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La homeopatía, una idea que se diluye

¿Qué cantidad de materia prima de origen animal, vegetal o mineral hay en una pastilla homeopática? ¿Cómo afecta la actitud del médico al recetar un placebo? ¿Qué relación guardan un caballo alemán capaz de realizar operaciones matemáticas y las pseudociencias? El divulgador científico Andrés Gomberoff, físico teórico formado en la Universidad de Chile, donde obtuvo su doctorado en 1996, responde a estas y otras preguntas en «El instinto científico» (Debate, 2024), un divertido, polémico y absorbente viaje intelectual que explora los orígenes y fundamentos del pensamiento científico, proceso decisivo en la construcción de la cultura occidental y de la joya de su corona: la ciencia. En el capítulo que aquí publicamos, titulado «Una idea que se diluye», Gomberoff explica por qué la homeopatía pudo haber sido una buena idea en 1796 para acabar desarrollando con argumentos por qué hoy ya no lo es: «La historia de la ciencia está llena de buenas ideas que el tiempo, el escrutinio público y el advenimiento de otras mejores van diluyendo hasta no dejar ninguna molécula de ellas».

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El divulgador cient\u00edfico Andr\u00e9s Gomberoff, f\u00edsico te\u00f3rico formado en la Universidad de Chile, donde obtuvo su doctorado en 1996, responde a estas y otras preguntas en \u00abEl instinto cient\u00edfico\u00bb (Debate, 2024), un divertido, pol\u00e9mico y absorbente viaje intelectual que explora los or\u00edgenes y fundamentos del pensamiento cient\u00edfico, proceso decisivo en la construcci\u00f3n de la cultura occidental y de la joya de su corona: la ciencia. 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que se den cuenta de lo inconmensurable de este n\u00famero, en 1 ml de agua, es decir, en la peque\u00f1a gota con que impregnan cada gl\u00f3bulo, solo hay unas 10 elevado a 22 mol\u00e9culas de agua. Para tener alguna probabilidad de encontrar una sola mol\u00e9cula de la sustancia inicial en esta diluci\u00f3n, debemos juntar un volumen tan grande que no cabe en el universo observable. En resumen, las p\u00edldoras de Oscillococcinum, como nuestro Neuritax, no contienen m\u00e1s que az\u00facar. Por supuesto, el home\u00f3pata tiene una respuesta a esto. Nos dir\u00e1 que la base te\u00f3rica de la homeopat\u00eda alude a la \u00abmemoria del agua\u00bb. Es decir, a pesar de que no hay vestigio alguno del h\u00edgado y coraz\u00f3n de pato en el medicamento, el agua en que fue impregnado es capaz de recordar el contacto que alguna vez tuvo con la sustancia activa. \u00bfHay alguna raz\u00f3n para creer que esto es cierto? Ninguna. La fisicoqu\u00edmica del agua se ha estudiado por siglos. Hoy los c\u00e1lculos te\u00f3ricos pueden explicar con delicioso detalle cada una de sus espectaculares propiedades. No hay teor\u00eda ni experimento que d\u00e9 cuenta de memoria alguna. En resumen, y para poner a prueba nuestro instinto cient\u00edfico: primero, tenemos una teor\u00eda \u00ablo similar cura lo similar\u00bb, que no solo no tiene asidero alguno, sino que, adem\u00e1s, es incompatible con los avances de las ciencias m\u00e9dicas que se desarrollaron en los siglos siguientes. Segundo, tenemos un principio activo \u2014h\u00edgado y coraz\u00f3n de pato\u2014 que no parece ni provocar ni prevenir los s\u00edntomas de la gripe. Tercero, ese principio activo est\u00e1 tan disuelto en agua que es m\u00e1s probable encontrar una mol\u00e9cula proveniente de un h\u00edgado de pato en el agua del grifo de su casa que en el l\u00edquido en que se impregnan estos gl\u00f3bulos homeop\u00e1ticos. Cuarto, no hay evidencia de que el agua recuerde nada, y hablamos de una sustancia que ha sido detalladamente estudiada desde todos sus \u00e1ngulos.\u00a0<\/p><p>El procedimiento homeop\u00e1tico, convengamos, no parece muy convincente. Esa intuici\u00f3n de que algo no resulta del todo l\u00f3gico, de que el argumento es d\u00e9bil, incoherente, es la primera defensa del pensamiento cr\u00edtico, del instinto cient\u00edfico. Ahora bien, alguien podr\u00eda, con raz\u00f3n, contradecir mi escepticismo te\u00f3rico, afirmando que, por muy extra\u00f1o que todo esto parezca, las p\u00edldoras funcionan. Afortunadamente, esa afirmaci\u00f3n es f\u00e1cil de poner a prueba. Veamos c\u00f3mo.