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So you can lose more sweat. and raise your game. Gatorade. Is it in you? Joining us now is Dr.
Suzanne O'Sullivan. She is a consultant neurologist and clinical neurophysiologist. She is the author of The Age of Diagnosis: How Our Obsession with Medical Labels is Making Us Sicker. Super interesting topic, Doctor. Thank you for joining me here.
Thanks so much for having me. This to me is so interesting. My husband is a physician, and you know, they always say, like, you know, what is it, the cobbler's children have no shoes.
So, whenever I'm sick, I'm always like, Oh, I think I got this, I think I got that, he's like, Yeah, you're fine, take some Tylenol.
So, Do we need to go back a little bit to that? That's my first question. Do we need to go back a little bit to the, yeah, you're fine type thing as opposed to everybody has an illness that they wear on their sleeve? It's got to be chronic. And we live in a society where they have to wear it and they have to tell you all about it and make a video about, well, I'm neurodivergent and I'm depressed and I have anxiety and ADHD and all of these things.
Have we gone too far? Um I possibly wouldn't put it quite as strongly as you just have, but I certainly think. We could perhaps go back a little bit, not back to how things were in the past. I think we've come from a period of neglect.
So I qualified as a doctor in nineteen ninety one.
So let's say around that time or before that time, You know, we we neglected people who had special learning needs or even you know uh physical diseases like diabetes, you know, people went to the doctor too late.
So we kind of had a period of underdiagnosis. And we needed to correct that. We've worked very hard to correct that. But I think it would be reasonable to say that for Some disorders now, we may have gone too far. We're picking up in order to kind of correct our past mistakes.
We have started to detect disorders in milder and milder and milder forms. But unfortunately, when you detect things in very, very mild forms, you can actually harm people by medicalizing them. potentially turning someone who is essentially healthy into a patient if their symptoms are quite minimal.
So I do agree that we've gone a little too far. And I certainly agree that there is a kind of modern tendency sometimes to take illness as identity. And I think when an illness is identity, that's really a problem. Because if if your illness is identity, that will reinforce your symptoms and how do you get better if if if your identity is so integrally linked to the illness that you have. Exactly.
And that's what I see, especially in younger people. My husband will tell you that he doesn't believe. It's very rare when he has a patient who's under the age of about 40, who doesn't come in with a list of allergies and also diagnoses, you know, anxiety, depression, all of the, you know, fatigue, chronic fatigue, these things that are very, very hard to get an official diagnosis for. And he'll ask them, well, you know, have you been diagnosed? They're like, oh, oh, no, but I know I have them.
They all have to have them. That's certainly, you know, and I share that concern. I've been a doctor for, you know, 35 years. I think doctors of my vintage are really seeing a change in how things are. And that's what's peaking a lot of doctors' concerns is now I care for a lot of people in their twenties or thirties as a neurologist.
I see people who in their thirties have 10 different diagnoses and are in 10 different medications. I don't object to it. medications and labels and diagnoses if they're making people better. But unfortunately, these labels very often seem to be describing a difficulty a person has, but not actually making their life better. And I think that's when medicalizing problems is harmful.
If it's not making you better, then what is the purpose of it? Right. You know, you suggest that sometimes we over-diagnose. We go too far to try to diagnose, and it's very costly, which is part of why some of our medical care is very, very costly. And you say that sometimes it's actually counterproductive.
And you mentioned breast cancer treatments. About a third of them are unnecessary. Certain prostate cancer screening programs have saved relatively few lives. Pre-diabetes can sometimes resolve itself without any intervention.
So let's talk about that. Why is there so much testing? Yeah.
So you You know, around the 1970s, we began doing things like screening for illnesses, so screening for cancers.
Now you've got to remember immediately that The kind of tests we have now, they weren't even available in the 1970s.
So we've got all these kind of Really high-tech tests that can detect. Diseases at earlier and earlier stages. And we've also got screening programs that are really active about. Proactively trying to find people with abnormal cancer cells at the earliest stage possible. But what we didn't really realize when we started those programs of looking for Cancer at a pre-symptomatic stage.
I should make the clear distinction between. A symptomatic cancer is one where you feel a lump or you have a symptom that has to be treated urgently. A screen cancer is one where you're perfectly well. And somebody finds an abnormality on a scan.
Now, what we didn't realize until we started really actively screening for cancers. Is that a huge? Number of people have abnormal cells in their body that look cancerous but never ever grow to threaten life or cause any serious problems. we are as different on the inside as we are on the outside. And because we didn't have the capability, the technical capability to find these cells before, we didn't know they existed.
