The Vape Cloud Hanging Over the FDA

Summary

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Podcast Summary: The Journal — "The Vape Cloud Hanging Over the FDA"

Date: May 12, 2026
Hosts: Jessica Mendoza (JM), Ryan Knutson
Guest: Liz Eslie White (LEW), Health Policy Reporter, The Wall Street Journal

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Episode Overview

This episode explores the political and policy firestorm that led to the resignation of FDA Commissioner Dr. Marty Makary, focusing on the increasingly contentious debate over vaping regulation. The story delves into the intersecting pressures from the vaping industry, political figures, and public health advocates—culminating in a dramatic shakeup at the FDA and a seismic shift in federal policy on nicotine products.

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Key Discussion Points & Insights

1. The Tumultuous Tenure of FDA Commissioner Dr. Marty Makary

• Dr. Makary, a surgeon, became FDA commissioner with promises to modernize the agency—phasing out artificial food dyes and cutting drug approval times ([00:37]).
• His leadership was marked by intense politics, staff turmoil (notably with Dr. Vinay Prasad’s firing and rehiring), and criticism from both the pharmaceutical industry and anti-abortion advocates ([01:05–02:00]).
• The most explosive controversy: his handling of vaping product approvals, which became a flashpoint for both industry frustration and political pressure ([02:00]).

2. The Politics of Vaping: Trump’s Shifting Stance

• Trump's anti-vaping position in his first term was spurred by public panic over youth vaping and lung disease, amplified by concerns from Melania Trump regarding their son Barron ([04:26–06:09]).
• In 2019–2020, regulations tightened: raising the tobacco age to 21 and banning kid-appealing vape flavors, except for tobacco and menthol.
• Flavored vapes, especially fruit varieties, were targeted because of their appeal to teens ([06:54–07:21]). Liz Eslie White notes:
  “You’re not going to go try a tobacco flavored vape as a 13 year old, but maybe blueberry would sound really fun or … watermelon fantasia.” ([07:01])
• Between administrations, the U.S. market was flooded with illegal, flavored Chinese vapes—fueling both black market growth and industry ire at the FDA ([07:21–07:58]).

3. The 2024 Election & Vaping as MAGA Culture

• Trump’s 2024 campaign recast vaping as a political cause, aimed at winning young men and libertarian-leaning voters.
  LEW: “His advisors really identified vaping as a way to reach young men who were a key constituency in the MAGA coalition.” ([08:24])
• Public conservative figures, including Tucker Carlson, openly promoted nicotine use ([09:16]).
• Despite campaign rhetoric, FDA leadership under Makary was unresponsive to the vaping industry, which began to see him as the obstacle ([09:45–10:08]).

4. The Glass Vape Case: Innovation and Bureaucratic Stalemate

• Glass (with one “s”) developed an app-enabled vape that required age verification for use, and requested approval for fruit-flavored vapes ([10:47–11:21]).
• The FDA’s scientific staff signed off, but the Commissioner's office—Makary—delayed final approval over concerns about the adequacy of age-gating technology ([11:35–11:55]).
• Makary’s rationale: persistent skepticism about the accuracy of youth use statistics and a firm public health stance against reintroducing kid-appealing flavors ([12:28–13:10]).

5. Political Fallout: Trump's Intervention

• Trump’s frustration escalated after discussions with advisors; within days, the FDA reversed course and approved Glass's mango and blueberry vapes ([13:18–14:11]).
• Coordinated pressure from industry and administration insiders precipitated Makary’s ouster ([14:19–14:51]).

6. A New FDA Policy: Floodgates Open for Nicotine Products

• Soon after Makary’s resignation, the FDA announced companies could market e-nicotine and pouch products while approval is pending—a major regulatory shift intended to counter the black market ([15:00–15:46]).
• LEW: “Industry experts think this is going to be a flood of new products in coming months.” ([15:00])
• Officials claim this will build a more robust, regulated market, but public health experts like Mitch Zeller warn of potential risk:
  “He is very concerned… because now people will be potentially able to get products where the risks might outweigh the benefits.” ([16:31])

