Marty Makary is gone.
An acting commissioner is now at the helm. Leading the agency that sits at the very center of American health, safety, and trust.
Do you care?
You should.
It’s not about politics. At least, not entirely. It’s about that quiet moment before you swallow a pill or sign your child up for a vaccine. The question you ask without realizing it. Can I trust this?
The FDA commissioner helps answer that. Every day. For millions.
The Invisible Hand
Most Americans only think about the Food and Drug Administration when things go wrong. A recall. An outbreak. A screaming match on social media over shots or abortion pills.
But the agency is everywhere else, too. Quietly. Constantly.
It touches your food supply. Your cosmetics. The nicotine in your vape pen. The antibiotics for your dog. Prescription meds and the generics behind the pharmacy counter. It is the invisible net beneath nearly every household.
The commissioner doesn’t read every paper. Doesn’t approve every molecule. Career scientists do the heavy lifting. Doctors, inspectors, regulatory experts who’ve been doing this for decades. They apply standards carved out of history, for goods made in Chicago and Chennai alike.
But the top sets the tone.
Leadership dictates priority. It shapes how decisions are explained. It decides how hard the agency pushes when the clock is ticking. It determines whether scientific debate is a rigorous process or a political wrestling match.
A Perfect Storm of Criticism
Makary’s time was messy.
Some loved the speed. Pushing on rare diseases. Demanding transparency from big pharma when trials failed. Moving fast on food chemicals.
Others saw overreach. Political theater dressed up as science. A dismissive attitude toward the advisory panels that used to be the guardrails.
Here is the rub: he was attacked from both sides. Simultaneously.
Anti-abortion groups said he wasn’t aggressive enough. Public health experts said he was reckless with vaccines. Anti-tobacco advocates said he moved too slow on teen vaping.
Sound contradictory? That’s the point.
The FDA is where all our deepest cultural fissures collide. It’s no longer just biology. It’s economics. Politics. Culture.
That creates an impossible job. We want speed. We want safety. We want it insulated from the news cycle.
Rare disease patients beg for faster approvals. Time is life, for them. Big Pharma wants clear rules, so they can bet their billions. Parents just want to know the data isn’t being cooked. Investors want stability.
How do you satisfy all of them? You usually don’t.
The Currency of Trust
This is why the process matters more than the product.
Joshua Sharfstein, a former FDA deputy, nailed it. Trust isn’t given. It’s built. Through transparency. Through visible, rigorous science. Not just announced from an ivory tower.
People can disagree with an outcome. Really. They can.
But they lose faith when the black box closes. When the methodology is hidden. When it looks like the winner is chosen before the experiment starts.
Credibility is the FDA’s only real currency. Enforcement power? Secondary. If people don’t believe the decisions are evidence-based, the regulations are just noise.
Leadership changes shake that foundation.
When the person at the top keeps changing, or changes direction, the ground shifts. Which rules apply? Which standards still count? Are long-held scientific processes still honored, or are they now subject to the latest whim in Washington?
Uncertainty is expensive. It costs innovation. It stalls patients waiting for treatment. It makes people hesitate when they should act.
We don’t have to love every decision the FDA makes. We probably never will.
But we need to trust the machine that makes them.
That trust is fragile. Maybe broken in some places.
So, when the commissioner changes, keep an eye on the desk.
Because the person sitting there holds the weight of our daily safety. And we might not know it until we’re in a crisis. Again.
