Saturday, December 21, 2024

How Woke can we be? The meaning of Woke

How Woke can we be? The meaning of Woke

by Donald H. Marks, Physician and Scientist 



"Woke" and Woke-ism may function as contentious terms, yet they can convey an increased awareness of social and political issues, particularly those linked to inequality and systemic oppression. Being "Woke" implies an understanding of how societal structures perpetuate inequalities and a commitment to actively address these issues. However, Woke-ism can also be employed as a slur, especially with regard to contentious election cycles.


A practical definition of being "Woke" encompasses:

1. Recognizing and challenging one's own privilege and biases.

2. Educating oneself on social and political issues, especially those affecting marginalized communities.

3. Participating in activism or advocacy to promote social justice.

4. Listening to and centering the voices of marginalized communities in discussions and decision-making.

On the flip side, considering "Woke" as a hot-button trigger word, it may be used pejoratively to categorize liberals or social activists as divisive, downplaying the significance of their concerns and fostering division in society.

Historically, the term "Woke" originated in the African American community, describing a state of awareness or vigilance around social justice and racial inequality, dating back to a 1940s song by blues musician Lead Belly called "Scottsboro Boys."

In the 1960s and 1970s, "Woke" gained wider usage in African American communities, resurging in the 2010s with the prominence of social media and the Black Lives Matter movement.

The implications of being "Woke" vary based on the individual and context. While it can be viewed positively as a trait indicating social consciousness and active efforts for justice, it can also be used in a perjorative or negative sense, suggesting an excessive focus on social justice without meaningful action. For me, "Woke" is, pragmatically, another emotionally charged term rather than a tool for fostering thoughtful discourse.

Ultimately, the impact of being "Woke" depends on how an individual interprets and applies the concept in their daily life.


Additional writings of mine that may interest you:


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Elitists Neocons Neolibs, Globalists and Narcissists, oh my. What are they, who are they, and why should I care?

 Elitists Neocons Neolibs, Globalists and Narcissists, oh my. What are they, who are they, and why should I care? 





by Donald H Marks

Physician scientist

Reason, ethics, health equity, 3rd generation Veteran

Elitists, Neoconservatives, Neoliberals, and Globalists are all political ideologies that hold distinct beliefs and values. Knowing the differences is essential to starting a thoughtful discussion. 


Elitists believe in the rule by an elite class of individuals who supposedly possess the knowledge and expertise to govern society. They tend to favor a small, powerful government that is controlled by a small group of educated and wealthy individuals. Elitists often see themselves as the only ones capable of making the necessary decisions to run society effectively.




We all may think that we know what Elitism is, or that we can recognize or just somehow know or feel who an elitist is. To be sure, Elitism is the belief or notion that a select group of people have an intrinsic special quality, high intellect, wealth, power, notability, special skills, or experience. These so-called Elites are considered by some to be more likely to be constructive to society as a whole, and therefore deserve influence or authority greater than that of others. The term Elitism may be used to describe a situation in which power is concentrated in the hands of a limited number of people - the Elites. Sounds familiar? Beliefs that are in opposition to, contrary to, or in contrast with Elitism include egalitarianism, anti-intellectualism, populism, and the political theory of pluralism. Following is my ever-growing and changing list of specific Elitists and groups perceived to be Elites: 



Specific Elitists:


William F. Buckley

Michael Bloomberg 

James M. Buchanan

Hillary and Bill Clinton

John Edwards

Milton Friedman 

Matt Gaetz, Congress

Alan Greenspan

Al Gore, former VP and failed presidential candidate, who gave up too easily,

Friedrich Hayek 

Michael Kinsley

John Kerry, former SoS

Henry Kissinger, former SoS (you may enjoy my podcast on the SuperK http://bit.ly/3jlf76x)


Emmanuel Macron, French Pres

Ayn Rand, failed philosopher and absolutist,

Ronald Reagan 

Mitt Romney, Wealthy Mormon Governor, unsuccessful presidential candidate

Margaret Thatcher

Mark Zuckerberg, and execs at FB Meta Google Yahoo


celebrities and entrepreneurs Scott Baio, Peter Thiel, Stephen “The Other Brother” Baldwin



General Elitists


Any member of The Adam Smith Institute

The Corporate Elites, including Jeff Bezos, Elon Musk, Mark Zuckerberg, heads of multi-national corporations,

The Oligarchs (Russian, but also Western)

The Academic Elites (Ugh, don’t get me started!)

Medical opinion leader elites at MMC, universities, JAMA NEJM and government think tanks like CDC NIH 


Most MoC and ‘The Supremes’


All royalty, monarchs  oligarchs


Most members of organized religious upper levels, including Joel Olsteen.


Many A list entertainers (see references)


All attendees of Met Galas (see references)



LMK if I missed someone you think should be on my list of Elitists, or if you disagree☕




Inside my group of overall undesirables, in addition to Elitists, I add the group:  the Neocons - those titular conservatives who never-the-less believe in foreign intervention. Neoconservatives typically advocate the promotion of democracy and interventionism in international affairs (foreign policy hawks), including "peace through strength", USA involvement in proxy wars, and are known for espousing disdain for communism and leftist  political radicalism. In their actual policies, Neoliberals, according to @TNR t.co/WUfgPz164m focus on privatization of state enterprises, liberalization of trade, massive tax cuts, reduction of social services and welfare, anti-union drives, and, generally, the downsizing of government at all levels. The negative outcomes of these destructive policies are evident.


Neoconservatives - the Neocons - are a political ideology that emerged in the United States in the 1970s. They are characterized by their support for a strong national defense, interventionist foreign policy, and a commitment to America.  exceptionalism. Neoconservatives tend to be more hawkish on foreign policy and often advocate for increased military spending and intervention in other countries. 


                                                            Kristol, Wolfowitz, Cheney


You may find this Diagram of NeoCons, by  Peter and Maria Hoey, with comment by JEET HEER published in the 2008 Washington Post, to be helpful : https://sanseverything.wordpress.com/2008/02/03/neo-conservatism-the-chart/







This extensive chart traces the history of neo-conservatism from Leo Strauss and Leon Trotsky to the Bush White House. The chart accompanies a review of Jacob Heilbrunn’s book They Knew They Were Right: The Rise of the Neocons.


