Epstein Files: A Functional Medicine Response

This isn’t the podcast I expected to release this month. Not even close. But, in the wake of the most recent release of Epstein-related documents, things took a turn. In the face of what is such a colossal abuse of power over young women, it’s easy to feel paralyzed. In fact, along with a deep sense of pain, it was one of the first feelings that I felt as this new wave of information washed over us.

Two bright lights in all this heavy fog are Drs. Sara Szal and Brad Jacobs, both physicians with deep integrity for whom I have the utmost respect. Their clarity of voice and thinking in their most recent communications thankfully jolted me out of any inertia–I knew at once this was a dialogue I wanted to support and hold space for. In this conversation, which I expect some listeners might find difficult at times, we don’t just cover the questionable moral judgments among those even in our field who appear to have supported Epstein and his activities, we tussle with what needs to change to make things safer for women. These are hard conversations about challenging issues. If we think that this falls outside the realm of functional medicine, we are sorely mistaken–at a minimum there are reams of data on the impact of trauma on chronic disease and “stolen” longevity. I encourage you to listen and share your thoughts. ~DrKF

Trigger Warning

Please be advised that this episode discusses the topic of sexual abuse, which may be a sensitive and difficult topic for some listeners. If you or someone you know is a victim of abuse, please seek help immediately. Resources for support can be found in our show notes. Remember, you are not alone and there is always help available. We hope that this episode can provide some support and insights for those who might be struggling.

Ethics in Healthcare: When Influence Outruns Accountability

We want to be clear; this is not a takedown episode. This is a values-based conversation about ethics, power, and responsibility in healthcare. The goal is not to attack individuals, but to examine what happens when influence, money, and platforms grow faster than accountability.

Sara Szal, MD and Brad Jacobs, MD, join New Frontiers in Functional Medicine to respond to the latest round of so-called “Epstein files,” released in January 2026. Together with Dr. Kara Fitzgerald, they discuss integrity, moral judgment, and accountability in medicine, including the unique responsibility of mandated reporters and the ethical standards we should expect from healthcare leaders with large platforms.

Importantly, the conversation expands beyond headlines into what needs to change systemically to better protect women and children, from improved training for healthcare professionals to practical, trauma-informed approaches for identifying potential signs of abuse in clinical settings. We also explore how clinicians can support patients and clients in identifying and interrupting intergenerational cycles that may perpetuate misogyny and harm, while still promoting purpose, authenticity, and healthy identity development.

We discuss:

In this episode of New Frontiers, learn about:

Dr. Kara Fitzgerald: Hi everybody, welcome to New Frontiers in Functional Medicine, where I continue to interview the best minds in functional medicine. But today we are having a different conversation. Of course, we’ve all been deeply touched by the horrors that have come forth with the release of the Epstein files and I know probably all of us have been moved deeply with the revelation around Peter Attia, Deepak Chopra and other scientists and physicians. For me, two of the clear voices speaking directly and powerfully to this within the functional medicine community are Dr. Sara Szal and Dr. Brad Jacobs.

Dr. Kara Fitzgerald: Let me give you a little background on both of them and then we’ll just jump right into this conversation. And also, this is a time when I want to hear from you, so please email, IM us on whatever social media platform you’re on. I would like your thoughts, whether you’re a clinician or provider in this space or just a person who’s been influenced by this. Of course we all have.

Dr. Kara Fitzgerald: Okay, we all know Sara, formerly Sara Gottfried, now Sara Szal, is a bestselling author of many different books. She’s a board-certified gynecologist and a well known voice in women’s health for many years, especially perimenopause and menopause through her clinical work, education and online presence. She’s helped bring much needed visibility and nuance to conversations around muscle health, metabolism, mood and cognitive vitality for women in midlife. And in this conversation, let me tell you, she has some very good thoughts, powerful thoughts, around screening adolescent girls in a way that isn’t done. And we have a frank conversation around how the medical system has failed these victims.

Dr. Kara Fitzgerald: Dr. Brad Jacobs brings another powerful lens to this discussion. He’s a Stanford-trained physician and outcomes researcher who is deeply in men’s health and longevity, looking not just at physiology, but at identity, resilience, and what it means for men to show up in the second half of life. His work bridges precision medicine with behavior, culture, and purpose. So again, we’re going to dive deep in this conversation. It will be a little bit painful for some of you, so take note. You may opt not to listen to it or to listen to it in chunks. But again, I would just really love to hear from you. This is a conversation that we all need to be having together as a community.

