Nuremberg & Thalidomide: The Good The Bad & The Ugly.

It is not really the first time we visited a place that has a rather haunting history. St. Petersburg is one such place especially when one re-visited the whole sordid saga of the murder of the small children of the Russian Tsar family.

Now we are starting our high school reunion on our river cruise. The journey starts at Nuremberg. All of us of course remember the Judgment at Nuremberg. I decided to watch it again. The principle that just because your boss told you to do things in a certain way did not absolve you from the greater humanitarian aspect of what you do. This is most important for doctors and if you think we have shied away from the Nuremberg era, think again. In one way or another, those that dare speak out against what management in our beloved NHS does were met with some of the worst fates unimaginable in any democratic society.

Nuremberg of course was the famous setting for one of Wagner’s well known Operas, Die Meistersinger von Nürnberg which was in 2011 performed at Glydnebourne for the first time ever to much international acclaim. 

But Nuremberg was sadly linked to one of the worst drugs disaster of our time. This was uncovered by none other than Newsweek.

As they opened a new Waitrose across from my clinic, I find myself shopping there most days after work. It was one of those de-roling activity that is important after a whole day being involved in the mad of sad world of child psychiatry. John Barnes in Swiss Cottage was the first local store that was very close to the Tavistock Clinic where I trained. It was there that I saw the wooden escalator that my father reminisce about of the ones in Shanghai in the 40s. John Lewis and Waitrose remained my favourite haunt for all these years.

One day, at one of the specially designed check outs, sat a girl on a special raised mechanical chair was a girl with arms a quarter the size of ours and a few minute fingers. Yes, a Thalidomide victim doing a proper check out job.

Yes, we tried our best not to notice and our best not to treat her any differently as we well know that that is what she would want. I raised my hat to Waitrose for treating her like any of their partners. That is how the world should be.

But I never knew that there was any link between Thalidomide and Nuremberg. O.K. I knew Thalidomide was developed by a German Company, Grünenthal.

Nuremberg©2015 Am Ang Zhang

The Nazis and Thalidomide: The Worst Drug Scandal of All Time

Newsweek

Adding to the dark shadow over the company, it is increasingly clear that, in the immediate postwar years, a rogues’ gallery of wanted and convicted Nazis, mass murderers who had practiced their science in notorious death camps, ended up working at Grünenthal, some of them directly involved in the development of thalidomide.

 What they had to offer was knowledge and skills developed in experiments that no civilized society would ever condone. It was in this company of men, indifferent to suffering and believers in a wretched philosophy that life is cheap, that thalidomide was developed and produced.

Perhaps the best known of Grünenthal’s murderous employees was Otto Ambros. He had been one of the four inventors of the nerve gas sarin. Clearly a brilliant chemist, described as charismatic, even charming, he was Hitler’s adviser on chemical warfare and had direct access to the führer—and committed crimes on a grand scale. As a senior figure in IG Farben, the giant cartel of chemical and pharmaceutical companies involved in numerous war crimes, he set up a forced labor camp at Dyhernfurth to produce nerve gases before creating the monolithic Auschwitz-Monowitz chemical factory to make synthetic rubber and oil.

In 1948 Ambros was found guilty at Nuremberg of mass murder and enslavement and sentenced to eight years in prison. But four years later, he was set free to aid the Cold War research effort, which he did, working for J. Peter Grace, Dow Chemical, and theU.S. Army Chemical Corps. Ambros was the chairman of Grünenthal’s advisory committee at the time of the development of thalidomide and was on the board of the company when Contergan was being sold. Having covered up so much of his own past, he could bring his skills to bear in attempts to cover up the trail that led from the production of thalidomide back through its hasty trials to any origins it may have had in the death camps.

Dr. Kelsey, FDA scientist who kept thalidomide off U.S. market, dies at 101.

Dr. Kelsey is honored by President John F. Kennedy in 1962. (Courtesy of FDA)

The tragedy was largely averted in the United States, with much credit due to Frances Oldham Kelsey, a medical officer at the Food and Drug Administration in Washington, who raised concerns about thalidomide before its effects were conclusively known. For a critical 19-month period, she fastidiously blocked its approval while drug company officials maligned her as a bureaucratic nitpicker.

Freedom of Speech: Truth & Thalidomide!

Case 5 – The Truth about Thalidomide Given the lack of a constitution enshrining free speech, we do need some protection against frivolous libel actions and injunctions which try to prevent the truth from being revealed. Otherwise the truth about thalidomide would never have been told.