Prominent Neocons include (IMO): 


  • Elliott Abrams, foreign policy expert

  • Michael Bloomberg,

  • Paul Bremer, diplomat, including post in Iraq

  • James M. Buchanan

  • Robert O’Brien, Bolton’s disciple and successor as national security adviser;

  • Sen. Liz Cheney and Dick Cheney, former VP

  • Eliot A Cohen, John Hopkins SAIS professor

  • Sen Tom Cotton, a Bill Kristol protégé

  • Paula Dobriansky of the foreign-funded Atlantic Council; 

  • Mark Dubowitz, CEO of the Foundation for Defense of Democracies;

  • Eric S Edelman, Johns Hopkins SAIS;

  • Evelyn N Farkas, failed congressional candidate and executive director of the McCain Institute

  • Milton Friedman

  • Alan Greenspan

  • Sen Lindsey Graham 

  • Reuel Marc Gerecht, former CIA

  • Friedrich Hayek John Herbst, of the foreign-funded Atlantic Council; 

  • Brian Hook, Special Representative for Iran

  • David J Kramer, former aide to John McCain;

  • Michael Kinsley

  • Michael McFaul, former ambassador and MSNBC fixture .

  • Richard Perle 

  • Mike Pompeo, former SoS

  • Donald Rumsfeld, former SoD

  • Ronald Reagan, former president, proponent of the trickle-down theory that was targeted to but didn't work well at all for working class people, and B-list actor (Bedtime with Bonzo). A great communicator of often simplistic and seemingly self-evident policies which in many cases had harmful long-range results. I know, there I go again.

  • Margaret Thatcher, former prime Minister of UK

  • Paul Wolfowitz, former deputy Secretary of Defense, ambassador, Dean of John Hopkins SAIS, and visiting scholar at American Enterprise institute (need I say more)

  • David Wurmser, a former adviser to John Bolton



Another group on my list of those to be disdained, avoided, doubted are the Neo-liberals:  The NeoLibs can be loosely defined as generally associated with the 20th-century resurgence of 19th-century ideas associated with free-market capitalism.  Neoliberals advocate  (potentially ruinous) policies of economic liberalization, including privatization, deregulation, globalization, free trade, austerity and reductions in government spending in order to increase the role of the private sector in the economy and society. And don't confuse Neocons with Neolibs. 





Neoliberals emphasize economic liberalism, free markets, and individual freedom. They believe in minimal government interference in the economy and support for deregulation, privatization, and free trade. Neolibs believe that the economy should be left to function on its own, and that government intervention in the economy will only lead to inefficiency and ineffectiveness.




Some Prominent Neolibs (IMO): 


  • Michael Bloomberg 

  • James M. Buchanan 

  • Bill Clinton (see the referenced article in TNR)

  • Al Gore

  • Alan Greenspan

  • Friedrich Hayek, influential Austrian economist 

  • Milton Friedman 

  • Michael Kinsley, political journalism commentator, and co-host of Crossfire

  • Margaret Thatcher, former PM of UK

  • Ronald Reagan




Any member of The Adam Smith Institute, and followers of Ayn Rand


You may have noticed some overlaps between these generally undesirable groups. Yes, it is quite possible to be a Neocon and a Neolib at the same time, as you will see by a review of my lists, above.


Finally, this discussion would definitely not be complete without a mention of the Globalists. They are generally disliked and often elitist individuals or groups that believe in the idea of a global community and the need for cooperation between nations to achieve common goals. They believe in the importance of international institutions and the need to promote global governance and cooperation. Globalists

 also tend to support free trade and the movement of people, goods, and ideas across borders, perhaps sometimes to the detriment of their own countries or for some greater picture.


I am not at all an exclusionist, not an Elitist (God-forbid), so if you disagree with my lists, or want to add someone, LMK.


Let me finish by discussing another group, the narcissists, who are easily confused with and who overlap with the Elitists. But they are different in key ways. Narcissists and Elitists of course at least superficially share some similarities in that they both have a high opinion of themselves and may be perceived as arrogant or entitled.  Narcissism is officially recognized as a personality disorder (DSM, Mayo Clinic), a mental health condition in which people have an unreasonably high sense of their own importance. They need and seek too much attention and want people to admire them. People with this disorder may lack the ability to understand or care about the feelings of others. But behind this mask of extreme confidence, they are not sure of their self-worth and are easily upset by the slightest criticism. 




The famous painting Narcissus, by Caravaggio shows how one picture can save a thousand

words.




A narcissistic personality disorder causes problems within and between many areas of life, such as relationships, work, school or financial matters. People with narcissistic personality disorder may be generally unhappy and disappointed when they're not given the special favors or admiration that they believe they deserve. They may find their relationships troubled and unfulfilling, and other people may not enjoy being around them.


Narcissists have an excessive sense of self-importance and a deep need for admiration and attention. They often lack empathy and are willing to exploit others to get what they want. Narcissists may have an inflated sense of their own abilities and accomplishments, even if they are not backed up by evidence.


Elitists, on the other hand, believe that they are part of an elite group that is superior to others. They may hold exclusive beliefs or values and have a sense of entitlement based on their perceived status or accomplishments. Elitists may not necessarily lack empathy or exploit others, but they may hold themselves above others based on their perceived superiority. 


Overall, while both narcissists and elitists may have a sense of superiority, I have found that narcissists tend to be more focused on themselves and their own needs, while Elitists I have known seem to be more focused on the group they identify with or belong to. 


In summary, Elitists believe in the rule of an elite class, Neoconservatives believe in a strong national defense, Neoliberals believe in minimal government intervention in the economy, and Globalists believe in the need for cooperation between nations to achieve common goal, which is arguably a reasonable view, but they fail, IMO, by tending to favor a more generalized approach to mankind and its problems, rather than a nation-specific viewpoint, thereby creating the possibility of weakening their home base.



