Medical Crimes Against Humanity

In April of 1944 the war between the Axis and Allied powers was still raging and Lieutenant-Captain Heinz-Wilhelm Eck was in command of the German submarine U-852.  Eck had begun serving with the Kriegsmarine in 1934 and had been promoted to Kapitänleutnant (LK) in 1941 assuming his first command in 1943.  By 1944 he was in command of U-852 and on his way to South Africa.  It was there that he came across a Greek civilian steamer, the SS Peleus, named for the father of Achilles, which was traveling from Freetown to Buenos Aires with a crew of thirty-five including eighteen Greek sailors, eight British, three Chinese, two Egyptian, and four of unknown nationality.

The Peleus was clearly marked as a civilian ship, carrying noncombatants.  Sinking such a ship is a violation of international law, a war crime.  Civilians are often surprised to find out that there are laws even in war, but those who have served in the Marines or Army will remember learning about the Laws of Land Warfare, which clearly lay out what you can and can’t do, even in combat.  But Captain Eck didn’t think those rules applied to him, and decided that he would track and sink the Peleus without warning.  That’s another war crime. Even if you have the right to sink a merchant vessel carrying military cargo, you must first evacuate the crew and passengers.  For whatever reason.  Captain Eck chose to ignore these laws and ordered two torpedoes to be fired at the Peleus exploding first the number two hold and then the number three, breaking the ship apart and sinking it in minutes.

About half the crew survived this destruction and found themselves in the water, clinging to whatever debris they could find.  Two of these, the third officer, Agis Kefalas, and a seaman, Pierre Neuman, were picked up from a raft and taken aboard U-852 for interrogation.  After questioning the men were returned to their raft.  Captain Eck knew he was in trouble for breaking the rules and he had a choice.  Minimize the damage that had been done and save those he could or abandon them to the sea.  But Captain Eck made a third choice.  He could destroy all evidence of his criminal act and pretend it never happened.  The order was given and for the next five hours, form 8 pm until 1 am, the surviving crew of the Peleus clung to debris while machine guns were fired, and grenades thrown to kill them.  In the end only four were able to escape in the darkness, and one of those later died from his wounds.

Chief Officer Antonios Liossis, seaman Dimitrios Argiros, and boiler operator Rocco Said drifted at sea for a month until they were rescued by the Alexandre Silva.  A Portuguese ship that took them on to safety in Angola.  The three men reported the crimes against humanity committed by Captain Eck to the British and the hunt was on. U-852 had continued to operate off the coast of Africa, and after sinking the Peleus had sunk the British cargo ship Dahomian, abandoning those survivors to the sea rather than take the time to machine gun them.  This is also a crime.  Captain Eck intended to continue his crime spree but just a month later, his luck ran out.

On the 30^th of April 1944 U-852 was spotted by a British bomber pilot, who attacked with aerial depth charges.  The submarine was damaged but not destroyed and headed for the Somalian coast to hide.  On the way it was spotted by six more Royal Air Force bombers that immediately attacked.  Being unable to dive due to the previous damage, the submarine ran aground on a coral reef, immediately after which it was boarded with the loss of seven crewman. But fifty-eight German sailors, including Captain Eck were captured. Captured also was Eck’s Kriegstagebuch or War Diary.

A little more than one year later, Captain Eck and four of his officers faced a military tribunal at Hamburg, Germany.  The Axis powers had lost the war, and now those responsible for crimes against humanity would be held to account.  Eck tried to defend his actions, claiming military necessity, and quoting the Laconia Order, which had been issued by the German Admiral Karl Donitz, forbidding the rescue of survivors.  Prior to this order, German submarines had routinely picked up survivors from vessels they sunk.  These altruistic actions were not just out of the goodness of their hearts. It was required by law. The International Convention for the Safety of Life at Sea (SOLAS) was first adopted in 1914 after the sinking of the RMS Titanic

While SOLAS was not specific to military operations, it was adopted as a fundamental principle of maritime law applicable to all vessels, even during war.  But then came the Laconia incident.  In September 1942, off the coast of West Africa three German submarines, U-156, U-506, and U-507, were attempting to rescue the survivors of the ocean liner RMS Laconia, which, as an armed merchant cruiser, was fair game.  U-156 had fired the torpedo that caused the ship to list to starboard when a second torpedo hit, she started to rapidly sink.  Captain Sharp of the Laconia ordered all women, children, and injured evacuated first and they were put in lifeboats.  The U-boats saw the civilians and surfaced to aid in the rescue, raising red cross flags and radioing that they were engaged in a rescue.

