Dear incoming GOP governors, don’t listen to the moderates



The morning after you win, the National Governors Association will call. Its leaders will offer a seminar, a binder, and a roster of former governors prepared to explain why you should slow down. Take the meeting if you must — but do not buy their theory.

The midterms may cost Republicans the House and possibly even the Senate. But they will not lose the states. Thirty-six governorships are on the ballot, and the incoming class, with open seats in Ohio, Alabama, Iowa, Georgia, Tennessee, Oklahoma, South Carolina, and others, will likely yield the most conservative slate of new governors in a generation.

The bureaucracy has weathered these past governors because they failed to act swiftly.

The federal government will likely be deadlocked in 2027, but the states offer hope for advancing a bold and transformative national agenda.

To carry out such an agenda, incoming governors must reject the advice found in the NGA’s transition manual, which is an apologia for paralysis. On page 39, a former governor offers what the association presents as wisdom: “As a businessman, I spent 90% of my time on process and 10% on policy. As governor, I find I spend 90% of my time on policy and 10% on process.” This advice comes from a man who once controlled his own calendar but learned to let someone else control it.

Unsurprisingly, he did not transform his state during his term in office.

The NGA’s strategic advice is designed to slow you down. In the first six to nine months, “Veteran governors advise that a new governor generally should minimize downtime by not undertaking major reorganizations, large-scale personnel changes beyond normal top-level appointments or other major actions unless absolutely necessary.”

The text then warns against using the honeymoon period to “eliminate some entrenched bureaucrat who has run a particular bureau like a fiefdom for 30 years,” because “experienced governors advise caution at precisely the time when difficult decisions seem easiest.” Page 19 adds a quota: Veteran governors “recommend only tackling three to five large programmatic changes during a term.”

The NGA seeks to lock you into stagnation by “maintaining credibility with the legislature, state bureaucracy, press, and public.” Fail at that, and you become a “caretaker, largely beholden to a bureaucracy that has previously weathered poor governors.”

The bureaucracy has weathered these past governors because they failed to act swiftly. As a new governor, you have a choice: safeguard left-wing institutions or act boldly with the mandate voters gave you.

Gov. Ron DeSantis (R-Fla.) declined the seminar’s theory of the job. In his first term, he suspended Hillsborough State Attorney Andrew Warren and won passage of the parental-rights law the education establishment said would never be approved. And when Disney used its private government to punish the state, DeSantis moved to dissolve the Reedy Creek Improvement District.

His second term opened at the same speed. In January 2023, he replaced the board of trustees at New College of Florida, which fired the president at its first meeting and shut down the diversity office within weeks. That summer, DeSantis suspended Orange-Osceola State Attorney Monique Worrell. He filled the Central Florida Tourism Oversight District, the replacement for Reedy Creek, with his appointees. None of this waited for month 10, and none of it counted against a “three-to-five” quota.

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Ron DeSantis immediately targeted the offices that decide what the law means, and as a result, he is the most consequential governor of modern times.

President Trump’s second transition is the federal version of the same choice. The work of remaking the government began well before he took the oath of office. Inauguration Day produced a seismic list of executive orders that revoked the prior administration’s directives and froze pending rules.

President Trump moved policy-making career officials into positions where refusal to carry out the elected president’s program became grounds for removal. His speed and decisiveness made it impossible for the bureaucracy to stop him. He understood that since bureaucracy wins through inaction, such qualities are the best counter to its playbook.

The state version of the problem is worse than the NGA manual admits. Agencies are overstaffed relative to the work. A large share of the professional class inside them opposed your election and will oppose any order that threatens a program, a grant, or a headcount.

The NGA’s advice for staffing hundreds of boards and commissions — to staff them defensively, to “avoid embarrassment,” to keep them from consuming the governor’s time, and to wait until the crush of transition has passed — amounts to a 48-month holding pattern. Its goal is to outlast you.

