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Vox
26-05-2025
- Health
- Vox
Does medicine have an over-diagnosis problem?
covers health for Vox, guiding readers through the emerging opportunities and challenges in improving our health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017. A new book argues doctors are too quickly and too confidently diagnosing their patients with too many medical problems. Corbis via Getty Images Patients in the 21st century are pretty lucky. Medical science and technology have advanced so much that we can diagnose many thousands of distinct conditions, and we can even take genetic tests that scour our DNA for signs of a disease that may not materialize for decades — offering us a peek into our own future. And with these advances, we are being diagnosed more and more. The number of people diagnosed with chronic health conditions and mental health disorders is at an all-time high — at least partly, most experts agree, because we have simply catalogued more diseases to catch. Yet we are also increasingly anxious, anxious about our health — even anxious that we're too anxious about our health. Our ability now to understand our bodies and put a name on what's wrong with them does not always provide comfort; instead, it can create new fears and impose new constraints on us. Some health care leaders, including Donald Trump's health secretary, Robert F. Kennedy Jr., argue that we are becoming over-medicalized — too ready to take a pill for something, just for the sake of taking something. The reality is nuanced because medicine is, to put it mildly, complicated. But we should in fact be careful about doling out diagnoses, says Dr. Suzanne O'Sullivan, an Irish neurologist and the author of a new book, The Age of Diagnosis: How Our Obsession With Medical Labels Is Making Us Sicker. In her book, O'Sullivan argues that our eagerness to diagnose, preemptively screen, and otherwise push these new tools to their limits is creating problems that deserve to be taken more seriously. She describes mutually reinforcing trends — the patient's insistence on certainty and the doctor's desire to avoid being blamed for missing something — that are driving clinical practice toward overdiagnosis. The phenomenon is even leading to more instances of doctors diagnosing certain cancers by 50 percent or more, due to the availability of new imaging tech that can detect even minuscule traces of abnormal cells. Overdiagnosis can cause real harm. And so O'Sullivan advocates for 'slow medicine,' in which doctors and patients take time to develop a relationship, monitor symptoms, and take a great deal of care before naming a condition — an approach that may sound quaint in an era of rapid-testing but something she says is actually more in tune with the reality that diagnosis is partly an art. 'Most diagnoses come with a huge amount of uncertainty. That covers asthma, diabetes, cancer, autism. Diagnosis is a clinical skill,' she told me in a recent interview. 'Now, the difficulty, I think, with modern medicine is a lot of people don't understand that and that they feel that the test — the blood test or the brain scan — makes the diagnosis, when actually a diagnosis is made on understanding the story in the context of the tests that are done.' There is a tension here. Slowing down could, at least in theory, risk missing an aggressive disease early at the most crucial time — when it can still be treated. And in the United States, simply getting a doctor's appointment can be more challenging than it should be. Each individual case is unique, O'Sullivan acknowledges, which is why a relationship with your own primary care doctor is so important. But she argues that, on the whole, doctors have erred too far in the other direction, toward diagnosing conditions too quickly and too confidently and creating a different set of problems for patients. During our conversation, we spoke about how to balance our tremendous new technological abilities with a more measured approach to clinical practice and how she would respond to critics who argue her advice would lead to people's health problems being missed. Our conversation has been edited for clarity and length. First, let's clarify something basic. What do you mean by overdiagnosis? How do you define it? I think of overdiagnosis as measuring the point at which a medical diagnosis ceases to be useful. A diagnosis may be right or it may be wrong, but it isn't always beneficial in a certain situation. Overdiagnosis is trying to ask when a diagnosis is genuinely a useful way of conceptualizing someone's difficulties, and when it is not. The first chapter is about Huntington's disease. Why did you start there? There's a genetic test available for Huntington's disease. If you happen to have the gene for Huntington's disease, you are destined to get Huntington's if you live long enough. If you have the genetic test, you can find out ahead of time that you have that at some point in your future. I needed people to understand the power of a diagnosis to make you sick even when you actually don't have much physically wrong with you. I tell the story of a patient named Valentina, who didn't have the gene but believed that she did because of her family history. Because of her strong belief that she had the gene, she