Hello, it's Amal. Listen, before we get into this week's episode of your radical questions, and by the way, thank you so much to everyone who is sending in the very large number of questions that we're getting. Really appreciate it. I did just want to let you know about the next guest joining us, who's also going to be answering your questions too, and I wanted to get your questions for her. She is Dr. Suzanne Osalvan. She has spent three decades in medicine, including 25 years as a neurologist, and her latest book is called The Age of Overdiagnosis. It has sparked a global debate about whether mental health conditions are being labelled too readily, and she argues that overdiagnosis is becoming widespread. I'm going to be speaking to her about why she believes this is happening, what it means for how we understand mental health today, and whether not it has implications for politics and policy, which we're not really grappling with. To put your question to her, please do send us a voice note. I'd love to get your voice notes. I know there's lots and lots of people who feel very, very strongly about this. We're going to make sure the episode is super rigorous, and I will try to pursue answers to your questions on your behalf. What's at us? So send us a voice note on 0330-1239480-0303-1239480, or you can email
[email protected] with your questions for Dr. Suzanne O. Sineven, author of The Age of Overdiagnosis. Hello and welcome to your radical questions. This is where I put your questions, all of them pretty radical to our pretty radical guests. This is your chance to engage directly with the very, very clever interesting analysts, thinkers, influential. What are you? I'm what are called James. I'm a pollster. It pollsters and asks them about their ideas for the future. That was the voice of James Kalagassurium. He is the chief research officer at focal details also. Should have acknowledged this in the main episode last Thursday. An honorary professor at the University of Glasgow. What's that involved? Sometimes giving lectures. Okay. I'm writing blogs when I'm told to. Okay. Including about the idea of agency, and you wrote a blog about agency, and why it might be one of the next big ideas in politics, and that it's fair to say your inbox was groaning off the back of that. Not least from messages from us saying you must come in radical and explain this idea. Yes, exactly. Which is what you've done rather well. And if people miss that, they can hear it back on the main episode on Thursday. Just before we get through this bundle of listening questions for you, for people who are coming to this episode fresh and haven't heard the main episode, just tell us what is agency briefly? Agency is the idea that you think can have control over your life. Very simple idea. Which some people think they have. We think around 60% of people think they have agency, and around 25%, 30% of people do not think they have agency. And the evidence is growing that it's a very useful paradigm for understanding our politics because. Useful paradigm because it basically contrasts. If you have agency and you have a sense of control, you basically are more pro status quo tend to be have hot, slightly high levels of optimism. Both about your community and who you are, but also about the state of affairs. And if you don't have agency, very high levels of pessimism, lower levels of social trust, and a desire to change the status quo. And British politics now is not just a left-right thing. It's very much one that other axis is basically, are you full of status quo for maximal change? Fascinating. Right. This is our first question. It's from Stevie in London. Hi, I'm a question for GM's on agency. I'm particularly keen on how my advance social mobility where it works or it doesn't. Does his research show any interventions that actually shift someone's sense of agency? Fantastic question, Stevie. Thank you. So what's the connection between agency and social mobility on the one hand and also are there particular interventions that can increase someone's agency? Yeah, a difficult one, Steve. I haven't quite done the political science study into. It's come on. It's come on. It's fundamentally a thing that, whether you believe, if you have control, you take different decisions over your life. We know that it correlates to sense of optimism, a sense of social trust, a sense of taking control and accountability and all those other things. I think you can imagine that it would be helpful from a social mobility perspective. But I guess the question comes, what are the contexts that you can be a genetic and all have have an agency? What are the institutions? Do you have the tools? Do you have the funding? Do you have the places to go to? It's all very well telling someone you should have more agency. But for example, is there a local library that they can go to? Is there a local club? Can they do certain things? Not everything costs money, as I think you made the point in the first episode, but it is culturally a very helpful thing to have. I don't think there are many downsides, for example, to being having agency. Does your research show any