Build the appointment list before election night. Know which boards can be abolished by statute and which must be filled by appointment in the first 60 days. Put your own counsel, budget director, and personnel leads in place before the inaugural balls are over. Carry out the reorganizations the NGA manual says to postpone. Publish the short list of agencies you intend to shrink — and shrink them while the people who run them are still writing memos about how hard that will be.

The bureaucracy is not your partner, and it is not waiting to be persuaded. It is overstaffed, and a meaningful share of its career employees do not want you to succeed. Treat it the way Donald Trump and Ron DeSantis are treating it, or spend four years learning why the conservative governor before you left office with a binder full of process and a state that is merely treading water.

Editor’s note: This article was published in the American Mind.

FAA Bureaucrats Make It Harder For Volunteer Pilots To Help Cancer Patients

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Washington must not forget the grassroots



Football is back. The first harbinger of fall is just around the corner, bringing game-day tailgates, late-night bonfires, and hope that this just might be your team’s year to win it all.

Fueling this hope is a fresh round of hype videos getting folks excited for the season. For NFL and college football fans alike, these edits of last season’s highlights are just the thing to paper over last year’s disappointment and turn over a new leaf for the season ahead.

The real strength of the conservative movement is not in the ivory tower or stone colonnade.

One hype video broke out of the college football echo chamber with over 4.5 million views online. What about this video is so resonant? The message — and conservatives should take notice.

The video opens in the Auburn Tigers' locker room, where coach Hugh Freeze is giving a pep talk. “Life is more about others than it is yourself,” he begins. “What buys long-lasting purpose is you understanding selflessness and it being about something bigger than yourself.”

Hopefully every coach and every political movement understands teamwork relies on humility to achieve a larger goal.

He continues, “Tonight, I submit to you that there’s some family that drove from I don’t know where, parked five miles away from this stadium, and they saved all ... year long, just to buy a ticket, to climb to the top of that stadium and watch your tail play!”

As the music builds to a crescendo, Freeze screams the most potent line of the video: “YOU OWE THEM SOMETHING!”

In sports, as in politics, conservatives must recommit to playing for the fans in the cheap seats.

This does not mean rallying around the lowest common denominator or dumbing down conservative messaging. It means remembering why so many conservative advocates got into the trenches to begin with.

How many of those players in the Auburn locker room started as kids in the cheap seats?

How many conservative politicos began as local activists knocking doors, eating cold pizza, and making calls for something they really believed in? Conservatives need to recapture some of that grassroots energy and turn it into tangible victories for the people who put them in office.

We owe them something.

For those working in the professional conservative movement in D.C., that means less time on niche debates and more time delivering for average Americans who share conservative values and need a voice in the nation’s capital.

In 2024, voters elected President Trump and a Republican Congress on clear promises to improve the country. They expect results, just like the family saving all year for one game expects the team to leave it all on the field.

With the announcement that the House is canceling the final two weeks of session this month, it’s now or never. The House will have four days left to crystallize the case they’ll take home ahead of the November elections.

There is no shortage of opportunities to create contrast.

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The Chloe Cole Act from Rep. Bob Onder (R-Mo.) or the Title IX Clarification Act from Rep. Jodey Arrington (R-Texas) would undermine the gender industrial complex in medicine and women’s sports.

The southern border is secure in part because of President Trump’s executive orders; Texas Republican Rep. Chip Roy’s Permanent Trump Secure Border Act would codify the administrative changes necessary to preserve national sovereignty if another open-borders Democrat came into office.

House Republicans could take a major step forward toward a longtime conservative priority to close the Department of Education by passing the Less Bureaucracy, Better Education Package, codifying transfers of authority of duplicative education programs.

Passing any of these measures would be a good step to demonstrate that conservatives in Washington are moving the ball down the field for those cheering fans.

No one wants to cheer for a team calling it quits while there is still time on the clock.

Those in D.C. tend to bristle at giving credit beyond their elite circles, but it is time to acknowledge the real strength of the conservative movement is not in the ivory tower or stone colonnade.