developed all the symptoms. When we take on a medical label, when we are told that we are sick in some way, we inadvertently search ourselves for the symptoms and signs of the label that we've been given. Our bodies are very noisy engines. There's all sorts of things to notice if you are given reason to notice. The Huntington's disease community is in this incredible situation where they have the opportunity to find out they have a diagnosis 20 years before the disease starts. And in most countries, only 10 percent to 20 percent of people actually have the genetic test that will advise them of the disease. They do that because they are a community who has given a great deal of thought to what it's like to live with the label of an impending disease. Once you discover you have a positive test, it completely changes your relationship with your body. It changes how you think about your health. And once you know, you can't unknow. I spoke to loads of people with Huntington's, and they all said the same thing: that living with the hope that you are negative and that everything is okay is a way better life than living with the knowledge that you're positive and waiting for the disease to start. One of the most interesting themes in the book is this idea that people want and have come to expect concrete answers from modern medicine. Black or white: You have a disease or you don't. But you cover chronic Lyme disease, long COVID, and autism, these conditions where the boundaries are fuzzier. What problems does that create? Most diagnoses come with a huge amount of uncertainty. That covers asthma, diabetes, cancer, autism. Diagnosis is a clinical skill. It requires a good clinician to be able to put the patient's story in the context of tests and findings. Now, the difficulty, I think, with modern medicine is a lot of people don't understand that and that they feel that the test makes the diagnosis, the blood test or the brain scan, when actually a diagnosis is made on understanding the story in the context of the tests that are done. That means that diagnosis is hugely subjective. I hear a lot of stories of people going to different doctors who said I didn't have a diagnosis, but then the 11th doctor said I did have it. There is an inherent subjectivity that doctors will manage differently. I'm a doctor in a highly specialized center, and I deliberately err on the side of slight underdiagnosis. I do that because I'm aware that when I make a diagnosis of a brain disease, I am changing that person's future forever. I'm not just changing their relationship with their body. I'm also changing their mortgage payments, their insurance, their confidence in themselves, their ability to get health insurance. I'm changing their finances, their practical future. I'm changing their ability to drive. There's so many things that come with the diagnosis that people don't think about. What many, many doctors do is they err on the side of overdiagnosis because that['s an easier place for a doctor to be. Because you're never going to come back to me and say, 'Listen, I don't really believe I had asthma when I was a child.' You'll say, 'Well, listen, I had it. You treated it and now I'm better.' It protects us against someone coming back and saying we missed something. I came into this book thinking that something like cancer would very much be more of a yes or no. You either have it or you don't. And if you do, you really would want to know about it — as soon as possible. And yet, after reading your book, I felt like you had complicated that story. How do we risk overdiagnosing cancer? Within the medical community, this has been well-known for a long time, but it just doesn't leak into the general conversation. The bottom line is if you screen healthy people for an illness, any illness, be it cancer or high blood pressure, diabetes, then you will be picking up borderline cases and overtreating them. In the case of cancer, I try to remind people we've only had MRI scans in regular clinical use in doctors' offices since the 1990s. They've only been as good as they are now in the last 10 years, as sensitive at picking up things. As we get these newer tests, we're finally seeing inside the healthy body of people. What we find when we screen people for things like cancer is we find abnormal cells. But not all abnormal cells go into cancer. Lots of people live out their lives having these abnormal cells. They never spread. They never do anything. They never grow. They would never threaten health. But our difficulty as doctors is because we're so new to finding all these irregular abnormalities that when we find them, we don't know which ones will turn into malignant cancers and which ones won't. So what we do is we treat them all as if they will inevitably turn into malignant cancers. One Cochrane Review estimated that if you screen 2,000 women for breast cancer, you will save one woman's life from breast cancer and treat 10 women for breast cancer who never needed to be treated. I think sometimes we're very in love with all of our access to screening tests and scans and health checks. A lot of that care is not only unnecessary, but actually doing us harm. One estimated that if you screen 2,000 women for breast cancer, you will save one woman's life from breast cancer and