Dr. Kara Fitzgerald: So welcome to New Frontiers both. Not quite my usual enthusiastic energy around having two fabulous human beings next to me in the virtual arena because we’re talking about something pretty challenging. We’re of course going to talk about medical and scientific leaders that are in the Epstein files. This moved my team deeply, and myself, when it came out that Attia was involved, to the extent that he was in the Epstein world. It moved us deeply, and there’s a sense of powerlessness, I think. My first reaction was just a really deep-seated pain, and where do we go? What do we do? How do we think about this? In fact, it felt to me a little bit like when COVID happened, SARS, it didn’t have a name. When people were dying and we didn’t know why, and the world was closing down.

Dr. Kara Fitzgerald: One day it was one thing, and then after that, it became something else. It was very difficult for me and our team, just those who were influenced by his work and so forth. But immediately, Sara, I came across your voice: clear, loud, strong, and I was moved. So I just want to share a little bit about what you said less than a week ago.

Dr. Kara Fitzgerald: You said, “I’m cautious about speaking up about another physician’s behavior unless it causes harm, or appears morally or ethically egregious. I’m breaking my silence on something the medical system and longevity industry cannot ignore. Peter Attia MD maintained an active friendship with a known pedophile, and expressed concern about Epstein’s legal troubles, not his victims. This isn’t just about crude comments regarding female anatomy, this situation is about the foundation of medical practice: DO NO HARM.” And then you said “This isn’t cancel culture, it is accountability culture.”

Dr. Kara Fitzgerald: I immediately liked your post and it felt deeply inadequate, by the way. Hearing your strong voice, and later your voice, Brad, as a physician yourself. But your focus on men’s well-being and hearing your voice come in and talk about the stain that this was on men, on men in powerful positions, men in medicine, and just in your own movement, through thinking about it from the male perspective. Immediately what I felt like I might be able to offer is this platform to have a frank dialogue.

Dr. Kara Fitzgerald: So I want to thank you both for making time. I know, Sara, you’re in the middle of a book. I’ve known you for many years now and when you’re writing a book, it’s no joke. So I appreciate you both making time. And I want to hear what prompted this movement into really putting yourselves out there in such a bold and direct way?

Sara Szal MD: Thank you so much, Kara. What you read was from Sunday, February 1st, I believe. And it was a few days after Peter Attia’s documents were released with the Department of Justice. And when I first heard about it, I was alarmed, I was saddened and somewhat surprised. But my first reaction, and I want to own this, was to wait for someone else to do the journalistic deep dive. And so when I first heard about it, we were at the airport at LAX coming home from a weekend and I went to see which news outlets were breaking about this. And what I saw was not anything reputable and so I thought, well, I’ll wait because that’s what we tend to do in medicine. We tend to be very cautious and and to continue with business as usual until we were absolutely forced to speak up or to change our behavior.

Sara Szal MD: So that was my first reaction. And I remember, I’m at LAX, I posted about some data on GLP-1s and how they reduce dementia in people with diabetes and one of the first comments I got was, are you going to prattle on about your usual topics or are you going to actually speak up about Peter Attia? I really took that comment to heart and that was when Brad and I—actually you did it first. You dove into the Department of Justice files and you searched Peter Attia and you got the 1800 mentions, and so we started looking at it together. So do you want to dive in with your response?

Brad Jacobs MD: Yeah, I think like most of us the first moment was freeze, like this can’t be true. Is this true? What does this mean? And we felt like, or at least I felt like, this is secondhand information. I had heard about this website where you can look. I had never really felt motivated to look, but I said, this is a colleague, this is a physician, this is a man.

Sara Szal MD: The context felt different.

Brad Jacobs MD: Yeah, it felt personal so that’s when we dove in. It’s quite a good database, frankly, and you can see literally all the emails. You can read them yourself so I felt like we don’t need someone else to source this who’s a professional, who’s a journalist. We have direct access. So we went in and started looking at it and we were appalled. And I particularly am appalled, as a white man of privilege, to see someone of similar orientation abuse his power and then put himself out there as a wellness guru. I struggle with someone who’s—I think, a white man of power and privilege and then a physician—I think each of those categories requires much more accountability.

Dr. Kara Fitzgerald: As you’ve stated beautifully, “asymmetric accountability”, really.

Brad Jacobs MD: Yeah.

Sara Szal MD: It’s part of the social contract, isn’t it, Kara, that when you have as much influence as Peter Attia has had, you know he’s sold three million copies of Outlive, he’s got this medical practice, and I have patients that have been in his medical practice. He’s got a lot of influence. And when you see this documented relationship with a predator, someone who took this plea bargain in 2008 which was public record and was a registered sex offender, it just brings up a lot of questions about their judgment, about their morality, about their ethical decision making, about what they knew. Did he take research funding from Epstein? There’s still a lot of questions that were not answered in his statement.

Dr. Kara Fitzgerald: Of course. Many.