It lies in every hardworking American chasing the American dream who still believes in the principles that have made America exceptional and votes to keep it that way.

We owe them our best. Let’s give them a reason to show up.

California regulates everything — except the trial lawyers exploiting it



California has perfected the art of regulating productive industries into oblivion while giving bad actors with the right political connections a free pass.

With more than 395,000 regulatory restrictions, the nation’s eighth-highest corporate tax rate, and an overzealous bureaucracy, Sacramento has driven hundreds of major employers — including Tesla, Oracle, and Hewlett Packard Enterprise — to business-friendly states like Texas.

California was once the crown jewel of American opportunity, but Sacramento’s progressive priorities have turned it into a cautionary tale.

Yet, while Gov. Gavin Newsom (D) micromanages everything from Hollywood film permits to brush-clearing fees, Sacramento looks the other way as an unchecked plaintiffs’ bar undermines local communities and distorts the justice system.

The latest investigative reporting out of Los Angeles County shows how far this racket has gone. Predatory personal-injury law firms have turned an environmental remediation challenge at the Chiquita Canyon Landfill into an unregulated gold rush, illustrating why the Trump administration and federal authorities must step in before those in Sacramento make the situation worse.

For years, the foothill community of Val Verde has dealt with noxious odors caused by an inactive portion of the Chiquita Canyon Landfill. The landfill operator tried to act as a responsible partner: complying with environmental guidelines, coordinating with multi-agency response teams, and providing nearly $25 million directly to affected local residents through a community relief fund.

Rather than encouraging a constructive resolution, a chaotic web of overlapping state regulators — including South Coast Air Quality Management District, L.A. County Public Works, and the Regional Water Quality Control Board — paralyzed the site with conflicting mandates, ultimately forcing the critical facility to halt waste intake.

Rather than protecting residents, progressive governance turned Val Verde into what locals described as the "Val Verde Hunger Games.” Text messages uncovered in court filings revealed Downtown L.A. Group boasting "PackemRackemStackem" and demanding recruiters "Get em for me ... all of them," leading to thousands of dubious claims that the landfill’s attorneys have flagged as infected with misconduct.

This dynamic is emblematic of California’s broader livability and business environment crisis. Sacramento imposes the nation’s highest income tax and an annual $800 LLC fee on entrepreneurs, yet allows predatory litigation mills to exploit vulnerable, non-English-speaking residents for 40% to 45% contingency fees.

Overregulation does not stop trash from being generated; it merely shifts waste to distant facilities, spikes consumer hauling costs, and enriches opportunistic trial lawyers.

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When state and local bureaucracy paralyzed debris removal following Southern California’s wildfires, the Trump administration took decisive action. Under Executive Order 14181, federal authorities expedited cleanup operations and completed in just 28 days what state bureaucrats estimated would take over a year.

The Trump administration and the Environmental Protection Agency under Administrator Lee Zeldin must apply that same standard of execution to Chiquita Canyon. The EPA must supersede Sacramento’s overlapping alphabet-soup agencies, streamline the process under unified federal oversight, and ensure actual technical remediation takes precedence over regulatory extortion and predatory lawsuits.

California was once the crown jewel of American opportunity, but Sacramento’s progressive priorities have turned it into a cautionary tale where critical infrastructure is strangled and legal grift thrives.

If Sacramento refuses to rein in its rogue plaintiffs’ bar and fix its broken regulatory state, the federal government must remind Californians to restore that which Newsom destroyed: common sense.

My son’s disease progressed while the FDA waited



Birthdays should mark milestones, offer hope for another year, and remind us to cherish the people we love.

But on the first anniversary of the Food and Drug Administration’s decision to restrict access to Elevidys, a gene therapy for Duchenne muscular dystrophy, there will be no cake or candles in our home.

The only birthdays Duchenne families want to celebrate are the ones our children are still here to have. The FDA should help us light those candles.

My 14-year-old son, Ryu, is still fighting to reach another birthday.

