RFK Jr. cut Martin Makary from the FDA commissioner role on May 12, after 13 months. If you’re pricing the deal: the White House traded a politically isolated commissioner for a food-safety lawyer with no pharmaceutical enemies.
The final straw wasn’t a drug filing. Makary’s refusal to clear fruit-flavored e-cigarettes forced the issue, but he’d already been losing ground on several fronts: pro-life groups pressured RFK Jr. over his handling of mifepristone, the Wall Street Journal editorial board criticized his drug approval record, and he clashed with HHS chief counselor Chris Klomp over personnel. He was due in front of the Senate to defend the FDA’s 2027 budget the morning after he resigned. He didn’t appear.
Kyle Diamantas, the FDA’s deputy commissioner for food, takes over as acting commissioner. He ran the Human Foods Program: food safety, not drug review. He’s been described as “no drama.”
What does the buyer get? A narrower target. Diamantas doesn’t carry the vape fight, the mifepristone battle, or the rare disease rejection blowback that defined Makary’s tenure. The structural bind Makary couldn’t resolve: satisfying MAHA’s demands, pro-life pressure on mifepristone, and pharma’s need for consistent review timelines simultaneously. Diamantas, coming from food safety, doesn’t face that same political crossfire.
Who gets nominated to replace Makary permanently is the question no one’s pricing yet.
— Diana Kowalski