Just As Well, The Women's Health Podcast - ADHD, Health Anxiety and the Hidden Harm of Overdiagnosis

Episode Date: July 14, 2026

Can a diagnosis sometimes do more harm than good? Claire Sanderson and Gemma Atkinson are joined by consultant neurologist and bestselling author Dr Suzanne O’Sullivan to explore why more people are receiving medical labels—and whether those labels always lead to better health. Suzanne explains the important difference between misdiagnosis and overdiagnosis, and why finding an abnormality doesn’t necessarily mean it will ever make you ill. The conversation covers the rise in ADHD and autism diagnoses, the risks of medicating children too readily, health anxiety, wearables, full-body scans and the impact of constantly monitoring our bodies. They also ask whether ordinary sadness and anxiety are becoming overmedicalised, and how we can raise awareness of menopause without making women fear it. Suzanne’s views have attracted criticism, but her argument isn’t that people should ignore symptoms or avoid medical care. Instead, she wants us to ask: what will this diagnosis give me, what harm could it cause and will it meaningfully improve my life? Dr Suzanne O’Sullivan’s latest book is The Age of Diagnosis. This episode is for general information and discussion and should not replace personalised medical advice. Want more from Women’s Health? Join the Women’s Health COLLECTIVE for workouts, exclusive events and expert advice to unlock your fittest self - Train smarter. Live better. Visit www.womenshealthmag.com/uk/wh-podcast Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello, I'm Gemma Atkinson. And I'm Claire Sanderson. We've just recorded an episode of Just as Well with Dr. Suzanne O'Sullivan. So Suzanne is a consultant neurologist. She's a best selling author and her latest book is called The Age of Diagnosis, where she explores medical labels and argues that as a society, we are over-diagnosing people and it is causing potential harm. She was so knowledgeable.

And she faces a lot of criticism from people in her views and opinions on the medical. medical world. She is a doctor herself obviously, so she's not anti-medicine at all. What she is highlighted in this episode is it's not an umbrella fix for everybody and there's a lot of misdiagnoses but there's a lot of diagnoses that didn't need to be highlighted that sometimes it can make a person feel worse. So she went through like an extensive list of what a doctor should be thinking about before offering someone a scan or before telling someone what they think they have as an ailment. She spoke about the rise in ADHD diagnoses in children.

Autism. And autism, yeah. And how so many people are diagnosed with cancer when it's not actually a cancerous cell. It's an abnormal cell. She said that needless testing. Did she say it was needless? No. She said she's not against screening. She said she just delay the screening. She said things are being found inside our bodies that could remain there and cause no harm for the rest of our lives. But they are labelled as cancer when really what they are is abnormal cells. Yet for every one person whose life is saved through cancer screening, 10 people needlessly have cancer treatment and could ultimately die earlier because of this invasive treatment.

Her work is not without his critics. She especially comes under a lot of flack from the autism community for her views on autism and ADHD. She's not saying that ADHD and autism doesn't exist, but she argues that the parameter in which people are diagnosed has grown to such an extent, people are now being brought into the spectrum that needlessly should be there

and can function perfectly well in society. It's controversial, it's well worth a listen, it's our job to bring different points of view and she has a different point of view. She does and at first I was a bit skeptical when I read the notes on her I thought oh this would be interesting but everything she said to me made a complete sense

and yeah it was brilliant please please take a listen to this episode take what you will from it if you have children or someone in your family who may be going through a diagnosis right now it's especially for you and please do like and share and support subscribe as well so we can get more wonderful guests on Just as well. Enjoy this episode.

Suzanne, welcome to Just as well. Thanks for having me. So we have your best-selling book next to us here, the age of diagnosis. Some of the compliments are outstanding, fascinating, brave, revelatory. So what do you mean when you say we are living in the age of diagnosis? Yeah, so I suppose I'll start by, I'll answer that really by kind of saying why I wrote the book, which, which is that I've been a neurologist for 30-odd years, a doctor for 35 years, and I've really noticed a changing pattern of the way we're diagnosing people. I work with a lot of really young patients, so not children, you know, adults say in their 20s,

and I've become increasingly aware of how many really young people have a list of diagnosis as long as you're on. You're using to see that 30 years ago. I have no objection to it in principle, if it does what it's supposed to do. So I think about diagnosis as being something that is supposed to explain your symptoms, lead to a treatment pathway, lead to support,

you know, result hopefully in cure, but at least in bettering your life in some way. But what I see is people accumulating diagnosis that don't lead to any of those things, just diagnosis as an end point. And that's just been a real concern for me, so I wanted to think more about it and that's what I hope I do in this book.

So you're a consultant, neurologist, at what point in your career did you think this overdiagnosis is doing more harm than good? Yeah, I think, you know, it's been a gradual thing that's happened over the last kind of 10 to 20 years. Let me just kind of explain what I mean by overdiagnosis because I always think that people hear that word and they think, oh, she's saying, there's nothing wrong with you, you're complaining about nothing.

So overdiagnosis and misdiagnosis are completely different things. So misdiagnosis means you've got the diagnosis wrong. It's simply wrong. Overdiagnosis, the diagnosis might well be entirely correct, but it's not necessarily benefiting you. I start the book with the story of a patient of my own called Stephanie, not her real name. Stephanie's a lady I've looked after for many years. She developed seizures in the 90s. I met her sometime in the 2000s and her seizures weren't getting better. Nobody knew what was wrong with her.