7. Implications for the FDA’s Future

• The new acting commissioner, Kyle Diamantis, is seen as a pragmatic, unflappable insider ([17:44–18:01]).
• The Trump's administration will require the next permanent commissioner to support its pro-vaping agenda:
  LEW: “This promise that the Trump White House has made to the vaping industry of saving vaping is not … negotiable for the next commissioner.” ([18:07])

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Notable Quotes & Memorable Moments

• “He had a tumultuous tenure full of intrigue and palace drama and politics and conflict…” — Liz Eslie White on Dr. Makary ([00:24])
• “The vaping argument is what really catalyzed the movement towards: let’s go ahead and pull the plug here.” — LEW on why vaping tipped the scales ([01:59])
• “It really does feel like the hand of God is massaging you.” — Tucker Carlson, on using nicotine pouches ([09:20])
• “Makary thinks fruit flavored vapes are a huge public health risk. And children should not have any access to them….He doesn't want to be seen as the doctor who allowed those onto the market.” — LEW on Makary’s motivation ([12:28])
• “Industry experts think this is going to be a flood of new products in coming months.” — LEW ([15:39])
• “That could introduce people to nicotine addiction who didn’t need to be addicted.” — LEW ([16:31])
• “The next FDA commissioner is going to have to be on board with carrying out this vision for vaping.” — LEW ([18:07])

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Important Timestamps

• [00:05] – Makary’s resignation and leadership struggles
• [02:27] – The vaping issue accelerates Makary’s exit
• [04:26] – Trump’s initial anti-vaping stance; rise of youth vaping panic
• [06:25] – Policy actions (age limit, flavor bans) under Trump
• [07:21] – Rise of illegal foreign vape products
• [08:24] – Vaping as a Trump/MAGA campaign issue
• [10:47] – Glass company’s age-gated vape technology
• [11:50] – FDA commissioner’s memo stalls Glass’s application
• [13:18] – Trump gets actively involved, Glass gets approval
• [15:00] – Policy shift: pre-market sales of unapproved nicotine products allowed
• [16:31] – Mitch Zeller’s warnings on public health risk
• [17:44] – Kyle Diamantis becomes acting FDA commissioner
• [18:07] – Future FDA leadership must support “saving vaping” agenda

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Tone & Takeaways

The episode is brisk, sharp, and urgent—emphasizing the churn of political and regulatory struggle over vaping. It offers a nuanced look at the collision between industry, politics, and health, making clear that federal nicotine policy is now driven as much by electioneering as by science or public health.
Bottom line: The vaping debate’s new direction—pro-industry, anti-regulatory—has reshaped not just the FDA’s leadership, but the entire future of the American nicotine market.

Transcript

[Jessica Mendoza]

The Food and Drug Administration saw a huge shakeup in leadership today.

[Liz Eslie White]

Today, The FDA commissioner, Dr. Marty Makary, resigned.

[Jessica Mendoza]

And how big a deal is that?

[Liz Eslie White]

I think it's a huge deal.

[Jessica Mendoza]

Our colleague Liz Eslie White covers health policy.

[Liz Eslie White]

He had a tumultuous tenure full of intrigue and palace drama and politics and conflict in a way that we haven't really seen with any other FDA commissioner.

[Jessica Mendoza]

President Trump called Makary, quote, a terrific guy, but added that he was having some difficulty. Makary, a surgeon by training, was sworn in as commissioner over a year ago with promises to usher in a new era at the fda. He started phasing out artificial food dyes and cut down on the time it takes for drugs to get FDA approval. But Makary also faced a lot of headwinds throughout his tenure.

[Amazon Health AI / Tucker Carlson / Various Interviewees]

Patients, oncologists and biotech investors have been pressing Commissioner Makary over a string of drug rejections, none more contentious than Rep. Limune.

[Liz Eslie White]

He's managed to make a lot of critics in the pharmaceutical industry who view him as unsympathetic to the cause of rare disease.

[Amazon Health AI / Tucker Carlson / Various Interviewees]

I don't work for Replimune. I work for the American people and I stand by the scientists at the fda.

[Jessica Mendoza]

The White House has also blamed Makary for a mess of bad PR from people he brought on, who then quickly left the agency. That's according to people familiar with the matter. The highest profile was Dr. Vinay Prasad, who was hired, fired, and then rehired as the FDA's vaccine chief. Prasad ultimately stepped down in March. Beyond the personnel issues, Makary has also been criticized for not moving fast enough on issues important to the gop.