“Thirty-eight years ago,” he wrote, “I sat through days of hearings by the Law Lords deliberating on whether I and the paper I edited were guilty of contempt in 1972-3 in campaigning for justice for the thalidomide families. All five Law Lords voted to ban publication of our report. Only a 13-11 victory in the European Court of Human Rights removed the gag order” – and thus, I add, enabled The Sunday Times to expose one of the great scandals of that time, and subsequently win compensation for the families with young children born damaged or deformed, often without legs or arms, because their mothers had taken the drug, thalidomide, which was marketed as a mild sedative that would relieve morning sickness in pregnancy.                                                                                             Telegraph

Luckily, the European Court eventually ruled for The Sunday Times:

“The newspaper then decided to fight the injunction on its investigation into the origins and testing of the drug. The case went right through the British legal system and up to the European Court of Human Rights, which decided that the injunction violated the right of ‘freedom of expression’. The full story of thalidomide could eventually be told in 1976, revealing that both Grünenthal (the maker) and Distillers had not met the basic testing requirements of the time.”

I mentioned thalidomide also because in 2002 Gordon Brown, the then chancellor, attempted to tax the benefits payable through the Thalidomide Trust.

Thalidomide: how men who blighted lives of thousands evaded justice | Harold Evans | The Guardian

Guardian: UK

"The original catastrophe maimed 20,000 babies and killed 80,000: war apart, it remains the greatest manmade global disaster."

Up to 80% that took it were affected.

Sad read as you go on:

Grünenthal had insisted that it was blameless: the thousands of abnormal births were an act of God. 

Photo from the Guardian.

https://www.theguardian.com/society/2014/nov/14/-sp-thalidomide-pill-how-evaded-justice

The Cockroach Catcher II: Attempted Living

Touched Untouchable:

Charles was another case on my ‘untouchable’ list. He was arrogantly untouchable.

“You are the DOCTOR, you tell me what’s wrong with me!”

Not the best way to establish a therapeutic alliance, really. Arrogance I could deal with, and he found his match! Stubborn patients require stubborn doctors and arrogant patients? Not that different!

Contrary to what Charles thought, his opening line could not have been better. I replied:

“You’ll have to find that yourself!”

No harm was done. He kept his subsequent appointments without fail, telling me how he could not stand the Maths teacher nor the one teaching history, and I listened. Unfortunately he was one of the few cases about which I had no clue whatsoever.

“This young man could not sleep. Probably depressed. Please see.”

This was from our well known referrer who amused our social workers no end. At meetings, they always joked about his exceptionally short referral letters. This one was probably four words longer than his average. I had no problem with referrers who did not try to influence me.

Charles was sixteen years old, an only child from a fairly stable home. Father worked at the airport as a baggage handler and mother worked at a local school as a dinner lady for a few hours a day.

For some time now, Charles could not sleep at night and he would get so tired during the day that he dozed off during class. A locum GP thought he might be depressed and mentioned that in his notes. When Charles saw his own GP again, his GP referred him.

Apart from his difficulties falling asleep, I simply could not decipher him.

After a slow start, when Charles realised that I was not going to medicate or in his view, poison him, he started to talk.

He wanted to be a pilot. Not a baggage handler.

It was not too difficult to work out why.

His grandfather on mother’s side was a pilot in the RAF. He was unfortunately killed during the War.

Now he wanted to be a pilot but only for commercial flights.

We chatted and chatted and I still had no clue to the cause of his insomnia.

“You are the mind doctor! You should know!”

Then one day, my secretary buzzed me.

“Mum left something for Charles to take home. She said it was for him anyway and she had too much other shopping. Could he take them home?”

“Do you know what it is?”

“Yes, six huge bottles of Coke!”

Ah, Caffeine.

That was why my secretary called me! What did I tell you? I had good secretaries.

In medicine, sometimes the answer could be very simple. I wished I had worked it out before then.

Arrogant doctors need good secretaries.

“At school, I was told that we must drink at least three litres a day and I find it difficult to drink just water. So I went on to the sodas, whatever is on sale.”

Now that we had the answer, I must do my bit of doctoring.

“Try flavouring your water with a wedge of lemon or lime and see what happens.”

He was willing to give it a go.

“If it works, I am not psychiatrically ill then, and I don’t need to see you anymore. Correct?”

“Correct!”

He came back a week later.

“Now I can sleep like I used to. So I am fine! But I do want some advice on how I can earn some good money to get myself one of those expensive remote control planes?”

Wow, he wanted some advice! And toy planes!

I was tempted to say, “I thought you wanted to be a real pilot.”

But I resisted!

“Try the new Waitrose over there, they just opened.”

“Thank you, doctor. By the way, I like the lemon flavoured water.”

