The reckoning that Robert Califf spent years warning about began, as so many things seem to these days, on social media. It was October 2024. His tenure as commissioner of the Food and Drug Administration was winding down, and he was starting to imagine a happy retirement surrounded by grandchildren when he noticed Robert F. Kennedy Jr. taking aim at his agency, and the 19,000 or so people who worked there, on X.

“FDA’s war on public health is about to end,” Kennedy wrote. “This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma. 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.”

It was a confused, almost comically pompous declaration, Califf recalls thinking, and it ought to have been the least of his concerns. Kennedy had not yet been tapped to serve as anything, let alone the highest health official in the land. Still, it struck a nerve. More and more, people seemed to clamor for things that were unproven, to question things that were and to express not only mistrust but outright hostility toward the doctors, scientists and civil servants trying to separate one from the other. That hostility was being nourished by exactly the kind of mis- and disinformation Kennedy was espousing. It was easy to paint the F.D.A. as a supervillain (an aggressive suppressor of sunlight, vitamins and exercise, to borrow Kennedy’s language), in part because the truth was so much more complex.

Americans have always been ambivalent about public health in general and the American regulatory project in particular. We want protection from bad food and bad medicine and other unsafe products, but we also want to draw the line between safe and unsafe for ourselves and to redraw it whenever we see fit. The F.D.A. has always reflected this tension. On the one hand, the agency’s regulators have a truly enormous remit: Which drugs, medical devices, food, pet food, dietary supplements, tobacco products and cosmetics we can buy — one in every five dollars we spend, by official estimates — comes down to the decisions they make. On the other hand, the agency itself is profoundly under-resourced.

The F.D.A. receives less money from Congress than any of its sibling institutions, including the Centers for Disease Control and Prevention and the National Institutes of Health. In fact, its federal budget is roughly the size of the budget of the local school district in Montgomery County, Md., where it is based. Its infrastructure is wildly inadequate: fax machines, clunky computer systems, warehouses full of paper records that should long since have been digitized. And its staff members are poorly paid and frequently outgunned by the companies they are charged with regulating.

One perfect example of this dynamic involved the food and beverage industry, which Kennedy was so fond of calling out. Regulators had been working for years to get companies to reduce the salt content of their products and to add more and better “front of package” health warnings. Critics seemed to relish pointing out that other countries managed to implement both policies to great effect and with ease. But the United States was not like other countries. In the United States, corporations had the same rights as individuals and were likely to advance legal challenges against just about any rule with which they were confronted. To prevail in court, the F.D.A. would need its own research, which it did not have the money to conduct, or industry data, which it did not have the authority to demand.