Will New FDA Commissioner Martin Makary Save Vaping?

The Senate has confirmed Trump nominee Dr. Martin Makary as the new commissioner of the Food and Drug Administration (FDA). 

The Senate last night confirmed Dr. Martin Makary as the next commissioner of the Food and Drug Administration (FDA). The job includes overseeing regulation of vaping products and all consumer tobacco and nicotine products, which is carried out by the agency’s Center for Tobacco Products (CTP).

Makary was confirmed by a 56-44 vote, getting the support of all 53 Senate Republican members and three Democrats, including anti-vaping hardliner Dick Durbin of Illinois.

The Senate also confirmed Jay Bhattacharya, President Trump’s nominee to run the National Institutes of Health (NIH), on a party-line 53-47 vote. In February, the Senate confirmed Robert F. Kennedy Jr. as Secretary of the Department of Health and Human Services (HHS), which oversees all federal health agencies. 

Makary says FDA could enforce with raids by “people with guns”

Makary, a pancreatic surgeon and professor at Johns Hopkins, is a well-known health policy expert, who has written and spoken on a range of healthcare topics, including overtreatment in the U.S. medical system, overuse of antibiotics, and medical education reform.

He apparently came to Trump’s attention during the COVID-19 pandemic, when he appeared on Fox News criticizing vaccine and mask mandates. Makary has also written several books on health and medical topics.

The new FDA commissioner’s positions on vaping and nicotine are mostly unknown, but during his March 6 Senate Health, Education, Labor and Pensions (HELP) Committee confirmation hearing, his answer to Florida Republican Senator Ashley Moody’s question about “illegal Chinese vapes” was not encouraging.

“We are being flooded with Chinese [vaping] products,” Makary told the anti-vaping freshman senator. “We have no idea what’s in these products, and public health isn’t even going to be able to study them because it takes so long for public health research to catch up. But it’s very concerning, and it’s not right that products are banned in China, and yet they’re manufacturing them and sending them to the United States. 

“There are a few things the FDA can do to try to address this problem,” he continued. “First of all, the Office of Inspections and Investigation has a lot of people with guns, and they do enforcement and raids, and we need—in collaboration with [the Department of Justice] and other areas of law enforcement—to try to address this problem of illegal products on our market.”

That answer must have been music to the ears of the tobacco industry, which has promoted harsh enforcement actions against its disposable vape competitors and other "unauthorized" vaping products (and also donated heavily to the Trump campaign). It also must have struck a chord with current CTP Director Brian King, who has spent much of his tenure rejecting clear product standards and instead focused on enforcement, including through FDA alliances with federal law enforcement agencies.

Will Makary help Trump "save flavored vaping"?

People who depend on vaping products better hope that Makary was just telling the Florida senator what she wanted to hear. Because the response sounded very similar to what we’ve heard from other FDA officials—including those running FDA tobacco regulation now.

Makary, for better or worse, will be the most important administration figure if Trump is serious about keeping his campaign promise to “save flavored vaping.”

If the administration intends to reconfigure the FDA’s vaping product regulation model to allow the sale of flavored products preferred by the vast majority of U.S. vaping consumers, the new commissioner will have to immediately shake up the CTP, which has grown comfortable rejecting scientific consensus on the benefits of non-combustible nicotine products and instead cherry-picked evidence to confirm its biases.

The FDA’s tobacco center is run by Brian King, an epidemiologist by training and former CDC employee, who was selected for the CTP job by previous commissioner Robert Califf precisely for his determined opposition to vaping. Califf also supported vaping prohibition before being named FDA commissioner by President Biden.

Since becoming CTP director, King has maintained cozy relationships with anti-vaping tobacco control organizations, rejected advice from his own science office regarding flavored vapes, and distinguished himself as a product regulator almost entirely focused on enforcement. A December 2022 report by the Reagan-Udall Foundation found the CTP had failed in its primary mission to regulate.

The question that will be answered soon is whether FDA Commissioner Martin Makary is interested in cleaning out the anti-vape extremism at the CTP—or if he agrees with it.