A year ago, I was exploring Elevidys as a treatment that might help him live a longer, fuller life. Then, almost overnight, that hope disappeared. The FDA first halted use of the therapy entirely before restoring access only for boys who could still walk. Ryu, who already uses a wheelchair, was left behind.

By age 14, more than 82% of Duchenne patients use a wheelchair. After age 15, the share exceeds 90%.

I have spent my life living with Duchenne muscular dystrophy, a rare, progressive genetic disease that causes muscles to waste away and almost always leads to premature death. It has shaped every chapter of my family’s story. I watched my brothers, Angelo and Antonio, die from Duchenne in their early 20s.

I began considering Elevidys because I trusted the science and the physician who brought it to my attention. I believed my son deserved the same opportunity other eligible patients were receiving.

Instead, the past year has been heartbreaking.

Ryu’s disease has progressed. His breathing is weaker, and he relies on his BiPAP machine more than he did a year ago. Duchenne families measure time differently. Every lost ability is marked by a clock that never turns back.

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The FDA said it restricted Elevidys after reports of three patient deaths. Those boys died from liver complications, not complications caused by wheelchair use. Families like mine struggle to understand why patients with advanced disease lost access to a treatment because of risks that were not unique to them.

Safety must remain paramount. We are not asking regulators to approve every experimental therapy or ignore serious adverse events. Elevidys had already passed through years of research and clinical trials and had been administered to Duchenne patients before access was narrowed.

We are asking for something more modest and more humane: When a disease is progressive and fatal, families should be allowed to work with their doctors to decide whether the potential benefit justifies the risk for their own children.

The anniversary of the Elevidys restriction also marks the moment I turned 40 years of helplessness into action. I learned what an op-ed was and wrote my first one. I entered the intimidating world of social media.

On my first trip to Washington, D.C., I learned how to call an Uber and met with senators, staff members, other rare-disease mothers, and patients. I did not go because I wanted to become an activist. I went because I am a mother. I had to speak for my son and honor the memory of my brothers, who never lived to see the possibilities available to patients today.

My brother Angelo volunteered for experimental research in the 1990s, when almost no treatment options existed. He wanted future children with Duchenne to benefit from his courage. Years later, one of those children would be his nephew — my son.

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The FDA is entering a period of new leadership. The next commissioner should put patients first, recognize that rare diseases demand urgency, and trust families and physicians to make informed decisions together. Returning to the old approach would cost families the one thing no regulator can restore: time.

Hope has a birthday too. We celebrate it whenever a scientist makes a breakthrough, a doctor refuses to give up, a parent fights for one more chance, or the FDA chooses urgency over bureaucracy.

I pray this dark anniversary is the last time FDA policy leaves Duchenne families behind — and the beginning of a new era in which boys like Ryu have the chance to live as fully and as long as possible.

The only birthdays Duchenne families want to celebrate are the ones our children are still here to have. The FDA should help us light those candles.

New York’s home-care fraud scandal exposes Medicaid’s rotten incentives



Medicaid is federally funded and state-run, but the program’s beneficiaries often have the least say in who provides their care and what that care costs.

That’s a built-in flaw. States have every incentive to maximize federal matching funds while federal taxpayers bear much of the cost. The result pits state bureaucrats against Washington’s need to control Medicaid spending — and against taxpayers’ interest in stopping providers, insurers, and contractors from cashing in on weak oversight.

New York’s home-care scandal is not merely a contracting failure. It is a warning about Medicaid’s overall design.

That is why cosmetic Medicaid reforms so often produce more spending, more inefficiency, and more fraud.

Just look at New York.

Democrat Governor Kathy Hochul’s administration botched the reform of its roughly $11 billion Consumer Directed Personal Assistance Program, a Medicaid-financed home-care benefit, so badly that federal prosecutors came knocking.