When I finished the clinic, I went over to the new Waitrose to see what I could get for dinner.

Who should be at one of the checkouts but my ‘arrogant untouchable’!

“That was quick!”

“Yeah, all the jobs were taken when I came over, but one of the new boys could not cope with the supervisor and left. I don’t mind. I think the other boy could not cope with her strange short arms and her being on a special electrical wheelchair. She was very nice to me and soon I forgot how she looked.”

Good for you untouchable. At last someone touched you.

Thank you, Waitrose¹, for having a Thalidomide victim in a supervisory position. I have trusted you to be my first store when I came to England and you will always be my favourite.

1


For those who do not know, Waitrose is a brand of British supermarkets and part of the employee-owned retailer John Lewis Partnership.

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Macau: A Private Asylum

 

Ruins of St. Paul's, Macau

The Consultation

Well, it did not take long for our host Lui to tell me about his brother: paranoid ideas, hallucinations, strange behaviours. From his account, there was no doubt that his brother was suffering from Schizophrenia, a sort of typical Castle Peak Mental Hospital case that I used to have to treat soon after graduation, but not so often in the British children clinics and hospitals.

The brother was put on the more traditional tranquillisers that were standard at the time. This was before Clozapine became the gold standard for treating schizophrenia in most countries, and in China in particular.

What Lui wanted to know was whether he should do what his brother’s psychiatrist in Macau recommended, to put him in a mental hospital.

Lui had heard horrible stories about the goings on inside these institutions. He was so worried that he set up a flat solely for the purpose of keeping his brother under round-the-clock watch. He wanted me to give my professional opinion. Was the arrangement going to do his brother harm, and would his brother be better off in a mental hospital?

The next day Lui picked us up to visit the flat. He was quite happy for my brother-in-law to know what was going on. In those days, many Chinese families still saw mental illness as a secret to be kept from outsiders.

“Without him, I would never have found you, Dai Foo!” Dai Foo, literally big master, the way Chinese respectfully address doctors.

I was not really prepared for what I was about to see.

The three-bedroom flat was furnished and equipped to provide “secure” accommodation for his brother. Two maids were employed to look after him and they worked in shifts so that there would always be someone to guard him and see to his needs. Fancy looking sliding aluminium doors were installed in such a way that the maids could be kept “safe” from the sometimes violent schizophrenic patient. These latticed doors formed secure partitions between rooms while allowing visibility and the patient was never allowed into the kitchen. The doors were designed such that at meal times, the maids could put the food on the table in the dining room, retreat into the kitchen and lock the partition before letting the patient into the dining room. Not difficult for a man in the aluminium business!

On Sundays, Lui would take the patient out to see the parents and have a nice meal, accompanied by one of the maids.

What could I say?

This businessman had as good as set up a private asylum for his brother. In his sitting room, he had installed for him a television with one of the largest screens one could buy at the time. He had two good carers. He could go out once a week for a family meal.

You can probably guess my answer.

Certainly not: “This is all wrong; you should let your brother go to a mental hospital!”

We were treated to another sumptuous meal in Macau that evening, before we took the ferry back to Hong Kong the next morning. It was just as well, as we must leave Lui free to spend time with his brother on Sunday.

The New Book: 

The Cockroach Catcher II: Attempted Living

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First Do No Harm: Ketogenic Diet :Non Alcoholic Fatty Liver Disease & Epilepsy!

Ketogenic Diet: over 100 years of history and first used in very young children.

Dr. David Unwin was worried about the abnormal liver function of a lady patient he referred her to some specialists in the Hospital and she was seen by a hepatologist and two gastroenterologists (I did wonder why!). 

They all thought that she was drinking too much and the poor lady was very upset because she really really never touch any alcohol all her life and yet she was being told off by the specialists as they all assumed that her abnormal liver function tests were due simply to alcohol! 

Then when she eventually gave up sugar and carbs, the liver function improved dramatically. It was such a relief for her and for Dr. Unwin who reckoned that the specialists had something to learn because all they did was to worry and humiliate her when the treatment could be so simple. A high percent of adults in Britain and other western countries suffered from such Non  Alcoholic Fatty Liver Syndrome.

Link: https://www.youtube.com/watch?v=TEYtRiPKBVA&t=10s

Many are worried about Ketogenic Diet and yet it has over a hundred years of history for the treatment of Epilepsy in very young children that did not respond to a multitude of established medications. Dr. Unwin's experience with T2 Diabetes and now NAFLD is simply carrying on the first principle of medicine: Do No Harm.