I was able to establish that she had epilepsy, but I wasn't able to. able to make her better. And that's the way it is with medicine sometimes. And we then had a kind of a long journey together with trying to make her better, failing. And then suddenly we noticed she had a new problem, difficulty walking. Now, full disclosure, I didn't know what was causing that either until there was a chance remark by her husband who said, oh, Stephanie walks just like Abigail. Abigail was their 15-year-old daughter. Now, I'd never met Abigail. As far as I knew, she was a perfectly healthy 15-year-old. As far as she knew, she was a perfectly healthy 15-year-old. But kids in school being a little bit cruel, noticed that she had what they called a funny walk. They gave her

nicknames. There were things she wasn't good at. She couldn't run. But didn't bother her. She liked swimming. Didn't need to run. You know, she did things that worked to her strands. Now, hearing that Abigail had a problem like Stephanie's is just, you know, doctors love that stuff. You know, we're like, oh my God, this is a clue. to this kind of difficult diagnosis because it immediately implied there was something genetic going on in that family. So I sent both Stephanie and Abigail,

who I'd like people to keep in mind, I'd never met to a neurogenetics clinic. Loads of tests were done and they established that mother and daughter had a genetic problem that causes epilepsy and walking difficulties. Now, I as a doctor had done exactly what I'm trained to do. I should be delighted with this course of events.

you know, I'd found a rare diagnosis. I'd diagnosed Abigail years before her mother, so she wouldn't go on a kind of diagnostic odyssey. I should be absolutely thrilled with that as an outcome, but actually afterwards I just felt just so guilty. And I felt guilty because what favour had I really done Abigail? And this is a real classical example of overdiagnosis. Yes, she had a walking problem,

which probably needed to be diagnosed at some point. The diagnosis was correct, but did she need it when she was. 15 years old, in school, looking forward to the rest of her life and believing that there wasn't a thing wrong with her. Had I actually made her life easier, or had I potentially made her paranoid about something that she simply never needed to think about or that she would not need to think about for years? So I tell that story just to explain to people that overdiagnosis doesn't mean the diagnosis is wrong. What it means is that the diagnosis potentially isn't useful

and potentially does more harm than good. Is in the point of a diagnosis to intervene to improve the life of that patient, whether that's cure them or make their symptoms more manageable? So in the case of Stephanie and Abigail, your diagnosis could have led to an intervention that could have improved? Except it didn't.

So when a diagnosis works well, exactly as you say, you get the diagnosis, it leads to a treatment. We're hoping the treatment will lead to cure, but even symptomatic relief. But actually this diagnosis of genetic disorder was untreatable. And therefore, and that's what we've, you know, diagnosis is always useful if it leads to treatment and cure.

But is it useful if it's just a label to explain something about yourself but doesn't actually lead to treatment or cure? And that's the real difficult. That's the point where a diagnosis can potentially do more harm than good. if it doesn't lead anywhere really useful, like a treatment or substantial improvement in the standard of your life, for example. I think as well it depends on the patient on how they manage stress and how they manage their condition

that they've been told they have completely different. But when I was pregnant, they found when they were doing my pregnancy scans, some little AMLs they called them on my kidneys. And they said, well, just follow up every year. And I was like, oh my God, what is it? What is it? What is it? It's like an accumulation of like blood cells, so they're just in one little place. So it looks like a clump of them. Right. So they just, but there's nothing bad with them.

Apparently, we all have them. It's very common. But when they told me about it, I was like, oh, my gosh. And I got the letter from my urologist to say, everything's fine, nothing to worry about. Your kidneys are all clear. But then it said, however, we've found a possible. cyst on your liver. And I was like, oh my God, because my liver, you're like, but I don't drink. What the hell?

What the hell? Anyway, I then had to wait, and the NHS were fantastic, and I had a scan on my liver. That came back. The lady he was doing the scan, she said to me, I'm no, I'm no concerns. Again, it's just a cluster of cells, completely fine. The letter came back, completely fine, very common. And my friend, who's a GP, when I got told about this potential cyst on my liver, I message to her, oh my God, what is it?

And she said, there's a reason why we don't just do full body scans. She said, because you will always find, because she said it's an incidental finding. She said, you'll always find something that you could have had from birth that is doing you no harm. But for the past four weeks, I was Googling liver cysts, liver cancer, liver this, for no reason. And I was stressed and I was worried.

And my partner was saying to me, you don't know what it is yet, but I said, but I know it's there. And only when I got that letter, it's all good. And I thought, if I'd have to wait years, which some people do, for a final diagnosis, that stress and worry could make the condition worse. I think you've summed up the entire issue absolutely perfectly, but also the solution in what you said at the very start, which is know what kind of person you are, you know, how will you react to this news?

So exactly as you say, I always kind of remind patients that some of the technology we now use to look inside the body, we didn't have until the 1990s, so MRI scans came in in the 1990s. And that means that we don't know what the, we didn't know what the inside of a healthy body looked like until we got MRI scans because you couldn't just do kind of scans, dangerous scans like CT scans have radiation. So therefore we only did scans on sick people. We didn't do scans on loads, loads of healthy people.

So it's only in the last 30 years we've known that inside all of us are cysts and little abnormal blood vessels and little clusters of abnormal cells. Again, I always kind of remind my patients, you know, we age on the outside, but we age on the inside too. So when we start seeing those early signs of aging or we see those little individual differences as doctors, we don't always know what to make of them. And that's why it's really important to only do a medical test. If you're doing it for a really good reason, I mean, you raise the issue of whole body scans. I mean, I just think they're a disaster

because if you're not sick and you do a whole body scan and you see a cyst, then... You panic. Yeah, absolutely. But I don't want to say to people don't have tests, but instead reinforce what you said in the first instance was, you know, what sort of person are you? Are you the kind of person who, when they find out they have assist,

can eventually be sort of accept the, the reassurance that everything is okay. And if you are that kind of person, well then if you think you need the test, have it. But if you're the type of person who will lie awake at night for the next 10 years worrying about that thing, then maybe you shouldn't have the test.

And it's as well, it's a difficult one for women, I think, because we've been treated as small men in the medical world for a long, long time. So it's kind of on one hand we're fighting to be believed and to be listened to. And for a doctor to say, listen, I believe you, what you're feeling is valuable. Let's look into it.

But then on the other hand, like we've just said, too much information can send a woman who's already juggling many plates just into a downward spiral, especially at different life stages. What advice would you give to any women who are maybe thinking, I'm feeling a certain way, I don't want to feel worried, what am I supposed to do? It's a tough one.

Yeah, I mean, it's a tough one for everyone to know, for both doctor and patient to know, you know, how actively, how aggressively should this be investigated, because too many tests aren't a great thing, too few tests aren't a great thing either. The important thing, I think, is that you have a doctor who you feel listens to you. So if you're worried about something, always go and talk to somebody about it, because the last thing you want to do is leave something until it's too late. But I think, you know, we know what a good interaction with the doctor feels like. If you feel like someone has listened to you and taken you seriously, then that's a good doctor.