The U.S. Justice Department recently sued the New York State Department of Health and Public Partnerships LLC, the program’s sole fiscal intermediary since 2025. Prosecutors allege that New York’s CDPAP reform, supposedly designed to reduce waste in a billion-dollar program, instead created conditions for an ongoing Medicaid fraud scheme.

Personal care — nonmedical long-term care provided in the homes of elderly and disabled patients — is especially vulnerable to waste and abuse. The reason? It’s difficult to verify that caregivers worked the hours billed or provided the services claimed.

“The service is delivered by unlicensed caregivers in private residences, usually with no on-site supervision,” Bill Hammond of the Empire Center has explained. “The risk is heightened when the aide is a friend or family member of the patient, which is allowed under the popular and rapidly growing [CDPAP].”

New York’s numbers show the scale of the problem.

In 2021, the state employed 138 home-health and personal care aides per 1,000 residents age 65 or older — more than double the national average. New York City employed 236 aides per 1,000 older residents. By 2024, the statewide rate had climbed to 171 aides per 1,000 older residents.

Home care was supposed to reduce New Yorkers’ reliance on nursing homes. Yet the share of elderly New Yorkers living in nursing homes declined more slowly than in almost every other state, while New York’s per capita Medicaid spending on nursing homes remained the highest in the nation and more than double the U.S. average.

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Over the decade leading up to 2025, hundreds of fiscal intermediaries emerged to process payroll for CDPAP lay caregivers and perform other administrative duties. These intermediaries eagerly tapped loosely supervised Medicaid dollars.

Many aggressively advertised the opportunity to become a CDPAP caregiver and get paid by Medicaid to care for a family member — eventually at the same legally mandated minimum pay as professionally trained home-care aides.

That helped fuel what Hammond described as “seemingly bottomless and unchecked demand for a costly Medicaid benefit, which has been rising almost 10 times faster than the growth of the state’s elderly population.”

In 2024, New York passed legislation consolidating CDPAP management under a single statewide contractor. The state awarded that role to PPL.

By then, CDPAP relied on nearly 600 intermediary firms, and enrollment had exploded from roughly 12,000 to more than 250,000 between 2015 and 2023.

By shrinking the bureaucracy, New York lawmakers claimed they would restrain CDPAP’s soaring costs. Once again, they promised greater accountability and hundreds of millions of dollars in savings.

They did not deliver.

According to the Justice Department, the procurement process for “one of the most lucrative contracts for administering a Medicaid program in the nation” was compromised from the beginning. Prosecutors allege that “PPL was preselected as the winner through a sham bid process.”

The transition from hundreds of intermediaries to PPL was also disorderly. An unrealistic timeline, evident to both PPL and the Department of Health, disrupted patient care.

Most important, prosecutors allege that “PPL and New York, without explanation, have disregarded key limits the contract imposed on the revenues and profits PPL was entitled to.” Those limits were “central to the goal of saving hundreds of millions of dollars through the CDPAP transition.”

PPL allegedly “siphoned millions of dollars of Medicaid funding,” with the state Department of Health complicit in the ongoing scheme.

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PPL can be replaced. But another company eager to rent-seek will inevitably take its place unless the incentive structure changes.

As long as federal taxpayers contribute anywhere from $1 to $9 for every $1 New York contributes to fund Medicaid for New Yorkers, state administrations and health officials will remain too complacent about the misuse of taxpayer money.

Any money recovered from this alleged scheme would be dwarfed by Medicaid’s broader improper spending crisis, which may have exceeded $1 trillion over the past decade.

New York’s home-care scandal is not merely a contracting failure. It is a warning about Medicaid’s overall design.

The program rewards states for spending more, obscures responsibility for waste, and leaves taxpayers chasing fraud after the money is gone. Overhauling Medicaid to restore accountability is long overdue.

The administrative state just took a major hit



The Supreme Court’s decision in Trump v. Slaughter is a major victory for constitutional government.

By restoring the president’s authority over the executive branch and overruling what remained of the mistaken Humphrey’s Executor precedent, the justices took an important step toward democratic accountability. The decision also opens a path for President Trump and future administrations to rein in the administrative state.