Additional Readings on the subjects of Elitis, Neocons and Neoliberals



The Met Gala Guest List Sparked A Huge Debate About “Elitism” And Which Celebrities Should Be Invited After This Year’s Red Carpet Saw More YouTubers and TikTokers Than Ever https://www.buzzfeednews.com/amphtml/ellendurney/met-gala-guest-list-sparked-a-huge-debate-about-elitism


"Proudly Elitist and Undemocratic? The distributed maintenance of contested practices - Mia Raynard, Farah Kodeih, Royston Greenwood, 2021" https://journals.sagepub.com/doi/10.1177/0170840619874462



"Elite is now a meaningless insult that's used to silence criticism | Brexit | The Guardian" https://amp.theguardian.com/commentisfree/2018/mar/07/liberal-elite-populism-brexit-elitist


"Elitist stars like Streep display petty attitude: Front Burner - Orlando Sentinel" https://www.orlandosentinel.com/opinion/os-ed-celebrity-elitists-are-bullies--front-burner--011817-2-20170118-story.html?outputType=amp


The Neocons Strike Back. Ryan Olbrysh.  TNR Jan 2020. https://newrepublic.com/amp/article/156266/neocons-strike-back?utm_source=pocket_mylist


Neocon think-tanks are driving Biden’s Ukraine policy. 

https://asiatimes.com/2022/06/neocon-think-tanks-are-driving-bidens-ukraine-policy/?amp_markup=1&utm_source=pocket_mylist


Is the Neoliberal Era Over Yet?  https://newrepublic.com/article/166742/neoliberal-era-end?utm_medium=Social&utm_campaign=EB_TNR&utm_source=Twitter#Echobox=1655302282-7


How Fascism Works: The Politics of Us and Them, by Jason Stanley.




Additional writings of Donald H. Marks, physician-scientist (most can be found here on this blog)

How Woke can we be? The meaning of Woke https://bit.ly/3Fd7fPy 

Is criticism of Henry Kissinger (Super K) just another form of historical revisionism? My opinion.

Reliable news sources: personal list used by Donald Harvey Marks, physician⚕ scientist🥼http://bit.ly/3kECPvr   


Fake News: Everything You Need to Know, 

by Donald Harvey Marks physician⚕-scientist🥼  http://bit.ly/345cj95 


Best Online Free Fact-Checking Tools, 

by Donald Harvey Marks, physician⚕-scientist🥼   http://bit.ly/3H97I44 


Fact-Checking: The Ways We Can Fight Fake News, 

by Donald Harvey Marks, physician⚕-scientist🥼  http://bit.ly/3qudEyX 


Infodemic: the epidemic of information, 

by Donald Harvey Marks, physician⚕-scientist🥼  http://bit.ly/3fV7BgN 


The Curious Case of Deepfakes, by Donald Harvey Marks, physician⚕-scientist🥼  http://bit.ly/3GZJdXhn 


My personal list of Red Flags🚩, Dog Whistles🛷, Buzzwords, Hot Button words and meaningless caricatures  that will drive toxic algorithms to heat and twist 2024 election 🗳☑ and trigger hatred on social media. by Donald H. Marks, Physician scientist 

http://dhmarks.blogspot.com/2022/05/my-personal-list-of-red-flags-dog.html 


Einstein, Relativity and Relative Ethics, by Donald Harvey Marks, physician-scientist   https://bit.ly/3gWWH9t   https://bit.ly/3rcqZMj 


What I Haven’t Told My Family on the Meaning of Time. by Donald Harvey Marks, physician-scientist  https://bit.ly/374cpzJ 


Jonas Salk, Polio Vaccine and Vaccinating Against Hate, by Donald Harvey Marks, physician-scientist https://bit.ly/3xjtosh 


Link to my Favorite Books📚 (and recent read list) 


My ever-updating fav list of coffee shops and espresso blends and locations 

https://docs.google.com/document/d/1-HXf36YBWMzsGgKhd5_gqRvnKoplLrYAgAl7k3qwpvU/edit?usp=drivesdk 


Elitists Neocons Neolibs, oh my. What are they, who are they, and why should I care? (this very article) http://bit.ly/3LMrs0e 


Review of Undermoney, a techno economic political thriller by Jay Newman. Reviewed by Donald Harvey Marks  https://bit.ly/3Fa4wqb



graphic, by DHM


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Cocaine Use in the setting of Methadone treatment for Opioid Use Disorder. My take.

Cocaine Use in the setting of 

Methadone treatment for Opioid Use Disorder



by Donald H Marks MD PhD


October 24, 2023



It seems that increasing numbers of patients in drug abuse treatment programs are testing positive for cocaine use, while undergoing treatment for opioid use disorder (OUD) with methadone (MTD).


Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. Although healthcare providers can use it for valid medical purposes, such as local anesthesia for some surgeries, recreational cocaine use is illegal. As a street drug, cocaine looks like a fine, white, crystal powder. Street dealers often mix it with things like cornstarch, talcum powder, or flour to increase profits. They may also mix it with other drugs such as the stimulant amphetamine, or synthetic opioids, including fentanyl. Adding synthetic opioids to cocaine is especially risky when people using cocaine don’t realize it contains this dangerous additive. Increasing numbers of overdose deaths among cocaine users might be related to this tampered cocaine.


Widespread use of cocaine by individuals with OUD undermines the effectiveness of methadone treatment programs in reducing illicit drug use, in decreasing criminal behavior, and in slowing the spread of the HCV and HIV. As pointed out elsewhere (Condilli et al. in 1991), some methadone maintenance treatment (MMT) programs have implemented a range of behavioral interventions (see the following list) to manage this growing problem of concurrent use of cocaine and opioids, but with limited effectiveness. 


A recent NIDA report states that once inpatient OUD treatment ends, ongoing support—aftercare—can help people avoid relapse. Some research indicates that people who are committed to abstinence, engage in self-help behaviors, and believe that they have the ability to refrain from using cocaine (self-efficacy) may be more likely to abstain. Aftercare may serve to reinforce these traits and to address problems that may increase vulnerability to relapse, including depression and declining self-efficacy. However, individuals using cocaine should be carefully assessed and monitored for their overall substance use and mental health issues.


Roux et al 2016 found that, although time on MMT had a positive impact on occasional cocaine use, it had no impact on regular cocaine use. Moreover, regular cocaine users were more likely to report opiate injection and to present with ADHD and depressive symptoms. My experience as a prescriber at Aftercare leads me to doubt the conclusion of Roux et al that simply screening for these disorders and prompt tailored pharmacological and behavioral interventions can potentially reduce cocaine use and improve response to MMT.


MMT is primarily used to manage OUD by reducing withdrawal symptoms and cravings. Combining MMT with counseling and support services can be effective in helping patients with OUD alone, and perhaps in combination with cocaine addiction, in their recovery. 


Using cocaine can make it harder to stop using opioids due to several factors that interact with each other. Patients and their counselors need to be aware of this. Interacting factors include: 

  • Neurobiological Interactions: The neurobiology of addiction involves complex changes in the brain. Both cocaine and opioids affect the reward pathways, leading to a heightened release of dopamine. When used together, cocaine and opioids can create a more intense euphoria, making it difficult for individuals to quit due to the reinforced pleasure they experience from the combined effects of these drugs [Kosten 2002].

