Makary, a professor at Johns Hopkins University, is the latest in a string of Trump nominees who have declared the U.S. health system “broken,” vowing a shakeup. As part of a flurry of nominations late Friday night, Trump also tapped doctor and former Republican Rep. Dave Weldon of Florida to lead the Centers for Disease Control and Prevention. Fox News contributor Janette Nesheiwat, meanwhile, is set to be the nation’s next surgeon general.

Some of Makary’s views align closely with the man who is poised to be his boss — prominent environmental lawyer and anti-vaccine organizer Robert F. Kennedy Jr., whom Trump put forward as the next U.S. Department of Health and Human Services secretary.

In books and articles, Makary has decried the overprescribing of drugs, the use of pesticides on foods and the undue influence of pharmaceutical and insurance companies over doctors and government regulators, points that Kennedy has also harped on for years.

Trump said Makary, trained as a surgeon and cancer specialist, “will restore FDA to the gold standard of scientific research, and cut the bureaucratic red tape at the agency to make sure Americans get the medical cures and treatments they deserve.”

Headquartered in the Maryland suburbs outside Washington, the 18,000 employees of the FDA are responsible for the safety and effectiveness of prescription drugs, vaccines and medical devices as well as a swath of other consumer goods, including food, cosmetics and vaping products. Altogether those products represent an estimated 20% of U.S. consumer spending annually, or $2.6 trillion.

Makary gained prominence on Fox News and other conservative outlets for his contrarian views during the COVID-19 pandemic. He questioned the need for masking and, though not opposed to the COVID-19 vaccine, had concerns about booster vaccinations in young children. He was part of a vocal group of physicians calling for greater emphasis on herd immunity to stop the virus, or the idea that mass infections would quickly lead to population-level protection.

The Centers for Disease Control and Prevention estimated that COVID-19 vaccinations prevented more than 686,000 U.S. deaths in 2020 and 2021 alone. While children faced much lower rates of hospitalization and death from the virus, medical societies including the American Academy of Pediatrics concluded that vaccinations significantly reduced severe disease in the age group.

Makary has lamented how drugmakers used misleading data to urge doctors to prescribe OxyContin and other opioids as low-risk, non-addictive pain relievers. That marketing was permitted under FDA-approved labeling from the 1990s, suggesting the drugs were safe for common ailments like back pain.

In more recent years, the FDA has come under fire for approving drugs for Alzheimer’s, ALS and other conditions based on incomplete data that failed to show meaningful benefits for patients.

A push toward greater scrutiny of drug safety and effectiveness would be a major reversal at FDA, which for decades has focused on speedier drug approvals. That trend has been fueled by industry lobbying and fees paid by drugmakers to help the FDA hire additional reviewers.

Kennedy has proposed ending those payments, which would require billions in new funding from the federal budget.

Other administration priorities would likely run into similar roadblocks. For instance, Kennedy wants to bar drugmakers from advertising on TV, a multibillion-dollar market that supports many TV and cable networks. The Supreme Court and other conservative judges would likely overturn such a ban on First Amendment grounds that protect commercial speech, experts note.

Less is known about Trump’s pick for the Atlanta-based CDC, which develops vaccines and monitors for infectious disease outbreaks.

Weldon is a staunch, self-described “pro-life” Republican. Legislation he introduced more than 20 years ago outlawed human cloning. He also brokered a deal with lawmakers to bar patents on human organisms, including genetically engineered embryos. Weldon also advocated against the removal of the feeding tube for Terri Schiavo, a Florida woman whose family battle over her vegetative state turned into a national debate.

Weldon’s nomination is likely to placate some anti-abortion advocates, who have been concerned about Trump’s nomination of Kennedy, a longtime Democrat and proponent of abortion rights, as the nation’s top health official.

Weldon retired from his congressional seat in 2008, after 14 years in public office. Earlier this year, he lost in a GOP primary for a seat in the Florida Legislature.

If he’s confirmed, he’ll be in charge of more than 13,000 employees and nearly 13,000 other contract workers.

Nesheiwat, meanwhile, will oversee 6,000 U.S. Public Health Service Corps members if the Republican-controlled Senate approves her nomination as the surgeon general. She is a medical director for an urgent care company in New York. She appears regularly on Fox News and has expressed frequent support for Trump, sharing photos of them together on her social media pages.

Surgeons general also have the power to issue advisories, warning of public health threats in the U.S. Those advisories can influence how the government, public and medical community respond to health crises in the country.