Losing our way

BMJ 2008; 336 doi: (Published 17 April 2008) Cite this as: BMJ 2008;336:867
  1. James Barrett, consultant psychiatrist
  1. 1West London Mental Health NHS Trust, London
  1. james.barrett{at}

    Men have better visuospatial abilities than women. They read a map better. But is this difference related to hormones or just because men have a Y chromosome?

    In the setting of a gender identity clinic one could investigate this question quite easily, since many of the patients are treated with high doses of cross-sex hormones and can be tested before and after such treatment.

    There was a heaven sent opportunity to conduct such a study when the clinic in which I work was to relocate to new premises. All the patients were to be sent a map showing them the new location. The effects of treatment on their visuospatial abilities could be investigated by simply asking them if they got lost trying to find the clinic. It seemed an ideal and unchallenging setting for such a study.

    Unchallenging, that is, until the application to the ethics committee had to be completed.

    I was asked to describe at length the purpose of the study, to describe the question I would ask, and to quantify how long I would spend asking it. I was required to get a consent form prepared, to be given to patients before I asked my question. It seemed that I was supposed to consider the risks attached to asking patients if they got lost, and how I would deal with those risks. In short, I was supposed to inform them that I was about to ask them if they got lost; tell them why I was about to ask them; get them to consider agreeing to be asked; ensure that they knew they did not have to answer my question; require them to fill out a form saying that they agreed to be asked; and then, finally, ask them if they got lost.

    The chances of getting an unrehearsed, unconsidered, and thus meaningful answer seemed slim. Another study that fell at the hurdle of ethics application. Shame.

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