I kind of want people to know what a good consultation looks like, which is not that every time you go to a doctor and say, you know, I feel a bit run down, I don't feel great. And they organize a scan and a blood test and another scan. Now, for some people, that sounds like, oh, my problem is being taken seriously. that's such an easy way to be a doctor you know to every single person who comes to me and says they has a headache I can do a scan on them I can do that in two minutes is the easiest thing in the world the hard thing to do as a doctor is to listen to the story

and really feel that you've understood it and then decide whether tests are appropriate or not appropriate and then for the reasons that you've already clearly set out decide that a scan might do more harm than good in this person because I don't think they really need it and I might find something that will just worry them. And I think, you know, if you see your doctor and you feel listened to and another good way of recognizing kind of good health care is then they follow you up for the problem, you know, they don't just see you one time because it can be hard in one

discussion to really get to the bottom of a problem. So someone sees you, they listen to you. They say, well, I don't think tests are needed now, but maybe let's meet again. a couple of months and see if anything has changed. A lot of things will have resolved in that time. So it's not the doctor. You're not looking for the doctor who does the test every time you ask for it. You're looking for the doctor who makes you feel heard.

So we're living in a culture where there's so much health information at our fingertips. I've edited women's health for 10 years and the level of information we have now is comparable to that of a professional athlete a decade ago. So we all know we can track our gut health our glucose, our sleep, our heart rate variability, our hormones. Do you think this level of information and this much more awareness of wellness

is actually breathing a culture of paranoia? Yeah, I absolutely do think it's a problem. I'll probably always come back to the point with the Gemmaid, which is know who you are and how you'll respond. But these internal processes that, you know, your heart rate, your breathing, your bowels, they're not supposed to be within your conscious awareness. we're not supposed to be thinking about those things all the time. And once they enter your conscious awareness,

you can start really worrying about them. I'll give an example. So let's say, every time we go up the stairs, our heart rate increases. So that's completely normal. We don't notice it because we're healthy. Maybe as you get older, you begin noticing it because now you're aging and it happens in a more pronounced way. But then you discover that, you know, your father or your mother has,

or a close relative has developed a severe heart problem. problem. Then the next time you walk up the stairs, that change in heart rate can suddenly become much more significant in your mind. And therefore, you pay attention to it and then you worry about it. So these internal processes, if for some reason they become a focus of your attention, you can start thinking that they're abnormal. And then once you do that, you start worrying about them. And then you get into a kind of a vicious cycle. You notice something, you worry it's abnormal. You pay more attention. You notice. it more and then your body's activated by the anxiety and there's more to notice. So it's not

necessarily a healthy thing to keep track of internal bodily things. So I would not track my sleep. I would not track my heart rate. You know, you know you've had enough sleep if you're refreshed in the daytime. That's the best measure of sleep. So I discourage people from doing it unless, of course, you know, you find it genuinely useful and you're not aware of listen to it. But if it becomes sort of something you become too focused on

it can become you can start worrying about your health excessively. The only thing I personally track is my steps because I know it's not sort of a scientific 10,000 steps

doesn't prove health or ill health but at least you know you're staying active. But my internal bodily processes I'm letting them stay as internal as possible for as long as possible. Because I'm sat next

to the queen of tracking, you track a lot of things, don't you? Your recovery and you do pay attention to it. Yeah, well, I have the whoop, so it's just sleep, my steps, which when I'm doing pods like this, I do less than 10,000, so I'm always at the end of the day running around to try and catch them up. And my cycle, it tracks my cycle in terms of, like it told me yesterday, your period is due tomorrow, and lo and behold this morning. So it's things like that, and my sleep's a big thing since I've been coming,

since having two young children. I function so much better on a good night's sleep. And sometimes I'm going through the day thinking, gosh, I feel irritable, I feel this. And I'll go on my whoop and be like, oh, well, my sleep was shite yesterday. Maybe that's why. But like you're saying, maybe that's not it.

Maybe it's because I'm at a stage in my cycle. Maybe it's because I've had back-to-back meetings. It could be a lot of things, but I'm putting it all on that sleep because I've seen it. Do you know what? It's fine, as long as it's kind of encouraging you, as long as it's encouraging you to be healthy, because I track my steps in the same way you do,

because sometimes I'm in the office, and then I think I look and I've done 1,000 steps. It's depressing. You've got to get up and down the stairs. So I genuinely find that useful. So that's something that's encouraging me to be healthier, but it's not encouraging me to worry about my health in an abnormal way. I wouldn't track my sleep because I don't want to get paranoid about how much I'm sleeping.

I just judge my well-being according to how well I feel. But on the other hand, you know, if there's somebody else who feels it's useful because, you know, they're neglectful of looking after their sleep because I've got so much else on, then I don't have a problem with it at all except to say, again, know who you are and how you respond to things.

You know, some people respond positively to health scares on tests and things and some people respond negatively. Just know who you are. Some people need that reminder as well. It's like the, rock and roll time of 8.30, my phone, my bedtime reminder comes on and from 8.30pm, my phones are silenced and I'm like, right, okay, time to put that down now because I don't want

to be on my screen. Yeah, yeah. And if I didn't have that notification at 8.30, I'd probably still be working away, scrolling, doom scrolling, looking at things, Googling symptoms that I don't have. Because the whole Dr. Google thing is real. Like, there's memes about them on social media. It's like you Google a symptom and suddenly you're planning your funeral because you can just go down a rabbit hole of information. Yeah. And it's really frightening when you think about a lot of it on there isn't even true. Yeah, I think it's so important that people when, and I should say, you know, I'm a doctor,

but I'm not immune to this. I remember once I had a sort of like little lesion on my lip and within a day I was imagining my entire face kind of distorted by this growing thing which clearly disappeared. spontaneously. So we're all prone to those sort of anxieties. And again, it's a matter of, first, what sites are you looking at? You know, I would encourage people to go and talk to their doctor and never, never Google anything. But if you're going to Google anything, make sure, are you looking at an NHS website? Or are you looking at something which is just promoting something or selling something? So I think it's important that people understand the quality of the information.

you need to know that you're on a reliable side. But overall, I would discourage people from the Googling while admitting that I do it myself. It's hard to resist. It's AI. It's chat EBT because it speaks to you in such a way that you genuinely think there is a person at the end somewhere giving you personalised advice.