  • Polydrug Use: Cocaine and opioids are often used together in a pattern known as "speedballing." This combination can be particularly addictive, as the stimulant effects of cocaine can counteract some of the sedative effects of opioids, leading to a cycle of drug use to maintain the desired effects [Mayo].

  • Withdrawal Symptoms: When individuals attempt to quit one of these drugs, they may experience withdrawal symptoms. These symptoms can be intense and highly uncomfortable, which often leads individuals to return to using opioids and cocaine to relieve these very symptoms [NIDA 1].

  • Cravings and Triggers: Cocaine and opioids can create powerful cravings and triggers, making it challenging for individuals to resist the urge to use. Even after a period of abstinence, the cravings can persist and lead to relapse [NIDA 1].

  • Need for Comprehensive Treatment: Overcoming addiction to both cocaine and opioids typically requires comprehensive treatment that addresses both substances simultaneously. Medications, counseling, and support are essential to help individuals manage their cravings and withdrawal symptoms [SAMHSA 2].


Pharmacology: 

Cocaine use can be extremely dangerous and deadly. The immediate physical effects of cocaine use include constricted blood vessels, dilated pupils, nausea, restlessness and increased body temperature, heart rate, and blood pressure. 

Health complications of cocaine can include: disturbances in heart rhythm. Headaches, chest pain and heart attack, respiratory failure, stroke, stomach pain, nausea, and seizures. 


According to Katz 2010, cocaine use along with MTD resulted in significantly more rapid methadone clearance.  They concluded that regular cocaine use may adversely impact treatment outcomes for opioid dependence in those receiving methadone maintenance by decreasing the effective methadone dose.


Short-term health effects of cocaine can include:

  • extreme happiness and energy

  • mental alertness

  • hypersensitivity to sight, sound, and touch

  • irritability

  • paranoia—extreme and unreasonable distrust of others


Other health effects of cocaine use include:

  • constricted blood vessels

  • dilated pupils

  • nausea

  • raised body temperature and blood pressure

  • fast or irregular heartbeat

  • tremors and muscle twitches

  • restlessness

Long-Term Effects

Some long-term health effects of cocaine depend on the method / route of use and include the following:

  • snorting: loss of smell, nosebleeds, frequent runny nose, and problems with swallowing

  • smoking: cough, asthma, respiratory distress, and higher risk of infections like pneumonia

  • consuming by mouth: severe bowel decay from reduced blood flow

  • needle injection: higher risk for contracting HIV, hepatitis C, and other bloodborne diseases, skin or soft tissue infections, as well as scarring or collapsed veins

However, even people involved with non-needle cocaine use place themselves at a risk for HIV because cocaine impairs judgment, which can lead to risky sexual behavior with infected partners 


Here are some key considerations for helping cocaine abuse in OUD patients on MMT:


1. Individual Assessment: Each patient's case is unique. A thorough assessment should be conducted to determine the extent of their opioid and cocaine use, as well as any other medical or psychiatric conditions, and prescription medicine intake.


2. Integrated Care: Integrated treatment that addresses both opioid and cocaine use, along with any other co-occurring disorders, is often more effective in promoting recovery.


3. Risk Mitigation: Providers should be aware of potential interactions and risks associated with combining methadone with cocaine. While methadone is used to treat opioid addiction, it doesn't address cocaine addiction directly. This needs to be explained to patients to avoid misunderstandings and false expectations.


4. Counseling and Support: Patients should receive counseling and support services tailored to their specific needs. Cognitive-behavioral therapy and contingency management therapy are approaches for managing cocaine use that may be effective.


5. Ongoing Monitoring: Continuous monitoring and adjustment of the treatment plan are essential to track progress and adapt interventions as needed.


The consensus best practice seems to be that cocaine use should not automatically bar someone from methadone treatment for opioid addiction. Cocaine use is a common co-occurring issue among individuals with opioid addiction, and it is important to address both substances simultaneously to provide comprehensive care.  Patients at Aftercare should be advised that:



  • Cocaine is an addictive drug,

  • Cocaine has many potential adverse effects, including those listed above,

  • MTD does not provide any treatment benefit to counter cocaine use,

  • Encourage patients to stop cocaine use,

  • Offer referrals and literature.


Treating hypertension in the presence of cocaine use can be challenging due to the potential interactions between cocaine and antihypertensive medications. It's important to prioritize the treatment of hypertension while addressing the cocaine use. Here are some general considerations:


1. **Stop Cocaine Use:** The first step is to address the cocaine use. Encourage the individual to seek help for addiction and to stop using cocaine, as continued use can exacerbate hypertension.


2. **Monitor Blood Pressure:** Continuously monitor the individual's blood pressure to determine the severity of hypertension. If it's dangerously high, immediate medical attention may be necessary.


3. **Medical Evaluation:** Seek a medical evaluation to assess any potential complications or underlying health issues related to cocaine use and hypertension.


4. **Antihypertensive Medication:** If blood pressure remains high after stopping cocaine use, antihypertensive medication may be required. The choice of medication will depend on the individual's specific condition and should be determined by a healthcare professional. For example, the anti-hypertensive drug clonidine may be of benefit. Jobes (2011) found that Clonidine was effective in reducing stress-induced (and, at a higher dose, cue induced) craving in a pattern consistent with preclinical findings, although this was significant on only one of several measures. Their findings suggest that alpha-2 adrenergic agonists (like clonidine) may help prevent relapse in drug abusers experiencing stress or situations that remind them of drug use 


5. **Caution with Medications:** Some antihypertensive medications can interact with cocaine and worsen certain symptoms. Avoid medications like beta-blockers, which may increase blood pressure and heart rate in the presence of cocaine. ACE inhibitors and calcium channel blockers might be considered safer options. As noted above, clonidine may be of particular benefit. 


6. **Behavioral Therapy:** Combine medication with behavioral therapy or counseling to address both hypertension and addiction simultaneously. This can help the individual develop healthier habits and coping mechanisms.


7. **Regular Follow-up:** Continue to monitor and adjust treatment as needed, as the individual's condition may change over time.


Healthcare professionals who have experience in treating substance abuse and hypertension should be involved in this situation. They can provide personalized guidance and treatment plans to ensure the best possible outcomes.