Dr. David Urwin:

Dr. David Unwin is GP based in Southport in the United Kingdom. After 25 years of attempting to treat diabetes by conventional methods, Dr. Unwin was introduced to low carb nutrition through one of his patients and the website www.diabetes.co.uk

From this revelation, Dr. Unwin now ignores official advice (NHS:

• eat a healthy diet – try to have a balanced diet high in fruits, vegetables, protein and carbohydrates, but low in fat, sugar and salt; eating smaller portions of food can help....Link: Non-alcoholic fatty liver disease (NAFLD) - NHS ) and treats his patients with a low-carbohydrate diet. Since adopting the approach, his practice now spends £50,000 less each year on drugs for diabetes than is average for his area.

Dr. Unwin is the RCGP National Champion for Collaborative Care and Support Planning in Obesity & Diabetes, as well as a Clinical Expert in diabetes. In 2015 he won the North West NHS ‘Innovator of the Year Award’ and in 2016 he won the National NHS 'Innovator of the Year Award' for his work in treating diabetes with a low carbohydrate approach.

More from Dr. Unwin:

“It’s not just about diabetes; belly fat matters.”

Up to 20% of the developed world now has a condition described as Fatty Liver Disease. This is split into alcoholic and Non-alcoholic Steatotic Hepatitis (NASH). The latter is in large part obesity related. In this way I worry that excess sugar and starchy carbs are leading to the three great modern epidemics; diabetes, obesity, and fatty liver disease. In 2008 The World Health Organization concluded there was convincing evidence that central obesity (defined as waist greater than 80 cms in women or 94 cms in men) was associated with significantly increased risk of cardiovascular disease, hypertension, colorectal and breast cancer and overall mortality.

The good news is that I have often seen a low carb approach help not just Type 2 Diabetes but also liver function, blood pressure, lipid profiles (particularly triglyceride and HDL cholesterol levels), and central obesity.

Link: https://www.lowcarbtogether.com/science/who-benefits-from-a-low-carb-lifestyle/

History: https://www.lchf-rd.com/2021/02/18/a-ketogenic-diet-was-used-first-in-diabetes-then-epilepsy/

On July 27, 1921, the Mayo Clinic’s Russell Wilder, M.D., first uses the term “ketogenic diet” to describe and propose a nutritional treatment for epilepsy that tricks the body into believing it is fasting. With 70%–90% of calories from fat and very limited amounts of carbohydrates and protein, the body becomes deprived of glucose and begins breaking down fat cells for energy. Wilder believes the diet could be just as effective as fasting in treating epilepsy. His colleagues at the Mayo Clinic test the theory on both children and adults with epilepsy and find it works. The keto diet is widely used after that by other institutions, including Johns Hopkins.

Charlie and his family seek care at Johns Hopkins

Charlie Abrahams, a 20-month-old patient with epilepsy and the son of noted film writer/producer/director Jim Abrahams (Airplane!, Top Secret! and The Naked Gun series), is admitted to Johns Hopkins Children’s Center after many epilepsy treatments and surgeries tried on him had failed. Within days of going on ketogenic diet therapy, his seizures completely stop. The Charlie Foundation for Ketogenic Therapies is founded by his parents to raise public and clinician awareness, promote scientific studies and provide research funding for the treatment. 

First Do No Harm is a 1997 American made-for-television drama film directed by Jim Abrahams about a boy whose severe epilepsy, unresponsive to medications with terrible side effects, is controlled by the ketogenic diet. Aspects of the story mirror Abrahams' own experience with his son Charlie.

Cockroach Catcher-Seven Minute Cure

Link: https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/keto-diet-timeline.html

From Nanjing to Hiroshima

 Nanjing

88 years ago, the people of Nanking, China's ancient capital city, were in the midst of one of the worst atrocities in history, the infamous Rape of Nanking. The truth of what actually happened is at the center of a bitter dispute between China and Japan that continues to play out in present-day relations. Many Chinese see Japan's election last month of ultraconservative nationalist Shinzo Abe as prime minister as just the latest in a string of insults. And it was recently reported that Japan is considering rolling back its 1993 apology regarding "comfort women," the thousands of women the Japanese army sexually enslaved during World War II.

In 1937, the Japanese Imperial Army, captured Nanking on Dec. 13. No one knows the exact toll the Japanese soldiers exacted on its citizens, but a postwar Allied investigation put the numbers at more than 200,000 killed and at least 20,000 women and girls raped in the six weeks after the city fell.

It was the mass rapes in Nanking and the brutalization of an entire populace that eventually convinced Japanese military leaders that they needed to contain the chaos. Japanese soldiers began rounding up women and forcing them to serve as sex slaves in so-called comfort stations.

