In a searing critique, the Neurologist Suzanne O’Sullivan argues that the increasing use of (diagnostic) labels and drugs is not helping people and risk making us sicker.

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Gerry Gajadharsingh writes:

“I first read Dr. Suzanne O’Sullivan’s book It’s All in Your Head around 2015. At the time, I noticed that it had as many five-star reviews as one-star reviews—a clear sign of its divisive nature. However, looking at its Google ratings now, they are overwhelmingly positive. Her latest book, The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far, seems to be just as controversial, as highlighted in a recent Times interview.

In my opinion, O’Sullivan is spot-on.

She argues: “We’re not getting sicker—we are attributing more conditions to sickness. Borderline medical problems are becoming ironclad diagnoses, and normal differences are being pathologized.”

Mental health diagnoses have been rising since the 1990s, yet instead of seeing a positive impact, we now have one in five young people diagnosed with a mental health condition. O’Sullivan suggests that some mental health awareness initiatives in schools might be contributing to distress rather than alleviating it. A recent study supports this, indicating that such programs can inadvertently heighten emotional distress.

The numbers are staggering: an estimated 20% of clinical work in the UK has no effect on patient outcomes, yet it costs the NHS billions. Meanwhile, over four million people in Britain are out of work due to long-term sickness, much of it related to mental health issues.

Many are placed on lifelong medication—antidepressants, stimulants for ADHD—that can have serious side effects and be highly addictive. O’Sullivan asks: “Have we not learned from the opioid crisis? These medications only control symptoms; they don’t treat them. It’s time to sit back and say, ‘OK, we thought this was a good thing, but it isn’t working.’”

 She believes that many diagnoses arise from a cycle of patients pushing for a label and doctors wanting to provide one. She understands why parents seek answers for children struggling in school, but she warns of the consequences: “It’s a collusion between people desperate for answers and people desperate to provide them.”

O’Sullivan also suggests that some suffering may be psychosomatic. Throughout history, people with unexplained chronic conditions have been drawn to prevailing diagnoses—chronic Lyme disease in the 1970s, ME in the 1980s and 1990s, and neurasthenia in the 19th century. She sees a similar pattern with long Covid, where the belief that recovery is impossible can become a self-fulfilling prophecy.

The issue extends beyond mental health. Studies show that for every 2,000 women screened for breast cancer, one life is saved—but ten women receive unnecessary treatments, including mastectomies, radiotherapy, and chemotherapy, which carry severe long-term side effects.

“Of course, Big Pharma is making money, but the public also has to take responsibility,” O’Sullivan says. She questions whether we are searching for answers where none exist. “Maybe we’re expecting too much of our children. It’s easier to use an ADHD diagnosis to explain why they’re not top of the class than to admit they’re not a genius. But perhaps we should recognize and support the child we have, understanding their strengths and weaknesses, rather than trying to optimize them through special accommodations or medication.”

O’Sullivan’s views may be contentious, but they force us to question whether more diagnoses—and more medical intervention—are always the answer.”

The Times

Julia Llewellyn Smith

You don’t need to be a doctor to have noticed that certain medical diagnoses that used to be rare now appear common. Anecdotally at least, it feels like everyone either has ADHD or knows someone who does. Neurodivergence was one of the buzzwords of 2024 and mood disorders such as depression and bipolar have skyrocketed.

The data backs this up. ADHD diagnoses doubled for boys and trebled for girls between 2000 and 2018. In the 1940s, autism was thought to affect one in 2,500 children, while today one in 100 has been diagnosed. Chronic conditions with no strict diagnostic criteria, such as chronic Lyme disease and long Covid, have also become a part of daily life.

Recently, I’ve been shaken by a couple of friends, who seemed in perfect health, being diagnosed with cancer after whole-body MRI scans, then undergoing invasive treatment. Alarmed, I was about to pay for my own scan, but now the NHS consultant neurologist Suzanne O’Sullivan tells me to do no such thing. It may lead to a cancer being detected that would never have grown, she says, but for which I’ll have unnecessary radiotherapy or chemotherapy.