Americans should celebrate this ruling as a victory for self-government.

At the heart of the ruling is a simple constitutional principle: The president, as the elected head of the executive branch, must have authority to direct executive policy and hold executive officers accountable.

That authority is not merely an administrative convenience. It is the mechanism through which the American people exercise control over executive government.

Article II vests “the executive Power” in a single president and charges him with ensuring that “the Laws be faithfully executed.” Officers exercising executive power derive that authority from the president and must remain accountable to him.

Without meaningful removal authority, the presidency risks becoming little more than a figurehead while unelected officials pursue agendas beyond democratic control.

For decades, Congress has increasingly insulated parts of the federal bureaucracy from presidential supervision. The founders envisioned no such arrangement.

The expansive appeals processes and employment protections shielding many federal employees are well known. Less appreciated is how much of the current system emerged during the 1960s and expanded over the following decades, producing a bureaucracy increasingly insulated from elected leadership.

Whatever the intentions behind those reforms, the result has been to weaken the president’s authority to manage the executive branch and the people’s ability to govern themselves through elections.

The consequences have become increasingly visible.

A Merit Systems Protection Board survey found that only about two in five federal supervisors believed they could successfully remove an employee for serious misconduct. That finding shows how procedural barriers have eroded managerial accountability.

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The same culture was evident during President Trump’s first term, when career officials embedded policies contrary to administration priorities in guidance documents, subregulatory materials, and even formal regulations.

When executive officials deliberately frustrate lawful presidential policy, the president must possess adequate authority to remove them.

Predictably, critics warn that Slaughter will politicize the civil service and revive the spoils system. Those concerns miss the point.

President Trump has repeatedly said federal hiring should be based on merit, qualifications, and competence. His administration’s executive orders, rules, and regulations reject political loyalty tests in career hiring.

Merit-based hiring and presidential accountability are not competing principles. They are complementary.

A professional civil service should be selected because its members are qualified to perform their duties. But once entrusted with executive authority, those officials must faithfully execute the lawful policies of the elected president.

That’s far from “patronage.” It’s how representative government should function.

The administration’s Schedule Policy/Career executive order reflects that distinction. It applies to career employees in confidential, policy-determining, policymaking, or policy-advocating positions. Those employees remain merit-based career officials, not political appointees.

But senior career officials exercising substantial policy influence should not be able to use endless procedural protections to delay, frustrate, or undermine an elected administration’s agenda.

The Civil Service Reform Act was never intended to create permanent insulation for officials exercising broad executive discretion.

The administration has also appropriately tested constitutional errors by removing officials whose statutory protections conflict with Article II. Those cases have allowed courts to reconsider precedents that steadily weakened presidential control over the executive branch.

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In its 2026 Jackler and Jaroch decision, the Merit Systems Protection Board recognized that statutory employment protections cannot override Article II when applied to inferior officers exercising significant executive authority.

The Supreme Court’s Slaughter decision builds on that reasoning and on other precedent. It rejects the fiction that agencies exercising executive power can remain meaningfully “independent” of the executive.

Those who execute federal law must ultimately answer to the president.

Opponents will characterize the decision as a dangerous expansion of presidential power. In reality, it restores the constitutional structure the founders designed.

Americans elect a president to implement policies on immigration, the economy, national security, and countless other questions. If unelected officials can frustrate those policies through institutional resistance or procedural barriers, elections become less meaningful.

Accountability disappears because voters cannot determine who is responsible for the success or failure of executive policy.

The Slaughter decision restores that chain of accountability. It strengthens the president’s ability to direct officers exercising executive power while preserving a federal workforce hired on merit and expected to execute the law faithfully. That is neither radical nor unprecedented. It is the constitution's design.

The federal government exists to serve the American people, not to function as an independent center of political power.

By reaffirming presidential authority under Article II, the Supreme Court strengthened democratic accountability and helped ensure that executive power remains where the Constitution places it: with the president elected by the American people.

