In the first decades of the last century, Arnold Rothstein, described by one social historian as “the JP Morgan of the underworld”, is widely regarded as the founder of American organised crime. Later Bernard Madoff, Sam Bankman-Fried as well as the odious Jeffrey Epstein and Harvey Weinstein have carried on this grim tradition, albeit with usually less lethal means.

Today, America’s most prominent malefactors are more those of privilege than products of mean streets. Their evolution is epitomised by Bankman-Fried, a graduate of MIT, who was described by the Jerusalem Post as the product of “an upper-middle class family of Jewish academics”, raised in a $4 million home near Stanford amid the elite culture of Silicon Valley. Like many would-be tech moguls, Bankman-Fried revelled in his “outsider” image — as demonstrated by his pervasively sloppy dress code — but he was also an insider whose large contributions to the Democrats won him access to White House officials even as FTX was collapsing around him.

The complex nature of Jewish economic life was shaped by history. With their homeland destroyed by the Romans in AD70, Jews, already scattered throughout the Mediterranean world, were forced to employ their smarts and connections to survive. Once Christianity became the state religion, Jews faced greater restrictions, eventually barring them from most economic activities and service in the government or army. They were, notes historian Yuri Slezkine, “a cohesive tribe of professional strangers”, as opposed to most peasants, who were not literate, knew little about how the cash economy worked and often lived their entire lives within a relatively small perimeter. With the rise of capitalism, however, these habits born of exclusion turned out to be advantageous, as originally observed by both a sympathetic Max Weber and more hostile Werner Sombart. Jews may not have been the originators of capitalism, but as the Jewish historian Ellis Rivkin has argued, they were “best positioned to benefit”.

It also helped that Jews were literate, sometimes in more than one language, with contacts and family dispersed across numerous geographies. Before the Holocaust, Jews made up the vast majority of Eastern Europe’s factory owners, bankers, lawyers and physicians. By the 1880s, Jews accounted for a bare 4% of the population of the Austrian Empire, but comprised 40% of Vienna’s gymnasium students, a pattern seen throughout Eastern Europe. They also dominated the professions and the stock exchanges. A handful rose to prominence as global banking families, most obviously the Rothschilds, who played a preeminent role in the rise of the modern European and then North American economies.

Yet such success led some to suggest Jews were by nature manipulative and dishonest, a view common among European Christians for most of the last two millennia. Two dominant archetypes emerged in terms of Jewish image — one elevated, the other despised. “From Moses the lawgiver to Madoff the shyster”, writes University of Michigan historian Jeffrey Veidlinger. “Jews have figured prominently in European myth for some 2,000 years.” They were seen either as unmatched moral exemplars or “feared and despised as imagined worshippers of the Anti-Christ, political conspirators, financial manipulators, child murderers, and threats to racial purity”.

In reality, like any ethnic group under assault, some felt compelled to break the law. As early as the 10th and 11th centuries, Jewish leaders worked to fight criminals in their communities, most urgently when the scams inspired antisemitism from outside. But Jews also sometimes were persuaded to protect those who ran afoul of secular governments, in part due to the clear antisemitic bias of such regimes. Jews arriving in America or Britain, argued historian Irving Howe, entered a new environment that was more free but they still carried attitudes from their past. “The Torah tells us to do business honestly and follow the rules of the country,” notes Rabbi David Eliezrie, a prominent Chabad author and intellectual. “But we all too often lived in countries where the rules were impossible to follow.”

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Not surprisingly, Jewish community leaders have tended to downplay the criminal element of their tribe. It’s understandable that they prefer to focus instead on Jews’ extraordinary portion of Nobel Prizes (accounting for well over 20% of all winners between 1901 and 2022 while comprising just 0.2% of global population) than engage in discussions about gangsters and schemers. The Holocaust has also tended to dominate community consciousness, given the impact on many of our families. But focusing on Jews largely as martyrs and moral exemplars constitutes, as the author Dara Horn notes, a preference, if you will, for dead Jews — as long as they provide “a service to mankind” — over living ones. Martyrdom and intellectual achievement have been elevated as the centrepieces of Jewish identity, says Steven Windmueller, a professor emeritus at the Hebrew Union College-Jewish Institute of Religion in Los Angeles, but “there’s an embarrassment about economic success”.

In reality, of course, Jews included not only saints and savants, but also criminals, hustlers and the marginal, unmoored luftmenschen (in Yiddish a person who seems to “float on air”). In the early 20th century, Jewish gangs flourished in cities such as London, where “the Kosher nostra” competed with other ethnic gangs for control of downscale areas like the East End. Much like the Lower East Side, London’s poorer areas had filled with recent Jewish immigrants from Russia and Poland, living amid what one contemporary described as “an abyss of human suffering, an inferno of misery”. Some resorted to crime, like the gangs that featured in Peaky Blinders, although the vast majority on both sides of the Atlantic plodded on legally, and ultimately with good results.

