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© 2019 by Citizens4health . Proudly created with


Welcome to Shrink The Government, the digital home for The James Madison Project, where we test the hypothesis that citizens, provided with an organizing format, information and tools can be trusted to reclaim their role within the political ecosystem.


Setting the Madisonian Stage for Citizen Engagement  

A series of blogs and related material setting the Madisonian stage for a six months long experiment in Citizenism, that will focus on the challenges associated with the opioid epidemic and the US healthcare system.

For the next six months, we focus on The Pain Opioid Epidemic Project starting with the Medical Case Presentation to test our hypothesis for citizen engagement.

The Medical Case of the Pain Opioid Epidemic and its Components:   We will introduce some of the elements for citizen engagement and how they are used in addressing the challenges of the opioid epidemic. 

The Narratives of the Opioid Epidemic: ( We review some of the narratives that have shaped the efforts to address the opioid-related challenges and shape the current conversation. 

The Path to the Current State: We systematically explore the many factors contributing to and maintaining the opioid epidemic.

The Ecosystem and the Stakeholders:  We take a deeper dive into the various stakeholders associated with the epidemic and highlight the potential for citizen action.

The Treatment PlanSalutogenesis and US 4.0: We provide a citizen-facing framework and treatment plan of sorts to address the many challenges associated with the opioid epidemic and more broadly the body politic.

Personal Statement

I am a United States citizen. Now more than ever, I realize that citizenship requires more active engagement in the political process. As a psychiatrist, I hope to contribute a unique voice to the current political conversation. 

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November 26, 2019


​​The Gutenberg Press, one of the most revolutionary inventions in human history rapidly promoted the publication of religious texts—and pornography. The technology itself did not determine the future of the printing press, however; it was the people using it who unleashed its power. One of its most important offspring was the scientific journal, a venue for reliable, peer-reviewed sharing of information that launched the scientific revolution and ushered in the age...

October 2, 2019

In order to actively participate in our politics, we need to be informed about political and public institutions, our representatives and other government officials. This easy-to-use tool provides a snapshot of the political system where citizens can learn about their representatives, organizations and other relevant aspects of their local, state and federal (or global) systems. The Ecosystem view assists citizens in developing a richer understanding of the social and political sy...

September 27, 2019

Origins of the Current Crisis 

The federal government has been a central player in the opioid epidemic. Shortly after being elected, President Trump declared the opioid epidemic a national emergency and tasked THE PRESIDENT’S COMMISSION ON COMBATING DRUG ADDICTION AND THE OPIOID CRISIS  to develop recommendations to combat the addiction crisis that is rampantly impacting our country. The report offers a narrative of the causes of the current state of the epidemic. After reviewing p...

September 25, 2019

A personal narrative Macklemore (Ben Haggerty)

A number of years ago I came across  Macklemore (Ben Haggerty) , a rapper from Seattle who has millions of dedicated fans including former president Obama. My initial exposure to Macklemore was during the American Music Awards when he and Leon Bridges sang the song, Kevin. The song is dedicated to Macklemore's friend who died of an opioid overdose. The powerful song seems to provide an overview on the view of the public about the opioi...

September 22, 2019

“You never let a serious crisis go to waste. And what I mean by that it’s an opportunity to do things you think you could not do before.”

Rahm Emanuel Wall Street Journal, November 19, 2008.

The opioid epidemic started at the turn of the century, continues to have a devastating impact on many individuals and communities throughout the United States. The statistics are overwhelming. The personal stories are heart-breaking.  According to the CDC, between 1999 and 2017 more than 400,00...

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Shrink the Government

Psychological insight about our politics