BJPsych Kaleidoscope May 2021

May’s Kaleidoscope column in the BJPsych asks did you know that women are not just small men*? Designers and scientists often don’t take this into account**.

Women are more likely to die in a car crash as seat belt and car crumple zone safety systems are modelled on a standard man’s body, and recently we’ve seen the issue of some PPE often not fitting women well as it was based on a stereotypical 70kg male physique.

In scientific research, women participants are often excluded for various reasons of confounding and ‘complicating’ the data: it pains me to write this, but some scientists*** have, for example, expressed concern that issues such as menstrual cycles in participants might skew their data. Again, this matters hugely: not only do women make up 51% of the population (that’s quite a significant minority), but we see variation that is clinically important.

As an example, some animal experimental chronic stress paradigms that have been used to model post-traumatic stress disorder (PTSD) have shown opposite brain changes in males and females, yet treatments are usually based on what’s found in males. Kaleidoscope reports on an editorial that calls this out and, importantly, proposes ways forward. The authors note how most research is funded by large grant-awarding bodies: if these said they would only fund research that included men and women, it would have an enormous instant impact, and that feels…rather simple to enact…like immediately.

The piece goes on to name others who have the ability to effect change: universities, scientific journals and so forth – they need to make active decisions on the types of work they will support.

You’ll be aware there’s lots of interest in repurposing illicit drugs therapeutically in mental health: cannabis, ketamine, ecstasy and so forth.

I’m sympathetic to the principle: none of us need reminding of the inadequacy, despite best efforts, of all types of current intervention, from pharmacological through psychological to sociological. We could do with any new treatments that work (I’m not trying to give primacy to medication here, I’ll take what I can get if it helps folk). Anyway, such research faces two major barriers: one, it’s using illegal substances, so it’s ethically trickier (certainly trickier than including ‘women’ in your research); and two, it’s hard to ‘blind’ participants to what they’re taking.

The basis of medication research is the double blind randomised controlled study: that’s harder to do if you give someone, for example, ecstasy: people tend to pick up that they’ve taken this. Kaleidoscope also reports on a really interesting novel study on ‘micro dosing’: this is the phenomenon of taking tiny (1/10th ‘normal’) doses of hallucinogens (LSD and the like) to improve creativity and well-being. It’s particularly recognised on the US west coast (notably Silicon Valley). There’s little ‘high’ from the small dose, so easier to hide from participants what they’re taking.

The scientists gave participants empty capsules that couldn’t be seen through: participants filled half with their micro-dose drug of choice and put these in a series of envelopes with ‘QR codes’ only a machine can scan/read; and half the capsules had nothing put in them (so were empty) and put in different (but identical looking) envelopes. Their unique QR codes were scanned by phone back to the research team (who now knew what’s in each envelope) and shuffled. The scientists were thus able to control what participants were taking, but the participants didn’t know as they were just given a scan code to find and open.

So, the first thing is – what a clever design: Go Scientists! (once you sort out that whole sexism thing) But the second interesting thing was that micro-dosing showed no benefit over placebo. It does not work…or, the gains you get are placebo: thinking you’re taking LSD is good for creativity and well-being.

*this is the title of a TEDx talk on the topic. The best-selling book Invisible Women: exposing data bias in a world designed for men by Caroline Criado Perez has more on this issue.

**men designers and scientists

Kaleidoscope Quiz May 2021

Answers will be revealed in the next BJPsych Kaleidoscope editorial.

1. A double-blind placebo-controlled trial of varying strength smoked cannabis has confirmed erstwhile anecdotal reports of THC effectiveness in reducing PTSD symptoms in military veterans.
2. The first randomised controlled trial of the impact of tweeting scientific articles has shown this leads to increased subsequent citations of the paper.
3. A triple-blinded randomised controlled trial has shown that, compared with placebo, antipsychotics produced significant grey matter increases in a first-onset psychosis cohort.

Back to our May 2021 eNewsletter.