The disastrous reign of Marty Makary and Vinay Prasad at the Food and Drug Administration (FDA) continues. What began as a seemingly internal management problem has metastasized into a credibility crisis for one of the nation’s most important scientific agencies. Left unaddressed, it now threatens to undermine President Donald Trump’s broader health agenda and, increasingly, his political standing.
President Trump campaigned on restoring confidence in public institutions and delivering healthier outcomes through accountability, transparency, and results. That promise resonated with millions of Americans who had lost trust in agencies that too often appeared captured by ideology, bureaucracy, or incompetence. But today, polling shows confidence in the FDA sinking toward historic lows — a warning sign that something has gone seriously wrong. The question is no longer whether the FDA has a leadership problem, but whether the White House can afford to let it continue.
As I pointed out in a previous post, Vinay Prasad is a Bernie Sanders–donating, pro-choice, Never-Trumper who found his way into senior leadership at the FDA largely because he questioned COVID-19 vaccine orthodoxy. A single good deed, however, does not excuse a pattern of reckless leadership — and Prasad’s tenure has become a case study in how not to run a scientific agency.
Since his return from his first firing, seven senior FDA officials have resigned. His leadership as Director of the Center for Biologics Evaluation and Research has been so bad, so rife with mistrust, that researchers are desperately trying to transfer to other departments within the FDA, only to be blocked by Prasad himself, apparently knowing he cannot afford to lose any more staff.
This is not leadership; it is bureaucratic bullying. Instead of strengthening one of the nation’s most important scientific agencies, Prasad has hollowed it out — driving away institutional knowledge and undermining the very people responsible for protecting patient safety.
And the damage does not stop with Prasad.
His boss, FDA Commissioner Marty Makary, is generating serious problems of his own. Under his watch the FDA approved a generic version of the abortion drug mifepristone, enraging conservatives. Susan B. Anthony Pro-Life America, meanwhile, has called for Makary’s immediate termination, citing concerns that he “slow-walked” a study into the effects of abortion drugs on women until after the midterm elections. SBA President Marjorie Dannenfelser put it plainly: “Commissioner Makary is severely undermining President Trump and Vice President Vance’s pro-life credentials and their position that states should have the right to enact and enforce pro-life protections. Makary must go.”
Makary is also presiding over a staffing crisis that would alarm any administration serious about governance. Most shocking was the swift departure of Dr. Richard Pazdur — a widely respected FDA veteran — only weeks after taking a role heading the agency’s largest division overseeing prescription drugs and over-the-counter medicines. Even Trump administration officials and Health and Human Services Secretary Robert F. Kennedy Jr. have reportedly grown frustrated with the turmoil and rapid turnover inside the FDA.
More troubling still, these agency-level failures are beginning to show up in broader political indicators. The polling troubles facing Secretary Kennedy and the agencies he oversees have coincided with a drop in President Trump’s overall approval rating to a new second-term low. Combine Prasad’s openly pro-choice values with Makary’s bungled handling of abortion-pill oversight, and the result is a leadership team fundamentally misaligned with the President’s priorities — and evidently, increasingly damaging to them.
MAHA — Make America Healthy Again — was one of the defining promises of Trump’s second term. Americans overwhelmingly support a serious reevaluation of FDA processes, including vaccines and drug approvals. But reform requires competence, discipline, and trusted leadership. It cannot succeed amid infighting, ego-driven management, and ideological drift.
President Trump has shown before that he is willing to make hard personnel decisions when the facts demand it. This is one of those moments. Both Vinay Prasad and Marty Makary have demonstrated that they are poor institutional leaders. Time and again, they have put personal agendas and internal power struggles ahead of stability, morale, and public trust.
The FDA can still be salvaged, but only if the White House acts decisively and makes some key personnel changes. The longer this FDA leadership crisis lingers, the higher the cost — not just for the beleaguered drug regulator, but for the president himself.
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