It also defines somehow divines what you're worried about. It's very hard. You know, I always find on the, I've never gone to AI. regarding my health, but just general questions, I find that it gives you answers that you're expecting. And I feel like I'm, the way I'm asking the question is implying the answer I want and I get the answer I want. And that would be a worry in terms of health questions. You know, if you express your question in such a way as to imply your fear, you might find that reflected back at you. And is there a big difference, well, I'm assuming there is, because, you know, people like myself and Claire,

We take our health seriously, but we're not consumed by it. And I'm more so very aware having two children, one who's a daughter. We eat very well in our house, but we also have pancakes. If she wants some sweets on a weekend, she has them. Because I'm very just the whole thing being consumed by your health. I want her to be aware of her health and the decisions she makes, but not consumed by it whereby if she's at a kid's party, she doesn't have the cake. and there will be a difference between a patient who's, you know, into their health seriously,

but on someone who's living at 24-7. Yeah. I mean, you know, it's, as everyone always says, it's moderation in all things. You know, people shouldn't feel that they have to abstain, you know, never drink alcohol, never eat cake. It's doing these things to excess and doing them every day. That's the issue. So it's really being, just having a little balance.

And like I always kind of want to say to my patients, you have to find a problem. balance between living your life in an enjoyable way and being healthy. So it isn't about not ever, you know, having a lazy period in your life or never eating complete rubbish. It's about just balancing it with good health the majority of the time. But why do you think as humans we do crave diagnostic certainty so strongly? Yeah, I mean, it's a real problem is that, you. you know, there are no answers to so many medical questions.

You know, so I'm a neurologist and so many of the diseases we deal with, we don't know why you get them, we don't, we can't cure them. There's enormous amount of uncertainty, but people come to us looking for certainty. And I think it's just, you know, it's very hard to live with those unanswered questions, isn't it? What was that pain in my chest? What is this headache? There are no answers for quite a lot of those questions. and we as doctors just have to make sure we've ruled out any of the serious things and reassure people.

Why do we look for certainty? I guess there's just peace of mind to be found in understanding exactly why something has happened. But I would encourage people not to expect certainty all the time because you will be faced with disappointment. It's better to accept that we don't understand everything. And as long as we have, in a medical sense, ruled out serious things, then most things will just go away spontaneously. Because some people are looking for that validation, aren't they?

They feel validated by their diagnosis. Well, you know, I know this is a very common thread now in discussions about neurodevelopmental disorders like ADHD and autism is that these diagnoses feel validating for people. And I would never wish to take a diagnosis away from somebody who feels that it has been validating. But I would express some caution

about the concept of diagnosis as validation because I worry that I'm always thinking in diagnostic terms is, is this diagnosis doing more good than it is harm? And if a diagnosis is validating but does very little else, then the potential is that that validation can reinforce your symptoms. So if a validation, for example, let's say somebody who's socially awkward, teenager, for example, attracts a diagnostic label of something like autism. If you validate that feeling of social discomfort and that feeling of not belonging through a medical

diagnosis, you might accidentally make that person think it's a hardwired thing that they can't escape. So they might then think, well, this is just how I am and this is how I will always be. So it becomes a self-fulfilling prophecy. And that's my problem with validation through diagnosis. is it makes the symptom something concrete, it makes it a difficulty which is tied to internal biology that can't be changed, rather than doing what I think we should do when we have difficulties,

whether they be whatever sort of problems, we should be looking out into our lives and seeing what we can change. You know, what am I doing socially, what am I doing psychologically, that I could change in order to improve this situation? So, again, I wouldn't wish to take away a diagnosis that a person felt validating.

but I would like us to think of the harms of being validated by diagnosis and ask, did anything else come with that validation? Anything truly useful. And if it did, well, then that validation was useful. But if it didn't, well, then perhaps you are in a situation where you diagnose is doing more harm than good. Depends as well who it's come from. And in what terms, it's on Netflix at the minute,

it's the Tyson Fury. I don't know if you've seen at home with the Furies. And there was a scene, his little boy, Adonis, he's coming home from school. And he's crying his eyes out because the teachers said, I think he may have ADHD. And he's crying in the scene saying, why are they saying, I've got ADHD? And his dad's saying, you've not got ADHD. It's just sometimes you're a bit naughty. Sometimes you're good, sometimes.

And the teachers at my kids' school are brilliant. They're so good. But I have had friends who, they've said, the teachers took them to one side and said, we think this, we think that. And she says, and it sent us, well, are we parenting wrong? Are they eating something wrong? What's wrong with them?

So then they start their ongoing process themselves to try and get a diagnosis for something they weren't aware of because when your kids in school, you're not with them all day, they're in school. So again, it's going to the right people for the right diagnosis. I've heard that story so many times,

just that story that you've accounted there of yes, people being alerted to by teachers that they think the child is a problem when they didn't feel. And this is how diagnosis gets. So if the parent doesn't feel the child has a problem, but the school does, this is where diagnosis kind of gets distilled down,

you know, so maybe a kid's not very well engaged in class. Just not being engaged in that one environment shouldn't attract a diagnosis. Because if you have a mental health diagnosis or a neurodevelopmental diagnosed like autism, it's supposed to be a fixed abnormality that everyone should see. It shouldn't be just in the class with one teacher.

It shouldn't be just in school and not at home. It should be a problem that's evident everywhere. But people have started distilling diagnosis down to this one thing they know, you know, a badly behaved child might have ADHD. A kid who's not great at concentrating in a particular environment, they might have ADHD. They don't understand that there's so much more to it than that. And I feel terribly sorry for these parents and these children. Because first of all, let's

imagine that child that you're describing. How old is Tyson Fury's child? I think he's seven, maybe. I mean, such a, I can't believe someone would say something like that to a child that young. Imagine the impact that could have in a child because he's essentially being told his brain isn't normal. He was visibly crying in the scene saying why are he saying that. And you can imagine that, you know, perhaps that child does have difficulties at school, perhaps he does. Perhaps he's not concentrating well or perhaps there's something he needs to be supported with. But my question is always, why did you have to say it's ADHD? Why could you not give that child support without labeling him in that way? You know, because schools don't need diagnoses in order to notice that a kid