Now we can find them and we don't always know what to do about them.
So what happens with screening programs is though too good in a sense. You know, they find things We feel compelled to treat them, and a large number of the people who we treat with these super, super early cancer cells. would never have needed to be treated if we hadn't found those cells. And that's sort of integral part of all screening programs. You have to treat a certain number of people to say one person.
And the number of people you have to treat can be very large. For example, in prostate. screening with with prostate specific antigen, which is a blood test. you potentially have to screen a thousand men save one life. But in that thousand men, you'll probably get two hundred, three hundred other men who have elevated abnormal blood test and they're going to need lots of tests.
So you have to do loads and loads of tests on loads and loads of people to benefit one person. And I think these sort of Way of practicing medicine survives because we're very focused on the person we saved. What I'd like to do is have a conversation about all those other people Who now are going down the road of lots of tests or scans or serial blood tests and perhaps.
Some of them will be treated for cancer and some of them will have very unpleasant investigations and perhaps they didn't all need that. It's not something we think about enough, I don't think.
So, let me ask you a question.
So, in this country, though, I think that the legal profession plays a huge role in this over-testing because of the unfettered lawsuits. Every doctor gets sued at some point in time and several times during his or her career. And because the threshold is so low for suing. And if you sue someone and they wind up getting dropped from the case because you really didn't have a lawsuit, because even the file clerk, people don't understand. Like, even the file clerk gets sued.
Any person who touched the file gets sued that doctors cover their buds. And so they just order a test. You have an abnormal cell, we're getting a test. And we're going to test and test and test because the last thing they need is in front of a jury, a lawyer getting up and going, This person had abnormal cells at the first test and scan or whatever, and you didn't do your due diligence in further testing them.
So the default then is to just test everyone for everything. What do you think? I mean well I I think it's It's more of a collusion between doctors and patients, if I'm being honest. I mean, I agree with what you're saying. Doctors can.
Practice defensively, you know, we are worried about being sued, but you know what we're more worried about? We're more worried about being wrong, and we're more worried about harming somebody's health. when we could have done something to help them.
So I think we will err on the side of doing tests if we are worried about sort of missing things.
However, you know, I I don't think It is just sort of that doctors are kind of doing this to patients. We also live in a world where and I speak as a patient and as a doctor, where we're desperate for answers. We people want to people are frightened and they are desperate for answers and they're trying to stay healthy as long as possible. and they are aware that all of this new technology is available. We are also very often, as doctors, under pressure from patients who ask us for tests and we don't necessarily want to do those tests.
It can be a really difficult consultation for a doctor. You know, I'm a neurologist and headache is the bread and butter of a neurologist. And who doesn't have a headache at some point in their lives? It's so common. A lot of people worry about having a brain tumor.
It's it's very ill advised to have an unnecessary MRI brain scan because the scanners are so good now that they can pick up all these little is incidental abnormalities that don't mean anything, but to be really worrying once you know they're there. But the consultation with a person with headache who's worried they have a brain tumor in which I'm saying you don't need a scan. That is a really long and difficult consultation, and then I'm taking a lot of responsibility if I turn out to be wrong in the long run. That's yeah. It's so much easier to do the scan.
So you know this, when you're under pressure from patients to do tests, you do tests that you don't necessarily feel that you would want to. There was an interesting study in Canada. where seventy three percent of doctors said they did unnecessary tests. But they That they didn't want to do. Yeah.
We've got more coming up with you because I want to talk to you about autism. It's in the news with RFK, and he's going to be making an announcement next month about that.
So we'll talk about that coming up and the rise in diagnosis of ADD and ADHD and autism.
So that's coming up. Our guest is Dr. Suzanne O'Sullivan. She's a neurologist and clinical neurophysiologist, and we're talking about her book, The Age of Diagnosis. More coming up on the Brian Kilmeat Show.
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and coming up in less than half an hour. 15 minutes, Chris Sununu will Be joining us. He has a new job that he's going to be starting. We'll find out what he's going to be doing. But right now, we're speaking with Dr.
Suzanne O'Sullivan. She's a consultant neurologist and also clinical neurophysiologist and the author of a new book, The Age of Diagnosis. And we're talking about diagnostic inflation, diagnostic creep, whatever you want to call it. But we have the ability to test more and more and more at earlier and earlier stages. And there comes a point where maybe it's diminishing returns, you know, and maybe, you know, why.