[Liz Eslie White]

He has been targeted by anti abortion advocates who called for his resignation after he promised a review of the safety of the abortion pill and has not produced it. But the vaping argument is what really catalyzed the movement towards. Let's go ahead and pull the plug here.

[Jessica Mendoza]

Why, of all things vaping, why was this the thing that caught the President's attention?

[Liz Eslie White]

Well, the President made a commitment to the vaping industry in his 2024 presidential campaign. He ran on a platform of let's save vaping. His advisors had identified that constituency as important to his base. They viewed it as a way to reach young MAGA voters. There were a lot of factors that led to this moment, but the vaping situation seems to have been an accelerant on the firestorm. Here it is. What seems to have sped up his ouster?

[Jessica Mendoza]

Makary didn't respond to Requests for comment. Welcome to the Journal, our show about money, business and power. I'm Jessica Mendoza. Tuesday, May 12th. Coming up on the show, the vaping firestorm that ousted the FDA commissioner.

[Amazon Health AI / Tucker Carlson / Various Interviewees]

Amazon Health AI presents painful thoughts.

[Liz Eslie White]

Why did I search the Internet for answers to my cold sore problem? Now I'm stuck down a rabbit hole filled with images of alarming graphic sores in various stages of ooze. I can clear my search history, but I can never unsee that.

[Amazon Health AI / Tucker Carlson / Various Interviewees]

Don't go down the rabbit hole. Amazon Health AI gets you the right care fast. Healthcare just got less painful. We have a problem in our country. It's a new problem. It's a problem nobody really thought about too much a few years ago. And it's called vaping.

[Jessica Mendoza]

That's President Trump speaking from the oval office in 2019. In his first term, Trump was clearly

[Amazon Health AI / Tucker Carlson / Various Interviewees]

anti vaping, especially vaping as it pertains to innocent children. And they're coming home and they're saying, mom, I want to vape.

[Jessica Mendoza]

Trump's comments were responding to a panic that was sweeping the nation.

[Liz Eslie White]

There was a real panic about these flavored vaping products and e cigarettes that, you know, you'd walk into a high school bathroom and it was just a cloud of vape. You hid your vape underneath your pillows. Yeah. And this was really bad to, you know, get all these kids addicted to nicotine.

[Amazon Health AI / Tucker Carlson / Various Interviewees]

And you would come and smoke how often?

[Liz Eslie White]

Oh, I couldn't go longer than like, 10, 15 minutes without hitting it. And then there was a time period where there was kind of an outbreak of lung disease and respiratory issues. In tonight's Health Watch, more disturbing news about the dangers of vaping. And people became increasingly concerned that something was going on with these products or they had been contaminated in some way that were harming the lungs of our young people.

[Jessica Mendoza]

The vaping industry was marketing its products as a healthier alternative for adults who want to kick smoking cigarettes. But public health advocates were concerned that vaping and e cigarettes were also being marketed to young people who had never smoked before and that getting kids started too early could lead to a lifetime of nicotine addiction. This concern even spread to the Trumps themselves. The first lady urged more regulation of vaping products. At the time, the Trump's youngest son, Barron, was in middle school.

[Liz Eslie White]

We had reported at the time that Trump's wife, Melania Trump, was an influential figure during this time and being concerned about her own son's health and safety and talking to her husband about that.

[Jessica Mendoza]

At the end of 2019, Trump signed legislation that Raised the age limit for all tobacco products from 18 to 21. Early the next year, the FDA enacted a ban on vape flavors that would appeal to kids. But the agency allowed flavors that might appeal to adult smokers trying to quit.

[Liz Eslie White]

And they ended up with sort of compromised position where they said, we will allow menthol and tobacco flavored vapes to remain on the market, but everything else is getting the boot.

[Jessica Mendoza]

So menthol and tobacco products were going to be allowed, but it sounds like there was a concern over flavoring specifically.

[Liz Eslie White]

Yeah, the flavoring is thought to be more appealing to children and to teenagers. The thought is, you know, you're not going to go try a tobacco flavored vape as a 13 year old, but maybe blueberry would sound really fun or maybe, you know, watermelon fantasia would sound amazing or things like that.