Brad Jacobs MD: Yeah, and it’s through this conversation that at some point it’d be good to talk about what does it mean to admit fault, and maybe use Peter Attia as a case example of what went well and what was, in my mind, very limited about how one accepts fault for what they’ve done.

Dr. Kara Fitzgerald: He is collegial. You know, I’ve certainly shared the stage with him and somebody asked me, were you surprised? And I said, in fact, yeah, I was surprised. I was surprised. So Brad, I want to start with you. How does this happen?

Brad Jacobs MD: In my mind, it’s a thirst for power, and you’re willing to subjugate your values and your principles in that pursuit. And he’s not alone. Clearly, there’s lots of people that have been teed up. But again, I just want to go back to—and this is—I’m running a men’s group, and in that men’s group there are people that were calling me out. Like, what are you so upset about? Why do you keep talking about this thing? And these are men. And I said, really? And he’s like, well, why do you care? And for me, it’s about him being a physician and the accountability, and I hate to say it again, already, in this podcast, but it is. It’s all about that.

Brad Jacobs MD: And it’s not even so much that he says, I go through withdrawals when I can’t be near you and it’s not so much about all the other things he said, even like comments around—There was some comment about why do we need to let women live beyond the reproductive years? Some completely misogynistic comment. The comment about… How do I say this? Well, I’ll just say what he said which is something like, eating pussy is low carb and gluten content is unclear. So it’s a joke. Yeah. It’s like saying to an alcoholic, encouraging them to drink alcohol. This is way worse. It’s predatory. But as a physician, there’s a responsibility that he completely crossed. And for me, that was the line of like, this is not OK. This is an abuse of power, but it’s also you’re enticing him to go back to this addiction that’s predatorial on minors?

Sara Szal MD: Yeah, it’s an interesting question about what does the behavior tell us about him? In some ways, I think it’s important to talk about Peter Attia, and it’s also important to talk about the larger problems that the Epstein files are pointing to directly with a medical system that failed the children that were part of the sex trafficking. But then indirectly with all of these powerful men, including a number of physicians, Deepak Chopra MD, Paul Conti MD, as well as Peter Attia.

Dr. Kara Fitzgerald: Oliver Sacks.

Sara Szal MD: Oliver Sacks. Yeah. One of the things that I feel when I have listened to Peter Attia’s podcast is I feel dysregulated. I feel dysregulated by the way he parses data and there’s kind of an abrasiveness to the way he talks about science that I find offputting. But I feel like dysregulation is a big part of what I see with him. Like I see a lot of dominance behaviors and it reminds me of your work in your TED talk talking about masculine overcompensation. I think that’s part of what is at play here. What do you think?

Brad Jacobs MD: Yeah, I think it’s emblematic of an inner sense of lack, just in general, beyond Peter Attia. People have a sense of not feeling love or insecurity and they’re trying to then satisfy this thirst by going outward. And what do we recognize in society? Power, money, fame, and trying to achieve that, and trying to get power money and fame. And there’s lots of examples of that and we can talk about the boundaries of what’s okay and what’s not, but when it comes to what this man, Jeffrey Epstein, did, I think that’s beyond our ethical boundaries, I think universally.

Brad Jacobs MD: But here we are with these powerful people that have—I’m talking about the princes and presidents and others that have ruled or are currently ruling—and what’s that about? And in part it might be, like one of the folks in my men’s group had mentioned, what’s the thing they can’t get? What’s enticing? Oh, underage women. Well, that’s something I can’t get. And he has access to that. And as perverse as that sounds, there’s some truth to that fact that for someone that has everything, this is something that creates a mystique. And living and walking in the shadows and allowing that to happen. And so for it to be called out, I think it’s a time for people to show up and speak to their truth. And I wish Peter Attia, and I would invite him, if he happens to listen to this conversation, to really go deep and be public about what is it that drew you to the fire.

Brad Jacobs MD: You’re ashamed. Okay, a 10-year-old can tell us that they’re ashamed. They feel bad. But if you’re a man and you’re reflective and you’re contemplative and you’re trying to seek wisdom for yourself and help others, go deeper. What is it that attracted you there? And how are you going to reconcile that? How are you going look at your daughters and your wife with any dignity without being able to go there? I did that myself, you know, and I spoke to that in my TED talk, about my relationship with my daughter where I was role-modeled to dominate over, by my father. And when my daughter was younger, she was pushing back, she had her own ideas. And that was to me a personal disrespect and I found myself, as she elevated, I elevated my emotions.

Brad Jacobs MD: And I’ve worked and apologized and then gone and explained to her where this came from and how I’m going to work on that. She’s 20 now and we’ve come a long way, but it required that. It doesn’t feel good. You feel embarrassed, you feel bad. You mentioned a quote from Pema Chödrön, you’ve got to step into the fire if you have any hope for release of your own suffering.

