The Age of Diagnosis

January 6, 2025
An epidemic of overdiagnosis is causing patients to pathologize normal differences and overtaxing the medical system, according to this thought-provoking treatise. Neurologist O’Sullivan (The Sleeping Beauties) explains how new screening techniques and expanded disease parameters have spiked rates of such conditions as autism, Huntington’s disease, and ADHD—risking, for mild cases, needless health anxiety, an overreliance on medication, and the “nocebo effect,” where labeling the disease can actually produce symptoms. Meanwhile, time and money is wasted in treating people for cases “that would never have progressed” or “would have resolved spontaneously if left alone.” At the root of the endless search for diagnoses—and medical institutions’ willingness to provide them—O’Sullivan finds a nebulous mix of “physical suffering and personal struggles” that, given modern society’s “general lack of caring institutions,” end up driving patients to the medical system for answers. She intriguingly illustrates this phenomenon through a discussion of the self-diagnosis of long Covid, which has become so hazily defined that scientists struggle to study it. While O’Sullivan’s argument has some paternalistic implications—well-intentioned efforts to withhold complex medical information can reduce patient choice, especially if new or alternative therapies become available—she makes salient points about the challenges of treating patients in a world where, despite scientific advances, "definite answers" about one's health are often elusive. This is sure to spark debate.

Starred review from March 1, 2025
Making a medical diagnosis is one of the fundamental tasks all physicians are trained to do. It's like solving a puzzle with very high stakes and often with a high degree of difficulty. But are doctors generating too many diagnoses these days? Have patients become much more receptive to receiving them? Neurologist O'Sullivan (The Sleeping Beauties, 2021) examines the concerning rise of overdiagnosis and overmedicalization. Despite climbing numbers of people diagnosed with autism (1 in 36 American kids), prediabetes and Lyme disease (other health problems are often mistakenly ascribed to this infection), she counsels that "we are not getting sicker--we are attributing more to sickness." Fear and billing requirements are two possible forces behind the rush to apply medical labels to individuals. O'Sullivan adeptly integrates stories of patients and their symptoms into her discussion about cancer screenings, psychosomatic illness, "diagnostic creep," long COVID-19, Lyme disease, autism, ADHD, predictive genetic diagnosis, and depression. She points out how the line between health and illness can be blurry, how treating some correct diagnoses can result in more harm than good. O'Sullivan's insightful commentary convincingly warns that "we are becoming victims of too much medicine and that it is time to turn back the dial.

COPYRIGHT(2025) Booklist, ALL RIGHTS RESERVED.