Dr. Marty Makary, the commissioner of the Food and Drug Administration, resigned on Tuesday, a move Preside Trump acknowledged on Tuesday, after weeks of pressure and rumors that the president was planning to fire him.

Dr. Makary ultimately resigned over concerns about the administration’s decision to authorize fruit-flavored e-cigarettes, an action he opposed, according to four people familiar with the matter. Dr. Makary told those close to him that he could not in good conscience approve flavored vapes, given their appeal to young people, and would not do something he did not believe in.

His departure caps a tumultuous run at the helm of an agency that regulates medical treatments, vaccines and much of the U.S. food supply. Dr. Makary came to the F.D.A. as a reformer, instituting so many new initiatives that he became known — and sometimes mocked — for his white board on wheels, festooned with Post-it notes lining up announcements that he promoted on frequent television appearances.

But his efforts at times put him at odds with the powerful food, tobacco and pharmaceutical industries. In the process, he made a number of enemies in Washington and on Wall Street, including some biotech leaders, abortion foes, tobacco executives and eventually some members of the administration.

He also drew criticism from public health leaders who viewed him as pandering to anti-vaccine activists with the release of an unsupported memo claiming that there were deaths related to Covid vaccines. Criticism flared again when he allowed the renewed use of unproven peptides, or injectable compounds with uncertain effects, a policy favored by Health Secretary Robert F. Kennedy Jr.

“He has offended almost everyone involved in F.D.A. issues, which is not easy to do,” said Diana Zuckerman, the president of the National Center for Health Research, which weighs in frequently on F.D.A. decisions. “But it would still be a disaster if he is replaced by someone who appeals primarily to tobacco companies, anti-abortion activists” and pharmaceutical lobbyists, she added.

The resignation was first reported by Politico.

Kyle Diamantas, the F.D.A.’s top food regulator, was named the acting commissioner. Mr. Diamantas came to the agency from Jones Day, a law firm where he represented Abbott Nutrition, a leader in the infant formula industry. He has become a vocal champion for policies to remove chemicals from the food supply and increase transparency around food ingredients.

The most consequential clash of his tenure was over the authorization of flavored e-cigarettes, a step Dr. Makary resisted over concerns that fruity and candy flavors would lure young people to addictive vapes. The White House ultimately prevailed. Earlier this month, two fruit-flavored vapes were approved. And last Friday, the F.D.A. quietly issued a policy allowing them to be more widely marketed.

Mr. Trump told reporters Tuesday afternoon that he wished Dr. Makary well.

“Marty’s a terrific guy, but he’s going to go on and he’s going to lead a good life,” Mr. Trump said as he left for a trip to China. “He’s a great doctor, and he was having some difficulty.”

Dr. Makary also faced repeated calls for his firing from abortion foes who accused him of dragging out the timetable for a study of the safety of mifepristone, an abortion drug, viewing the exercise as one that could support their efforts to restrict the drug’s distribution.

Dr. Makary, who was a Johns Hopkins University cancer surgeon and health policy researcher before entering government, attempted to play to Mr. Kennedy’s Make America Healthy Again movement, going as far as sitting in a frigid plunge pool with the wellness influencer and biohacker Gary Brecka. He also led popular efforts to authorize natural food dyes and change how people talked about hormone replacement therapy for women.

With the support of MAHA voters, Mr. Trump framed Dr. Makary as a bold reformer, someone who would right an agency that had “lost sight of its primary role as a regulator.”

Early on, Dr. Makary and Dr. Vinay Prasad — his handpicked director of gene therapies, stem cell treatments and vaccines — drew scrutiny when they restricted the criteria for prescribing Covid vaccines to people older than 65 or with a list of health concerns.

Dr. Prasad resigned under pressure last summer after he was targeted by the right-wing influencer Laura Loomer, in part over his crackdown on a drug company tied to several patient deaths. Dr. Prasad was later brought back, but left the agency again in recent weeks.

