For those concerned that opinion and not science may determine US public health policy under president-elect Trump, the choice of surgeon Martin Makary as head of the FDA may be reassuring. While Makary is known as a healthcare critic, his views appear to be far less extreme than the controversial Robert F Kennedy Jr, chosen as secretary of health and human services, and some of Trump’s other public health picks.
An Outspoken Critic and Apparent Kennedy Ally
Incoming US president Donald Trump has made his choice of commissioner for the Food and Drug Administration (FDA), the professor of surgery and health policy, Martin Makary. Respected head of islet transplant surgery at Johns Hopkins University and visiting professor at over 25 medical schools, Makary is also an author and a frequent guest on Fox News who has often criticized the country’s healthcare system.
Through his books, articles and public appearances, he has spoken out against medical errors and argued for more transparency in medicine. In his most recent book, “Blind Spots: When Medicine Gets It Wrong and What It Means for Our Health,” Makary denounced what he called “an epidemic of inappropriate care.”
Apparently aligned with Rober F Kennedy Jr’s views on health, he participated along with Kennedy at the congressional roundtable “American Health and Nutrition: A Second Opinion,” where he was critical of the country’s public health agencies. “The greatest perpetrator of misinformation has been the United States government,” he claimed.
Trump said his pick for the top job at the FDA would work closely with Kennedy to “properly evaluate harmful chemicals poisoning our Nation’s food supply and drugs and biologics being given to our Nation’s youth, so that we can finally address the Childhood Chronic Disease Epidemic.”
More Temperate than Other Trump Choices
While Makary was outspoken during the COVID-19 crisis, his views are somewhat more moderate and science-based than other vocal vaccine sceptics, particularly when compared to Kennedy and Trump selections Dr Mehmet Oz as head of the Centers for Medicare and Medicaid Services and Dr Dave Weldon as lead for the Centers for Disease Control and Prevention.
Against children using masks and widespread vaccination during the pandemic, he argued for a more targeted approach focusing on healthcare workers. He advocated for herd immunity, lashed out against public health officials for insisting that workers with natural immunity be fired if they were not vaccinated, and called the Centers for Disease Control and Prevention (CDC) under Biden “the most political CDC in history.”
Although his views may be debatable, Makary has spoken of the dangers of allowing opinion to sway decisions, claiming that “when modern medicine is interpreted through the harsh lens of opinion and edict,” it can have disastrous impact on public health. Having advocated for a universal flu vaccine, Makary is not a full-blown vaccine sceptic.
The news of Trump’s choice for the FDA was reasonably well-received by some. “While Drs Makary and Nesheiwat [Janette Nesheiwat, named US surgeon general] seemingly lack experience in managing large organizations … I believe they are competent physicians who will prioritize science-based decision making,” said Dr Jerome Adams, surgeon general during the first Trump administration. According to Endpoints News, one biopharma executive claimed that the choice “could be much worse.”
Others were more sceptical. “It’ll be very difficult for them [the new officials] to just make the decisions that are right for the health of the American people and not get swayed by someone who doesn’t understand evidence and data but has strongly held views,” said Dr Ashish Jha, former White House COVID-19 response coordinator under Biden, referring to Kennedy’s influence.
FDA Overhaul?
Kennedy has pinpointed the FDA as an enemy of public health and voiced his plans to radically overhaul the agency: “FDA’s war on public health is about to end. If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags.”
The current FDA head Dr Robert Califf, at the helm of the agency since 2022 and during the Obama administration, recognized the inevitable. “It’s pretty clear that the gist of this administration … is to change a lot of things.”
If confirmed by the Senate, Makary would oversee the FDA and its USD 7.2 billion budget and have the ability to sway decisions, including those relating to vaccines, but how much he will take apart the agency as Kennedy says he aims to do remains to be seen. Comparing Makary to Kennedy, Brian Abrahams, head of global healthcare research at RBC Capital maintained that he would be “less apt to dismantle” the FDA, but perhaps more likely to “evolve the agency toward a more industry-unfriendly stance.”
Makary, who worked with the previous Trump administration on a drug price transparency executive order, has been known to condemn Americans’ over reliance on drugs claiming that “the best way to lower drug costs in the US is to stop taking drugs we don’t need.” His possible lack of allegiance with the drug industry is, however, contradicted by the fact that he is board member at ophthalmology specialized pharma Harrow Eye.
