If you’ve ever swallowed an aspirin, put milk in your coffee, fed your pet, or filled a prescription, then you’ve relied on the lifesaving oversight of the U.S. Food and Drug Administration. Long viewed as the world’s gold standard in regulating food and medicine, the FDA is a behemoth that oversees products comprising roughly one quarter of the U.S. economy.

Even on the best of days, the FDA commissioner — a Senate-confirmed position — must wander a pitiless wilderness of excruciating judgement calls, whether the record-speed approval of Covid-19 vaccines or the minefield of mail-order birth control pills, all while fending off powerful companies expecting VIP treatment.

Doing the job well, or even at all, is not a friend-building exercise.

After days of being dangled like a cat toy between warring parties in the White House and the Department of Health and Human Services, which oversees FDA, news broke on Tuesday that President Donald Trump’s embattled FDA commissioner, Dr. Marty Makary, a Johns Hopkins surgeon, was resigning.

Attention immediately turned to the question of which towering medical figure might step into the job. Soon after Trump posted Makary’s resignation text to Truth Social, Kyle Diamantas, 38, an obscure Florida lawyer who first landed at the FDA in 2025 as director of the human foods program, following his previous role as Don Jr.’s hunting buddy, was named acting FDA commissioner.

Come for the grift, stay for the nepotism.