By David Tuller, DrPH
*This is a crowdfunding month at UC Berkeley. If you’d like to support my work, the link is here.
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BBC Radio 4 highlights criticism of interview with neurologist and author Suzanne O’Sullivan
In March, neurologist Suzanne O’Sullivan spoke on a BBC Radio 4 podcast called Radical, hosted by journalist Amol Rajan. The title of the episode was “Over-Diagnosis: Are Too Many People Being Given Medical Labels?” The discussion triggered some dismay from listeners because of Dr O’Sullivan’s perspective that Long COVID is largely psychosomatic.
The conversation was related to Dr O’Sullivan’s most recent book, “The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker,” which received a big publicity boost last year. The Guardian ran a lengthy excerpt. O’Sullivan appeared on the popular podcast Freakonomics. Multiple publications published profiles of her, with credulous assessments of her work. At the time, I discussed her problematic views in a blog post.
O’Sullivan has long been a major promotor of psycho-behavioral explanations for complex illnesses. Her previous books in this vein–including It’s All in Your Head: True Stories of Imaginary Illness, and The Sleeping Beauties: And Other Stories of Mystery Illness—were bestsellers. In the SARS-CoV-2 era, it should not be surprising that she has now scooped up Long Covid and incorporated it into her expansive worldview. “As no one saw doctors during the pandemic, it’s inescapable that the period was a melting pot for psychosomatic conditions,” she explained in one interview last year.
On April 16th, a BBC Radio 4 show called “Feedback”, which is identified as the network’s “forum for comments, queries, criticisms and congratulations,” gave voice to some of the criticisms from patients and advocates. (It is the opening discussion.) The Feedback piece included an extended interview with patient advocate Nicky Proctor, who later posted about it on Facebook.
Per the Feedback website:
“Listeners have been telling us their thoughts about a recent episode of Radical with Amol Rajan, in which he interviewed Dr Suzanne O’Sullivan, a physician specialising in neurology and clinical neurophysiology. It was an in-depth discussion about the potential dangers of “over-diagnosis” – but some listeners felt that Dr O’Sullivan’s views could have been challenged more. We get some answers to your questions.”
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Debate over functional somatic disorder in Frontiers in Medicine
Last May, Frontiers in Medicine published an article called “Internal medicine at the crossroads of long COVID diagnosis and management.” The two co-authors, medical professionals from France and Belgium, presented Long COVID [LC] as a form of functional somatic disorder (FSD), and therefore beyond the scope of purely biomedical solutions.
FSD is one name for a category that is also called “somatic symptom disorder,” “medically unexplained symptoms,” “persistent physical synptoms,” and related terms. Although each might have slightly varying definitions, they all capture the large number of patients whose medical complaints resist easy biomedical explanations. In advancing their case, the authors of the Frontiers in Medicine article trotted out the standard unproven claims often made about the purported causes of FSD, to wit:
“FSD is often triggered by a somatic illness (in particular an infectious disease) but also involves brain conditioning along with socio-psychological predisposing factors (perfectionism, alexithymia, childhood traumatic experience…). Most importantly the long term persistence of symptoms is favored by cognitive (involuntary attentional focusing on symptoms, catastrophism, illness-related anxiety, feeling of rejection…) and behavioral factors, including avoidance of physical effort that leads to physical deconditioning as well as avoidance of uncertainty that leads to never-ending request for medical tests and consultations.”
None of these assertions should be called evidence-based. They are assumptions, not facts. Trials of interventions for Long COVID and ME/CFS based on these assumptions, including some cited by the Frontiers in Medicine article, have claimed success. However, as I have frequently noted about these and related trials, they are fraught with flaws, and such reported results cannot be taken at face value.
This month, Frontiers in Medicine published a commentary in response to the original piece, called “When psychologizing Long COVID causes harm,” from a group of patient representatives, health professionals, and researchers. Tom Molmans, a Dutch psychiatrist disabled by Long COVID and a co-author of the commentary, posted a thread about it on X. The commentary effectively rebuts the arguments advanced by the earlier article. The authors critique the FSD construct and suggest that its proponents are misinterpreting some of the effects of chronic illness as causal factors.
As they write:
“We suggest the article overemphasizes psychosomatic/psychosocial explanations by drawing primarily on a narrow subset of the literature over the broader biomedical and medico-sociological record; evidence from chronic disease research indicates that psychological responses typically reflect the consequences of prolonged illness rather than its primary cause—a pattern also observed in LC.”
I wonder, will the medical profession ever consider and evaluate the very many risks of iatrogenic harm of the functional model that its proponents have seemingly turned a blind eye to, including the loss of ability to work due to under-investigation, under-treatment and neglect?
“avoidance of uncertainty that leads to never-ending request for medical tests and consultations” — one does wonder who, exactly, is avoiding uncertainty here