Americans should celebrate this ruling as a victory for self-government.

Elections cannot provide meaningful accountability when officials exercising executive power are insulated from the president voters chose.

Slaughter helps restore that constitutional chain: Executive officers answer to the president, and the president answers to the people.

Marty Makary left behind an FDA families learned not to trust



With so much bad news in the world, it is worth pausing for one encouraging development: Marty Makary finally resigned as commissioner of the Food and Drug Administration last week.

Makary’s tenure at the FDA was marred by internal scandals, forced resignations, dreadful morale, and record staff turnover. More important, he actively sandbagged President Trump’s push to expand clinical trials for rare diseases through the aptly named “right-to-try” framework.

Trump’s next appointee should restore the spirit of right to try and make safe, effective treatments available to children as quickly as possible.

The idea behind right to try is straightforward. Patients with rare conditions, especially those for whom conventional medicine has failed, should have the freedom to pursue experimental treatments that have not yet received full FDA approval. Families fighting the clock have little left to lose. Government should not stand between them and a potentially lifesaving breakthrough.

Makary did.

Members of the MPS community sent more than 10 letters asking Makary for a meeting. They got a form letter in return. Sen. Ron Johnson (R-Wis.) later announced an investigation into the FDA’s denials. Makary’s agency responded by claiming approvals were already “at their peak.” The Wall Street Journal took notice of the FDA’s foot-dragging last year, yet the agency kept rejecting relevant rare-disease treatments in early 2026, including RGX-121 and drugs from Biohaven and Saol Therapeutics.

That stonewalling forced families to escalate.

In March, more than 100 mothers and other advocates staged a mock funeral outside FDA offices. Dressed in black and carrying a real coffin, they sought to draw attention to a group of rare metabolic disorders known as mucopolysaccharidoses. These disorders can show up as mild symptoms such as depression or hyperactivity, or as devastating conditions such as heart disease and skeletal abnormalities.

Many MPS disorders still have no approved treatments, even though they can severely diminish children’s quality of life or kill them outright. The FDA’s regulatory process serves a legitimate purpose. But when a bureaucracy grows so rigid, self-protective, and arrogant that it blocks desperately ill children from access to promising therapies, it stops functioning as a safeguard and starts functioning as a death sentence.

Mark Dant of the Ryan Foundation told Newsweek that some of these drugs were denied because of the FDA’s institutional “dislike” of the accelerated-approval pathway. “For decades we waited for science to find our tomorrows,” he said. “Now it has, and bureaucrats within the agency we pay for are keeping those treatments from our children. We know they are there. … We just cannot reach them.”

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Makary’s resignation will not undo the damage. But it does create an opening. We may not yet know what the FDA’s next leadership will look like, but Trump’s appointee should restore the spirit of right to try and make safe, effective treatments available to children as quickly as possible.

Across the world, in the nation of Georgia, parents have staged a protest lasting more than 500 consecutive days, maintaining a round-the-clock presence outside the main government building in Tbilisi. They are willing to risk everything to give their children the best chance at life. Americans should not have to camp outside federal offices for 500 days to get their government to listen.

The new FDA leadership must explain denials of right-to-try clinical trials with enough specificity that sponsors and families understand what evidence could change the decision. Patient and caregiver testimony should shape decisions early, not get folded in at the end as a token gesture. And Congress must demand transparency without turning each drug review into a partisan circus.

Children’s lives are not bargaining chips. The FDA exists to serve the public, not to protect its own bureaucracy from embarrassment. If Makary’s departure opens the door to that truth, families battling ultra-rare diseases may finally have reason to hope.

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How This Conservative Group Is Breaking The Bureaucratic Bloat Wrecking Red States

'The bureaucratic control that the left has is a huge problem ... and so we're trying to give [the conservative movement] a laser-focused strategy for [combatting] this,' SLI Founder Noah Wall told The Federalist.