Marty Makary resigned as commissioner of the Food and Drug Administration on Tuesday afternoon, ending a 14-month tenure that had been the subject of rolling reports of internal conflict for the past month and a single sustained dispute over the approval of fruit-flavoured electronic cigarettes. President Donald Trump signed off on a plan to remove Makary last week, three administration officials told CNN; Makary chose to resign rather than be fired or appear before a House subcommittee on Wednesday to defend the e-cigarette decision.
Trump named Kyle Diamantas, the FDA's deputy commissioner for human foods, as acting commissioner. Diamantas — a former corporate-side food and drug litigator who joined the agency in February 2025 — will run the FDA pending the nomination of a permanent successor, which the White House has indicated will not happen before late summer.
The trigger for the resignation was a Friday FDA decision authorising the sale of seven fruit-flavoured nicotine vape SKUs from two manufacturers. Makary, whose pre-FDA academic record had centred on tobacco-product harm reduction, opposed the authorisation internally and told colleagues he was "not going to be the one defending it on the Hill", according to one official familiar with his thinking.
The dispute is the latest in a sequence that defined Makary's tenure. The commissioner had clashed with the pharmaceutical industry over post-approval safety monitoring rules; with anti-abortion campaign groups over the FDA's continued approval of the abortion drug mifepristone; and with Health and Human Services Secretary Robert F Kennedy Jr over a series of vaccine-policy decisions. Eight high-level officials have left the agency since January.
Trump's relationship with Makary deteriorated through the spring. The president confronted Makary directly over the flavoured-vape file in early April after a White House meeting in which the vape industry's lobbying arm presented polling data on Republican base support for flavoured products. The CNN report on Saturday — that Trump had signed off on a plan to remove Makary — was the first public sign that the relationship had reached its conclusion.
Makary's exit thins an FDA leadership that the agency's career staff had already described as thinly stretched. The agency is conducting reviews of weight-loss drug labelling, mifepristone safety, vaccine schedules and the regulatory framework for AI-assisted diagnostic tools, all subject to compressed timelines tied to the administration's wider deregulatory agenda.
Diamantas, the new acting commissioner, has not previously held a medical or public-health position. His public statements as deputy commissioner for human foods have centred on food-additive review and supply-chain rules. The Wall Street Journal reported on Tuesday evening that the White House's longer-list candidates for permanent commissioner include Vinay Prasad, a UCSF haematologist-oncologist, and Stanford's Jay Bhattacharya — the latter currently serving as director of the National Institutes of Health.