Hay que ser cautos al asociar biomarcadores y enfermedad

Algunas personas sólo guiñan los ojos para poder apuntar mejor

Billy Wilder

JAMA publica hoy un estudio en el que se cuestiona la validez de ciertos biomarcadores y su relación con ciertas enfermedades. El trabajo dice que en ocasiones se exageran los datos, sobre todo si provienen de estudios pequeños, por lo que sugiere que se sigan a largo plazo.

Más de dos docenas de estudios ampliamente citados que asocian genes u otros biomarcadores a enfermedades específicas exageran dicha relación, según un estudio coordinado por John Ioannidis, director del Centro de Investigación Preventiva de la Universidad de Stanford, que se publica hoy en The Journal of the American Medical Association.

Para el autor del trabajo, como consecuencia de estos resultados los clínicos pueden tomar decisiones para sus pacientes basadas en conclusiones que no son del todo exactas.

Los estudios mencionados incluyen la asociación entre las mutaciones en el BRCA1 y cáncer de colon, entre la proteína C reactiva y la enfermedad cardiovascular y entre los niveles de homocisteína y enfermedad vascular.

“Las investigaciones estudiadas no son inciertas, sólo que se producen fluctuaciones. No se trata ni de un fraude ni de un diseño inexacto de los trabajos; tan sólo es expectativa estadística. Algunos resultados son más sólidos y otros más limitados, pero a las revistas y a los investigadores les gusta publicar grandes asociaciones”.

Estudios revisados
El grupo de Ioannidis ha analizado 35 estudios de referencia. Ha encontrado que menos de la mitad de los biomarcadores de esos estudios tienen asociaciones estadísticamente significativas con el riesgo de enfermedad en estudios de seguimiento a largo plazo. Es más, sólo uno de cada cinco de los estudios seleccionados elevaba el riesgo relativo a 1,37 de una determinada enfermedad para el paciente.

Según Ioannidis, “han encontrado que, en general, en los estudios de mayor tamaño hay una relación más consolidada entre los marcadores y el seguimiento de los pacientes. Así, en los metanálisis hay una mayor exactitud que en los pequeños estudios piloto.

Los autores del trabajo han recordado que los investigadores tienden a jugar con los conjuntos de datos y los analizan de diferentes formas. “Es necesario seguir los métodos científicos hasta el final y pedir que se puedan reproducir y verificar antes de que se acepten como un hecho”.

Para Ioannidis, una de las conclusiones del estudio es que es necesario validar los originales con estudios a gran escala; de esa forma se podrá conocer realmente el valor de los biomarcadores.

(JAMA 2011; 305: 2.229-2.2230).


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