What happened next is not a proud moment in American military history.  A B-24 Liberator had spotted the subs and radioed their location to the American base on Ascension Island and, with the commander claiming to not know of the rescue, an attack was ordered.  The submarines were strafed with refugees still on the decks and had to dive, abandoning those above to the seas.  Despite rescue efforts by other ships, one thousand six hundred and fifty-eight people perished, more than those lost on the Titanic.  An order was then given by the German High Command, that all efforts to save survivors of sunken ships must stop.  Even providing food and water to those in lifeboats was forbidden.  The Laconia Order read “Be harsh.  Remember the enemy has no regard for women and children when bombing German cities!”

And that dear readers, is how people lose their souls when engaging in a war.  Captain Eck felt that this order to be harsh protected him from prosecution after the war was lost.  It did not, and he was referred to the Nuremberg war trials, with his tribunal to be held at Hamburg.  The judge was an English barrister named Melford Stevenson, who, during a four-day hearing,  read the war diary and heard testimony from the surviving crew members.  It was decided that even if higher ups order an action, if that action is a violation of basic human rights, it cannot be followed.  And those that do will be held accountable.  Captain Eck was ordered to the gallows.  This was the only case of U-boat personnel being prosecuted for war crimes despite even more heinous actions on both sides during World War I.  The difference was that after World War I, laws had been established to protect human rights, obviating the excuse that they were “just following orders.”

And that brings us to the war which has cost the lives and liberty of more Americans than any other in US history.  No, not the Civil War.  The War on Drugs.  Started under the Nixon administration as a tool to target anti-Vietnam war protestors and black civil rights activists and militants, it has morphed into an end justifies the means operation, costing trillions of dollars and hundreds of thousands of lives.  Where any cruelty is excused because the perceived enemy is not worthy of the most basic considerations.  And that brings us to the case of Dr. Bockoff.  Dr. David Bockoff was a physician practicing pain management in Beverly Hills, California.  He had over fifty-five years of experience. Having graduated from the Wayne State University School of Medicine in 1968.

By all accounts Dr. Bockoff was a kind and caring physician dedicated to improving the lives of his patients.  Why would the DEA target such a doctor?  It’s obvious from their tactics.  The federal government is forbidden by law to try to influence the practice of medicine, and the US Supreme Court has affirmed that only the states have the right to determine medical practice.  But the DEA had decided that in their efforts to reduce prescription diversion, they would get around these laws, by making some examples.  If you want to terrorize the medical community into not using a class of pain medications specifically approved for the treatment of pain, you don’t just target doctors with clear criminal intent, you target those who are stone cold innocent of any crime.  If you only targeted the guilty the innocent are not terrorized, and might keep prescribing what they consider to be a reasonable treatment, but that changes if you put the head of a kind and caring physician on a pike.

The DEA pulled Dr. Bockoff’s license to prescribe controlled substances on the first of November, 2022, claiming that five of his patients were in “imminent danger” because they had been prescribed “high doses of opiates.” What gives the DEA the right to decide what dose is “too high” for a specific patient is yet to be elucidated.  It is critical to understand that opiate medications are unlike any type of medication that doctors commonly use.  The incredible variation in cytochrome P450 enzyme activity, opiate receptor response differences, and other factors,  make patient response extremely variable.  Some people will become intoxicated after a single dose of codeine or tramadol, while others will take a dose of oxycodone or morphine above the LD50 and show no ill effect.  Each chronic pain patient on long-term opiate therapy must be treated with an individualized regimen.  Something that even the CDC acknowledges and Dr. Brockoff was clearly doing.

It’s important to also understand that a specialist like Dr. Brockoff does not see the “usual” patient.  In fact, there is no usual or average pain patient.  This is not high blood pressure.  Each patient’s suffering is unique and its treatment is complex.  But the DEA does not understand this.  They think that being harsh now is necessary, and that if some innocent doctors are destroyed, that’s just the price to be paid to get to what they see as a utopia, where there is no diversion of prescription medications, earning them awards and accolades for a job well done.  But armed with several hours of DEA produced training videos and an absolute righteousness of purpose, the DEA decided to go after Dr. Brockoff and close his practice.  What happens when a doctor is targeted and shut down by the DEA? The patients under that doctor’s care become medical refugees, adrift in a sea of suffering.  The DEA claims that they have a response team to help patients find treatment, but what this entailed in Dr. Brockoff’s case was to leave a list of nearby ERs on the office door.

How effective is this?  It’s like pointing out the direction of the shoreline to a drowning person.  Worse than useless.  As a physician with a lot of ER experience, I was the director of two hospital ERs, and I can tell you that the ER is NOT where you want to go for chronic pain treatment.  ER doctors treat a lot of pain, about eighty percent of patients who come to the ER have pain, but chronic pain is much more complicated than acute or subacute pain, and more time is demanded to its treatment than an ER doctor has available.