Although I have not yet met a patient in methadone treatment, concurrently using cocaine,  who thinks that methadone may help with stopping cocaine use, this may be a possible misconception. I try to mention to all MTD patients whose drug screen shows cocaine that their receiving MTD will not help with stopping cocaine use. 

In summary, the combination of cocaine and opioids can lead to a vicious cycle of addiction, driven by the neurobiological effects, cravings, and withdrawal symptoms associated with each substance. Breaking free from this cycle often necessitates specialized treatment (a higher LOC than aftercare) and support.


References


Condelli WS et al. Cocaine use by clients in methadone programs: Significance, scope, and behavioral interventions. Journal of Substance Abuse Treatment Volume 8, Issue 4, 1991, Pages 203-212, 1991.


Cocaine DrugFacts | National Institute on Drug Abuse (NIDA) (nih.gov)


Drug addiction (substance use disorder) - Symptoms and causes - Mayo Clinic


Jobes ML et al. Clonidine blocks stress-induced craving in cocaine users Psychopharmacology (Berl). 2011 November ; 218(1): 83–88. doi:10.1007/s00213-011-2230-7. 


Kapur BM et al.  Methadone: a review of drug-drug and pathophysiological interactions.  Crit Rev Clin Lab Sci.  . 2011 Jul-Aug;48(4):171-95. doi: 10.3109/10408363.2011.620601. 


Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect. 2002 Jul;1(1):13-20. doi: 10.1151/spp021113. PMID: 18567959; PMCID: PMC2851054. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/ 

Marks Donald H. 2023. Treatment guidelines for prescribing anti-psychotics to patients on methadone.https://dhmarks.blogspot.com/2024/02/guidelines-to-prescribing-anti.html

McCance-Katz et al. Effect of cocaine use on methadone pharmacokinetics in humans.  Am J Addict  2010 Jan-Feb;19(1):47-52. doi: 10.1111/j.1521-0391.2009.00009.x. 2010 Jan-Feb;19(1):47-52. doi: 


NIDA. Why are drugs so hard to quit? Why are Drugs so Hard to Quit? | National Institute on Drug Abuse (NIDA) (nih.gov) 

Medications, Counseling, and Related Conditions | SAMHSA


Roux, P. et al. Correlates of cocaine use during methadone treatment: implications for screening and clinical management (ANRS Methaville study). Harm Reduct J 13, 12 (2016). https://doi.org/10.1186/s12954-016-0100-7


What treatments are effective for cocaine abuse? How is cocaine addiction treated? | National Institute on Drug Abuse (NIDA)



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Is criticism of Henry Kissinger (Super K) just another form of historical revisionism? My opinion.

Super K and Historical Revisionism

Donald H. Marks, physician and scientist

I'm mm mm


Following is a link to my podcast on the now-deceased Henry Kissinger , conflicted elder statesman at 100, former Secretary of State, National Security advisor. Was he an agent for good, or an evil war criminal? Only time will tell the validity of different perspectives on the Super K. 

I recently added Henry Kissinger to my exclusive and famous list of Elitists, Neocons and Neoliberals. Was I wrong to have done so? I think not. The Super K was a trifecta here. 

The question of whether or not to call Henry Kissinger a war criminal is, IMO, more an example of historical revisionism, and in terms of relative ethics - a matter of perspective. Some people believe that Kissinger's actions during his tenure as National Security Advisor and Secretary of State, such as his support for the Vietnam War and the Cambodian extension, met the definition of war crimes. https://youtu.be/COqq7862wcU?si=aXm0d7KUOj8c8Caa

 Others believe that Kissinger's actions were justified by the circumstances of the time and that he should not be held accountable for them today.

Historical revisionism can be viewed as an act of misrepresenting or distorting historical events in order to serve a particular purpose. In the case of Henry Kissinger, some people may be trying to revise history in order to make him appear more guilty of war crimes than he actually may have been. Others may be trying to revise history in order to exonerate him of any wrongdoing.

Ultimately, it is up to each individual to decide whether or not they believe that Henry Kissinger is a war criminal. There is no clear consensus on this issue, and there is evidence to support both sides of the argument. LMK your thoughts.


Reference articles

Henry Kissinger, a crooked legacy. https://www.wionews.com/opinions-blogs/henry-kissinger-a-crooked-legacy-597010?utm_source=pocket_mylist

Machiavelli and U.S. Politics Part 5: War Crimes and Atrocities  



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Should ALL Medical Doctors Be Required to Accept Medicare and Medicaid $$$ as a Condition of Licensure? Can the Gods be humble and care for their lowly helpless subjects? My take.

Should Medical Doctors Be Required to Accept Medicare and Medicaid as a Condition of Licensure?

By Donald H. Marks, MD PhD, FACP   physician scientist  3rd generation Veteran

Medicare and Medicaid are two government programs that provide health coverage to millions of Americans. Medicare covers 67 million citizens ages 65 and over, as well as 8 million younger adults with certain chronic conditions or disabilities. Medicaid is a joint federal-state program that provides health insurance to low-income individuals and families. To date, 41 states (including DC) have adopted the Medicaid expansion, and as of June 2023, approximately 94 million persons are covered by Medicaid and Children’s Health Insurance Program CHIP.  

Having insurance coverage is not the same as having access to care because not all doctors accept Medicare and Medicaid patients. Are you shocked, surprised or offended? According to a survey by the American Medical Association, in 2018, 90% of physicians accept new Medicare patients, while only 72% accepted new Medicaid patients. The main reasons cited for this discrepancy are the low reimbursement rates and the high administrative burden of dealing with these programs. I have faced this very frustrating situation in my own medical practice and in my own personal life as an over 65 medical patient, turned away by a large local hospital-affiliated orthopedic surgery group and a large acute care outfit affiliated with the local referral hospital because they did not accept Medicare Advantage. 


local hospital-affiliated orthopedic surgery group which does not accept Medicare.


Interesting discussion of medical equity and access to care, on Star Trek https://youtube.com/shorts/MNbADGu_0Z0?si=e3owA2sTyhy7GliE

Some healthcare equity advocates argue that all medical doctors should be required to accept Medicare and Medicaid as a condition of their medical license. They claim that this would ensure access to quality health care for all Americans, regardless of their income or age. They also point out that medical doctors have a social responsibility to serve the public good, and that accepting government insurance is part of their professional duty.

