In its current term, the US Supreme Court will decide Food and Drug Administration (FDA) v Alliance for Hippocratic Medicine (AHM), a case challenging FDA’s regulation of mifepristone, a drug involved in more than half of US abortions. Many have drawn attention to the case’s clear implications for reproductive justice, as well as its potentially destabilizing influence on the drug development and innovation ecosystem.¹ It is also important, however, to understand AHM’s broader context, which is likely to influence both its outcome and its impact. We focus on 3 elements of that critical background, including an agency that sometimes struggles with the tension between scientific judgments and political considerations, deepening attacks on administrative agencies and FDA in particular, and questions about state authority over abortion vs FDA’s authority to determine which drugs may be marketed nationwide.