Dr. Prasad and his counterpart in the agency’s drug division rejected a number of new drugs for rare diseases, citing flaws in a company’s research supporting an approval. As Dr. Makary went on television to defend the rejections, frustrated biotech leaders and investors vented to the White House and Mr. Kennedy’s office.

“On vaccines and mifepristone, Makary rarely prioritized rigorous evidence,” said Lawrence O. Gostin, a professor at Georgetown Law who studies the F.D.A. “Ironically, his one stand for high-quality science — on flavored vapes — created the friction with the White House that contributed to him losing his job.”

Dr. Makary also faced a series of challenges inside his agency. He started his work last year contending with a haphazard array of staff cuts led by Mr. Kennedy and Elon Musk’s Department of Government Efficiency. Some staff members vital to reviewing complex surgical devices, inspecting food manufacturers and monitoring drug safety were laid off.

Though some people were hired back, another wave of voluntary departures left the agency without more than 4,000 staff members, or about a fifth of its work force.

Dr. Makary ultimately became a champion for the agency’s staff, fighting to get authorization to hire about 3,000 employees. The process of recruiting and hiring has moved slowly, though, leaving staff members at the agency and those who watch it concerned about its future.

Nathan Cortez, a Southern Methodist University law professor who studies the F.D.A., said that finding a permanent replacement could be a major challenge.

“The new commissioner will have to walk a tight rope between what the administration wants — Trump and R.F.K. Jr. — and what federal law commands of F.D.A.,” he said in an email, adding: “Historically, the expectation is someone with an M.D. or PhD and real scientific chops. It’s a lot of pressure.”

Karoun Demirjian contributed reporting.

When President Trump visited China in late 2017, Xi Jinping welcomed him with a grand display of Chinese history and culture: a four-hour private tour of the Forbidden City culminating in a performance by the Peking Opera.

Eight years, a pandemic and two trade wars later, Mr. Trump is returning to Beijing, where the theme of future dominance, not ancient majesty, has filled domestic and international headlines with articles about dancing robots, drone swarms and the quiet hum of electric vehicles.

China increasingly casts itself not as a fading civilization trying to catch up to the West but as a superpower poised to surpass it. Chinese nationalists and state-linked commentators say they have Mr. Trump to thank. America under his rule, they say, validates Mr. Xi’s worldview centered on “the rise of the East and decline of the West.”

For decades, many Chinese viewed the United States with a mix of admiration, envy and resentment. America represented wealth, technological sophistication and institutional confidence. Even critics of Washington who reviled the American system often assumed that it worked.

Mr. Trump’s ascent and his volatile second term shattered that image.

In January, a nationalistic Beijing think tank affiliated with Renmin University published a triumphant report about Mr. Trump’s first year back in office. The report argued that his tariffs, attacks on allies, anti-immigration policies and assaults on the American political establishment had inadvertently strengthened China while weakening the United States. Its title: “Thank Trump.”

The report called Mr. Trump an “accelerator of American political decay,” with the United States sliding toward polarization, institutional dysfunction and even “Latin American-style instability.” His hostility toward China, the authors argued, was a “reverse booster” that unified the country and helped bring about its strategic self-reliance.

“At this turning point in history,” the authors wrote, “what we hear is the heavy and haunting toll of an empire’s evening bell.”

Such language, once confined largely to nationalist corners of the Chinese internet, has increasingly entered mainstream political discourse.

Evidence of this shift is measurable: The use of terms related to “American decline” in official Chinese sources nearly doubled in 2025, according to a study by two Brookings Institution researchers.

The narrative of American decline did not begin with Mr. Trump. For years, Chinese state media and nationalist pundits have highlighted mass shootings, homelessness, political polarization and economic inequality in the United States as evidence of the failures of Western democracy. More recently, official outlets embraced the viral phrase “kill line,” borrowed from video game culture, to describe what they portrayed as the irreversible downward spiral facing America’s working poor. It’s a familiar tactic of the Communist Party to distract the Chinese public from the country’s own issues.