treat 10 women for breast cancer who never needed to be treated. Obviously being able to better more precisely diagnose conditions and to test samples at a genetic level represents advancement in science and an improvement in our understanding of our own body. How do we encourage that kind of development while mitigating the problems that you're writing about? I work with people who've got rare brain diseases. The advancement in genetics and the ability to diagnose rare genetic conditions is amazing. I don't want to in any way detract from what a phenomenal kind of medical advancement that is. I have no doubt that going forward in 20, 30, 40 years, it will continue contributing to science and to medicine in very positive ways. How to talk to your doctor about 'slow' medicine O'Sullivan's book is not a self-help guide, but after reading it, it's easy to come up with some strategies that could help each of us bring a 'slow-medicine' sensibility to our next doctor's appointment and potentially avoid overdiagnosis. Such as: • Set expectations with your doctor. Make clear that you don't want to be quick to judgment or treatment. • Press your doctor to get a better sense of how confident they are in a diagnosis, what could change their mind, what additional steps could be taken to double-check. • If you're really worried about something, speak up. Slow medicine means being thoughtful — not ignoring what your body is telling you. But something being modern and expensive and cutting-edge doesn't mean it's always better medicine. We need to be a little bit more open with the general public about the uncertainties. We'll never understand the meaning of different genes to healthy populations if we don't test them, so we need to do the population-based testing. But we need to be careful before we begin offering genetic tests to unsuspecting members of the public who probably think we understand them a great deal better than we do. We're really on a learning curve at the moment. A little bit more clarity and honesty with the public would go a long way. How would you respond to somebody who hears we should be testing less and diagnosing less and immediately thinks, 'Well, you're just going to put my health at risk.' Listen, I don't want a diagnosis missed in myself. I don't want to be the doctor who misses things either. So I completely understand people's fear of dialing back. It's not about replacing all these tests with nothing. It's really advocating for this concept of slow, thoughtful medicine with good clinicians that we invest in good doctors, good nurses, good diagnosticians, and we don't feel the need to be compelled to jump into tests and diagnosis at that first meeting. We have time to spend with our patients and meet them again to discuss the problem. That's how you come to both a good understanding between patient and doctor. A quality diagnosis is made with time and understanding.
Associated Press
07-04-2025
- Health
- Associated Press
CCHR Says Despite Record-High Spending, Mental Health Outcomes Decline-Experts Say Fault Lies with Flawed Diagnostic System
LOS ANGELES, Calif., April 7, 2025 (SEND2PRESS NEWSWIRE) — The Citizens Commission on Human Rights International (CCHR) is sounding the alarm on the unchecked expansion of psychiatric diagnoses—most notably through the Diagnostic and Statistical Manual of Mental Disorders (DSM). What began in 1952 with just 106 diagnoses exploded to over 300 by 2013, despite a lack of objective biological testing to support these labels. The United States is spending more than ever on mental health – yet outcomes continue to worsen. Suicide rates are rising, psychiatric hospitalizations are increasing, and more Americans than ever are on psychiatric drugs. A growing number of experts and watchdog organizations argue that the root of the problem lies not in a lack of access or funding, but in the very foundation of modern psychiatry: an unscientific diagnostic system that pathologizes normal life. According to neurologist Dr. Suzanne O'Sullivan, author of ' The Age of Diagnosis,' 'fad' diagnoses pathologize the human condition itself. 'We are not getting sicker,' she writes, 'we are attributing more to sickness.'[1] Despite massive investments in mental health care, U.S. outcomes are deteriorating: Mental health/behavioral spending reached $329 billion in 2022—a 94% increase since 2012 [2]—yet suicide rates have jumped 30% since 2000.[3] Time in a psychiatric hospital raises suicide likelihood by over 44 times; psychotropic drugs alone can raise it nearly six times.[4] One-third of admitted psychiatric patients are readmitted within a year, highlighting treatment failure.[5] Involuntary commitment accounts for over half of all psychiatric admissions.[6] Yet evidence shows that forced treatment is ineffective.[7] The diagnostic system's credibility is undermined by deep financial ties to the pharmaceutical industry. According to research: 69% of DSM-5 task force members had financial ties to drug companies. Lisa Cosgrove, Ph.D., of the University of Massachusetts Boston, warns that the 'disease model' of psychiatry secured legitimacy for the field but at the cost of objectivity. 