Who's read 'Age of Diagnosis' (overdiagnosis in Long Covid, ADHD, Lymes, autism, cancer screening)

[FrodoBiggins]

Inspired by another thread, has anyone read/ listened to Suzanne O’Sullivan's new book Age of Diagnosis? I just finished it and found it so interesting. She's a high profile consultant neurologist.

Touches on Long Covid, Autism, ADHD, Lymes disease (all in terms of diagnostic debates) and also Huntingdons genetic testing and Cancer/ Alzheimers screening (along what benefits there are of knowing of a risk/ certainty of future illness, especially if there is no cure).

I'll quote from a review:

"in her outstanding new book O’Sullivan offers a third possibility; that variance in bodily and mental health is being unnecessarily medicalised and pathologised: “We are not getting sicker – we are attributing more to sickness.”
She describes a trinity of “overs”. Overdiagnosis, where a medical problem is treated when treatment might not be needed; overmedicalisation, where non-medical behaviours are turned into the business of doctors; and underlying both, overdetection: we are ever better at identifying signals of disease, sometimes earlier than necessary, when those indicators may not end up presaging the disease itself. Alongside balanced analysis of the epidemiological data on prostate and breast cancer, O’Sullivan examines the growth in behavioural conditions such as autism and ADHD. The tone is not sneering or dismissive, as debunkings of bad science so often can be. O’Sullivan is instead full of compassion, care and grace."

I believe it was also the Radio 4 Book of the Week. The full review quoted from above is here: https://www.theguardian.com/books/2025/mar/12/the-age-of-diagnosis-by-suzanne-osullivan-review-do-no-harm?CMP=Share_AndroidApp_Other

Has anyone else read it? Thoughts?

I expect that the more we insist on the binary view of ND vs NT, or binary interpretation of the diagnostic criteria in general (you're either autistic or not, it's not a spectrum, you cannot possibly have ND traits but no diagnosis), the more pressure there will be to minimise any differences within those groups. It's ironic that neurodiversity suggests we're all different and unique - as long as we stick to our neatly labelled boxes....

Surely it’s very early days in the treatment or support of people with adhd or autism.
The crazy outcry about all these people claiming to have/ being diagnosed with one or the other or both - so many don’t believe it.

Demanding that we have the vocabulary to differentiate people is pointless this early. And being annoyed or offended because people aren’t using high-functioning or whatever some person has decided is the correct term for some people but with no clear definition is madness -give it a couple more years.

Autism and ADHD have been recognised and ‘treated’ for ages, not just since they were discovered by TikTok. Ritalin as an ADHD treatment was becoming more widespread in the 1980s I believe.

But I guess you are right that it is still early days in this new wave that is triggering the debate.

So I’m curious, what are the downsides of pursuing a diagnostics then?
Because let’s be honest, I’ve never heard someone saying there downsides of pursuing a diagnosis if you have type1 diabetes or a heart attack. Or even pneumonia, tooth abscess, sepsis, meningitis etc etc…

Its always about illnesses that could be seen as ‘controversial’, ones where people have or still are told to just pull themselves up by the boot straps.

She is merely selling the idea that all of those diagnosis aren’t real and if people really wanted to, they could have a normal life.

I've been thinking about this question. I think there are downsides about pursuing a diagnosis of the conditions in the first paragraph, because there would be a sense of the individual knowing that something was wrong enough in their body's performance (and often something deteriorating) to affect their life, but not necessarily knowing what exactly without proper knowledge of how the symptoms work. If you are in an age where these things could prove to be greater 'danger zones' than at other times, such as pneumonia for older people, then it's more urgent to get a correct diagnosis or to deteriorate very seriously.

And a lot of health conditions may not be identified completely correctly, first time, although some markers in medical tests have now become extremely reliable. The medical treatments are broadly safe and effective, but lifestyle adaptations may also be important for success, such as weight loss, protection from severe cold and damp, etc.

The 'controversial' illnesses have often been attributed to other causes that have gone through stages of looking to be simple answers laid at the door of the one who sticks out, but then being debunked (to a degree, but without being totally thrown out). For example, e-numbers etc. for ADHD. These may worsen reactions - make the effects very obvious - but through developing knowledge, have turned out not to be the root cause that can be 'cured' and forgotten. Lifestyle adaptations, adjustments, and a treatment that can be calibrated to help will steer many to a more manageable life, even though it's not as easy as it sounds to work out a good combination.

What schools and stress/regulation demands seem to aim for, though, is that someone's ND or 'controversial' traits have the least visibility, or inconvenience, to the general whole, and not the individual, no matter what the environment and pressures of its effects. It's changed for the better since, say, the '80s and earlier, but I'd say it's not made great strides.

But the thing is, getting causes or treatment wrong has always been part if medicine. I mean, to start with, cancer was thought to be a psychological illness. MS we now know is linked to an infection with EBV. Etc etc….

Thats not getting the diagnosis that has a negative impact. It’s our (not yet fully formed) view of what the illness is about, how to approach it etc….

@Ormally

I don’t think education has made great strides. I’ve seen a huge shift in behaviour management being the responsibility of the school by ensuring good differentiation, visible/consistent teachers, visible headteachers, clear behaviour policies, never hearing of a child being excluded to - today : where this is a huge rise in diagnosis (which SHOULD help but I don’t think schools are equipped to help), a SEND system in crisis, unclear behaviour policies, a high number of less qualified adults doing the most demanding work (whereas the most qualified consistent adults are often not in their classroom or not classroom based), a record high number of exclusions, funding not going on the basics (provision for children) but spent on non-classroom based SLT (often in meetings/on computers)/fashions (brain gym)/initiatives/glossy laminated signs and worksheets/paper waste/the latest shiny IT accessory. I think it’s very sink or swim - and a job that should actually be one of the most rewarding jobs around has got people in complete burn out.

The book's been reviewed here https://thecritic.co.uk/im-afraid-the-news-is-not-good/

For those who don't want to follow the link, the conclusion:

"Artistically, The Art of Diagnosis has a lot going for it. There is a reliable narrator, a rich cast of characters. With its intriguing narratives and ever-shifting perspectives, readers will find it a most thought-provoking book."

So The Critic is a right wing “modern magazine” funded by a Tory party donor with Toby Young and Peter Hitchins as contributors. I’ll pass thanks.

Meanwhile the BBC reported last week how ADHD is not becoming more common thus illustrating how misguided said book is as regards ND in particular.

www.bbc.co.uk/news/articles/cg5vp62dnnro.amp

I’ll pass thanks.

I would too, it was a very poorly-written review.

www.bbc.co.uk/news/health-65534448.amp

In what way?