We are living in an “age of overdiagnosis”, O’Sullivan says. “We’re turning people into patients, medicalising their lives, affecting their quality of their lives and causing undue anxiety with no benefit.”

An esteemed doctor for nearly 35 years, O’Sullivan works at the National Hospital for Neurology and Neurosurgery in London and in a specialist unit at the Epilepsy Society.

She’s also a prizewinning author of three acclaimed books, the last of which, All in the Head, focused on psychosomatic disorders that often manifest in a variety of nebulous and unpleasant symptoms that have now been given labels.

Her new book is The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far, which explores why dubious labels are being put on what the NHS calls “medically unexplained symptoms”, as well as normal (if challenging) emotional states. “People are not sad, they have ‘low serotonin level’,” she says. “They are not forgetful or fidgety or unsettled, their ‘brain is wired wrongly’.” All this feeds into an “illness identity” and can remove agency and incentives for people to try to improve their lot, she says.

O’Sullivan, along with many colleagues, is increasingly concerned that technological advances in scanning and an explosion in testing for diseases and genetic disorders (a lot of it DIY) is leading to people believing themselves to be seriously ill, when the sickness they’ve “discovered” may never manifest.

For a doctor to suggest that her profession is dramatically overreaching sounds counterintuitive, and this book will be controversial. After all, perhaps the modern world is making us more mentally and physically unwell. If not, have we become more aware of various conditions and proactive about seeking treatment? O’Sullivan sees a third option. “We’re not getting sicker — we are attributing more conditions to sickness. Borderline medical problems are becoming ironclad diagnoses and normal differences are being pathologised.”

O’Sullivan agrees that the rise in diagnoses, especially in the early stages of disease, would be fabulous if it actually led to improved health outcomes. But overall, it isn’t. “We’ve been diagnosing cancer, blood pressure, diabetes earlier, but we’re not making anyone any better,” she points out. Neck ultrasounds introduced in the 1980s saw rates of thyroid cancer skyrocket worldwide, yet today deaths from thyroid cancer remain the same.

Thyroid cancer rates

Incidence has tripled since the mid-1990s, but the death rate is flat

By the same token mental health diagnoses have been rising since the 1990s, yet not only are we not seeing any positive impact, but she also argues — we’re now seeing one in five young people with a mental health condition. “I think we need to dial back some of the mental health awareness work that we’re doing in schools. A recent study showed it actually added to emotional distress, rather than subtracting from it.”

But isn’t it better to be safe than sorry, spotting diseases rather than missing them altogether? “We are correcting a mistake which definitely needed to be corrected,” she acknowledges. “You look back at the 1980s, when I was at school, there must have been people with special educational needs that were never acknowledged. But now there’s mounting evidence we’re pushed too far and meandered into overdiagnosis and that can be just as harmful — or more so.”

This evidence includes statistics that 20 per cent of clinical work in the UK is thought to have no effect on outcomes but costs the NHS billions. Meanwhile there are now more than four million people in Britain now out of work with long-term sickness, much of it related to mental health issues.

Off sick

Numbers shot up during the pandemic and stayed there

Many people are ending up on lifelong medication, such as antidepressants or stimulants for ADHD, that can have serious side-effects and be hugely addictive. O’Sullivan asks: “Have we not learnt from the opioid crisis? And these medications only control symptoms, they don’t treat them. It’s time to sit back and say, ‘OK, we thought this was a good thing, but it isn’t working.’”

In O’Sullivan’s opinion, many diagnoses come about as a result of patients pushing doctors for a label and doctors wanting to keep them happy. She’s not critical of parents, whose children might be struggling at school, searching for solutions. But the outcome is not a desirable one. “It’s a collusion between people desperate for answers and people desperate to provide answers and to satisfy people.”

O’Sullivan’s argument will certainly provoke a backlash in some quarters. Take long Covid, which 1.9 million people in Britain currently report having. O’Sullivan thinks that it became a catch-all for many ailments and issues.

Early in the pandemic, she says, “all sorts of people got together on social media, who were suffering in different ways and attributed their suffering to the virus, and it became a thing”.

