WASHINGTON — Food and Drug Administration Commissioner Marty Makary resigned Tuesday after irking President Trump by slow-walking flavored e-cigarette approvals.
Trump confirmed that Makary, a former Johns Hopkins cancer surgeon, stepped down as the president left the White House en route to China for a summit with Xi Jinping.
“He’s a great doctor [but] he was having some difficulty,” Trump explained, adding that he thought Makary was “going to go on and live a good life.”
Trump later posted Markary’s resignation note, which was bizarrely addressed to “Dr. President Trump.”
“Please accept my resignation, effective today,” Makary wrote in what appeared to be a text message.
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“During my tenure, I announced 50 major FDA reforms. Joe Biden’s FDA had none,” he wrote.
“I’m extremely proud that we reduced drug review times from a year to 1-2 months, wrote new guidance to advance psychedelics, introduced a new ‘plausible mechanism’ pathway for rare disease drugs, and changed estrogen labels to tell women the truth about menopausal hormone replacement. It’s been the honor of a lifetime to serve as your FDA Commissioner.”
Makary regularly appeared with Trump over the past year at events promoting public health initiatives and the president’s efforts to drive down prescription drug prices, but he also made powerful enemies.
In addition to well-connected executives in the vape industry, whom Trump promised to support during his successful 2024 presidential campaign, Makary angered advocates for the rapid approval of treatments for rare ailments like Huntington’s disease.
He also earned foes among anti-abortion advocates who wanted him to stop the mailing of mifepristone, part of a two-drug cocktail used to terminate pregnancies.
“Dr. Makary was uniquely destructive to the prolife movement,” Sen. Josh Hawley (R-Mo.) said on X Tuesday.
“He attempted to place pro-abortion lawyers in key positions. He slow walked a vitally necessary review of the abortion drug mifepristone. He used his discretion to approve a new abortion drug when the data shows it sends 1 in 10 women to the emergency room. He froze out prolife leaders and repeatedly stonewalled Congress. His resignation is an opportunity for the FDA to reset.”
Administration officials, meanwhile, told The Post they were infuriated by Makary meeting with, providing funding to and hiring subordinates associated with what they viewed as left-leaning causes.
The vape battle reportedly prompted Trump to directly reprimand Makary last week — viewing him as frustrating a headline-grabbing campaign promise.
A pivotal matter involved Makary standing in the way of market approval for a California manufacturer’s “age-gated” e-cigarrette that requires users to scan an ID to unlock the nicotine-laced vapor.
In December, the FDA’s website announced approval of fruit-flavored vapes, including mango, from California manufacturer Glas, which uses Bluetooth technology to verify users are at least 21 under an age limit signed into law by Trump in 2019.
The FDA chief blocked implementation of the approval for months, before the agency proceeded after Trump’s intervention last week.
On Friday, the FDA announced plans to relax enforcement against e-cigarette makers with pending product applications.
E-cigarettes have been the subject of intense public health debate over the past decade. Opponents say they could reverse progress in combating youth addiction to nicotine, while supporters say they are likely a safer alternative for adults who use combustible cigarettes known to cause cancer and heart disease.
Youth vaping peaked in 2019, with 27.5% of high school students and 10.5% of middle school students reporting past-month use in the National Youth Tobacco Survey, though teen use seems to have fallen since Trump enacted legislation raising the minimum age for purchase from 18.
The 2025 federal survey showed 7.1% of high school students and 2.6% of middle schoolers reported past-month vape use — a roughly three-fourths decline among both groups.
The novelty and diversity of vaping devices make long-term health effects difficult to determine, though nicotine increases blood pressure and is highly addictive.
The battle over federal vaping approvals dates to the first Trump administration, when flavor options were effectively banned during the COVID-19 pandemic — despite Trump’s concern that less-safe Chinese products would fill the market void, which came to pass.