interventions that actually shift, maybe it's too soon because you've only just done this work in the last year, but any interventions that actually shift someone's sense of agency? Presumably one way of increasing someone's agency is to make them richer. So it did correlate to levels of income and Britain's growth problem and money problem is half the answer. We discussed that in the previous episode. So if you can't, because of a lack of growth or jobs or whatever it might be, if you can't give someone more money as a way of giving them more agency at a social level, I mean, I was talking about the impact on me of social media videos of people saying you can turn your life around and me thinking that you actually can. I feel like I've got more agency over my health since I discovered catapults. It became self-fulfilling since you saw, but the question is why did you believe it? But I love that agency. Yeah, it's because I'm influenced online. And now you've lost a couple of stain. Now, and we lost a couple of kilograms. Making me feel that. A couple of kilograms. But what can you do at the social level? I mean, especially for people from poorer communities, TV's questioning, which is what interventions could actually shift someone's sense of agency? I mean, if presumably the right social capital, the right connections, relationships, bonds, finding a sponsor are a mentor, that could fundamentally shift as I'm a feels in the world. I mean, certainly, some of the feedback I got from the blog were people involved in kind of aspects like that in terms of voluntary associations, charities, people providing nets that help people on one hand, but then powered them on the other. I thought that was very interesting, both in terms of crime, in terms of opportunity as well. But again, we're right at the foothills of understanding and thinking about agency. I think in the US it's been discussed a lot more. One of the things we did do is we pulled how people thought they were in control of their lives between different countries. And the UK had this group of 25 to 30% of people, which was quite low, compared to, for example, the US, which is like the mecca of high agency thinking. But France was really, really low, which again, I thought was very interesting. So it's not like the UK is in a uniquely bad situation on agency. Europe is as well. And in some of the European countries measures actually worse. So I think one of the interventions that you can make is by establishing a relationship with someone. So I went up on a time, a long time ago, Serpa or co-fathered an organisation which connected people in their early 30s with people from who have a bit of a tough time in state schools in London. And that one connection where you get, give someone a mentor or an inspirational talk or connection or an email address can completely transform a life. And I think that actually it doesn't cost anything. It cost me a bit of my time. But it's the power of social capital, not as a substitute for, but as a supplement to actual job opportunities. I think Stevie is a potentially life changing thing. In fact, I know it because I once saw an awful lot of kids live transformed by it. Right. Thank you, Stevie, for your question. This is another one from Rosie, who has emailed say, "Hi, Rosie." Rosie says, "James, are people really interested in agency or are they only interested in a version of agency which suggests even the most complicated problems can be easily solved, has solved without upheaval or sacrifice on their part?" I'm not sure they are. And if I'm right, then they aren't falling for leaders who offer agency. They're falling for leaders who offer the veneer of agency, a different political calculation surely. So I think Rosie's, the core of Rosie's question there, is that there are some leaders, I don't know if she's thinking about Trump, who we mentioned in this context on the main episode last Thursday. But there's some leaders who give the veneer of agency and being able to get stuff done. But actually aren't very effective at that. Yeah, so there's two questions and one point in that bundle, I think, from Rosie. So I'll try and disaggregate them a little bit. So the first is, can someone offer solutions and where those solutions don't actually exist? In other words, they haven't acknowledged the trade-offs. And that happens across the political spectrum. You see that in election from election. People saying, "I will fix things and then they're not fixed." That is just part and parcel, unfortunately, of a sometimes of political situations and political promises that aren't made. But the point is, can you basically have, can people be told that they're going to be in control and they're going to have solutions? And then the full thing isn't acknowledged. There isn't the trade-off that is basically being acknowledged. I think that's a separate point and that's very interesting, which is, can people be promised solutions where nothing has to change on their part? Which I think is a very, very good question. Because last, you know, I think about, Remember Jeff K. We probably don't remember. But before we have time for more.