is suffering or struggling a little bit or falling behind a little bit. They don't need it diagnosis in order to put a little bit of extra support in place. It's the label. I mean, you know, when I went to school, which is a very, very long time ago, nobody was recognized as having any kind of special needs. I'm not advocating that we go back to that kind of time when everyone was just children who were struggling were kind of ignored. But what I'm advocating for is really that a child such as you describe can be noticed and supported without being given that awful label that applies to something abnormal about them. You've come under criticism from the autism community

for your views on the over-diagnosis of autism and ADHD. Are you saying that there are people getting diagnosed who are not autistic or that the parameters in which we assess conditions like autism and ADHD have shifted throughout the years? Yeah, I think it's both things. So we think that autism as a concept, was created in 1940s, and it was created to explain a group of children who had severe learning disabilities. They were nonverbal, couldn't communicate at all. And they were the people who

originally described as autistic. Then in the 1960s, somebody came along and said, I think I'm seeing similar sort of characteristics, but in children who aren't necessarily as severely disabled or nonverbal or learning disabled. So they kind of expanded the concept to include children with milder difficulties. And you can see all of this is happening with really good intention. You know, if you can help people with severe difficulties,

maybe you can also help people with a milder form of this. But then since the 1960s, these diagnostic concepts, every time they're kind of re-described, they change a little bit to draw new people into the group. So it used to be you could only,

be diagnosed with autism in childhood, whereas now people are being diagnosed as adults because the description of the attacks, a description of the disorder, sorry, allows the diagnosed in adulthood now, which it didn't, you know, 10 years ago. So the description has been relaxed in order to include more people in the group. And that means that what autism looks like now in some people is nothing like it used to look like 40 years ago. So, or 60 years ago. So let's say in the 1940s, the description of autism was a child who was no more interested in people than they were in filing cabinets.

Not a very nice description, but that's how it was described. But now people in this autism category are people like Anthony Hopkins. Well, you know, these two people, severe learning disabled, nonverbal people are now in a group of extremely sort of apparently socially capable people like Anthony Hopkins. I don't know them personally, but I'm assuming. And that's how much the diagnosis has been stretched. And I would say that in that stretching, people have been drawn into the category of autism who probably aren't autistic.

I also think that the diagnosis is, especially in private sector, is being really the process of diagnosis, isn't being done with great accuracy. So if we say that, you know, in some centers where you go to be investigated for the potential that you have autism, they have 100% of people who are tested are told they're autistic. And that's astonishing. You know, that's essentially impossible. And in some research studies, if they recruit autistic people from the community into the research study to see, you know, whatever the study might be, and they retest them for autism,

according to, you know, the high standard you would need for research, they find only 50% of people meet that standard. So I think we've got a combination of the diagnosis being relaxed and people being diagnosed to a low standard. But I want to really emphasize here, my argument again, if we come back to what overdiagnosis is, I'm not saying that people are being diagnosed or just snowflakes or they're not, they don't have a problem.

I think that anyone who goes to the trouble of seeking a diagnosis, I've got to assume that they have a problem that they really need solved, but is solving it by calling it autism the right way to go about it? And that's my question. So ADHD seems to have exploded. I spoke to a colleague this week actually, and she said 80% of the boys in her son's class are medicated for ADHD. Oh my goodness. 80%.

Wow. Yes. Surely this is a problem that we are giving young people drugs when they maybe don't need it. I'm not saying ADHD doesn't exist. I'm sure it does. But to go back to your analogy earlier when you were in school, no one was diagnosed with it. I don't remember anyone in my school being diagnosed with ADHD or autism. No one in my school. No. Yeah, you're absolutely right. There's been an absolute explosion in ADHD diagnosis, particularly since the pandemic. It was already rising and then the pandemic, it just went sky high from that point.

And it's a really difficult one to untangle because, first of all, there's a whole new population of people being diagnosed with ADHD who wouldn't have been diagnosed before. And, you know, many of the scientists who work in that field will look at the research and say, well, you know, long-term follow-up of people taking stimulants, children, you know, are very safe. And different kinds of studies show that if you diagnose ADHD early enough in childhood, you can prevent all sorts of horrible outcomes like drug abuse and mental health problems and criminality. I would argue that, first of all, long-term studies of these sort of disorders are not. You know, if you think long term, you might be thinking 20 years,

but in these fields, long term is three years. You know, so I don't think we have a huge population of healthy young children who've been on stimulants for many years that we can say with as much certainty as some people say that it's definitely safe. It would certainly scare the living daylights out of me. And I feel like, you know, how many crises have we had with medications? You know, in the 80s, we had benzodiazepine crisis. We've got the opioid crisis.

even with things like antibiotics, we overuse them now, so they're less effective than they were in the past. So there is no hard evidence out there at all to say that long-term use of stimulants started in childhood is harmful, but I personally would be very cautious about introducing them unless they were definitely required. And I fear that, again, we are distilling ordinary naughtiness that could probably be,

helped with a good, you know, better classroom structure, better, more time for the teachers to support the children. I fear we're medicating social problems or structural problems in schools and we're medicating children for them. I agree in terms of, like you say, the ordinary naughtiness because parenting, I'm very much old school, like my mum brought me up.

I mean, if I was being naughty out and about, my mum wouldn't take me aside and go listen how you're feeling is valid however we need to get this shopping done when we're home she would say to me fix your face or I'll fix it for you and I would go that was it that's all she said

you know that's all that was needed whereas I think now all over social media all over mainstream media it's you know it was the introduction of the naughty step they don't sit on the step and think what they've done they're thinking what they're going to do next

because the kids you know It's what they do. We've all been kids. We know what it's like. But I think it's this overcompensation of, like you've said, ordinary mischievous. Because it's what kids do. It's what puppies do. Until they learn, don't do that because of this. It's going to happen. And when it happens regularly, like you say, some people are quick to say, oh, he must have autism. He must have ADHD or she must have this. And it might just be, no, they're just going through that really annoying phase. Because the hormones are everywhere and they're eating shite most nights because the kids. grow out of it if you give it time.