But Mr. Trump’s return to office and his administration’s erratic decision-making in both domestic and foreign policy have supplied the propaganda machine with plentiful fresh material. Images of immigration raids, the Minneapolis shootings and bitter political infighting circulate widely on Chinese social media alongside triumphant commentary about American dysfunction. What once sounded to many educated Chinese like exaggerated propaganda increasingly feels, to some, observational.

A 31-year-old education consultant in northern China who advises families on overseas study told me that parents who had once aspired to Ivy League degrees for their children now saw America as “too chaotic.” A decade ago, more than 80 percent of his students considered the United States for study abroad, said the consultant, who asked me to use only his family name, Wang, for fear of government retribution. Now, he estimated, the figure has fallen to 45 percent.

Mr. Wang described watching footage of the Jan. 6, 2021, attack on the U.S. Capitol and finding himself thinking of the Red Guards that Mao Zedong dispatched to tear apart China’s institutions during the Cultural Revolution. That feeling returned more insistently with the immigration raids and the targeting of perceived enemies during Mr. Trump’s second term.

“The America that represented wealth, freedom and institutional confidence feels like it belonged to a different era,” Mr. Wang said.

Among China’s foreign policy analysts, the conversation has turned to what Beijing can gain from the bilateral relationship, which has become more transactional under Mr. Trump than under President Joseph R. Biden Jr.

“Only China can save Trump,” said Huang Jing, a professor at Shanghai International Studies University, during a media event that was livestreamed in late 2025. With the U.S. midterm elections approaching, he argued, Mr. Trump needed visible wins such as Chinese purchases of American soybeans, corn and natural gas that could play well in swing states.

“Since Trump,” Mr. Huang said at the event, “the United States has become increasingly prone to compromise.”

Wu Xinbo, a leading American studies scholar at Fudan University, offered a similar assessment. If Republicans lose control of the House this fall, he said at the same event, Mr. Trump is likely to pivot toward his foreign policy legacy, creating space for a larger accommodation with Beijing.

China, he said, “should make good use of this opportunity.”

The war in Iran has reinforced the view that China has the upper hand with Mr. Trump. At a conference in late April, Mr. Wu argued that the war reduced Washington’s leverage against China while increasing Beijing’s by consuming American military and diplomatic attention in the Middle East.

The logic helps explain why China’s official language regarding Mr. Trump has often been less hostile than it was regarding Mr. Biden. According to a project by the Tracking People’s Daily newsletter, which used artificial intelligence to analyze nearly 7,000 Chinese official statements since 2021, Mr. Biden was presented as a more systemic threat — so serious that Mr. Xi accused Washington of “encirclement and suppression,” unusually confrontational language for a Chinese leader.

By contrast, the study noted, “Trump’s transactionalism is something Beijing understands and can work with.”

Yet belief in U.S. decline has not translated into aggressive Chinese foreign policy, at least not the kind of overt geopolitical gamble that Russia made before invading Ukraine.

China has become more assertive, pressuring U.S. allies, expanding military activity around Taiwan and restricting rare-earth exports in response to Mr. Trump’s tariffs. But even as Beijing advances the idea of the decline of American power, it appears wary of directly confronting what many Chinese analysts describe as a still dangerous superpower.

Two factors play into this circumspection. First, many Chinese strategists believe Beijing can do better by sitting back while the Trump administration fumbles. Second, an unstable and distracted United States may also be a more unpredictable one.

Beijing’s export-dependent economy needs a stable international order to function. An erratic United States threatens that stability in ways a confident, predictable America never did, Zongyuan Zoe Liu, an economist at the Council for Foreign Relations, told me.

Mr. Xi “is getting the United States he always wanted,” she said, “and the America he most feared at the same time.”