'It opened the door to an improper dependence on the pharmaceutical industry,' she says. DSM-driven diagnostic inflation has led to an explosion in labels that often medicalize experiences. Examples now classified as disorders include: Caffeine Use Disorder (8%) Restless Leg Syndrome (13%) Adjustment Disorder (15%) Oppositional Defiant Disorder in children (6%) Some estimates suggest that, when added together, DSM-labeled 'illnesses' outnumber the U.S. population. While the DSM gives the appearance of a clinical guidebook, it remains—by the admission of psychiatrists—scientifically unsound. Dr. Thomas Insel, former director of the National Institute of Mental Health, declared: 'The weakness of DSM is its lack of validity…. DSM diagnoses are based on consensus about clusters of symptoms, not any objective laboratory measure.'[8] Psychiatrist Allen Frances, who led the DSM-IV task force, has since warned that DSM has led to the 'medicalization of childhood' and a 'massive, careless over-diagnosis' epidemic. He emphasized: 'Mental illness is terribly misleading because the disorders we diagnose are merely descriptions of behaviors, not well-established diseases.' In other words, there is no verifiable biological test for depression, ADHD, bipolar or other any other mental disorder. Yet millions are labeled and treated as if they were suffering from chronic medical diseases. Psychiatric diagnoses do not reveal chemical imbalances. In fact, psychiatrist Professor Joanna Moncrieff, of University College London, notes: 'The theory that depression is caused by low serotonin is not supported by reliable evidence.' Still, patients are routinely prescribed antidepressants under the presumption of such imbalances. The consequences of psychiatric diagnosing are not just financial—they're deeply personal and often devastating. Women and children are disproportionately affected. Two-thirds of electroshock recipients are women. Children as young as five are prescribed psychiatric drugs. The American Academy of Pediatrics reported a 66% rise in antidepressant use in ages 12–25 between 2016 and 2022.[9] TIME and Smithsonian have reported on the enduring trend of diagnosing women's physical and emotional struggles as mental illness, delaying real medical care and increasing vulnerability to psychiatric interventions.[10] Even as access to treatment expands, mental health is declining across all major metrics. TIME summed it up: 'Even as more people flock to therapy, U.S. mental health is getting worse.'[11] Experts and advocates are calling not for more funding, but for systemic change. Dr. Frances advises: 'Ignore DSM-5. Its suggestions are reckless, unsupported by science, and will result in unnecessary, harmful, costly treatment.'[12] 'The DSM must be abolished,' says psychiatrist Samuel Timimi.[13] CCHR, established in 1969 by the Church of Scientology and professor of psychiatry Thomas Szasz, urges lawmakers, healthcare leaders, and the public to reconsider the current trajectory of mental health policy. 'Until psychiatry is held accountable for its unscientific diagnostic system and the harm it inflicts,' says Jan Eastgate, President, CCHR International, 'the crisis will only deepen.' Sources: [1] Hanna Barnes, 'Our overdiagnosis epidemic: How a marked rise in the treatment of certain conditions – physical and mental – is harming, not protecting, public health,' The New Statesman, 10 Mar. 2025, [5] 'Readmission of Patients to Acute Psychiatric Hospitals: Influential Factors and Interventions to Reduce Psychiatric Readmission Rates,' Healthcare (Basel). 2022 Sep 19;10(9):1808, [6] 'National Mental Health Services Survey (N-MHSS): 2018 Data on Mental Health Treatment Facilities – Data on Mental Health Treatment Facilities,' SAMSHA, 2019; Christopher Lane, Ph.D., 'When Psychiatric Treatment Isn't Voluntary,' Psychology Today, 31 Mar. 2023, [7] 'Forcing homeless people into mental health treatment isn't the way to solve homelessness,' Los Angeles Times, 28 Jan. 2020, [8] Thomas Insel, 'Transforming Diagnosis,' NIMH Website, 20 Apr. 2013, [11] 'America Has Reached Peak Therapy. Why Is Our Mental Health Getting Worse?' TIME, 28 Aug. 2024, [13] Samuel Timimi, 'No more psychiatric labels: Why formal psychiatric diagnostic systems should be abolished,' Int. Journ. of Clinical and Health Psychology, Sept.-Dec. 2014, MULTIMEDIA: Image caption: 'Until psychiatry is held accountable for its unscientific diagnostic system and the harm it inflicts, the crisis will only deepen.' – Jan Eastgate, President, CCHR International NEWS SOURCE: Citizens Commission on Human Rights Keywords: Religion and Churches, Citizens Commission on Human Rights, CCHR International, psychiatry, LOS ANGELES, Calif. Send2Press® Newswire. Information is believed accurate but not guaranteed. Story ID: S2P125332 APNF0325A
The Guardian
19-03-2025
- Health
- The Guardian
Culture warriors see not sick Britain, but a plague of 'overdiagnosis'. How convenient