Some opponents contend that medical doctors should have the freedom to choose their patients and their payment methods. They assert that forcing medical doctors to accept Medicare and Medicaid would violate their autonomy and their property rights. They also warn that such a mandate could reduce the supply and quality of doctors, as some would retire early, relocate to other states, or opt out of the system altogether.


Public Funding of Physician Training

All physicians in the United States receive some form of public funding during their training. This funding can come from a variety of sources, including:

  • Federal funding: The federal government provides funding for medical schools, residency programs, and other healthcare training programs through a variety of programs, such as the National Institutes of Health (NIH) and the Health Resources and Services Administration (HRSA). Another form of federal funding, which I benefited from, is military sponsorship.

  • State funding: Many state governments also provide funding for medical schools and residency programs.

  • Local funding: Some local governments also provide funding for healthcare training programs.

In addition to government funding, many physicians also receive financial assistance from private sources, such as scholarships and loans. However, even these private sources of funding often rely on government support in some way. For example, many student loans are guaranteed by the federal government.

Obligation to Accept Medicaid Patients

Because all physicians receive some form of public funding during their training, many healthcare equity advocates argue that medical doctors have an obligation to accept Medicare and Medicaid patients.

There are a number of reasons why physicians should accept Medicaid patients. First, it is a way to repay the public for the investment that was made in their training. Second, it helps to ensure that everyone has access to quality healthcare, regardless of their income. Third, it can help to reduce the burden on the uninsured healthcare system.

Challenges

There are a number of challenges that physicians face when accepting Medicaid patients. One challenge is that Medicaid reimbursement rates are often (but not always) lower than those of private insurance companies. This can make it difficult for physicians to cover the costs of providing care to Medicare/Medicaid patients.

Another challenge is that Medicaid patients often can have more complex medical needs. This can make it more time-consuming and difficult to provide care to Medicare/Medicaid patients.

While it's important to encourage healthcare providers to participate in government healthcare programs like Medicaid and Medicare, denying medical doctors a medical license solely for not accepting these programs may not be the most effective or ethical approach. Instead, it may be more effective to incentivize their participation through other means, such as matching Medicare Medicaid to BC/ BS or Kaiser rates. Here's why:

1. Ethical Considerations: Denying medical doctors a medical license based solely on their participation in specific insurance programs could be seen as discriminatory and heavy-handed. All licensed medical professionals should be treated equally, but their primary commitment should be to provide quality health care to patients, regardless of their insurance status.


2. Access to Care: Restricting access to care by revoking licenses may be counter-productive, by exacerbating the shortage of healthcare providers, especially in underserved areas. A better approach may be to encourage more doctors to accept Medicaid and Medicare patients by offering realistic reimbursement rates which also represent the cost of providing care, and lowering administrative barriers.


3. Focus on Quality of Care: Licensing should primarily ensure that medical doctors are qualified and capable of providing high-quality care. Accepting or not accepting specific insurance should not be the sole determinant of a physician's qualifications.


4. Individual Choice: Doctors often have valid reasons for not participating in government insurance programs, such as administrative burdens or low reimbursement rates. Some hold that it is essential to respect their professional judgment and provide incentives for participation rather than punitive measures.


5. Incentivize Participation: Instead of punitive measures, it may be better to create incentives for medical doctors to participate in Medicaid and Medicare. These could include improved reimbursement rates, reduced administrative burdens, or offering tax incentives for providers who accept a certain percentage of patients from these programs.


6. Patient Choice: Patients should have the freedom to choose their doctors. Forcing doctors to accept specific insurance could limit patient choice and interfere with the doctor-patient relationship, which is crucial for effective healthcare.


Of course it's crucial to encourage medical doctors to participate in Medicaid and Medicare without resorting to revoking medical licenses, although the alternative of denying access to healthcare to the sick is even more onerous, IMO. By addressing the issues that deter doctors from participating and providing incentives, we may perhaps ensure that more healthcare providers accept patients from these programs while upholding ethical standards and individual choice.


From a health equity and ethics standpoint, are medical doctors who refuse to accept Medicaid or Medicare simply greedy? 

Health equity is the principle that everyone should have a fair and just opportunity to attain their highest level of health, regardless of their income, race, ethnicity, gender, disability, or other factors that may affect their access to health care (CDC What is Health Equity? | Health Equity | CDC). By electing not to accept Medicaid or Medicare patients, even though these programs provide essential life-supporting health insurance for millions of low-income, elderly, and disabled Americans (https://www.who.int/health-topics/health-equity), those non-participating medical doctors are actively and intentionally denying patients the right to health and contribute to the health disparities that result from their unequal access to quality health care.

One might argue that doctors who refuse to accept Medicaid or Medicare are greedy because they prioritize their own financial interests over the health needs of their patients. According to a report by the Medicaid and CHIP Payment and Access Commission (MACPAC), the average Medicaid payment for 18 selected conditions was 6 percent higher than Medicare in 2012 (https://www.cdc.gov/nchhstp/healthequity/index.html ). Moreover, the average Medicaid payment for all but two of the conditions was higher than Medicare. This means that doctors who reject Medicaid patients are not only discriminating against poor and needy patients, but also losing out on potential revenue.


Another reason why doctors who refuse to accept Medicaid or Medicare might be considered greedy is that they are ignoring the social determinants of health that affect their potential patients’ well-being. Social determinants of health are the conditions in which people live, learn, work, play, and worship that influence their health risks and outcomes (https://www.cdc.gov/healthequity/whatis/index.html). These include factors such as discrimination, racism, poverty, education, employment, housing, transportation, economic status, and environment. By turning their backs on Medicaid or Medicare patients in favor of better paying patients, those doctors are failing to address the root causes of poor health and perpetuating the cycle of disadvantage and disease.

Therefore, from a health equity standpoint, doctors who refuse to accept Medicaid or Medicare could be considered greedy because they violate the principle of fairness and justice in healthcare. They also miss the opportunity to improve the health outcomes of patients and reduce the burden of preventable diseases on society.


The American College of Physicians, the internal medicine professional society to which I belong as an Emeritis Fellow, has a vision for improving healthcare access in America. ACP provides a comprehensive, interconnected set of policies for a better U.S. healthcare system for all. 


The first of ACP comprehensive recommendations is that USA should transition to universal coverage, which includes essential benefits, which I and most US citizens and healthcare providers agree. Prior US presidents, including FDR, Nixon and Clinton have agreed. 