When I transitioned to primary care, I took classes taught by Harvard physicians titled Pain Management for the Primary Care Physician and Addictions, and completed hundreds of hours of CME, eventually becoming one of the few primary care doctors willing to treat addiction.  Still at only 7%. All of this so that I would have the necessary knowledge to treat this common problem when patients were referred to me for primary care follow-up after specialist diagnosis and treatment. If someone was too complicated, I sent them to a specialist, and Dr. Brockoff is a perfect  example of the type of specialist I would differ to. But what happens when the specialists we rely on are being targeted and taken out? And again, what of the patients?

One such doctor was arrested and when he said, “what will happen to my patients?” was told, “your addicts will be just fine.”  This is also a common confusion. One suffered by not just DEA agents but more than a few ER doctors, who mistakenly equate a patient’s need for medication with drug seeking, and withdrawals with addiction.  These are not the same thing.  When a patient begs for a medication to ease their suffering that is not addiction or drug seeking, that is treatment seeking.  If a DEA agent ever comes into the ER with their leg on fire begging for relief, should I show him the door as a drug seeker?  I don’t think so.

And withdrawals, despite what government paid “experts” might say in court, is NOT a sign of addiction in a patient on chronic opiate therapy.  It is an expected consequence of many medications, not just opiates.  If I have you on the blood pressure medications like beta blockers or clonidine, and they are stopped abruptly, your blood pressure will spike to insane levels, and you might die of a heart attack or stroke.  Does that mean you were addicted to those medications?  No. It means that I created your medical problem by jerking you off of them.

There is a common medical fallacy that patients do not die from opioid withdrawals.  This is simply not true.  There are recognized conditions, like Opioid Withdrawal Induced Cardiomyopathy, that are recognized internationally as a potentially fatal consequence of rapid opioid discontinuation.  One of Dr. Brockoff’s patients was Jessica Fujimaki.  Jessica had Ehler-Danlos Syndrome (EDS), an inherited disorder that causes joint instability, leading to dislocations and torn joint capsules, soft tissue tears, neuropathic pain from nerve compression and autonomic dysfunction, and spinal stenosis and cord abnormalities.

One of these that Jessica suffered from is arachnoiditis, a terrifyingly painful medical problem that does not show up on any CT or MRI. Jessica was taking high dose hydromorphone and was able to help care for her husband and children. This ability, to contribute to those you care about, is an often-unrecognized necessity to quality of life.  Once you lose that, it’s a rapid downward spiral. Jessica’s health deteriorated to the point that her family took her to Mexico twice to get her some relief.  Being such a burden one your family is also caustic to a person’s sense of self, and Jessica died.  But she wasn’t the only one.

Another of Dr. Brockoff’s patients was Danny Elliot.  Danny had suffered a fifteen-minute electrocution injury several years prior, and the nerve and tissue damage caused him to have severe, intolerable pain, you can listen to his account of it online. His devoted wife, Gretchen Elliot, helped care for him.  Danny had seen over twenty-five physicians and specialists before he was finally treated with fentanyl and, for the first time in ten years, had some relief. The first doctor to prescribe fentanyl was Dr. Thomas Sachy.  But Dr. Sachy was targeted along with 600 other doctors by US Attorney General Jeff Sessions.  Danny struggled to find someone to treat his pain, fighting terrible withdrawals.  The DEA put out a list of pain clinics in the area but none of them wants to treat the patient of a targeted doctor, because it is well known that the DEA watches where the patients go and targets those physicians brave enough to treat these patients.  Danny was at the end of his rope, when he found Dr. Brockoff, and now Brockoff was gone.  Danny faced an impossible choice and decided to end his life.  Gretchen joined him and took hers also.

The targeting of Dr. Brockoff, and the tragedy of his patients deaths,  is a clear example of the DEA shutting down pain doctors in an entire area, leaving the patients to travel long distances, then targeting any doctor who treats them because the patient has travelled a long distance.  A red flag according to the DEAs admitted algorithms.  They are not just sinking the boat leaving thousands floundering in a sea of pain, they are firing on any ship brave enough to try to pick up the survivors.  But no one has the power to bring them to account.  No one but Congress anyway.  Good luck trying to get the attention of a legislator these days if you’re not a billionaire.  So dedicated physicians are going to prison, their families terrorized and, in some cases, threatened with prosecution to get the doctor to plead guilty, and hundreds of thousands of American citizens, whose only crime is that they suffer from severe chronic pain, are losing hope and dying.

By the way, the DEA response team gave itself an award for their wonderful actions in the war on drugs.  Some may see this as an injustice, and I understand why, but I don’t think it goes far enough.  I think they deserve a vacation.  In fact, I hear the weather’s nice in Nuremberg this time of year.