BJPsych Kaleidoscope April 2019

magazine-coverThere has been a rightful push to expose and redress the gender pay gap and differential career progression in health care (and elsewhere): what about representation in research participants?

April’s Kaleidoscope reports on a paper confirming the repeated finding that most participants in study trials are…men. Now, from my own personal reflections over the years as a man, two things have repeatedly struck me: i) I’m fairly sure that women make up about half the population, and ii) they are definitely different to me (such are the observational powers of a good psychiatrist). Of course research tries to remove confounders, and have as much participant homogeneity as possible; I’m embarrassed to finish this sentence, but one ‘key’ reported reason (by, typically, men scientists) that women have often been excluded was because it was thought they would show too much participant variability due to menstrual cycles. I know. As well as being a(n offensive) myth, in fact, on many psychological traits men show greater variability. Things have been improving, with growing numbers of women participants, but it’s good to call this out. If you are involved in research, time for some reflection on the practice around you.

To a topic that is very difficult but will happen to many of us: the death of a patient by suicide.

At such times, our primary thoughts turn to the person who has died and their family. We then naturally begin to question what we have done; I know I have run through arguments in my head asking what I might have done differently, and the usually impossible-to-answer question of what difference that might have made. Then the investigation happens, as it must. I’ve been part of it, and felt it, on both sides: I’ve been the manager who turns up to try support staff but equally knowing that my presence is also a stress on others; similarly I’ve had lovely and thoughtful people ask me about my own practice, genuinely telling me they weren’t seeking to blame, yet reinforcing my doubts about myself. Kaleidoscope reports on what I think is a very moving piece by a doctor talking about her hidden grief when one of her patients died; the complexity of a loss that brings bereavement, guilt, and a sense of failure. Across healthcare more broadly, she argues that we do not yet have, as professionals, rituals of our own to mark a death and find a path toward healing. I’m not sure I have any answers to this, but I understand what she says, and I think you will also.


  1. A recent review of neuronal activity describes how up the majority of these brain cells never fire and are permanently silent – what the author labels the ‘dark matter of the brain’.
  2. A review of the landmark 2016 paper that calculated medical error was the third leading cause of death in the US has confirmed the original finding.
  3. A Canadian study evaluating the lower rates of successful grant applications from women principle investigators showed that this could be almost entirely accounted for through the confounders of applicants’ age and specific research domain.


  1. True, though this is highly challengeable.
  2. False, it argues that it’s an order of magnitude less than this, accounting for 3.6, not 36% of deaths.
  3. False, the data suggest it’s from a poorer appraisal of the scientists themselves; aka sexism.
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