Dr. Kara Fitzgerald: I was going to ask you, Brad, why you are different, why you have accountability, why you take your role as teacher and physician seriously. I would say that you have adopted asymmetric moral responsibility, but you’ve just explained it’s because— I mean, you weren’t walking in the direction of the people in the Epstein files, but you had your own journey of reckoning in relationship to your daughter and she sounds like she must be really powerful if she held that mirror up to you. She sounds like a badass. We all have daughters here, by the way. All of us. Yes. And that’s important. And we’ll get to that, Sara, in a minute and talk about the medical system and girls.

Dr. Kara Fitzgerald: So she held this powerful mirror up to you and you decided to take that in. You decided to hear it. Why?

Brad Jacobs MD: I feel like our children are our best teachers. They’re the little Buddhas running around and they speak their unfiltered truth. And if you’re not willing to hear the truth and you go hide in the shadows– I’ve been a seeker since I was a kid and I’m always desiring to be released from our suffering that we all experienced and so that’s that path. And there’s shame and embarrassment about how I behaved. I think of myself as a striving, amazing father, and always trying to be better. So I think being called out that way was really shocking and hit my system and I felt the last thing I wanted was to harm my daughter.

Brad Jacobs MD: But I do feel like there’s some depth there for us, particularly as men. I felt it as disrespectful. I felt it as emasculating. Here’s this little girl that’s controlling the situation, not listening to me when she was a teenager and had her own views and would storm off and slam the door or whatever. And then I’d find myself storming into the room and maybe slamming a door too. That was dysregulated. So being called out and you’re either willing to face it—it takes the courage frankly as a man. You either have the courage or you don’t yet have the courage. You’re too caught up in your own delusions.

Dr. Kara Fitzgerald: How do we foster space for men to be able to have that courage?

Brad Jacobs MD: I think it requires some safety for them. They need to know they’re not going to be torched over it. I think people in the public arena have a different level of responsibility and so they’re going to be torched over it because they’re in the public.

Sara Szal MD: And physicians have a different level of responsibility.

Brad Jacobs MD: I think even a higher level. And I think that’s number one. Number two, they need to learn how to regulate their system. And like I mentioned before, rather than shaming men, we need to help them learn how to regulate their system so that they have the capacity to then show up and look at themselves and have the resilience in place to look into the hard stuff. And a lot of men don’t have those tools. They either don’t have that awareness, as child many men were shut down for having any emotions, so they learned to detach from emotions, so they don’t even recognize when they have them.

Brad Jacobs MD: When I work with lot of men and I ask them, how are you feeling, they have no idea. Or if they know they’re feeling upset, they can’t put words to it. So there’s that. I think the awareness piece is super important. And then the tools to work with that regulation, whether it’s breath work or being in nature, playing guitar, whatever it is for them that helps them feel centered and grounded.

Dr. Kara Fitzgerald: Right, and the willingness, I think, to just even ask those early questions. Maybe the, who am I?

Brad Jacobs MD: I think for that, frankly, it often requires being called out, or reaching some version of bottom. Like an alcoholic, when they hit the bottom they’re then willing to do the work. There’s got to be several examples of that with clients, you know, one guy in particular, he was going to lose his marriage and he was a functional alcoholic but he was an alcoholic and he’s been nine years sober. But that’s what it took.

Sara Szal MD: Do you think that Attia is being called out sufficiently? Part of what I get concerned about, I’m an optimistic person, but this feels like business as usual in medicine, honestly. You know, there’s a lot of men in history who’ve had problematic relationships with felons, with predators and calling out Peter Attia— You know, I saw his follower count on Instagram go from 1.7 million to 1.6 million. Like, is that really impactful? And creating safety for him to talk about his relationship with Epstein and to answer some of these questions, be held accountable beyond the very limited drips that we got on X.

Sara Szal MD: If his relationship with Epstein was as casual and didn’t include financial connections or funding for his research, then he would be cleared by having that kind of accounting. And I think also the absence of the full accounting is what creates speculation and concern, especially for people who’ve been failed by the medical system. You know, here I think about those who are survivors of sexual abuse and who’s looking out for them? Who’s holding these men accountable?

Dr. Kara Fitzgerald: I want to say again that you put your voice out there exquisitely clearly to talk about a medical system absolutely failing girls in such an exquisitely painful way. I want you to talk about that and I want to make sure we circle back too and talk about some of the other powerful voices that have stepped forward and contributed important things, both men and women in our space. I’ve been focusing more on our community, doctors and so forth, but yeah, talk about how you see the medical system just deeply failing.