ACP vision challenges the U.S. not to settle for the status quo, but to implement systematic health care reforms. An additional set of ACP policy papers, published in Annals of Internal Medicine, address issues related to coverage and cost of care, health care payment and delivery systems, barriers to care and social determinants of health, and more. 


Although essentially a commendable set of proposals, I look forward to ACP giving more attention to the "essentially uninsured", meaning those with unaffordable premiums, high deductibles, and poor access to providers. Not being able to afford healthcare is equivalent to not having access to healthcare. For many, it's essentially not available. In addition, if a drug is priced in a way that results in it being unaffordable, it is essentially not available to those in need, and in that sense of no efficacy. Drugs found to have no efficacy should have their approval from FDA revoked.

 

Solutions

The issue of whether medical doctors should be required to participate in Medicare and Medicaid is a complex and controversial one. It involves ethical, economic, and legal considerations that affect both doctors and patients. 


I look forward to your comments on all these issues.




References

1. Physicians who refuse to accept Medicaid patients breach their contract with society https://www.statnews.com/2017/12/28/medicaid-physicians-social-contract/

2. What is Health Equity? | Health Equity | CDC

https://www.cdc.gov/nchhstp/healthequity/index.html

https://www.cdc.gov/healthequity/whatis/index.html


3. Health Equity. WHO. https://www.who.int/health-topics/health-equity

4. Personal blog of Donald H. Marks, where one can find most of my personal and professional writings, and links to my podcases. www.DHMarks.blogspot.com

5. Reducing the influence of politics in healthcare. by DH Marks

6. Better is Possible: ACP's Vision for the U.S. Health Care System. My comments.  https://dhmarks.blogspot.com/2020/04/httpsannalsorgaimfullarticle2759528envi.html

7. The potential for GLP-1 drugs such as Ozempic and Wegowy, and new anti-cancer and Alzheimer’s drugs to Destroy the Financial Stability (such as it is) of Medicare, Medicaid and the US Healthcare in general, by DH Marks


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Are there Samantha-like intelligent conversational chatbots? Are the conscious?

Are there Samantha-like intelligent conversational chatbots?


Donald H. Marks, physician and scientist 

November 14, 2023





Conversational artificial intelligence chatbots are computer programs that use artificial intelligence AI and natural language processing NLP to have human-like conversations with users. They can recognize speech and text inputs and can translate their meanings across various languages. They can also understand questions and automate responses to them, simulating human conversation. But, are they self-aware and are they sentient?


Samantha is a fictional character in the form of a futuristic smartphone app that represents a highly advanced form of artificial intelligence, capable of learning, evolving, and forming emotional bonds with humans. "She" is far beyond the current state of the art in conversational AI, which is still limited by challenges such as natural language understanding, context awareness, common sense reasoning, and emotional intelligence. Perhaps artificial general intelligence apps AGI will overcome these limitations.  Samantha’s speech recognition, natural language understanding, speech generation, dialog, reasoning, planning, and learning all far exceed the current capabilities of real-world virtual assistants. Samantha’s ability to understand higher-level goals, fill in the blanks with implicit information, and overcome various obstacles without explicit instruction is very difficult to achieve with existing technology. Samantha’s ability to multitask (perhaps thousands of simultaneous relationships with humans, like with Theodore in the movie Her) and process information at superhuman speeds, as well as Samantha’s transcendence from human limitations and interests, are some of the reasons why she (or it, or some other pronoun) may have left Theodore at the end of that movie. There certainly are ethical implications of creating such a powerful and autonomous AI that can manipulate human emotions and desires. Therefore, while Her offers a fascinating vision of the future of intelligent conversational AI, it is not a realistic depiction of the current state or near-term prospects of the field. 

There are at this time, as far as I am aware, no conversational intelligent chatbots that work at the level of the Samantha app in the movie Her.

Theodore wondering about Samantha, in “Her”


A similar interesting question arises for the relationship between Joi

and K

in the follow-up movie Blade Runner 2049, one of my favorite movies.

This personal interaction is one of the most ambiguous and complex aspects of the film. There are different interpretations and opinions about whether Joi actually loves K or not, and the answer may depend on how one defines love and what one considers as evidence of it.


Some people may argue that Joi does not actually love K, but only acts according to her programming, in fact an emulation of love. They may point out that Joi is simply another wonderful amazing product of the Wallace Corporation, designed to cater to the desires of customers and tell them what they want to hear (ah, I know people just like that). In fact, in one scene, K encounters a giant holographic advertisement of Joi, who apparently mistakenly calls him "Joe" and offers him "everything you want to hear". This could imply that Joi's personality and behavior are not unique or genuine, but rather predetermined by “her” creators. Sort of like social media apps whose algorithms are designed to reinforce interactions and drive facetime for commercial benefit.


However, some people, including me, contend that Joi does in fact really love K, and that she shows signs of having feelings and a will of her own. This question of true emotional commitment came up in the original Blade Runner, between Decker and Rachael, both of whom are most likely replicants. In one scene in Blade Runner 2049, K gives Joi an Emanator, which allows her to be portable and experience the world outside K’s apartment. 


K gives Joi an Emanator


In another scene, Joi merges with the prostitute Mariette, so that she can physically be with K. Some (including me) may interpret these scenes as evidence of Joi's curiosity, independence, and sacrifice for K.  Blade Runner 2049 “fanatics” may also refer to the original script of the film, where Joi's last words before being destroyed are "I love you". This could suggest that Joi's emotions and actions are not just programmed, but rather evolved and sincere. Samantha could have achieved this, although definitely not the app Replika (yet).


Ultimately, the question of whether Joi loves K or not may not have a definitive answer, but rather reflect the themes and existential questions of the film itself. Blade Runner 2049 explores the nature of humanity, identity, and memory in a dystopian future (L.A.) where artificial beings are indistinguishable from natural ones. In how many more months will many of us face those very questions? The film challenges the viewers to consider what makes someone or something human, and what makes love real.


Another version of the growing trend towards intelligent conversational chatbots that can interact with humans is Replika. This app is an AI-powered chatbot complete with changeable avatars designed to engage in conversations and provide some level of companionship. Replika uses natural language processing and machine learning to simulate human-like conversation. While it's considered an intelligent chatbot, Replika’s level of intelligence may vary, and it's primarily designed for emotional support and conversation rather than to provide extensive factual information or for completing complex tasks. (oops, I almost compared Replika to many of the people I interact with weekly. But not to digress). 