[Jessica Mendoza]

The ban on fruit flavored vapes stayed in place through the Biden administration. But a black market emerged, flooded by competitors from overseas who were not operating under FDA rules.

[Liz Eslie White]

These Chinese vapes, you know, that were illegal and possibly contaminated were just everywhere at any gas station. And there are a lot of people say, we don't really even know what's in these products. So there was really no healthy, robust, regulated market. It was mostly an illegal market that had sprung up. They are in gas stations, they are in smoke shops. You know, it is not hard to get your hands on a flavored vape.

[Jessica Mendoza]

This frustrated the US vaping industry. They publicly argued that the FDA's unwillingness to authorize flavored products meant more demand for illegal Chinese vapes. Over the course of the 2024 presidential campaign, Trump went through an evolution on vaping. He saw an opportunity to reach an important voting bloc by supporting vaping and other nicotine products.

[Liz Eslie White]

We know that his advisors really identified vaping as a way to reach young men who were a key constituency in the MAGA coalition. And it appealed to Trump's brand of I'm gonna do, you know, what's right for the American people. You know, I'm not gonna basically let big government trample on your rights, you know, skepticism of the public health establishment that followed the pandemic.

[Jessica Mendoza]

In September of 2024, Trump posted on social media, quote, I saved flavored vaping in 2019, and it greatly helped people get off smoking. He ended with the quote, I'll say vaping again. Supporters of the MAGA movement have also embraced nicotine products. Tucker Carlson talked about enjoying nicotine while promoting his own brand of nicotine pouches.

[Amazon Health AI / Tucker Carlson / Various Interviewees]

I mean, you throw it in like you would a dip of tobacco.

[Jessica Mendoza]

Okay.

[Amazon Health AI / Tucker Carlson / Various Interviewees]

But you just let it sit there and then it suffuses your nervous system with life giving nicotine. And it really does feel like the hand of God is massaging you. Okay.

[Jessica Mendoza]

So, you know, 2024, Trump is reelected with a different position on vaping. How do vaping and E cigarette companies respond to this new environment?

[Liz Eslie White]

Yeah, I heard a lot of optimism at the beginning of the administration, but then there wasn't much action. You know, there was very little movement from the fda. And my understanding as the industry came to the conclusion that the person standing in their way was Dr. Marty Makary.

[Jessica Mendoza]

After the break, a power struggle at the FDA and a flood of new nicotine products. The test case for the new nicotine friendly Trump presidency came from a vaping company called Glass with One S. It had been trying to get FDA approval for a new product since 2021. In its application, Glass said it had developed a vape that was almost impossible for teens to use.

[Liz Eslie White]

You have to have an app on your phone and you have to prove your age, and you can't use the device without it being near the phone. And it'll randomly at other times make you kind of reprove your age.

[Jessica Mendoza]

Because the device worked so well, Glass argued to the FDA they should be able to sell fruity flavors with it.

[Liz Eslie White]

In addition, they had a range of flavors that they were seeking approval for. So they had tobacco flavors, menthol flavors, and they had what they call golden sapphire flavors, which are mango and blueberry.

[Jessica Mendoza]

This February, Glass met with FDA representatives who apologized for the delays and promised news was coming. According to Liz's reporting, after that meeting, an agency document shows a key FDA scientist signed off on the Glass application.

[Liz Eslie White]

But after that, a memo came from the commissioner's office. And the memo said, actually, you know, we need more time. We're not really sure about whether this age gated technology is adequate.

[Jessica Mendoza]

So the application was ultimately stalled by FDA Commissioner Marty Makary.

[Liz Eslie White]

Yes. Yeah. And you know, this is years into this process for this company, and it was viewed as this kind of abrupt turnaround from them working with the FDA closely. They were feeling like this was political interference.

[Jessica Mendoza]

In a 2024 study, the CDC found that E cigarette use among teens had dropped to its lowest level in a decade. But Makary, a physician, wanted to avoid approving fruit flavors because he was worried about the public health risks.

