Marty Makary lasted 13 months as head of the Food and Drug Administration. He arrived with a surgeon’s precision and a reputation for challenging consensus. He left Tuesday after clashing with the White House, industry lobbyists, anti-abortion activists and pharmaceutical executives. The breaking point came over mango and blueberry.
The FDA authorized the first fruit-flavored electronic cigarettes for the U.S. market just days after President Donald Trump personally pressed Makary to move faster. Those approvals marked a sharp departure from years of strict limits aimed at curbing teen vaping. Makary had resisted. Insiders close to him told reporters the pressure proved too much. So he sent a text. “Dr. President Trump, Please accept my resignation, effective today.” Trump shared the message on social media and praised the outgoing commissioner as a hard worker headed for an outstanding career in medicine. Kyle Diamantas, the FDA’s top food regulator, stepped in as acting chief.
The sequence exposed deep tensions inside the agency and the administration’s willingness to intervene directly in scientific decisions. Makary, a former Johns Hopkins cancer surgeon, entered the role in March 2025. He quickly made enemies. Biotech and tobacco lobbyists complained about delays. Pharma executives described reviews as inconsistent. Anti-abortion groups accused him of slow-walking a promised safety review of mifepristone, the abortion pill. Public health advocates, meanwhile, watched warily as vaccine oversight shifted in directions favored by Health Secretary Robert F. Kennedy Jr.
“He has offended almost everyone involved in FDA issues, which is not easy to do,” Diana Zuckerman, president of the National Center for Health Research, told The New York Times. The remark captured a tenure defined by friction.
Nowhere did that friction burn hotter than on vaping. During the 2024 campaign Trump promised to “save vaping.” The industry responded with donations and votes. E-cigarette companies, shop owners and enthusiasts backed his return to the White House. Once in office, their representatives kept the pressure on. A representative from R.J. Reynolds met with Trump in Florida. Soon after, the president called Makary directly. The message was clear. Approve the flavors. Move faster. The Wall Street Journal first reported the weekend rebuke. Within days the FDA reversed course. It greenlit products from Los Angeles-based Glas Inc. in mango, blueberry and two menthol varieties. The agency also issued new guidance that eases marketing for flavored vapes equipped with age-verification technology such as ID scanning, smartphone pairing and biometric checks.
Bret Koplow, acting director of the FDA’s Center for Tobacco Products, later highlighted those safeguards at a nicotine conference. “These flavored products are exclusively used with device technology, which includes ID verification, smartphone pairing, and periodic biometric check-ins,” he said. The administration argues such tools limit access to adults trying to quit cigarettes, which still kill 480,000 Americans each year.
But the decision drew swift criticism from health groups. The vast majority of teen vapers already use unauthorized fruit and candy flavors sold in cheap disposable devices, many smuggled from China. Previous FDA policy under both parties had denied more than a million marketing applications for such appealing tastes. That crackdown helped drive teen vaping to a 10-year low. Kathy Crosby of the Truth Initiative warned that vigilance remains essential. “Ultimately, it’s critical that we remain vigilant in protecting young people, including closely monitoring the use of authorized products.”
Makary had shared those concerns. He blocked formal approval of the Glas products for months even after staff supported them. His stance aligned with long-standing public health efforts to prevent another surge in youth nicotine addiction. Yet it put him at odds with Trump’s campaign pledge and the tobacco industry’s interests. The president’s intervention settled the matter. The FDA announced the authorizations on a Tuesday in early May. News of plans to fire Makary broke Friday. His resignation followed four days later.
The episode raises fresh questions about the FDA’s independence. Trump officials maintain the flavored vapes target only adult smokers. They point to the built-in age gates as proof of responsible regulation. Critics see politics overriding science. They note that illicit flavored products already flood the market. Legalizing certain versions from established manufacturers, they argue, could normalize the habit again and open prime shelf space in thousands of stores.
Makary’s broader record drew fire from multiple directions. Pharmaceutical companies griped about chaotic drug reviews and personnel turnover, including the departures of key leaders like Richard Pazdur and Peter Marks. Anti-abortion Republicans grew furious over continued telehealth access to mifepristone. Sen. Josh Hawley called Makary “uniquely destructive to the prolife movement.” Marjorie Dannenfelser of SBA Pro-Life America demanded his immediate dismissal. At the same time, changes to vaccine review processes drew accusations that the agency was bending toward Kennedy’s views on immunization.
Public health experts watched the vaping reversal with particular alarm. They recall the 2019 teen vaping epidemic fueled by sweet flavors. They worry history could repeat. Yet the administration frames the policy as harm reduction. Adult smokers, it says, deserve options that taste better than tobacco and come with modern safety features. The Vapor Technology Association and other industry voices had lobbied aggressively for exactly this outcome.
Trump confirmed the resignation himself. His tone stayed positive despite earlier reports of frustration. He described Makary as a “great guy” and a friend who simply encountered “some difficulty.” The president made no direct mention of the vaping dispute in his public comments. Makary’s own circle pointed to that dispute as the final straw. After a year of bucking the administration and alienating powerful interests, the surgeon decided to step aside rather than wait for formal dismissal.
The FDA now operates under acting leadership once again. Diamantas inherits an agency facing lawsuits, congressional scrutiny and persistent questions about political influence. The new flavored vapes will hit the market under close watch. Regulators promise to track youth uptake. Manufacturers insist the technology prevents underage sales. The real test will unfold in convenience stores and on social media feeds where teens scroll.
Makary returns to private life with a mixed legacy. He announced dozens of reforms during his brief tenure. He appeared alongside Trump at events promoting lower drug prices and better public health. Yet his departure leaves the FDA without a permanent commissioner at a moment when decisions on nicotine, abortion drugs and vaccine policy carry heavy political weight. The administration’s willingness to pressure the agency on fruity e-cigs may signal more such interventions ahead. Industry insiders already sense opportunity. Public health advocates see risk. Both sides will be watching the data on youth vaping rates in the months to come.
The approval of those mango and blueberry pods may prove a minor footnote in FDA history. Or it may mark the start of a broader retreat from flavor restrictions that defined tobacco policy for years. Either way, the episode illustrates how quickly a commissioner can fall when he stands between a president’s promise and a favored industry’s demands. Makary chose to leave on his own terms. The text message made that clear. The rest of the story is still being written inside an agency that suddenly finds itself without its leader.
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