O’Sullivan isn’t suggesting people with long Covid are inventing it, and she stresses the crucial point that such illnesses don’t make patients’ suffering any less real.

But she does think that some, not all, of their suffering may be psychosomatic. “There’s always been a cohort of people who are chronically suffering with things that are hard to put a name to and they choose whichever diagnosis is salient at the time. In the 1970s in Connecticut, they’d have been called chronic Lyme disease; in the 1980s and 1990s it was ME; in the 19th century the same symptoms would have been called neurasthenia.” The problem, in her view, was people being told they’d never recover from long Covid. “That became a self-fulfilling prophecy.”

Compassionate and engaging in demeanour and in her writing, O’Sullivan, sitting in her pretty north London flat, doesn’t appear the type to want to set the cat among the pigeons. Is she prepared for kickback? “One of the reasons we’re not talking about these issues is it’s very difficult to say these things without upsetting someone and threatening their sense of identity,” she says. “But sometimes I have to tell my patients things that are hard to hear.”

She adds: “I’m certainly not saying ‘snap out of it, you’re imagining your suffering’. But perhaps you need to identify these people without giving them a medical diagnosis. Because as well intentioned as it is, what we’re doing now isn’t working.”

Part of the problem is that ever more sophisticated tests and screening equipment can now spot the earliest signs of diseases and genetic conditions, even though many have no cure. Others may never progress.

“We have amazing technologies that can pick up on tiny things and when we find them, we’re a little bit powerless to ignore them,” she says. “We know lots of people live with small cancer cells or cancer genes their whole lives, but when we find them in an apparently healthy person, we assume they’re going to cause problems and scare the living daylights out of people.”

Studies show that out of 2,000 women screened for breast cancer, one life will be saved but ten women will have treatment they may not have needed, including unnecessary mastectomies, radiotherapy and chemotherapy. The last two can have severe long-term side-effects.

Meanwhile, commercial tests for the BRCA gene that shows women to be at greater risk of breast and ovarian cancer can offer as many as 96 per cent false positives, resulting in huge emotional distress. Around 50 per cent of women subsequently choose a preventative mastectomy, without knowing if the cancer would have developed.

“I don’t want to put people off screening, I just want them to know if something’s found it’s OK to wait a while before deciding if they want a course of treatment,” says O’Sullivan, who would like to see much of the money spent on unnecessary tests redirected towards making GPs more available. “Ultimately what makes people feel better is having someone genuinely listening to them.”

What also frustrates her and many of her peers is how the eagerness for a diagnosis is dominated by the pushy “worried well”, while those who genuinely need help are often overlooked. “Screening programmes often don’t reach the people who really need help, who ignore invitations,” she says. “Instead, they’re picking up educated people who worry about their health, who exercise and eat healthily.”

Similarly, while ADHD is clearly a significant challenge for many, O’Sullivan thinks such labels can limit rather than liberate when applied too liberally, especially to children. She was a timid child and is relieved that no one saw her shyness as an issue. “I came out of myself just fine, but my worry is if you tell a child, who’s very much figuring out their strengths and weaknesses, that the reason they have social difficulties or intense interests or difficulty concentrating is related to a neurodevelopmental brain problem, it gives a really strong sense this can’t be overcome. The reality is for most people these issues will diminish as they mature.”

Many attribute perceived overdiagnosis to Big Pharma, eager to amplify ailments for which it can peddle remedies. And it’s true that an entire industry has grown up around conditions such as ADHD, but O’Sullivan is less convinced that we should be blaming quackery.

“Of course, they’re making money, but the public has to also take responsibility,” she says, suggesting we might be looking for answers where none can be found. “Maybe we’re expecting too much of our children. It’s easier to use an ADHD diagnosis to explain why they’re not top of their class than to admit their child is not a genius, but maybe you should be recognising the child you have, understanding their strengths and weaknesses, rather than trying to optimise what they can do through special accommodations or medication.”

Increasingly, she argues, we are also straining against the inevitability of our own biology. “Maybe we’re unwilling to accept when our bodies are failing, and they do fail with time, rather than thinking we can be supremely healthy in unrealistic ways.”