Is 'overdiagnosis' the new culture-war buzzword of choice? I had been wondering this for a while, and then Wes Streeting claimed on Sunday that there is an 'overdiagnosis' of some mental health conditions. Now I am certain it is. I first noticed the term being used in relation to anxiety and depression, then attention deficit hyperactivity disorder (ADHD) and most recently autism. Two books on overdiagnosis, Suzanne O'Sullivan's The Age of Diagnosis and Searching for Normal by Sami Timimi, have garnered attention across the media, adding fuel to a new fire that we might characterise as 'Bloody everyone has a label these days, don't they?'. This is not to say that these authors and medical professionals don't have valid points, or that the medicalisation of societal issues isn't of concern. We all know how 'therapy speak' has leached into public discourse, how teens are now throwing around terms such as 'trauma response' and 'stimming' – lifted from earnest TikToks – with a confidence that must seem startling to some of their elders, who grew up with the idea that you only went to a shrink or a counsellor if there was something 'wrong' with you, or you were about to get divorced. There is a generational aspect here, though really the divide is determined by our openness to examining our mental health. In some households, a faultline can develop between those who have had a diagnosis and therapy (often younger), and those who won't countenance it (often older). Just look at Prince Harry, whose determination, after extensive therapy, to talk about the trauma of his mother's death was considered ghastly and exhibitionist by those used to the stiff-upper-lip attitude of previous generations of royals. Post-traumatic stress disorder – a diagnosis I have had in the past – is another one of those conditions people like to claim isn't real. We have all noticed that the autism spectrum has widened massively in the past three decades, partly owing to the removal of the Asperger's diagnosis. When my brother was formally diagnosed at four years old, in 1997, you usually had to be what they then called 'severe'. Nowadays, there are children who are verbal and able to be in mainstream school who have diagnoses. This surge deserves examination, too. However, I am not one of the people saying this must mean that those people aren't autistic, or that they don't face enormous challenges. Heterogenous and multifactoral disorders tend to be that way. It isn't the existence of books on overdiagnosis that perturbs me. I have a lot of respect for the opinions of doctors, especially those who ask vital questions about how we treat patients with chronic illness, mental distress and neurodivergence. What is alarming is how the concept of overdiagnosis is being deployed by culture warriors as a battering ram to beat ill and disabled people with, to cast doubt on their diagnoses, to mock them and, in the case of politicians, to justify further punitive cuts to their support systems. Take this paragraph from a Sunday Times review of Timimi's book: 'Instead of operating on the Socratic principles of doctors talking with patients to find the emotional and historical source of their unhappiness, too many have pivoted to treating mental health like physical health. They diagnose their patients with a 'disorder', slap them with a pathologising label (ADHD, autism etc) and medicate them.' Where to start? The fact that autism and ADHD aren't mental illnesses? Autism and ADHD are neurodevelopmental disorders (they can both co-occur with mental-health issues). But what I find most troubling is the suggestion that doctors are slapping diagnoses of neurodevelopmental disorders on to patients willy nilly. Presumably we must now mistrust the neurologists, the developmental paediatricians, the psychiatrists, the geneticists and the speech and occupational therapists involved in a diagnosis? The parents who have noticed that their child is struggling to meet their milestones, the school special educational needs coordinators, and the GPs and health visitors who refer? The wait for an NHS autism assessment – and the meagre support that may result from it – is more than four years in some trusts. No one is simply 'slapping' an autism diagnosis on anybody, at least not in the NHS. I do worry about the private market for diagnosis, though it is worth noting that in order for these diagnoses to be of any use, many boroughs require that they be reviewed by a panel of NHS experts. Amid all this ill-informed noise about overdiagnosis, there has been little discussion about what it is about Britain that makes so many people struggle to function within it, no real admission of the fact that this country has become quite a depressing place to live, or what has been done to an education system within which anxious and neurodivergent children are simply the canaries in the coalmine. This culture war places the onus on the individual to function within a brutal society that makes little effort to include or support them. It demonises patients as a starting point, and has real-world effects on people's lives. It means people having to repeatedly justify their diagnoses or those of their children, even to others in their families. It means people having to fight harder for support for themselves or their children. It means being confronted with people parroting lines like: 'ADHD? What he needs is a good smack.' It means a general atmosphere of ignorance and contempt. Sick people, disabled people and the parents who advocate for their children, as well as the professionals who support them, deserve far better than this unkindness. The measure of our society lies in how we treat our vulnerable. As it stands, it is downright nasty. Rhiannon Lucy Cosslett is a Guardian columnist