Like East London, Brownsville, located in an unfashionable part of Brooklyn, served as an incubator for crime syndicates like Murder Incorporated, which essentially preformed hits for organised crime, particularly the Italian mafia. My late mother, who grew up there, charmingly described it as “a shitty place then, a shitty place now”. Raised in poverty, the New York gangsters, like Detroit’s Purple Gang and parts of Chicago’s potent underworld, engaged in protection rackets, bootlegging, prostitution, loan sharking and gambling.

To a large extent, community leaders ignored this aspect of Jewish life. Even the worst of them still occasionally attended high holy days and frequently supported synagogues and Jewish causes, including Israel. Few community icons spoke about this criminal past — even as they collected money from them. They knew about them, for sure, recalled one Detroit community leader, but “we were afraid to admit it”.

Even when I was growing up in New York and Long Island, this ambivalence remained. After all “the tough Jews” were known as people who, at a time when millions of European Jews were about to be exterminated, fought American Nazis in the streets, while their counterparts in London battled Mosley’s blackshirts. Most Jews remained law-abiding, but even in my own family, my father told me, we had both a gangster as well as a New York cop. The garment industry, which employed much of my family both as workers and owners, operated in resigned cooperation with the mob, a nagging part of everyday business. As one such individual memorably told the father of one of my high school friends: “what’s mine is mine and what’s yours is mine.”

In recent decades, the nature of Jewish crime changed. Violence, noted Meyer Lansky, has always been “a poor substitute for brains”. Crooked Jews looked for more “respectable” ways of relieving the unwary of their money; there were few multi-generational Jewish crime families. The new wave is personified by Madoff, Bankman-Fried, Weinstein and Epstein, all creatures of middle-class suburban families. Of the leading Jewish malefactors of the 20th century, only the corrupt British newspaper magnate Robert Maxwell — a survivor of the Holocaust, a military hero and father of Epstein’s partner Ghislaine — came from the truly school of hard knocks. Maxwell, a former Labour MP, died in 1991 at sea, perhaps by suicide, just as the extent of his fraud was being uncovered.

Like their more violent predecessors, these inheritors broke the rules, but not by blowing up safes, bootlegging or beating up deadbeats. Weinstein used bullying, particularly towards women, to get his way. Epstein and his partner Ghislaine Maxwell used the enticements of sex on a world of powerful figures and investors which, although it included many Jews, extended to distinctly goyishe figures like Bill Clinton and Prince Andrew.

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Then there was Bernard Madoff, an ambitious but not particularly well-educated financial hustler who defrauded investors of around $65 billion. Madoff was shameless, basking in the glow of Wall Street respectability as he ran a massive Ponzi scheme until he was nailed by regulators long asleep at the wheel. Critically, Madoff’s rise grew from exploiting Jewish ties. He raised money heavily from Jewish investors and served as chairman of Yeshiva University’s business school, among other institutions; the school’s investments with Madoff cost it an estimated $100 million. Madoff also scammed major Jewish charities such as Hadassah and Elie Wiesel’s Foundation for Humanity. Overall, noted The St. Louis Jewish Light after his death in 2021, Madoff’s activities constituted an “American Jewish catastrophe”.

This contradicts the conspiratorial notion that Jews get rich at the expense of Gentiles. In reality, much Jewish crime, like ethnic crime in general, preys on their own community. Just last month, an Israeli man allegedly bilked Orthodox Jews in LA and New Jersey out of an estimated $47 million. Such revelations, however, feed antisemitic memes at a time of rising hostility to Jews across wide parts of the population.

At his height, worth over $20 billion dollars and already crowned by the New York Times as “crypto emperor” in his early thirties, Bankman-Fried personified an elite background that was less ethnically tribal. Although he likely defrauded some Jews, he seems to have engaged in little of the traditional tribal schmoozing favoured by Madoff, Harvey Weinstein or Jeffrey Epstein. Instead of bilking country-club parvenus, Bankman-Fried dabbled in progressive political memes, much like his parents. He did contribute to the Democratic Majority for Israel and United Democracy Project, both supporters of Zionism. But his connections as a major Democratic donor — just like Madoff, Harvey Weinstein and Jeffrey Epstein — fitted him into a regime characterised by ultra-loose Federal monetary policies and lack of SEC oversight, a perfect terroir for his scam. He is also reportedly being investigated for making large, illegal political contributions.