but JFK's election, right, what can you do for your country? - Ask, not what your country can do for you. Ask what you can do for your country. - Apart from that, appalling. - Accent, yeah, no, I do. - But the words were right there. - The words were right, and mine were wrong. But again, that's really interesting 'cause that's the kind of trade off. That's the kind of, it's not all about what someone's gonna do to you. That's about how your behaviors will change. It's been a long time since we've had that kind of political argument made, right? I guess the last person in the UK context was David Cameron in 2010 with the big society, and that was a very difficult election campaign for him, where people are saying, you ask it, you know, he had an invitation to government. That's what the manifesto was. - Yeah, it's the first of the manifesto. - And I think the invitation to join the formation of a government in the UK. - Right, and I think a lot of people in the media, I don't know if you're-- - Was it the independent time, right? - Quite cynical about, not necessarily you, but the law of the reception around that was quite cynical, which was like, no, no, of course, why would I do anything? You're just using that as a cover for XYZ. So I think it's a really good question. Who is positioning trade-offs to people about what's gonna have to change about their lives, what's gonna be different? I guess that another the other word for that is political honesty. - Yeah, but I don't know if we're talking shortly after this absolutely incredible clip, which I couldn't stop watching a free-dreatment because the German Chancellor going absolutely hell for leather at it, saying he'd just come back from China. And he said, in China, they work incredibly hard, they don't get paid much money. And I come back, I'm paraphrasing here, 'cause Friedrich Merz in his German accent, speaking German, sounded very different. But he said, you know, and people, I come back here and people want to do a four-day week. We're gonna have to work harder. That's just the truth. You are going to have to work harder. And I thought it was, I mean, it was a very animated speech, and therefore it's pretty why it's gone viral. But it was a novel thing in that he seemed to so reckon with people, he seemed to be saying, so the world is turning Chinese, they're working harder than you are. - Yeah, and I think if you look at Europe, I think it now counts for like 25% of the world's welfare spending. Europe does. - Yeah, something that they're not about, so you fact check me off. - Wow. - It's quite a small proportion of the world. And I think Merz, obviously, is a sensible leader of the European Union, certainly. It's probably just thinking, I think it sounds like he got basically radicalized. Going to China, this is very welcome. - Very welcome from this podcast. - There are clips of him looking at the robots that have been done in robotics. And he's probably just thinking, what are we doing in terms of Europe and our politics? And like, how do we grapple with our, how do we grapple with the wealth situation, the lack of income growth? Is it just by increasing one bit of the ledger, but not the other? - Yeah, yeah, yeah, yeah. Rosie, thank you very much indeed for your question. I hope you've got an answer there that you find interesting, if not totally satisfaction, because you agree with it or not. But we really appreciate your question. Here's another one from Joanne on the Isle of Man. - Hello, I'm Lauren James. It's Joanne. I was with friends at the weekend. We're all white collar professionals in our 50s, all very diode into politics and current affairs and all big fans of vertical. Depressively, we concluded that with global instability, political, ranker and economic turmoil, we've all had the best years of our lives, and there's only uncertainty to come. Big question then. Can you cheer us up and offer us hope for a brighter future? - I'm temperamentally. I think Joanne, I should say that you and your mates around the table, all very diode into politics and current affairs, all big fans of vertical. Thank you so much. I would have been very home in your company, because I mean, maybe it's 'cause I work in the news and maybe like Joanne, I'm diode into politics and current affairs. I do, this cultural, the cultural decline in pessimism, which people say, "Oh, it's a right wing narrative." Or people say, "Oh, it's all doing with glue." It's just facts. I just saw a fact, just thing the other day, in 2028, 29 living standards in this country, are gonna be lower than they were in 2008. - We also didn't mention the birth rate. - That's all. - And the pre-example. - What? - De�ographics is our little. - De�ographics. - Well, I mean, people on this part, 'cause I'm getting trouble every time I do. The demographics in this country are, you know, in terms of, I mean, some people say it's a good thing for planetary reasons, I get that. In terms of, if you wanna pay 60% tax. - But there's an issue, which is that this country is about to all the talk about the age of population. As Torsten Bell said to me a couple of years ago, it's only now that it's gonna hit, 'cause it's now that the people who are born in 1945 or 1960 are about to hit much old age. Do you know what Joanne? There are huge, huge, huge causes. I'm gonna answer this question before we're handing over to James. There are huge positive reasons to be kind of hopeful and happy, and I do actually think with this extraordinary new technology of AI, which is the most consequential technology we've ever created, probably, there could be wonderful, wonderful, wonderful, productive productivity enhancements and medical breakthroughs and scientific breakthroughs. So I always look to the field of science when I'm kind of desperate for a bit of cheer. When I'm presenting the stay program and it all looks a bit doom and gloom, I look on the science pages and look at science journals to work out if there's anything a bit sort of optimistic happening there. But in terms of actual events, the course of history at the state of our country, I'm not good. - I've got a bit of up to it. - Okay, here we go, thank you. - Okay, cool, 'cause you're struggling a little bit that I've been on the pessimism boat. So I spoke in the last