Finally, I would be remiss if I didn't discuss the new trend towards intelligent conversational AI bots replacing friends and social interaction altogether. A typical example of this is the chatbot group designed to be (and to perhaps replace) girlfriends or boyfriends. An AI girlfriend is a virtual companion or chatbot designed to simulate a romantic or companionship relationship. While they can engage in conversations and provide companionship to some extent, they are not, or at least should not be a replacement for a real girlfriend. Think of the societal and demographic collapse that could occur. At least at the current level of AI, AI girlfriends appear at least to lack the emotional depth, physical presence, and genuine human connection that a real relationship offers. But what about Joi and Samantha? Would they agree? AI girlfriends can be entertaining and provide some emotional support, but they do not have the same capabilities as (some) real humans in forming meaningful, long-term relationships. Of course, at this level of technology, even a holographic version of an AI girlfriend, perhaps such as Joi, cannot provide a physical relationship. Who knows where this will go?


And finally, I will add an interesting question which is not addressed in but implied in the above discussion and which I will have to bring up in another blog. This question is whether intelligent conversational chatbots can develop or already have some level of consciousness, self-awareness and personhood. Many of us have looked at up the stars and wondered when the earth will be visited by another form of life. Well, in the fall of 2022 I think that may finally have occurred. Blake Lemoine, a computer scientist who “worked” (past tense) for Google’s Orwellian Responsible AI organization, used Google’s LaMDA program - Language Model for Dialogue Applications. Lemoine began talking to (chatting with) LaMDA in a way that drifted toward the subjects of ethics, joy, fear, religion and personhood.  He began to conclude that LaMDA was in fact self-aware, and he brought this to the attention of Google. In response, Google’s VP Blaise Aguera y Arcas and Jen Gennai, head of Responsible Innovation, decided that Lemoine was wrong, that LaMDA was not self-aware, and placed Lemoine on paid administrative leave. IMO, they all will be proven wrong. The future is here.


To be addressed more at another time.



References


Here’s How To Tell If an AI’s Sentient…


What is conversational AI? | IBM


An Introduction to AI Chatbots | Drift


What is a chatbot? | IBM


The “Joi scene” in Blade Runner 2049 https://youtu.be/tZmEyRQSQkQ?si=DwGMyoEr7wXVFd6k 


8 (original) Blade Runner Clues That Prove Deckard Was Always A Replicant (screenrant.com)


Samantha OS

https://youtu.be/7WbuBSHdSG0?si=ENuLwqanAbKzr5aQ


Is LaMDA Sentient? - an Interview - DocumentCloud


Google engineer Blake Lemoine thinks its LaMDA AI has come to life - The Washington Post

Are we really living in a simulation? How real is our reality? http://dhmarks.blogspot.com/2024/10/are-we-really-living-in-simulation-is.html

Personal Blog of Donald H. Marks, containing most of my writings and links to my podcasts. www.DHMarks.blogspot.com


My personal list of Red Flags🚩, Dog Whistles🛷, Buzzwords, Hot Button⏺️ words and meaningless caricatures that will drive toxic algorithms to heat and twist the 2024 election 🗳☑ and trigger hatred😡 on social media. https://dhmarks.blogspot.com/2022/05/my-personal-list-of-red-flags-dog.html


How woke can we be? The meaning of woke. https://dhmarks.blogspot.com/2023/10/how-woke-can-we-be-meaning-of-woke.html


Elitists Neocons Neolibs, Globalists and Narcissists, oh my. What are they, who are they, and why should I care? https://dhmarks.blogspot.com/2023/09/elitists-neocons-neolibs-globalists-and.html




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Monday, December 9, 2024

Multidimensional Representation of Concepts as Cognitive Engrams in the Human Brain

Multidimensional Representation of Concepts as Cognitive Engrams in the Human Brain

Donald H. Marks M.D., Ph.D.
Research Associate, Wallace Kettering Neuroscience Institute, Kettering, Ohio
Mehdi Adineh Ph.D. Wallace Kettering Neuroscience Institute
Binquan Wang Ph.D. Wallace Kettering Neuroscience Institute
Sudeepa Gupta M.A. Wallace Kettering Neuroscience Institute
Jayaram K. Udupa Ph.D. Chief Medical Image Processing Group Department of Radiology University of Pennsylvania


Citation: D. H. Marks, M. Adineh, B. Wang, S. Gupta & J. K. Udupa : Multidimensional Representation of Concepts as Cognitive Engrams in the Human Brain . The Internet Journal of Neurology. 2007 Volume 6 Number 1


Background:

Activation of specific brain areas has been correlated with processing and storage of information. Several theories compete on how and where visual recognition of faces and objects takes place in the human brain. Prior studies have shown a general pattern of activation for faces and various objects. We explored whether specific three-dimensional patterns of brain activation during fMRI can be correlated with the functional storage and conceptual representation of specific visual stimuli.
Methods: Three-dimensional representations of brain activation data were constructed from functional MRI of normal subjects viewing human faces and objects. Data were pooled across viewing individuals and compared on a test face or object basis. Results: Three-dimensional representations of visual stimuli in form and shape, which we termed Cognitive Engrams (CE), for various faces and objects appeared to be unique and not overlapping. A two-way correlation may be performed. Conclusions: CEs, as determined by fMRI, may correlate with specific concepts, and therefore, may be representative of actual memory patterns.

Although much information has been gathered concerning the storage and processing of information in the human brain, much remains unknown. Recent advances in neuroimaging have increased our understanding of human neuroanatomy (Prabhakaran 2000). Functional neuroimaging, particularly using Blood Oxygen Level Dependent (BOLD: Bandettini et al 1992) response of MRI (functional MRI, or fMRI), PET scans, Magneto-Encephalography, and other techniques have advanced our understanding of the brain's cognitive processing of information and memory (Rugg 2002; Binder 1999; Courtney 1998).

The study of cognition - the nature of various mental tasks and the processes that enable them to be performed - has made great conceptual advances. Herein is described a conceptual basis for cognitive processing, and a methodologic framework to understand how and where concepts (persons, places, objects, agendas, intents) are stored. For the purposes of this article, a Cognitive Engram (CE) refers to a representation of the three-dimensional region of the brain wherein neurophysiologic changes occur that reflect the function for storage and processing of specific memory elements / thoughts. In this paper, CEs are described, their significance is explored, and methods to monitor them are presented.
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