Sara Szal MD: Well, I think there’s a couple of concepts that get confused here. When we’re talking about Peter Attia and Deepak Chopra and we’re looking at their emails and texts with Jeffrey Epstein and what I would call fawning behavior, that’s an ethical decision that those guys made to lend their social capital to a predator. So that’s one piece. The other piece is the clinicians who saw these girls and they had a direct obligation—legal, ethical, moral—to report what was going on and to protect these girls. And I’ll be honest, diving into the Epstein files and reading dozens and dozens of emails, there’s a limit to how much my system can take.

Sara Szal MD: And so I’ve read some of the testimonies of victims that have come forward, and a lot of my writing is based on what they described. But they all describe going to doctors, some talked about their abuse and that they were treated with lithium. Some of them got treated with Xanax. The ages of these survivors whose accounts I read—I know there were younger children involved and also boys—but the girls, now women, who gave their testimony were as young as 14 with multiple STIs, sexually transmitted infections. To me, that’s an opportunity to save these girls when they interact with the medical system. And that is a medical system that is not set up to protect them adequately.

Dr. Kara Fitzgerald: Yes.

Sara Szal MD: To maintain my license in the states where I’m licensed, I have to pass this exam related to mandatory reporting for even the slightest suspicion of sexual abuse. But there’s a way that not all clinicians take that as seriously. So it feels like a major failure, systemically, of the medical system. I don’t think this is all about Peter Attia and Deepak Chopra.

Dr. Kara Fitzgerald: That’s right.

Sara Szal MD: It’s pointing to the ways in which our culture and our medical system fails children. So I feel strongly about that. And as a gynecologist who’s seen adolescents, when I think about the girls that I’ve taken care of who were 14, 15, 16, asking for birth control, my first question was not, are you safe? It is now, but that’s the kind of training that we need to be providing.

Dr. Kara Fitzgerald: Yes. Very, very, very important point. Just incredibly important point. There’s some very strong voices that have come forward and spoken clearly. Dr. Mary Claire Haver posted really painful, but clear statistics sort of juxtaposing the longevity pursuit with child sexual assault and the data on that basically taking the option of longevity away from those that have experienced childhood sexual assault in massive massive cohorts, massive databases. Aviva Romm and others, kind of calling out perhaps the influencer sort of ‘bro wellness’ culture, as she calls it, in general. There has been this change that’s occurred in this influencer space that we exist in. What are your thoughts there?

Sara Szal, MD: (32:43) Well, I really appreciate the other voices. I’ve known Aviva a long time. I don’t know Mary Claire, but Aviva speaks to patriarchy in a really important way, which is really at the root of all of this. And patriarchy is not just men, it’s power over. And I think Aviva speaks to it really eloquently. One of the things that she’s speaking to is for those that are defending Attia or who are telling us women who are speaking up to shut up or take a chill pill—I’ve been told both of those things many times over the past week—what are you protecting? You’re not protecting girls. You’re protecting the status quo. And it’s atrocities, like the Epstein case, that point to us how patriarchy still shows up daily in our lives and the work that still needs to be done.

Dr. Kara Fitzgerald: Yes.

Sara Szal, MD: So I appreciate this point you’re making about Mary Claire and how longevity is stolen from these victims. And you you’ve published incredible work on longevity and how you can turn it around with lifestyle medicine. And I just wrote a book about trauma and how it is associated with 45 different chronic diseases, and for many of which, accelerated aging is a critical part of that. So I take that point too. I think it’s an important way to frame this. As the man in the audience here, what are your thoughts about, kind of, the manosphere and patriarchy? And how do we hold all these complicated threads?

Brad Jacobs, MD: At one level it’s nuanced, really super nuanced, I feel like. And on the other level, it’s pretty simple because building out this framework around healthy masculinity, what that means. And there’s the traditional views on that, which is that I’m strong and I’m a protector and I provide, I’m provider, I’m decisive. And then the shadow parts of that is, and I dominate, and in the setting of conflict I will power over. I will dominate and I get rewarded for that. And culturally that is rewarded, if you look at the politicians in power, right now in particular. And also, the consequence is, I detach emotionally and I’m shut down or I rage. So what’s the anecdote to that? I think a lot of people feel what I’ve witnessed, what I’ve lived through personally in the shadow of growing up in that, is, well, I’m going to surrender my power. I’m going to allow my partner, or put myself in a workplace, where I accommodate because my needs aren’t as important as the other and I’ve seen this go sideways.

Brad Jacobs, MD: I’m emotionally available, I’m present, I’ve refined my emotional skills, but I’ve lost my own sense of purpose and my North Star. But I think that isn’t the antidote. I mean, that’s sort of the yin-yang. I think it’s taking from both of those opportunities. And I think that’s the opportunity we have here is for those that are what I call an M2, the second version, is to say, okay, let’s have some courage to speak out, and be authentic, and use your voice, and let’s hear what you have to say. And for the traditionalists that tend to lean towards misogyny and power and domination and patriarchy, is to look into what is driving that and to learn, like I was saying earlier, to gain these skills of emotional awareness and then regulation.

