Recommendations of the Editorial team
Anyone who has ever swallowed an aspirin, poured milk into coffee, fed their pet or filled a prescription has relied on the life-saving oversight of the US Food and Drug Administration. The FDA has long been considered the world’s gold standard in food and drug regulation – an agency that oversees products worth about a quarter of the U.S. economy.
Even under the best of circumstances, the FDA commissioner – a position subject to Senate confirmation – must navigate a merciless thicket of difficult trade-offs: the record-breaking approval of Covid-19 vaccines, the minefield of mailed contraceptive pills – all while powerful corporations push for special treatment.
Doing this job well – or doing it at all – is not an exercise in friendship.
Makary steps back
After days of back and forth between hostile camps in the White House and the Department of Health, which oversees the FDA, it became known on Tuesday: Trump’s embattled FDA Commissioner Dr. Marty Makary, a surgeon at Johns Hopkins University, is resigning.
The question immediately arose as to which outstanding medical figure would take his place. Shortly after Trump posted Makary’s resignation letter on Truth Social, Kyle Diamantas, 38, a largely unknown Florida lawyer, was named acting FDA commissioner. Diamantas first joined the FDA in 2025 as director of the food program – previously he was best known as Don Jr.’s hunting buddy.
In March 2021, Don Jr. and Diamantas posed with killed Osceola turkeys – I first reported this. Mike Tussey, founder of hunting operator Osceola Outdoors, described the scene on X: “Don Jr. with his good friend Kyle Diamantas! Kyle’s first Osceola!” A photo of Trump Jr., Diamantas and Tussey with a single turkey can be seen on the Osceola Outdoors website.
Relationships as qualifications
How you go from shooting turkeys with the president’s son to leading 1,000 employees in the FDA food program to acting FDA chief is a story whose basic pattern has become familiar in Trump’s second term: Knowing the right people is a qualification in itself.
That Diamantas was the only deputy commissioner who could credibly assume the role is perhaps indicative of the current state of the FDA, says Susan Mayne, an adjunct professor at the Yale School of Public Health who served as the FDA’s director of food safety from 2015 to 2023. “Mr. Diamantas is not a doctor. It’s an unusual choice. But given the circumstances, it’s the logical one.”
After DOGE job cuts devastated the agency and ongoing turmoil drove scientists to quit in droves, the FDA’s organizational chart is largely leaderless. And in an agency plagued by divas-like personnel escalations, Diamantas demonstrated a “more balanced leadership style,” said Mayne.
Chaos under Makary
What should have been a sober regulatory environment was often dominated by chaos under Makary’s leadership. There was George Tidmarsh, director of the Center for Drug Evaluation and Research, who was forced to resign after allegedly using his regulatory role to go after a former business partner.
And there was Vinay Prasad, director of the FDA Center for Biologics Evaluation and Research, who startled the pharmaceutical industry—and his own employees—with an aggressive leadership style and brusque rejection of certain drug applications.
Amid countless conflicts, it was ultimately a dispute over fruit-flavored vapes that ended Makary’s term: Trump had a “disastrous lunch” with tobacco lobbyists seeking approval of their products, according to an FDA official.
The end of the rope
The White House urged the FDA to approve the products, but Makary balked – after all, such products obviously appeal to children. “That was the end of the rope for him,” says a confidante of Makary. “He didn’t want to wave through the candy flavors.”
In the end he did, just too late to save his job. Trump thanked him in a social media post on Tuesday: “He was a hard worker who was respected by everyone and will have an outstanding career in medicine.”
Diamantas only holds the job on an interim basis for the time being; Whoever would fill the position permanently would have to go through Senate confirmation hearings. Admiral Brett Giroir, a pediatrician who served as Assistant Secretary for Health at HHS in Trump’s first term and coordinated diagnostic testing during the Covid pandemic, is being discussed as a possible candidate. Giroir was reached by ROLLING STONE on Tuesday but declined to comment.
Uncertain duration
It is unclear whether and when Trump will nominate someone – and how long Diamantas could lead the FDA on an interim basis is anyone’s guess.