If you have some cells or some things that are a little abnormal, that's kind of normal in us as humans. We do have some stuff that's abnormal. But, Doctor, I want to talk about autism. The growth of autism since the 1990s has been crazy, 60-fold since the 1990s. To what do we account?
attribute this. Is this just the the ability to diagnose it better? I think that it it's too I mean, the first thing to be clear is that there's not an increase in the number of people who have autism per se.
So it's not that there suddenly are a great deal more people who have autism than there were. 50 or 60 years ago. What has changed is twofold. One is there has been a gradual change in the diagnostic criteria. that allow us to diagnose autism.
So they have been relaxed and relaxed and relaxed. in order to allow the diagnosis in milder and milder and milder forms.
So if we say fifty years ago to have autism, you had to have a very severe level of disability. And it had to be evident in infancy. but they gradually adjust the age upwards so the diagnosis can be made in older and older people with milder and milder symptoms.
So that's it's not that there are actually more people with autism. It's that what autism is has changed completely from what it was fifty years ago. combine that with all of the kind of autism awareness that's happening now.
So we have a combination of much more relaxed diagnostic criteria with a lot of people being aware of this diagnosis as a potential explanation for the difficulties and therefore presenting for diagnosis.
So it's not that people have changed. It's that we have made a societal decision to diagnose more of this condition in milder forms in more people. Why would we want to do that?
So again, it's really very s similar to the what we were previously talking about with cancer screening.
So if I think about you know, I went to school in the nineteen seventies, nineteen eighties. No children in my class of 120 were recognized as having any special learning needs. Right. And at class that size, there must have been some.
So we kind of realized that we were probably missing children at school level who, if they had just been recognized as having some extra needs and had got a bit of support, that their lives would have been much easier.
So it's a really well-intentioned change. We assume that if we find milder forms of any disease or behavioral or learning problem, and we give people help that we will improve their lives.
So it's Yeah. just an assumption really that um the the help that you give to someone with a severe disorder will be equally helpful to somebody with a mild disorder. But unfortunately, it doesn't take into account something really important. which is when you give somebody a medical label who's difficulties are in the really borderline Zone.
So they don't have a really obvious medical problem, and you're diagnosing them. Quite mild symptoms, you can disable them through the labeling effect, through the kind of nocebo effect. Meaning, the opposite of the placebo effect. If you believe you're sick, then you behave like you're sick. you believe you're not able to do something and you and that belief is given strength through a medical diagnosis.
then you might stop trying to do that thing.
So at this mild end of the spectrum, a medical diagnosis can be quite harmful. Right. No, that's very true.
So in the time we have left, Health and Human Services Secretary Robert F. Kennedy, Jr. said earlier in the week that he is on track to identify, quote, interventions that are certainly causing autism and possible ways of addressing them. And he's going to make that That known is going to give that speech, he's going to come back to us in September sometime. He's going to make this announcement.
And what? What do you think about it? I just want your take on that, what's causing autism and possible ways to address them. Do we know what causes autism? We don't know what causes autism.
I would basically wouldn't hold my breath that any announcement that's about to be made will be helpful at all to the Autchester community. First of all, we don't know what causes autism, and I'd like to make it clear that there's zero evidence that autism is A, increasing in actual numbers. It's just increasing in milder cases for reasons explained. And B, it's absolutely definitely not due to vaccinations. We don't know what's causing autism, but we do have a scientific Problem on our hands now as the diagnostic criteria are relaxed more and more and more.
so that people are kind of So heterogeneous are so different, and people with autism are so different now than they used to be. It's going to get harder and harder to provide that answer, and it certainly won't come about in September. Yeah, it's going to be very interesting to see what happens. I found this so interesting because just I have so many friends who have kids who have this and that and ADDA da da da da da, and they wear it as a badge of parenting on their sleeve. And so I think we have to, as you said, strike that balance and kind of find a middle ground here with all of this.
We can't go back to the way it was of just take Tylenol, you'll be fine. Or back then it was take an aspirin.
So we have to strike that balance. Dr. Susanna Sullivan, thank you so much for joining me here on the Brian Kilmead Show. Coming up, Chris Sununu, that's next. This is Jason Chaffetz from the Jason in the House podcast.
Join me every Monday to dive deeper into the latest political headlines and chat with remarkable guests. Listen and follow now at FoxnewsPodcast.com or wherever you download podcasts.