No doubt some reflexive antisemites will refer to Bankman-Fried’s ancestry to explain his behaviour, but this misses the changes he represents. Bankman-Fried, if he is to be considered in his Jewish context, reflects something far less distinctly ethnic than Meyer Lansky or even Bernard Madoff. He is not a product of the ghetto or of the struggling middle class. He may fit the profile of malicious cleverness, but in ways more reminiscent of the new tech oligarchy than of the old tribal traditions. Like everything else, crime gradually is losing its distinct ethnic flavour. Years of acceptance and upward mobility have merged our people with our surrounding communities, and will make our failings less reflective of our heritage and more part of the general decadence of the age.

The correlation between alcohol and violence is well-known, and something we contend with on a daily basis in A&E. Handling drunk patients, and their often-volatile friends, is one of the job’s less pleasant challenges. Their perceptions of common decency are warped, their ability to communicate impaired, their behaviour unpredictable. Anger can quickly descend into violence. And when you mix the sick and frail with the intoxicated or inebriated, you create a morbid cocktail.

But it’s not for me to judge my patients’ transgressions or “lifestyle choices”. Whether they are drunk or stoned or high, incurred an injury in a car chase, or fell ill from swallowing a handful of drugs before they were arrested — all this is immaterial from a medic’s point of view, and must not pollute any assessment. There’s one A&E department nearby that saved the lives of two separate patients who had been brought in by the police with serious injuries sustained from fighting. Both were later charged with murder.

Even though I’m pretty accustomed to the risks now, there are still times when I genuinely fear for my own safety. On one occasion, a local criminal with a history of mental health problems confronted me. He had a habit of loudly threatening to commit suicide if he didn’t get to skip the queue — a threat which we had no reason to think was genuine, and which therefore got him nowhere with the staff on duty. When he accosted me, I could see that he was on the verge of hitting me, so I called the police and had him removed. He was twice my size and had that crazed look in his eyes; who knew what he would do? After all, if he didn’t take a swing at me, there’s every chance he could attack a member of my team. Or what if he decided to wait for me in the shadows of the staff car park? I wouldn’t be the first, or last, female doctor to be intimidated on her way home.

And then there are the patients who show up in A&E with weapons. Last week, a police pursuit in Rochdale ended when the suspect’s car collided with another vehicle. Officers detained the man and took him to Fairfield Hospital in Bury for treatment, only to find that he was carrying a gun. According to the Manchester Evening News, “police confirmed that there was never any risk to the public, and the weapon was recovered safely” — a statement that strikes me as, at best, nonsense and, at worst, evidence of a potentially sackable offence. If police officers had properly searched him, they would have found the gun, instead of allowing it onto hospital premises and putting countless lives in harm’s way.

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It was not an isolated incident. Last year, a clinician in a nearby hospital stumbled across a concealed weapon on a patient who had been brought in by police. Apparently, all hell broke loose. The officer guarding the suspect hit the panic button on his radio, and a team of armed police descended on the patient’s cubicle — much to the distress, no doubt, of other patients.

And it’s worth remembering that untrained, illicit firearms users are as much a risk to themselves as the public. A colleague once treated a young man who had received a gunshot wound to a rather delicate part of his anatomy after a firearm he’d concealed in the waistband of his jeans accidentally went off. (One of the patient’s testicles was rendered redundant.)

But even if external forces and authorities are responsible for bringing potential violence to A&E, the conditions within hospitals serve as a catalyst. Long waiting times, overcrowding, stressed-out patients and relatives, staff shortages: all these factors mean tempers run high. As one nurse who is preparing to strike over pay and conditions told me earlier this week: “Part of our campaign is about safe staffing on wards. The ratio of nurses to patients is out of kilter. This is often why people become aggressive in A&E: because they can’t get seen as we’re so short-staffed.” Nurses feel that they are expected to put up with abusive behaviour because, according to a recent survey, it ​was seen as “just part of the job”. Some described it as “normal” because of the frequency of incidents.

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Nurses aren’t the only ones who need better pay and treatment in order to keep patients safe. A&E departments in areas that see a lot of crime also need security staff who are capable of quickly deescalating potentially violent situations. Some hospitals already have this: men with special forces beards, who dress in combat trousers and tactical vests; they look like they are about to carry out a dawn raid with the SAS, not direct Mavis to the disabled parking bay. But these guards are the exception. Those who guard the nation’s emergency departments tend to earn disastrously low wages — and, as the NHS well knows, poor pay attracts poorly trained, unmotivated staff.

These failures trickle down. It shouldn’t need spelling out, but it does: when clinical staff are distracted, abused or assaulted, our capacity to deal with patients is limited, and our departments become less effective. According to The Lancet: “Violence costs the NHS £2.9 billion a year. Indirect costs are much greater, including loss of psychological and social function to the individual, diminished community cohesion, and loss of economic productivity.”

Until the public and the Government realise the immediate, future and generational cost of violence, not just to the healthcare system but to society as a whole, I fear Britain will be paying off a debt it can ill-afford. In the meantime, my staff will continue to look over their shoulders, knowing full well that more tragedies are inevitable.