Brad Jacobs, MD: And we as clinicians can help teach that. And I know that you’ve done a lot of work around this and lifestyle, and you’ve documented how you can change biological age by lifestyle, right? So we can measure this. There’s no doubt that men that are dysregulated, that are doing this work, are physiologically not thriving.

Sara Szal, MD: That’s a really important point, that it’s not just in their heads. That this is measurable.

Dr. Kara Fitzgerald: It is. Yes, that’s right. That’s absolutely right. And it shows up in women as well. That same kind of energy. I can see in some of the career women I’ve worked with. Or just women. I’ll just be more broad than that. It can be hard for us to consider the emotional element, to consider stress, to consider those as real variables profoundly impacting health. I’ve had many patients, but one comes to mind, early in my practice who was raising kids and taking the train to New York City where she practiced as a lawyer. And we did all the work, we did all the labs, we did all the supplements, we did the exercise routine, we worked on all of this.

Dr. Kara Fitzgerald: And I would bring her stress up, I mean, it was obvious, she was just living an incredibly intense existence. And she had her goals of what she wanted to achieve together, and it wasn’t until really kind of the final hour after quite a while working together that she became willing to consider the impact of some of her life choices on her physiology. And when she finally did, miracles happened. When she finally did take that step– It’s my job as a physician to A, talk about it, to continue to bring it up gently. I mean, it was clear that this was a place that she wasn’t willing to go to for a long time, until she was, and also hold that safe space for the dialogue, and to still be present when she’s opting to not do that. It was a really important teaching case for me around being present and holding that space, but also holding the mirror and speaking the truth about what I could see was happening.

Dr. Kara Fitzgerald: So I think there is a role for us to get involved in this and the way that we deliver care in a very respectful way. This isn’t political. This is working with human beings. We’re all clinicians. We’re working with patients, all of us. The majority of my audience are physicians actually. we always try to lean into what’s clinically actionable. What are we going to take home? What is our Monday morning action? So what do we do? What are we going to do with this information? How is this going to influence us as healers?

Brad Jacobs, MD: Yeah, I think asking the questions, you were speaking to it about asking young girls, if they’re asking about contraception or other things, are you safe? Is this a safe relationship? Get the potential perpetrators out of the room for that conversation. And the potential future perpetrators or people who are just dysregulated to lean in and ask those questions. I think step one is an ACE questionnaire, which may drive a lot, right?

Dr. Kara Fitzgerald: Yes.

Brad Jacobs, MD: Adverse Childhood Experiences. And for people that are metabolically unhealthy, I often lean into that conversation of, what was your childhood like, and have them complete the ACE questionnaire and/or lean into that and and then lean into what is their current relationship and to really use that as a place and an entree to have these conversations. You’re not going to come out straight and say, you know, “Are you having sex with minors?” But it’s a larger conversation. How are they showing up in a patriarchal way, dominating over others in other ways that makes it unhealthy for them. I think it’s a different version of shortening one’s lifespan by having been raped, but the perpetrators have their own version of physiological derangement as well because of the shame and guilt that they may or may not have unless they’re completely pathological.

Sara Szal, MD: It’s such a good point because my focus tends to be identifying victims. So I do ACE scores and my focus is always on the victims, identifying the victims, looking for things like autoimmune disease, and the increased risk of prediabetes and diabetes, and insulin resistance, and all the depression and anxiety, and post-traumatic stress disorder. But this point you’re making is really critical, especially for boys and for men, that an elevated ACE score is associated with this cycle of violence that leads to what we see with Epstein. So I really like this point. I think that’s an important takeaway. Do an ACE score in every patient that you have. Not just to look for the victims like me, but to look at the men who are caught in this cycle of violence.

Dr. Kara Fitzgerald: Yes, I think that makes a lot of sense. I think that we do bring that forward more. There is room for that within the functional medicine model, and we can lean into it further still. You know, for a long time lived, as you know, in Sandy Hook, where we sustained some of the worst violence against children with the Sandy Hook shooting. And it’s such a deep, painful scar and that town pays attention. Kids are paid attention to in a way that comes from that kind of, you know, deep, deep pain. So there was a transformation that occurred there, thank God. I mean, through such intense tragedy.

Sara Szal, MD: Yeah, a sensitivity, it sounds like, and also some hypervigilance and–

Dr. Kara Fitzgerald: Structures were built into place.

Sara Szal, MD: So structural changes were made and it’s such a good point because we don’t want to wait for the catastrophe to make these kind of structural changes. The kind of changes you’re talking about in Sandy Hook, why can’t we make those across the United States?

