FDA commissioner's abortion pill minefield

The big picture: President Trump hedged on many abortion questions during the campaign, but told Time magazine in December that he'll ensure the FDA doesn't strip access to the pill.

• But the Trump health team's commitment to the anti-abortion cause has also been questioned throughout a series of Senate confirmation hearings.
• Makary was asked repeatedly about mifepristone and Mehmet Oz, Trump's nominee to lead the Centers for Medicare and Medicaid Services, who had his own abortion views questioned by Sen. Josh Hawley (R-Mo.).
• Health and Human Services Secretary Robert F. Kennedy Jr. also was pressed on his previous support for abortion rights, ultimately convincing nervous Republicans that he'd stick to Trump's views once confirmed.

But abortion politics did scuttle one Trump appointee: Makary's own choice for the FDA's top lawyer.

• Hilary Perkins, a career Justice Department lawyer and Makary's pick for chief counsel at the FDA, defended the Biden administration's loosening of mifepristone restrictions in a case brought by anti-abortion groups that reached the Supreme Court, Axios reported.
• The next day, Hawley — whose wife represented the petitioners at the Supreme Court as a lawyer for the Alliance Defending Freedom — posted several times on X about Perkins' selection for the FDA post, referring to her as a "Biden abortion lawyer."
• A day after that, Perkins resigned, just before the Senate health committee that Hawley sits on voted on whether to advance Makary's nomination.

Yes, but: Perkins has since said her role was mischaracterized by Hawley, and that the majority of the cases she handled at DOJ were actually defending the FDA's restrictions on mifepristone against challenges by abortion rights groups.

• "As a pro-life conservative who is committed to fighting for President Trump's agenda, I was the right person to serve as FDA chief counsel," Perkins told Axios in a statement. "Senator Hawley misunderstood the role of DOJ attorneys, which is to defend the legality of the government's actions regardless of their personal views. He should fix this mistake."
• Perkins defended herself in more detail in an op-ed published Tuesday night in the WSJ.

• Hawley said he stands by his position: "My message to conservatives is, if you want a promotion, don't sign briefs that promote abortions."

Between the lines: The tense episode may foreshadow the pressures Makary is about to face regardless of what he does or doesn't do about mifepristone.

• Even studying the safety of the medication, which many studies have found is safe and effective, could immediately draw criticism from Democrats and the scientific community.
• But anti-abortion groups, who argue there are major safety concerns with the pill, generally want restrictions on its use reimposed by the FDA, including an in-person dispensing requirement, to eliminate tele-prescribing. Some have argued that the agency's approval of the drug should be revoked altogether.
• Threading the needle between both sides will be impossible.

What he's saying: During his confirmation hearing, Makary presented his approach as a scientist.

• "Once I'm in office, I will do a review of the data. I have no preconceived plans to make changes to the mifepristone policy," he said in response to one line of questioning.
• "If you look at my track record, I have never been afraid to speak my honest scientific opinion."

The bottom line: Makary has already experienced firsthand what a lightning rod mifepristone is shaking out to be. His actions — or inactions — at the beginning of his tenure as FDA commissioner will likely only reinforce that lesson.