[Liz Eslie White]

According to the people I've talked to, Makary thinks fruit flavored vapes are a huge public health risk. And children should not have any access to them. He doesn't want to be seen as the doctor who allowed those onto the market. He's worried that the statistics around youth vaping are inaccurate, that it's actually really bad still. It's not gotten better in the years since the 2020 ban. And he sees kids who are potentially gonna be addicted to nicotine. And, you know, his thinking is, why would we do that? That's a terrible policy.

[Jessica Mendoza]

So Makary puts his foot down, gets in the way of glasses flavored vape application. How did this issue get on Trump's radar?

[Liz Eslie White]

Yeah, so earlier this month, according to people we talked to, we know that Trump was having a weekend away and he started talking to some people and got upset and frustrated about the vaping issue and the slow pace of change at the fda. And he started calling advisors and saying, what do you think about this Marty guy? What's going on? What's the deal with the vaping situation? And getting pretty spun up and frustrated. And then we saw that following week, on Tuesday, the authorization for those flavors that Makary had previously stalled. So mango and blueberry from Glass got approval. The four newly approved E cigs come in mango, blueberry and menthol flavors. This major shift comes after months of appeals to President Trump by the vaping industry.

[Jessica Mendoza]

And, and then how did we get from the approval of the Glass application to Makary potentially getting fired?

[Liz Eslie White]

We knew going into that weekend where Trump got upset about vaping, that there were already people in the vaping industry and the pharmaceutical industry who had become so upset about certain actions that McCary had taken that they were already willing to call for his firing. They wanted him out. It appears that there were enough concerns inside the administration that officials did come up with this plan to oust Makary and got the initial sign off from Trump.

[Jessica Mendoza]

The news about McCary's potential firing overshadowed another significant change on nicotine products, which the FDA announced last Friday.

[Liz Eslie White]

We had a big policy announcement from the FDA that said, hey, tobacco industry, if you have an electronic nicotine product or a pouch product that you've already filed an application for, you can go ahead and market it. And we're not going to enforce against that. We're not going to come after you, basically. So even while you're waiting for our official pre market approval, you can move ahead with selling these products. And industry experts think this is going to be a flood of new products in coming months.

[Jessica Mendoza]

Wow. So essentially, vaping products that are waiting for FDA approval can now go on the market seems like a pretty big shift.

[Liz Eslie White]

Yeah, it's a big shift. They're saying, well, this is not a guarantee of authorization. The stated intention of the policy is to move the market from a dominated by unregulated Chinese vapes to a more regulated market where most of what you see in the vape shop is stuff that the FDA has signed off on. It is clear that this was a response to the frustration that President Trump exhibited on this issue the other weekend. They were, you know, moving quickly to try to carry out this aim of the Trump administration in a way that they had not previously done.

[Jessica Mendoza]

And what about public health experts? What have they said about this policy change?

[Liz Eslie White]

Depending on where you sit, that could be a good thing, that could help smokers who want to quit, or it could be a really bad thing. It could introduce people to nicotine addiction who didn't need to be addicted. And I talked to a former tobacco regulator at the fda, Mitch Zeller, and he is very concerned about the substance of the policy because it's allowing all these products that have not been scientifically authorized by the FDA onto the market in a way that is not the intent of the law. That's very concerning because now people will be potentially able to get products where the risks might outweigh the benefits. So he's very worried. And in addition, we have seen, you know, some vape retailers express assurance that there would be a lot more products coming their way. So according to Mitch Zeller, that could mean hundreds, thousands or tens of thousands new products in the coming months.

[Jessica Mendoza]

With Makary out, the White House has appointed Kyle Diamantis as the acting FDA commissioner. Diamantis is an attorney who'd been in charge of the agency's food division.

[Liz Eslie White]

He's actually proven quite popular with FDA staff. He's known as a level headed operator.

[Jessica Mendoza]

And what do you think the administration will be looking for in whoever runs the FDA next?

[Liz Eslie White]

I think it's pretty clear that the next FDA commissioner is going to have to be on board with carrying out this vision for vaping. This promise that the Trump White House has made to the vaping industry of saving vaping is not something that is going to be negotiable for the next commissioner.

[Jessica Mendoza]

That's all for today. Tuesday, May 12 the Journal is a co production of Spotify and the Wall Street Journal. Additional reporting in this episode by Natalie Andrews, Laura Cooper and Josh Dawsey. Thanks for listening. See you tomorrow.