I mean, I couldn't agree more. It's, you know, that's, and it really worries me. So first of all, let's imagine we've got this naughty child and we kind of have different ways of conceptualizing it and we say it's ADHD. Well, you know, what is ADHD? It's a disorder that's supposed to be a neurodevelopmental brain disorder. If you think about the child's problems like that,

I fear it really gets in the way of exactly what you just described, which is more ordinary fixes, which is, is this child eating a healthy diet? You know, does this child go to school and act up because somebody gave them a packet of monster munch per breakfast? And, you know, is it a social difficulty or is it a really neurodevelopmental brain disorder? And it gets in the way also of being able to say to a child,

well, that behavior is not okay. You know, if we're conceptualizing it as a medical problem, then we're potentially saying, well, you can't help it. whereas actually a really important part of growing up is learning to control your behaviour and be in environments that you don't like being in and do things you don't want to do and putting up with people disagreeing with you

and I fear, you know, medicalising these difficulties means that kids don't get to learn those important lessons. Is there a percentage that's been found in research of children who genuinely do have neurological developmental disorder like autism or ADHD? You know, that's such a contentious question. So some would argue that there's what we call like a true prevalence. For example, for ADHD, Nice,

which National Institute of Care Excellence says at 5% of the population, you know, should or would be expected to have ADHD. But you cannot truly, for anyone to say that there's a right or wrong number is kind of mildly ridiculous because these disorders are not defined. find by brain pathology. You can't do a brain scan on somebody and say, you definitely have it and you definitely don't. They are just on a continuum of normal.

Is your attention span just a little bit sort of not great but not in the disordered range or where do you draw the lines in these things? So people absolutely try to apply percentages. And there's an argument in the press at the moment that says 5% of UK should have ADHD and we're only diagnosing 3% and therefore we should be diagnosing more people with it. But I would say that that logic is deeply flawed

when you're dealing with a disorder for which is no hard evidence that even exists. There's no hard evidence that ADHD even exists. It's not a concrete thing. It's just a set of behaviours. You know, you're impulsive or you're inattentive are the main two features. And if you are this amount of impulsive

and this amount inattentive, then we potentially will label you as having ADHD. But there's no, you know, there's no number of, I mean, for decades, scientists have been doing brain scans and blood tests and hormone tests and trying to establish, is it a discrete thing? And every single test has come up a blank. So it's almost certainly not a discrete thing. But instead, like a set of behaviors that happens for lots of reasons. And the kind of reasons that they happen is, you know, that you grew up in care, that you have.

that you have a socially deprived childhood, that you had an abuse of childhood. And I wish that's where we'd focus. We're talking about ADHD here today. I'm even doing it, and I wish I wouldn't. I'm talking about it like it was a discrete disorder, when really it's a set of behaviours that arises very often out of social deprivation.

And I think that's another worry of mine is how much it distracts from the real problem, which is that better lives for children, better supported children, are less likely to have these difficulties. But we're all talking about stimulants and brains, when we should probably be talking about

how do you support kids better in early childhood? Because it's kind of like they're all being given one treatment for many different... Say, for example, if two people come to you with high blood pressure, one of them's heavily pregnant, one of them's in their late 70s and overweight. They've both got high blood pressure for obvious different reasons, but they put on blood pressure tablets to do the same thing,

but once this baby's out, yours will likely drop. So it's kind of an umbrella treatment, as is the ADHD, like you say, depending on why it's there, if it's there in the first place. And it's sort of, although it's aware of what, yeah, it happens for multiple different reasons, but although we were aware of it kind of, for me it's distracting from the real difficulty, which is that the people who get ADHD have probably had quite difficult childhoods. That's more likely than not.

And, you know, I fear that discussion about giving stimulants to children and locating the problem in brain development somehow gets us away from solving a much, much harder problem, which is how do you solve? of social inequality and abuse and social deprivation. I want to talk about mental health. So I've seen the much greater cultural recognition of mental health issues. People are talking about them more openly, much more willing to say, I have depression or conditions like bipolar, etc.

But are we endangered of over-medicalising watch on? what are normal human emotions, grief, sadness, frustration, etc.? Yeah, I think we are over-medicalizing those things. We really fall very, again, this is not to say a person is not suffering. The question, again, is that suffering, you know, appropriate to their life circumstances, or is it an actual medical thing called depression, etc. So I think, you know, we fall very easily now,

don't we, into using those medical words when we don't feel well? I feel depressed for, well, you know what, my job is rubbish and I'm having trouble in my relationship at the moment and therefore I feel low and that may be an appropriate thing. It shouldn't necessarily attract a mental health diagnosis. So I think we use medical language far too easily now. We're also, you know, this is going to seem counterintuitive to people, but it's very important that we've reduced the stigma of mental health because, again, going back to my earlier

years in school or whatever, no one would ever admit that they had a mental health problem. It's very important that we have reduced the stigma so people feel able to talk about things. But along with that, reduced stigma and awareness programs were kind of making people worry about things they wouldn't have worried about before. You know, awareness programs are going into schools

and saying, you know, things about anxiety or feeling low and then kids notice that they're anxious and they feel low. which is ubiquitous part of human experience, and they think it's abnormal. So there's been an odd sort of, its awareness and reducing stigma is so important, but I think it's now having a knock-on negative effect by creating the impression

that you're supposed to feel happy all the time and that it's not okay to feel down sometimes. I think we'd do better for young people in particular if we reminded them that life is hard sometimes. sometimes and you feel low sometimes and you feel anxious and it's perfectly okay. I agree and I think it's especially like, for example, perimenopause or menopausal women. You know, we now know it's not just you have irregular periods and hot flushes. There's a lot more that can happen.

