhaul the FDA in ways that would require Makary to abandon his medical training. Makary’s ability to balance his scientific expertise with Kennedy’s radical vision will determine the future of American healthcare. During his Senate testimony, Makary aligned himself with Kennedy’s focus on improving diet and addressing chronic disease, even expressing concern about “highly addictive chemicals” in the food supply—a stance that could win him favor with the health secretary. However, Makary also reiterated his belief that vaccines save lives, a position that directly contradicts Kennedy’s long-standing anti-vaccine advocacy.
Navigating the Science and the Politics
While Makary’s alignment with Kennedy on some issues may help him gain traction, his stance on other topics could create tension. For instance, he has criticized the Biden administration’s handling of COVID, particularly the approval of boosters for young, healthy Americans, arguing that the decision was not sufficiently supported by evidence. Makary’s skepticism about government policies and accusations of “cherry-picked” data resonate with Trump loyalists but raise concerns about his willingness to defy scientific consensus. His endorsement of Kennedy’s book on Anthony Fauci, which falsely claims that COVID vaccines caused more harm than good, further complicates his reputation. Patel, a friend of Makary, has defended him, suggesting that his public persona on Fox News does not fully reflect his private self.
The Challenges Ahead: Science vs. Ideology
Much of Makary’s agenda remains unclear, as he spent little time during his testimony outlining specific actions he would take as commissioner. However, Kennedy’s proposed changes to the FDA—such as ending the “war” on treatments like stem cells and psychedelic drugs—would require Makary to disregard scientific evidence and agency protocols. The FDA’s decisions on these treatments are based on rigorous testing and safety data, and Kennedy’s vision for deregulation would undermine the agency’s core mission. Legal experts note that while the FDA commissioner has significant authority, the HHS secretary has the power to overrule decisions, leaving Makary in a precarious position. If Makary resists Kennedy’s demands, he would not be the first FDA commissioner to clash with a powerful administration official. For instance, David Kessler faced intense pressure from the White House during his investigations into the tobacco industry.
The Ultimate Test: Balancing Science and Politics
The first major test of Makary’s independence may come in the form of mifepristone, an abortion pill. Kennedy has called for a review of the drug’s safety, despite the FDA’s recent determination that current restrictions are unnecessary. If Makary challenges the agency’s findings and restricts access to mifepristone, it would signal that his loyalty lies with Kennedy rather than the FDA’s scientists. During his confirmation hearing, Makary’s refusal to clarify his stance on the issue frustrated Democratic senators, leaving many wondering whether he will prioritize science over politics. As the FDA commissioner, Makary will oversee everything from infant formula to chemotherapy, flu shots, and hand sanitizer. His ability to manage up and navigate the treacherous waters of the Trump administration will determine not only his legacy but also the future of public health in America.