By now, MAGA voters have learned that in Washington, getting rid of a problem doesn’t always mean it stays gone. In the case of Dr. Vinay Prasad -- the Bernie-loving, Fauci-fawning saboteur who briefly infiltrated the FDA under Trump -- the danger isn’t just what he did. It’s the fact that he might come back.
Yes, Prasad is out -- for now. But not because of the obvious incompetence, ideological subversion, or bureaucratic malpractice that defined his short, damaging tenure. No, his exit is being spun as a matter the commute being “brutal.” According to FDA Commissioner Marty Makary, Prasad didn’t undermine the President’s pro-innovation agenda; he just couldn’t handle the jet lag from San Francisco.
Let’s be very clear: Prasad didn’t belong in the FDA to begin with. And the fact that his former boss is openly pining for his return is Exhibit A that the rot at the FDA starts at the top. This isn’t about one bad hire -- it’s about an institution captured by people who seem more interested in rehabilitating progressive bureaucrats than implementing Trump’s health care agenda.
From the beginning, Prasad’s appointment made no sense -- unless your goal was to quietly kneecap President Trump’s medical innovation platform from within. This is a man who once declared Trump “perhaps the worst president in the history of the Republic,” proudly backed Bernie Sanders, and built a career championing the kind of public health authoritarianism that MAGA voters roundly rejected in 2020 and again in 2024.
And yet, he was appointed to head the FDA’s Center for Biologics Evaluation and Research (CBER), one of the most critical positions in the entire agency. His policies? Predictably progressive. Delays on drug approvals. Regulatory roadblocks for gene therapies. Backdoor policy rewrites disguised as academic articles instead of real, transparent guidance.
That alone should have been enough to show Prasad the door. But instead of owning up to the error, Makary called him a “genius” and credited him with “tremendous” policy shifts -- many of which amounted to slow-walking life-saving treatments and prioritizing red tape over patient access.
Which brings us to the real threat: the man who hired him.
Commissioner Marty Makary wasn’t duped by Prasad. He wasn’t blindsided. He knew exactly who he was bringing into the fold. In fact, by his own admission, he still talks to Prasad and would gladly bring him back.
This isn’t speculation -- it’s confession. Makary has praised Prasad as an innovator and dismissed concerns about his ideology as irrelevant. Never mind that Prasad’s tenure oversaw a spike in the FDA’s rejection of critical therapies, especially those aimed at rare diseases and pediatric conditions. Never mind that under his leadership, the FDA became more opaque and less responsive to patient groups. According to Makary, the problem wasn’t Prasad -- it was geography.
If you want a case study in how the administrative state survives every election, this is it. Prasad’s exit was not a purge. It was a sabbatical. And Makary is keeping the door open.
Since Makary and Prasad arrived at the FDA, the agency has been handing out Complete Response Letters (CRLs) -- government-speak for “we’re rejecting your drug application” -- at a clip nearly three times higher than before. That’s not a coincidence. That’s a signal.
These CRLs haven’t cited safety issues. In fact, nearly three-quarters of them point to manufacturing or “quality” concerns -- process flaws, not danger to patients. It’s the bureaucratic equivalent of denying a fire truck a license because its siren wasn’t the right shade of red.
And who suffers? Families with children fighting rare diseases. Patients hoping for relief from conditions that have no existing therapies. Small biotech firms trying to compete with Big Pharma but stuck waiting while the FDA dithers over formatting.
The FDA under Makary and Prasad didn’t just slow down -- it reversed. Instead of embracing President Trump’s “Right to Try” ethos, it returned to a “Right to Wait” model where innovation is strangled in the crib by obsessive compliance checks.
So why is Makary still defending Prasad?
In reality, Trump made the right call. He recognized that Prasad was a liability -- ideologically, administratively, and politically. But as long as Makary remains in charge, Prasad’s influence lingers. Whether it’s through formal rehiring, backdoor consultations, or simply keeping his policies in place, the sabotage continues.
The metaphor of a Trojan Horse isn’t just apt -- it is prophetic. Prasad didn’t storm the FDA gates. He was wheeled in by someone already inside, praised as brilliant, and allowed to remake policy from within. He’s gone now, but the horse remains -- and its architect is still calling the shots.
Let’s not kid ourselves: personnel is policy. And right now, we’re watching the same failed personnel being lined up for round two.
If President Trump wants to deliver on his promises for healthcare reform, he needs more than just firings. He needs a fundamental reset at the FDA. That means closing the back door Makary left open, installing leadership that shares his vision for innovation and patient-first policy, and making sure that lab-coat liberals like Prasad don’t get a second chance to dismantle the America First medical agenda.
The American people did not elect President Trump to install progressive regulators with Bernie bumper stickers on their electric vehicles. They elected him to fight the swamp. To dismantle the bureaucratic industrial complex. To put patients ahead of process.
That fight doesn’t stop at the top. It means rooting out the enablers as well as the operatives. It means removing not just Prasad, but the network that allowed him to ascend in the first place. And it starts with Marty Makary.
Makary had his chance. He chose ideology over patients, loyalty to insiders over fidelity to the President’s agenda. He empowered a saboteur, defended him even after his departure, and has made clear that nothing has fundamentally changed at the FDA.
If the Trump administration is serious about healthcare reform -- and the trust of the MAGA base -- it must send a message: The days of backroom appointments and ideological infiltrators are over.
Prasad must stay gone. Makary must go. And the FDA must be rebuilt -- from the ground up, in the image of a government that puts patients, not bureaucrats, first.
Julio Rivera is a business and political strategist, cybersecurity researcher, founder of ItFunk.Org, and a political commentator and columnist. His writing, which is focused on cybersecurity and politics, is regularly published by many of the largest news organizations in the world.
Image: FDA