This is what most historians believe. But not in Japan, where a large faction of conservatives, led by Abe, denies that the Japanese military forced women into sexual slavery. They maintain that any suggestion to the contrary is simply anti-Japanese propaganda and probably spread by China. At the furthest end of the spectrum, the minimizing turns to flat-out denial; one professor we interviewed at a top Japanese university adamantly insisted there were no killings or rapes in Nanking.

Not surprisingly, all this minimizing and denial enrages the Chinese and others in Asia. But this is a familiar pattern.

Nanking Poster: THINKFilm

On July 2, 1996, the anniversary of Ernest Hemingway’s own suicide, Margaux Louise Hemingway, his grand daughter was found dead in her studio apartment in Santa Monica, California at age 41.

On November 9, 2004, Iris Chang (張純如), who was propelled into the limelight by her 1997 best-selling account of the Nanking Massacre “The Rape of Nanking: The Forgotten Holocaust of World War II”, committed suicide. Earlier she had a nervous breakdown and was said to be at the risk of developing Bipolar illness. She was on the mood stabilizer divalproex and Risperidone, an antipsychotic drug commonly used to control mania. There was a detailed report in San Francisco Chronicle.

Now back to the Japanese atrocities in the Nanking Massacre in 1937, one of history’s worst but relegated to obscurity. The impact of Iris’ book and her tragic death was such on Ted Leonsis, Vice Chairman of AOL, that he went on to produce a film on the subject. The film, Nanking, premiered in Sundance Festival last year, was shortlisted in the documentary feature category of the Academy Awards, and won the Humanitarian award for documentary in the Hong Kong International Film Festival.

Mariel Hemingway, younger sister of Margaux, read the words of Minnie Vautrin in the film. Minnie Vautrin was an American missionary renowned for saving the lives of many women at the Ginling Girls College in Nanking, China during the Nanjing Massacre. In 1941, Minnie Vautrin committed suicide.

In July, 2007 the film premiered in Beijing. The BBC said:

“It is doubtful, though, it will ever be shown in Japan, where historians claim the massacre has been exaggerated.”

Experts estimate the Japanese killed 150,000 to 200,000 people and raped more than 20,000 women and children, but a group of MPs from Japan's governing party recently said no more than 20,000 were killed.

Doctor Atomic

Batter my heart, three-person'd God ; for you
As yet but knock ; breathe, shine, and seek to mend ;
That I may rise, and stand, o'erthrow me, and bend
Your force, to break, blow, burn, and make me new.
I, like an usurp'd town, to another due,
Labour to admit you, but O, to no end.
Reason, your viceroy in me, me should defend,
But is captived, and proves weak or untrue.
Yet dearly I love you, and would be loved fain,
But am betroth'd unto your enemy ;
Divorce me, untie, or break that knot again,
Take me to you, imprison me, for I,
Except you enthrall me, never shall be free,
Nor ever chaste, except you ravish me.
HOLY SONNETS. XIV John Donne (1572-1631)

Doctor Atomic Metropolitan Opera House

At the end of Act 1 of Dr Atomic (premiere at the Metropolitan Opera House, New York this season - composer: John Adams), Oppenheimer, the father of the Atomic bomb, faces his own personal crisis alone in the desert, recalling this sonnet by John Donne.

Gerald Finley as J. Robert Oppenheimer in "Doctor Atomic." Terrence McCarthy

This opera was first performed in San Francisco in 2005. You can read about that here.

The Cockroach Catcher and his wife were at the Met’s performance on the 13th of November 2008, a review of which you can read here.

I am not here to discuss the rights and wrongs of the Atomic bomb and its derivatives. There are now 50,000 such weapons worldwide. What is clear is that it has always been humans who hold the key to mass destruction. In Nanking. the Japanese grew bamboo through living Chinese as a means of destruction. It did not take an Einstein to work that one out nor an Oppenheimer to execute it.

In Dr Atomic, at the high point of the final countdown to the test firing of the bomb, there was a tape recorded voice of a Japanese woman repeatedly asking for a glass of water. 

5:29:45 am Mountain War Time on July 16, 1945 Los Alamos National Laboratory

What would the effect have been if images of Japanese atrocities in Nanking or in Hong Kong were projected on stage at the same time? Or perhaps Pearl Harbour, for an American audience?

After all there have been recent attempts by Japan to change their history textbooks. Guilt must in the end find its proper home.

That I may rise, and stand, o'erthrow me, and bend
Your force, to break, blow, burn, and make me new.

 On a Monday in August 1945, Little Boy was dropped on Hiroshima by the crew of an American B-29 bomber Enola Gay.

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Cockroach Catcher-Seven Minute Cure