Dr. Kara Fitzgerald: Yeah. Well, here we are again with this opportunity to make these structural changes with, you know, with the Epstein files. With the widespread fallout of that. So thoughts on this, like the way forward? I mean, I think you’ve both brought a lot up and there’s much that remains to be said and done.

Brad Jacobs, MD: For me, I’m personally shifting my career more and more towards what we’re talking about. Because we’re all looking for root cause, right? That’s what brought us into functional medicine and precision medicine. And as I’ve gone deeper and deeper, I’m realizing the psycho-emotional piece affects our thinking, our beliefs, which drive our behaviors and actions. And so much of that relates to our lifestyle and our epigenetics. And so I went and trained in a type of psychotherapy called Hakomi. It’s been about six years now and for me, that’s if we can shift it at the psycho-emotional level people, as you just described, then all of sudden they reach less for the alcohol, less for the desserts. And hopefully they also show up in a way where their moral compass can be there and they can learn to have greater capacity and not need to dominate and can collaborate. It’s what this new world order needs for us to survive here on this planet as we become more and more of a global village.

Dr. Kara Fitzgerald: Yes.

Brad Jacobs, MD: And as AI becomes more entrenched in everything we do, the human spirit is what’s remaining. And we need to nourish that as much as we can.

Dr. Kara Fitzgerald: I just think it’s great, Brad, that you’ve taken on the work, that you’re called to doing this work with men and you mentioned that you’re doing some group work. Tell me about it. And can the people listening access this? Can the clinicians refer or go themselves? Are you accepting new folks?

Brad Jacobs, MD: Yeah, we both do in-person and online men’s groups, the 12-week program, and then we’re building out an online course that’s more asynchronous so that’s more affordable, less of a touch. And we’re measuring masculinity, actually. So we’re doing physiological measures, psych-emotional measures at baseline. Then we go through a 12-week program and at the end retest and look at our physiology and our psycho-emotional spaces. It’s been fantastic. We can direct folks to a website if people are interested.

Dr. Kara Fitzgerald: It’s timely. Yeah, it’s very timely, your work. So thanks for taking that on and bringing it forward. We’ll link to it for sure in the show notes, folks.

Dr. Kara Fitzgerald: Sara, what do we do with regard to medical education?

Sara Szal, MD: Well, I think we’re in a reckoning. We need to take a clear-eyed look at the Epstein cases and really understand that we need to be better trauma-informed. You know, how does that filter into every aspect of clinical training? So not just for physicians who take the oath of do no harm, but nurses too. You know, a lot of these girls and young women were also treated by nurses, school nurses. And I’ve had nurses post on my social media that they never received education about looking for some of these conditions, like anxiety in a 14-year-old and asking questions about safety and making sure that, potentially, perpetrators are there in the room with that child. And so that’s one of the reasons why we always talk to children and adolescents without the parents in the room.

Sara Szal, MD: So I think we’ve got to look at medical education. I think it also points to another question about who has integrity? You know, when you look at some of the platforms that you pay attention to, we’re in an attention economy. So your eyeballs are voting for certain people. There’s a lot of clickbait that is trying to get your attention. So who do you pay attention to? So I keep getting asked, okay, if I’m not going to follow Peter Attia, who should I follow? And I’m like, Kara Fitzgerald, you should definitely be following her. She has got so much integrity. She’s done a couple of randomized trials showing a decrease in biological age with eight weeks of lifestyle medicine.

Sara Szal, MD: But it brings up this bigger question of how do you know that someone’s congruent? Does that matter to you? Do you care if someone is eating Chick-fil-A and also giving nutrition advice? Do you want the personal and the professional to have alignment? How do you assess safety? How do you assess integrity? I don’t have the answer to all those things, but I think we need a framework for how to look at the folks who are influencers and have really large platforms, how do we hold them to a higher standard? Because I think health is really sacred and being in the position to give advice is something we have to take very seriously.

Dr. Kara Fitzgerald: Yes. There’s a lot of people with very definitive answers. I think that’s probably an easy low-hanging fruit for a red flag. You know, if somebody knows and isn’t willing to admit uncertainty then maybe there’s space there for a pause.

Sara Szal, MD: Yeah, that’s a good point. I mean, there’s a lot of gray area. There’s a lot of places where the data are mixed, whether it’s seed oils or should you take a statin or, you know, what about rapamycin? Like there’s a lot of nuance. And for the people who are so certain, yeah, you gotta wonder.

Dr. Kara Fitzgerald: Yeah. Yes. That’s right, that is, because there is a lot of nuance. You know, embrace the uncertainty is what my mentor Richard Lord always said. So I’m comfortable in that arena. But a lot of people want to be told what to do and so we do make ourselves vulnerable, I think, when we fall into that. But medicine’s complex. Science is complex. I understand that. I understand wanting the science served in a way that is direct and action-oriented. So it is. It’s very nuanced, as both of you have said.