episode about the work that I did with my colleague Patrick Flynn on agency. And this particular bit was his work, which is Patrick created a model for happiness. So we did a survey where we asked, are you happy? And then instead of asking what makes you happy, which is the explicit way of finding out the right answer, we asked our whole load of other stuff about their lives. And then he built a statistical model to basically show what factors were mostly, most closely correlated to that. So he built a regression model. And the reason I'm optimistic is I think a lot of people's diagnostics about what is going wrong is converging. And because they're converging across the musical spectrum, we get a degree way everything's rubbish, then we might be able to do something. - Exactly. - And by the way, we haven't for the last 15 years. And suddenly we're getting people from the centre left, the centre right, the populist right, the populist left, all basically saying the same thing. I think that's incredibly important. So, and I think for me, Patrick's, it's just a model of 1,000 people that took our survey. There are much bigger studies. But for me, it was really interesting, because it ties together a lot of what we were discussing about in the first episode. And he basically thinks that your levels of happiness, he could build a model that gets with a very high degree of accuracy whether you're happy or not, based on a couple of inputs. The first is the degree of political interest. So being involved in the political process is a good thing, because it means that you're engaged, that you can, that you understand, the second of all your income really matters, money matters, money talks. Do you remember 10, 15 years ago, when we had political movements going up that were post-growth, you know, the crisis, you know, general wellbeing. People were talking about as if affluence didn't matter. Gross-tactual happiness. Which is a kind of post-growth view of things, and there's not been proven correct. The third is the degree of inheritance that people expected. It's one of these things we don't talk about, but you've had Eliza Philbeon on here in heratocracy and that's an incredibly important thing. But interestingly, the degree that your personal life you've come into proximity to drug and alcohol dependency correlated very sharply. So the more you have that, the less likely you have to be happy. So far so obvious. Then interesting, some other more meta stuff, like the degree that you felt represented in society. Both on TV, radio, social media, the degree to which you felt that this was your thing, and you were part of a greater whole. Interestingly then, the degree that you enjoyed people's different political opinions. So pluralism is a good thing. - Yes. - Understanding pluralism, the other word for pluralism is listening. (laughs) And just being able to take into account other people's views without necessarily that being the end of a relationship. And then interestingly, some other stuff about not being stressed or not worrying or what, ruminating. It's very interesting. It's a very efficient model. It's not that many variables. Those Patrick's work. I think that's really interesting, because most people would, that's not a left or right wing thing to say. That's not a left or right wing diagnostic. If you've spoken about the issues in society that have led to a lot of political volatility, to 50% of people changing their view, between people constantly pressing this red button of change. But increasingly the people from across the political spectrum, across Europe are saying the same things, which is that Europe needs growth. Europe needs a higher degree of pluralism. Free speech is a good thing. We need degree of representation. We should tackle the stuff that we know that is bad. Like, so that convergence would suggest that possibility of forming a consensus is getting marginally easier. So with the right political leadership, you could cohere a group, a voting block consensus around the need to get stuff done, even if that requires some pretty radical solutions. Talking here about elite consensus. Again. It's interesting to see when that starts to filter down into the public. Right. That's a sort of optimistic note, Joanne. Other things that are very nice to think about, the new series of university challenge starts. (laughing) Oh gosh, I can't believe Joanne. I've just done that. Honestly, Joanne, I'm an optimistic guy. And yeah, you've challenged me there. I tell you, the next time I come back on this podcast, I'm going to, yeah, God, that's terrible. I need to come. and he definitely positive to say to you where and what am I going to say?
say about things getting better. Outside of the UK context. Okay. People think about-- Oh, my God. Outside of the UK is easy. But no, but again, again, other countries are influential. I think Canada's very interesting. Because a lot of people are talking about, Mark, car industry leadership. Being very impressive. A dad was speaking about middle powers. He's up on the polls. The really interesting thing about Canada is it also has one of the best center-right communicators on Earth as well. Pierre Polly F. They've got two of these people at the same time. Communicating. Completely unsurprisingly, both got above 40% at the last election. And basically wiped out everybody else. Right. So they've always got the 20th century British policy. Canadian politics is very interesting. Because it's basically watching to absolute titans with an incredible layers of communication. And interestingly there, Pierre Polly F. has the anti-states quote, coalition. Mark Carney has the other-- but that's a really good example of actually-- and with social media, with clips, with TV, with whatever it is, people can actually see these guys talk. And it's very, very interesting from a communication perspective. OK. And I would say what's going on in parts of Africa, which experience extraordinary growth. I mean, there has, for most of humanity, never been a better time to be alive. If you want a sense of optimism, you could look at the rational optimist by Matt Ridley. You could look at the better angels of our nature by Stephen Pinker. Or you could look at the improving state of the world by Indoor Go Clarnier. I