But it's treated as something else. My friend, she was actually put on antidepressants nearly 10 years ago and she was, I'm not depressed. I'm not depressed. The doctor was like, I think this is what it is. And it turned out she was going through the menopause in her 30s. I'd really love to normalize the conversation a bit around menopause in a way because I think, again, we've gone from no one talked about menopause

to the point where I feel like menopause is being pathologized in a bit of a way. You know, actually it's a normal thing. And I think that it is important that we find that perfect. balance, no balance is ever perfect, but we find some balance between recognizing that there's a stage in life that we go through as women that is where bodies are changing very dramatically and that, and we feel that, but also not taking it to the point where sometimes I feel like menopause has talked about almost like a disability or something, that it's, um, you have to hide away when you're going through it. Exactly. But it's like, it's like anything. It's like,

periods or anything. You know, some people get them terribly and they're painful and they're awful and they're really heavy and they really take a lot out of people. But actually the norm is not that. The norm is that periods and menopause and these different stages in a woman's hormonal life, some people will have an awful experience, but most people won't. And I'd love just to remind people of that a little bit because I think sometimes the conversation around menopause now, you know, for young women who haven't gone through it yet, they must be facing it and thinking, oh my God, it sounds horrendous. But actually for a lot of women, it's quite a neutral experience and comes with some positives in that you no longer have to

suffer the monthly period, etc. So I do think it's important, again, to find that balance between being able to talk about it, but not talking about it as if it's kind of some looming catastrophe in a woman's life. It's for most women, it really isn't. The balance is the key word there because when I started having perimenopausal symptoms about the age 39 and 40, I had no idea what was going on

because people were not discussing the perimenopause. Never even heard it as a word. It wasn't part of common vernacular. And I went to the doctor and was told I was depressed. So I think the more conversation is a positive

but what you're referring to is the scaremongering. Yeah, it's the tone of the conversation. I think it's useful. I also, when I was in the kind of early stages of menopause, I got palpitations. I'm a doctor, but, you know, I've never thought terribly much about menopause, and therefore I didn't know that these particular palpitations

were due to that, and therefore I went to the doctor with them. And once I was told that this was a common symptom of menopause, then I felt fine about it. So I think that sort of conversation is really used. to say these things happen, during this time of change, these symptoms happen, and if you feel them, don't worry about them. But I feel that sometimes the conversation veers into, you know, really creating the impression that women will suffer terribly in the menopause.

The bodies will change and some women will absolutely suffer. But that isn't necessarily the norm. The norm is probably to just go through a change and come out of it feeling better. that's what my mum did my auntie so my mum's sister she struggled whereas my mum said I was a bit hot now and again she said but nothing else so I'm kind of hoping

that that'll be me but my sister my sister yeah my sister struggled and she went on HRT but then she had to come off it and she actually said to me recently she said I'm just going to ride through it now she said I don't want to take anything she said I'm just going to just let my body do its thing and she said and if I get hot if I have a heavy period

palpitations, I know that's what it is so she said I'll just deal with it because she now knows what it is I think it's the fear in the not knowing but it's like once a girl when her menstrual cycle starts you know that okay every month now I should bleed

because the first time you bleed from down there you know it's fright even if you know all my periods have started when you first see blood in the toilet you know as a young woman you go oh my gosh what's that but then the second one you think oh okay this is

It's meant to happen. So it's just knowing the symptoms and knowing what to expect. It's kind of like reading a review in a restaurant before you go. It's that whole you get a bit more reassurance, don't you? And you sit down. Suzanne, your work is so valuable, but you have come under some criticism for your views on ADHD and autism, which we touched upon.

And people sometimes worry that our message could discourage people from seeking health. What would you say to them? I just think it really comes down to this recurrence. kind of conversation about harm versus benefit. So it's really important we understand that if you're suffering, you should still seek help. But that help doesn't have to come through a medical label. And if you are faced with either someone suggesting that you pursue a certain diagnosis

or pursuing it yourself, just always ask yourself, is what will I get if I'm diagnosed? What are the good things? What are the supportive things I will get? And what are the potential harms? and understand that a label can change a person's sense of who they are. It can concentrate your attention on your symptoms. And sometimes that's not the best thing. Sometimes you're better to think, well, what can I change?

So I wouldn't wish to discourage anyone from going for a diagnosis. What I really want is for people to understand the issues. Some people work with ignorance as bliss, don't they? You know, even some people in relationships, they don't want to know what the partner is doing when they're not there. whereas others are like, I need to know where they are, who's in the room with them. And again, it boils down to who you are as a person. 100%.

You need to assess, do I need this information or do I crack on without it? Well, to that point, and I think you touch upon this in your book, about cancer diagnosis and the overdiagnosis of certain cancers, that for everyone life is saved, 10 people needlessly have cancer treatment because cells have been discovered that are, mislabeled as cancer when actually they are abnormal cells that very well could have remained dormant and not bothered someone for the entire life. Yeah, again, I don't want to frighten anyone

away from screening, have screening, but understand the issues. And the issue is that, you know, we've only had the technology in the last 30-odd years or a bit longer in the case of breast cancer to scrutinize the inside of healthy people's bodies looking for abnormal cells. So we've only just realized that. that lots of people live out completely healthy lives into their 80s, 90s, with abnormal cells that never grew into cancers. But now because we actively screen for them, we find them. And every time we find them, we just assume that every single one will grow into a cancer.

And what that means is that we inevitably, when we do any type of cancer screening, we will inevitably treat people for cancer who never needed to be treated. and we're saving lives that way, 100% we're saving lives, but we will also treat people for cancer who would have been fine. And what I would like people to know about that is not to not go for the screening, but let's say if you screen 2,000 women for breast cancer, as you've said, you'll save one life and you'll potentially treat 10 people who didn't need to be treated.

Now, how you approach that, how I would approach that, I'll have the screening. But if anything is ever found on that screening, I'll say, well, listen, you know, how sure are we? This is something. And if we're not completely sure, then could I potentially have another scan done in two months time and see if this thing is changing? So there are watchful, so make the distinction between a cancer that is found because you have a symptom always needs to be treated. So you feel a lump, you have blood coming from somewhere, you've got pain, that always needs to be treated. It's symptomatic cancer. But cancer found on screening, you can ask for a thing called watchful waiting, which means that you just say, well, listen, can we just wait a month or two and do the scan again

and see if anything has changed? And you might find that it's disappeared or it hasn't changed at all. And then you might feel encouraged to just wait and see what unfolds. But people don't even know they have those options. We just hear the word cancer and we think you've got to get it out. I think that's one of the big problems is when we find abnormal cells on screening, we call them all cancer. I'm sure, what would you do if you were told you had cancer cells?

You'd say, get them out. Some people would argue, particularly for these abnormal cells on breast screenings, that we should give them a different name because they're not exactly the same as cancer. They may just be innocent cells. So if we call them something different, then you'd get a little bit more headspace. You'd realize it's not exactly the same. So maybe I can wait for a while. So there's, yeah.

