On Trust, Power, and the Physician's Covenant

This week revealed that famous online physician to the ultra-rich, and major influencer Peter Attia cultivated a close friendship with convicted trafficker and abuser of underage girls Jeffrey Epstein, continuing for years after Epstein's conviction. 

One email in particular indicates Attia knew what he was doing was deeply wrong. He quips that the hardest thing about being friends with Epstein is that his “lifestyle is so outrageous and yet I can’t tell a soul.”

Trust

When you walk into a doctor's office, you're not just entering a transaction. You're entering a covenant.

A contract says, "I pay, you provide a service."

A covenant says, "I let you see me at my most exposed, and you use your power, knowledge, and influence to protect, not exploit."

I realize that many people don't experience medicine this way at all. They experience it as rushed visits, opaque decisions, and being at someone’s mercy. They wonder if doctors sometimes choose the drug they get a kickback from, or the decision that moves them on quickly to the next patient, rather than the slower, messier work of actual listening and considering possibilities.

Trust has already been frayed through multiple experiences.

Is this different?

So when I talk about covenant here, I'm not asking you to believe in a fairy tale about saintly doctors. I charge cash for my own work. I am not outside this tension. I also understand that by living in the world we almost inevitably participate in some ugliness.

But there is still an unbridgeable distance between everyday compromise and what Attia did:  choosing intimacy with someone whose whole life was built on exploiting the vulnerable, and, no less, in order to gain power, fame, and fortune.

When a prominent doctor actively courts a man widely known for his despicable actions, it desecrates a privilege physicians have been granted. It creates a setting that makes the work of doctoring impossible for the rest of us.

This is not credible as passive tolerance or naïveté. This was pursuit. This was a physician choosing proximity to a predator of women and children, over and over again for years, while building a public brand telling you what is good for you.

Influence makes it worse

Peter Attia didn't just care for patients. He shaped the thinking of thousands of clinicians and millions of laypeople. Many physicians recommended his work to patients as a trustworthy source.

The betrayal lands in two directions:

First: "You were our teacher, our peer, our voice in the public square. Your actions therefore are causing powerful harm.”

Second: "By amplifying you, we unintentionally vouched for someone whose moral compass around vulnerability and power was catastrophically broken."

Many of us feel like we helped a stain spread far and wide. We can’t always recognize danger, and that’s a painful realization.

I feel shaken

If you already feel that doctors rush you, sell you things, or withhold information, you're not imagining the power imbalance. That's exactly why this kind of revelation hits so hard: it confirms your worst fears about how lightly some of us hold your vulnerability.

I didn't need him to be my doctor to feel shaken. The knowledge that he could write those emails, make those choices, keep that company while holding himself as the authority on discipline and well-being—it makes me question what we've been willing to overlook in the name of expertise. And we missed it, even though it was extreme. The tone of those emails—the pursuit, the flattery, the crass banter, the choice to prioritize that meeting over his own family in crisis—suggests Attia found in Epstein something he yearned to be near.

Takeaways

For clinicians: Be ruthlessly honest about the power you hold, and about the ways money, status, and access tug on it. Say no sooner. Walk away sooner. Refuse to lend your credibility to people whose relationship to the vulnerable terrifies you. Basic decency is critical. This is a demanding profession. Work at keeping people’s trust.

For patients: Treat character as data. If a doctor's public life shows contempt for vulnerability or fascination with predation, that is relevant to how you may benefit (or not) from them, even if they're technically competent. You have every right to expect basic decency from us.

And yet, we are human. We will let you down. We will betray some of you. 

But we can—we must—draw the line at overlooking harm or actively seeking harm to any human being

Will we ever see this again?

There may not soon be another Epstein. But there will always be new versions of the same temptation: to cozy up to power that feeds on vulnerability and tell ourselves it's harmless, or private, or "just networking."

The covenant isn't tested by the average day in clinic. It's tested by what we do when proximity to harm looks like an opportunity.

The lesson for me isn't that one man failed. It's that trust in medicine lives or dies in the quiet choices we all make about whose harm we minimize, whose power we admire, and whose side we take when there's something to lose.