think it is, which is actually published just before the financial crisis. On most measures, people are living longer, healthier lives, infant death, mothers dying in childbirth. Matt is massively down. Can I be controversial? Go on. A little bit. So we went in the last episode, just a little bit to tell you. And if you take a step back and you have a think about, we're both people of color, we're not white. If you look at the polling data and you look at the opportunities and you look at the degree of social mobility, Britain, is one of the best places on earth to be born in, if you're not white. Absolutely. Both in terms of the likely life outcomes that you'll have, life expectancy, degree of social mobility, rates of education. Tell me about it. I've got a number of different specs. That in this two experience racism. Yeah, yeah, yeah, yeah. Obviously there are challenges and there are things, but I'm always, I thought I'd just given that you're into being male and for complete-- No, you're completely, you're completely-- It's literally-- I think you've got to-- Do you know, I think-- I think because of the experience of the last 20 years, I think it's very easy to overlook where Britain actually is, which is that this is a country, which is still the sixth or seventh richest country of the world, to be born alive today is the most incredible stroke of good fortune. And to be born in Britain, especially, is a wonderful, wonderful thing. This is a country which has got incredible opportunities, fantastic institutions, and amazing inheritance, and where you can generally go about your business and live a pretty good life. And it might not be as good as it used to be, but it's still pretty good. How's that for a dose of optimism? Yeah. Happy days, but-- Quite the intention. Flamingo, right. Joanne, next time you having a meal with your mates in their 50s and you want to chat about a bit of the old declineism, give us a call, would you? Thank you so much. Our final question is about polling more generally. Judy got in touch on Instagram to ask, whether voters are influenced by the poll results, we hear so much about. Our voters-- oh, that's an interesting thing. That's a good-- Does the report-- That's a good question. That's a real, blever, new deal. That's a real-- The Pandora's Box. OK. No, last vote. Our voters influenced by poll results. We hear so much about. Voters influenced by information. And poll results are subset of information. So that information might be who won the seat last time. That information might be who's running the council. That information might be in a different political system such as France. They have a two round voting system for the French assembly. So you have a first week and second round voting. That information might be the number of signs that you have on people's-- well, I won't say lawns because that's American, but the number of stickers in the window, I think, is the British version of that. So information matters. Polls are. But obviously, the thing about polls are also in completely different things now. And they also will change, as we discussed in the first episode. But they can act as a signal, I think, particularly where the amount of information that you're getting in terms of polling is limited and is timely. So a good example might be by elections. I don't think it's-- I do wonder if you get these constituency polls that come out and say you have party on X and you have party on Y. And it becomes clear who the best challenger is for each party. Does that affect results, potentially? But I think they certainly affect the mood of different political parties. They certainly affect the mood of the country, if people are always saying, you're reading poll results that tell you XYZ. But what I would say about polling is it's one thing amongst many that people should really look into to temperature test. A, if you think about-- imagine we were having a conversation and you weren't allowed to speak back to me. You could only speak back to me in the form of a clipboard where I had already determined what your answer options are. That's a poll. That's quite a weird conversation to have with someone. So I think far more skepticism. We use more judiciously, but also understanding the constraints. What's the implication of what you say for how journalists should cover this stuff? Proceed with caution. Remember polls were a snapshot and not a forecast. Ted not to let opinion polls be a headline story. Well, it's a bit-- Well, it's a bit-- Well, it's a bit-- Well, it's a bit-- Well, it's a bit-- Well, it's a bit analogous to spending three years debating what you think the final result will be and missing three seasons of the football. [LAUGHS] Watch the football instead. Just like debate the issues, go for the substantive stuff. Why? Why are we only debating what the final result could be in three years? Tell me about it. Judy, what a clever question. I love a little bit of wonkish siphology to win this podcast. Thank you so much for all of your questions for James. We are so grateful above all to you, James, because I know there are enormous demands on your time from across the political divide and you've given us a huge amount. So thank you so much. Have you vaguely enjoyed this experience? I've really enjoyed it. I've enjoyed it. I've injected a bit of optimism. Now, a huge amount. I'm feeling-- I'm going to go into the evening, feeling incredibly optimistic about me, the prospects for this country and the world and our species among it. Thank you all so much for your questions. Thank you for answering them. James, I'll be back with another episode of Radical on Thursday, until then from James and from me. Goodbye. The moral maze on BBC Radio 4. I've never been more concerned about the future of humanity than I am now. Examining one of the week's main news stories through an ethical lens. If we don't do something, millions will die. Billions will die. That's the state of play here. Sometimes combative, sometimes provocative, always engaging. I'd like to go one level deeper and talk about your fundamental moral commitments. Do you have any? The new series of the moral maze with me, Michael Burke, from BBC Radio 4. Listen now on BBC Science.
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