Dr. Kara Fitzgerald: So just want to kind of end with a couple of thoughts, a question, and that is that the one person being held accountable for this in the legal system is a woman. As far as I’m aware of the one person is Ghislaine—I don’t know if I’m saying her name right—Maxwell, she’s actually, she’s in prison. I mean, do you think that we’re going to see some accountability here a little more broadly?

Sara Szal, MD: It’s tricky. I’m not a lawyer, so I’m speculating in some ways here, but you know, when I think about the medical board, they’re looking for mostly illegal behavior. And if you have a DUI, they suspend your license. Is fawning over Jeffrey Epstein grounds for losing your medical license? I don’t know. I feel like that’s a decision that– I feel like he is morally bankrupt based on the emails that I read, but I don’t know if you lose your license over that. So it’s a really good question. I hope that this situation will bring us to the point of reckoning where we want to hold people accountable. One of the things I was looking for over the past couple of days is who are these clinicians that these girls saw? I haven’t seen any names. I saw someone on threads found like two physicians, MDs, that were not redacted in the Epstein files. But I haven’t seen anyone convicted for being a mandated reporter and not reporting.

Sara Szal, MD: So I hope that we will hold more people accountable. And yeah, it’s amazing to me that the only one serving in prison is a woman. What do you think? Do you think with the medical board, like do they have any teeth to go after?

Brad Jacobs, MD: No. I don’t think so.

Sara Szal, MD: Peter Attia, Deepak Chopra.

Brad Jacobs, MD: No, unless they committed illegal acts or perform malpractice, right? And that we know of, they haven’t. But to your point, they’re, in my mind, morally bankrupt. What is the attention span of the public on that? And people don’t like, as Al Gore said, the inconvenient truth about our planet. Similarly, people want to believe in someone and they have a hard time with a fallen hero.

Sara Szal, MD: Right. I mean, even CBS seems to be keeping him on as a contributor (as of February 10, 2026).

Brad Jacobs, MD: Right. Will they actually allow him to show up live on camera? That’ll be the second question. But what is the accountability? I think that in part that’s why I’m glad that people are speaking out about Peter Attia and others. I think it’s important that we speak out. I think the silence is the problem. But I think that the answer is that we need to keep the dialogue alive.

Sara Szal, MD: Yeah, silence supports the status quo and we have seen the effect of the status quo in the Epstein files. So this is our opportunity to change our system.

Dr. Kara Fitzgerald: I’m glad that you were both willing to join me. This was just our contribution to continuing to voice it. So thank you both to be continued.

Sara Szal, MD: Yeah. Thanks for the conversation, Kara.

Sara Szal MD is a physician, researcher, educator, mother, and seeker. She graduated from Harvard Medical School and MIT, and is more likely to prescribe a continuous glucose monitor and microbiome restoration than the latest pharmaceutical. Dr. Szal is a global keynote speaker and the author of four New York Times bestselling books about hormones, longevity, and health, including THE HORMONE CURE. She is Clinical Assistant Professor in Dept. of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University, and Director of Precision Medicine at the Marcus Institute of Integrative Health. Her focus is at the interface of mental, physical, and spiritual health, personalized molecular profiling, use of wearables, and how to leverage novel technologies to feel your best

Website: saraszalmd.com

Substack

Dr. Bradly Jacobs is a Stanford-trained physician and outcomes researcher who helps men in midlife and beyond build vitality, presence, and longevity by integrating evidence-based medicine, behavior change, and self-awareness. Through precision medicine, executive programs, and retreats, he bridges physiology, mental health, and consciousness to augment healthspan, sustainable performance and personal transformation- Bringing rigor, depth, and a little rebellion to modern medicine.

Dr. Brad Jacobs

Website: Blue Wave Medicine

Abuse and Domestic Violence Helplines

Adverse Childhood Experiences (ACE) Screening Tools

Healing the Masculine with Dr. Brad Jacobs

Dr. Sara Szal website

Trauma, adversity, and biological aging: behavioral mechanisms relevant to treatment and theory (peer-reviewed)

New York Times (paywall): Peter Attia’s Ties to Epstein Spark a Backlash From Doctors (Dr. Szal is quoted)

Bio Age Lab Test

Bio Age Self Assessment Quiz

Younger You Practitioner Training Program

Younger You book

Better Broths and Healing Tonics book

Younger You Daily Supplements are Now Here!

What could be more convenient than having your daily supplements all pre-portioned in one pouch? Choose your level to get the combination of supplements that’s right from you. Monthly subscription available.

(note you’ll be leaving www.drkarafitzgerald.com to go to www.vitaboom.com to complete your purchase)