Because it could change the whole trajectory of someone's life being treated without needing to be because if they went on to have children, when you're feeling in a health check, has anyone in your family been treated for? They'll tick the box saying they have, which would then put them classed as a higher risk. So their treatment plan would change for something that wasn't needed. It changes much more than people realize. It's not just, it's also, you know, your life insurance, your health insurance, you everything.

lots of really practical things new life change. I've got to start writing more positive books because I always end up talking about really negative things. But the scary truth of cancer screening is the study was done in 2023 to look at how many lives were saved by cancer screening.

And essentially, with the exception of colon cancer, no lives are saved by cancer screening. So what that means is not that no lives are saved. So you will save one life, someone whose cancer was found that would have caused them problems, but you'll treat someone else for cancer and they'll probably, who didn't really need it, and they may die slightly earlier because of the treatment that you gave them.

So these are the trade-offs that we have going all the time, and medicine isn't fantastic at examining these trade-offs and figuring out whether we're doing the right thing or not. But if you're the person whose life has been saved or your mum or dad's life has been saved, then surely you'd argue that even if nine, people or 10 people have been treated needlessly, it saved that one life, so that's worth it?

Well, that person will feel it's worth it. And I think what happens, no, but the thing is the 10 others will all think they were the life that was saved. And I think that's why it continues. If we take those 11 people, everyone will assume they were the life that was saved. And I think that's why it continues. But hopefully science will find a way of distinguishing these different cells to know which are truly life-threatening and which aren't.

and this will sort itself out. But in the meantime, it's a useful thing for people to know so they can have a kind of discussion with their doctor if anything is found about waiting a while. Before we wrap up, it's been brilliant, by the way, this chat. The last question, if you could change one thing about the way modern society thinks about health, what would it be?

It wouldn't be about modern society. It would be about how we approach supporting people how we approach healthcare and it would be fixing the time that we have with doctors. You know those five-minute consultations and we're talking about very sophisticated things here that take ages to explain

and we're expecting doctors to be able to look after your health in a five-minute consultation. So what I would love to see, instead of spending tons of money on new scanners and new genetic tests that are producing results

we don't really understand, I would love to see us spending money on staff. So doctors, nurses, physiotherapists, psychologists, you know, people who can, so you can go into your doctor and have a 15-minute conversation and really feel you've been understood. And then they have the time to follow you up in two weeks' time

to make sure that everything is okay. Those are the solutions, I think. So back to the old days then. Well, not all, not everything of the old days. Pre-covid days. There were some things that were valuable. Your doctor knew you and was able to put you in the context of your life. You had a family doctor.

I had the same doctor from being a baby until I was about 15. Yeah. And there's a lot to be said for that. So much to be said for it, I think. Well, Suzanne, thank you so much of coming on just as well today. Before we let you go, we do have some quick fire questions. As you can tell, I don't answer quickly. I'll try my hardest.

So the first one is Gemma and I are coming to your house for dinner. And what you're cooking us? Oh, you know, I only started cooking after the pandemic. So your timing is excellent. Ten years ago you would have got a takeaway. Now I would buy, my favorite current recipe is in a one-pot cookery book where it's peanut butter, chili chicken on a bed of tomato rice. Very nice.

And it's only, if I cook it, you can be guaranteed. It's very easy to cook. Peanuts are chili chicken. One pot is well. I like in the one pot. Yes. I love the sound of that. You just described all my favorite ingredients.

Not necessarily I've ever combined them before with a peanut butter. Lovely. You're going to live on a desert island for one year by yourself. What's the one thing that you will take with you? Okay. It's going to have to be a book, isn't it?

I would definitely bring a book and I'm going to say a book that I basically wish I read. I've tried to read about four times and failed every time. This might be the opportunity. Ulysses by James Joyce. Just, I'm Irish, and every writer I know says,

you have to read that book to be a good writer, and I've never succeeded once. So perhaps I'll try on my desert. Is it a beast of a book? It isn't. It is. And it's, you know, lacking in punctuation. And, you know, but apparently it's poetry if you can get through it.

Right. Any day. He's added to my list. Coffee or wine? For the rest of your life, by the way. Oh, you're wine, yeah. Wine? Wine.

white or red or rose a cow. Red. I love my coffee in the morning and I don't want to, I don't want to dish coffee in any kind of way. But if I could literally only have one, then I'd prefer a glass of red wine. Thanks very much. Antioxidants. Exactly. Yeah, I mean, if you cherry pick your research appropriately, people who drink wine live longer. But I'm sure. In those Italy villages, stuff in the mountains, they're all drinking wine.

What was the last thing that made you belly laugh? Oh gosh Anna that's way too hard I don't think I can think of anything I think you might have to cut that question out of your podcast You're not watching anything on TV Yes but unfortunately I watch things that don't make you belly laugh

Like married at first sight and the traitors They make you I saw something on Channel 4 You said Married at First Site Have you seen Virgin Island? I can't watch it I watch a bit of Virgin Island It's the most shocking

shocking It made me embarrassing I was watching it going red. I'm far too much of a prude to watch it. Well, you know what I'm like. If I couldn't watch it, Claire, then you know it. No way I could watch it. No, it is absolutely the most difficult thing to watch.

Imagine if you've got lots of people who never lost a virginity and then they go on television to lose it. Like, what a bizarre concept. But it shows them like doing, yeah. A man was doing an internal on a woman. Oh, no way. And she was saying, this is this. is that and he was that oh is it supposed to feel like this is it?

Oh no. And he was a grown man blessing but he'd never seen a vagina then he smelled his finger he said I'm just curious to know what it smells like Oh no It's on television. That's on national TV On Channel 4

Oh goodness me And we've both seen it which is the worst thing Yeah I expect to review of you Gemma Yeah that's true Researching you It was yes research for me as well yeah What's one thing someone can do today to make themselves feel a bit better?

Just be less hard on yourself, I think. You know, I think psychologists say something, which I find really, really useful, which is that basically we always compare our internal selves with other people's external selves, which is a terrible way to make comparisons because we're all putting on that sort of external kind of best face, really. So I think just realise that, you know,

what you're going through is probably normal and be less hard on yourself. Well, on that note, thank you. so much for coming into Jess as well. Thank you for having me. Much appreciated.