Dr. Suzanne O'Sullivan
speaker
271 appearances
2 recordings
2 series
first heard Mar 2025
last heard Apr 2025
Dr. Suzanne O'Sullivan’s voice in public audio — every appearance, attributed to the second.
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This is a kind of a collusion between society and the scientific world and the medical world.
And we are responding to the needs of the culture in which we live. So it's a kind of collusion of multiple different sections of society. But basically I see these young women, I always say women, but it's not only women, but it is slightly more women. And I think perhaps I became interested because I could kind of relate to these people in this situation being dismissed.
They'll come and they'll have ADHD, autism, a condition which people may or may not know called POTS, postural orthostatic tachycardia syndrome. If you haven't heard of it, you will soon. It's best you don't. No, it's coming. It might be best you never hear it and then you can't get it. Then you won't get it.
I'll stop listing them. They'll have 10 diagnoses that often come in a little batch together. What's really noteworthy, I was chatting about this with a colleague recently, is basically we didn't see people with this constellation of diagnoses 10 years ago, but we also didn't see these people with a constellation of undiagnosed symptoms that fit with these diagnoses 10 years ago.
It's not like you can say that 10 years ago or 20 years ago or 30 years ago, there were loads of people suffering in this way and no one knew what it was. And now there are names for it. People are developing groups of symptoms that people didn't have 30, 40 years ago. And we're giving it names.
When you talk about medical overdiagnosis, or you say you're writing a book about medical overdiagnosis, everyone thinks of the autism, ADHD things, but you've already raised diabetes. This actually overdiagnosis kind of epidemic applies to both physical and mental health problems.
So it applies to cancer, it applies to diabetes, it applies to asthma, it applies to high blood pressure, high cholesterol, as much as it does depression, ADHD.
There's different ways that this happens. The two main ways that it happens is one, you are kind of diagnosing things that don't need to be diagnosed. So if we take diabetes as an example, we now have this state of pre-diabetes. So you don't have diabetes yet, but you're almost getting it. It's not really a diagnosis in itself, but it's becoming one.
Basically, the way these things come about is that we as doctors and scientists are encouraged to make sure we keep as many people healthy as possible and therefore to find as many people who might be at risk of disease as possible and treat them. So we are incentivized to find as many people who might get diabetes as we can.
And an absolutely religious belief in the assumption that finding diagnosis early and treating it is the right thing to do. So what we'll do is we'll say, OK, to be pre-diabetic used to mean that you had to have a fasting blood sugar of six. But you know what? I think that's too high. We might be missing some people.
So we expert committee get together and we say, let's change that parameter and say you can have pre-diabetes at 5.6%. Nothing has changed in science. Nothing has changed in our bodies or in society. The only thing that has changed is that in order to make sure we are missing as few people at risk of diabetes as possible, we are going to change the number at which you can be diagnosed.
And the idea then is obviously you identify all these extra people with pre-diabetes and that particular change applied to the entire population of China would have meant that 50% of men in China were pre-diabetic and something like a third of people in the US would be pre-diabetic. So these thresholds are being set phenomenally sensitively.
The thing we're not great at is proving that that actually is making people healthier. And there isn't an awful lot of evidence to suggest that by adjusting thresholds in order to identify pre-diabetes at an earlier stage, you're actually preventing lots of people from getting sick further down the road. Well, actually, probably aren't. And we tend to move these goalposts
and consider success to be how many new sick people can we find, rather than the more important endpoint, which is what difference has that made to these people's long-term health. What we very often don't do, say in the case of cancer, we'll say, well, we screened a thousand women for cancer and we saved one life, but we potentially treated 10 people for cancer who didn't need to be treated.
And what was the impact of that? What was the impact emotionally, physically, psychologically, everything? We're very good at capturing more and more disease, but we're not terribly good at measuring the implications of that down the road.
I don't know specifically about amputations, but have we reduced the number of people who are ultimately developing diabetes? No, diabetes is still rising. And that's always my issue with these things is now we've got this whole new population with pre-diabetes, which isn't really a disease state, but a kind of a warning. And if identifying those people and then giving them advice really worked...
We should ultimately have fewer people with diabetes and fewer people with serious diabetes, but we don't. So what are we doing? Why are we doing it? And what has been the impact for those people newly labeled pre-diabetic?
Autism was developed as a concept in 1943. And when it was developed, the people who were affected by autism had very severe communication problems. So severe that they would have no interest in people at all. So there were very, very disabled young people. And it began in infancy. It began at a very young age. It was obvious from an early age that
And the people who had it could not function normally in the world. Now, at some point in the 1960s, Lorna Wing, a scientist, she said, well, I think perhaps this thing called autism, we're probably missing cases of it. We can see these really severely affected children. You don't have to look very hard to see them.
But I think if we look in these schools, we can see there are other children who are being poorly served by society because perhaps they have a milder version of this. And I think that's really valid because when I was in school in the 1980s, there was no people with special learning needs. There must have been people who were being neglected.
Showing 161–180 of 271 · page 9 of 14
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