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659. Can Marty Makary Fix the F.D.A.?

January 16, 2026·55 min·4 clips

The FDA commissioner explains why avoiding peanut butter until age three caused a surge in allergies.

Public health is crowded right now. The cold open sketches a federal health agenda moving quickly through Robert F. Kennedy Jr., with attention on childhood vaccines, animal proteins, ultra-processed foods, refined carbohydrates, and added sugars. The FDA has its own busy docket, including recent approvals for rare diseases, rheumatoid arthritis, HIV, and a non-opioid pain medicine. Against that backdrop, Marty Makary appears as FDA commissioner, after past visits to the show and a brief recent appearance about brain supplements. The conversation stays careful. The host treats Makary's promises as interesting, but not proven just because they sound good, especially when the talk turns to faster decisions on promising treatments. PTSD becomes the first stress test. Makary says people have gone overseas or used black-market products, and that some possible treatments have also been used recreationally or as anesthetics. His answer is regulation. If people are already looking for these treatments, he argues, the FDA can build a safer route for Americans who do not have wealth or special access. The host pushes back instead of waving it through. He calls the list enticing, then asks for one evidence-backed example that would show this is not a pipe dream. Type 1 diabetes gets that role. Makary points to pancreas islet transplantation, beta cells grown in a laboratory, and the possibility that infused insulin-producing cells could respond to sugar levels in a person or animal. That mechanism gives the discussion some footing. The interview shifts from regulatory ambition to the biology of insulin-producing cells, which keeps the claim closer to evidence than hope. Makary also describes a change in posture. Instead of waiting in receive-only mode, he says the FDA is going into scientific review divisions and asking what promising treatments they are seeing, even in early, preclinical, phase-one, animal-based, or mechanism-of-action data. That is the bet on the institution. In his version, the agency can reach out, facilitate, and partner earlier while keeping the formal scientific safety review independent. The host keeps doing what Freakonomics does well: pulling the answer back to access, mechanisms, and the distance between a plausible pipeline and a treatment people can actually use. Even the credits add a little texture, with a small off-mic moment about taking a drink that gives the policy machinery a brief, human wobble.

As heard by us

A grounded look at FDA speed, safety standards, and biotech promise under new political pressure.

Freakonomics Radio frames the FDA as a regulator under unusual political and commercial pressure. The episode starts with Robert F. Kennedy Jr.'s busy, controversial health agenda, then turns to Marty Makary's first government role running an agency already moving on rare…

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Why you'd press play

The FDA commissioner walks you through what he wants to change, from faster decisions on promising treatments to a more proactive agency posture.

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