\u00a0<\/p><p>Para verificar la eficacia de un medicamento debemos tener en cuenta todos los posibles autoenga\u00f1os. Evitarlos a la luz de las trampas cognitivas que el pasado nos ha revelado. Fue el m\u00e9dico norteamericano Henry Beecher quien en 1955 encendi\u00f3 todas las alarmas de la investigaci\u00f3n m\u00e9dica en su art\u00edculo \u00abThe powerful placebo\u00bb \u00abel poderoso placebo\u00bb en 1955 (Beecher, 1955). A pesar de los varios errores estad\u00edsticos que hoy se sabe que este art\u00edculo contiene, su influencia fue tremenda. Puso todas las luces sobre los fallos que se estaban cometiendo al evaluar los efectos de un tratamiento, particularmente sobre la importancia de la respuesta placebo. Fue el comienzo de un nuevo est\u00e1ndar en la realizaci\u00f3n de ensayos cl\u00ednicos. Hoy se exige que estos estudios sean aleatorizados, doble ciegos y controlados con placebo. Paso a explicar estos t\u00e9rminos usando el ejemplo de nuestros gl\u00f3bulos homeop\u00e1ticos.\u00a0<\/p><p>Para verificar si el Oscillococcinum es efectivo para combatir los s\u00edntomas de la gripe, debemos partir, por supuesto, con un grupo de personas con gripe y observar el efecto que el medicamento tiene sobre el desarrollo de la enfermedad. Sabemos que la inmensa mayor\u00eda de nuestros voluntarios se recuperar\u00e1n con o sin tratamiento; despu\u00e9s de todo, es solo una gripe. Por lo tanto, debemos tener tambi\u00e9n un \u00abgrupo de control\u00bb. Este es otro grupo de agripados, a los que en lugar del Oscillococcinum se les administrar\u00e1 un placebo. El placebo debe tener id\u00e9ntica apariencia, venir en id\u00e9ntico envase y ser recetado en las mismas condiciones que a quienes se les entreg\u00f3 el medicamento en estudio. Es claro que la eficacia de cualquier medicamento solo podr\u00e1 ser validada si aquellos que lo recibieron tienen, estad\u00edsticamente, una mejor\u00eda m\u00e1s r\u00e1pida que aquellos que recibieron el placebo. A esto nos referimos cuando decimos que el estudio es \u00abcontrolado por 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que tener algunos cuidados, sin embargo, con el conjunto de voluntarios. Primero, debe ser una muestra representativa. Si queremos validar el uso de un medicamento, digamos, en todo Chile, no podemos usar solo pacientes hombres que vivan en Antofagasta. La muestra debe ser representativa, considerar todos los sexos, regiones geogr\u00e1ficas, niveles socioecon\u00f3micos, etc.\u00a0<\/p><p>Pero m\u00e1s importante a\u00fan, la divisi\u00f3n de los voluntarios en dos grupos se debe realizar en forma aleatoria. Solo as\u00ed podremos argumentar que cualquier distinci\u00f3n en el desarrollo de la enfermedad entre los grupos se debe a los distintos tratamientos y no, por ejemplo, a una diferencia en sus h\u00e1bitos alimenticios o en el clima de la regi\u00f3n en donde residen. A todo esto nos referimos cuando decimos que el estudio es \u00abaleatorizado\u00bb.\u00a0<\/p><p>Finalmente, \u00abdoble ciego\u00bb significa que ni los pacientes en el estudio ni los cient\u00edficos que les entregaron sus p\u00edldoras saben a qu\u00e9 grupo pertenece cada uno. La idea es que los voluntarios no tengan ninguna sospecha de qu\u00e9 es lo que est\u00e1n tomando. Ahora bien, \u00bfpor qu\u00e9 tampoco el m\u00e9dico tratante puede saberlo? Porque el lenguaje corporal es tremendamente poderoso y es muy f\u00e1cil que inconscientemente exista una comunicaci\u00f3n entre las dos partes que permita al paciente obtener alguna pista. Una historia muy notable que evidencia este poder de la comunicaci\u00f3n corporal inconsciente y nos alerta sobre el cuidado que debemos tener al hacer observaciones en las que pueda darse, es la de Hans el listo.\u00a0<\/p><p>Hans el listo era un caballo que a comienzos del siglo xx, en Berl\u00edn, impresionaba a sus audiencias haciendo operaciones matem\u00e1ticas, identificando al autor de piezas musicales, contando el n\u00famero de personas en una audiencia o leyendo la hora en un reloj (Samhita y Gross, 2013). Hans hab\u00eda sido entrenado cuatro a\u00f1os por el profesor de matem\u00e1ticas Wilhelm von Osten, quien se ganaba la vida present\u00e1ndolo al p\u00fablico por toda Alemania. En cada espect\u00e1culo, el caballo respond\u00eda las preguntas num\u00e9ricas golpeando sus pezu\u00f1as en el suelo un n\u00famero de veces. Para responder texto, Von Osten asignaba a cada letra un n\u00famero y exhib\u00eda las reglas en una pizarra. La precisi\u00f3n del caballo en sus respuestas era tan alta que la fama de Hans y de su entrenador crecieron r\u00e1pidamente, tanto en Alemania como en todo el mundo. Fue tan grande el revuelo que en 1904 el Consejo de Educaci\u00f3n alem\u00e1n cre\u00f3 una comisi\u00f3n para averiguar qu\u00e9 era lo que realmente estaba ocurriendo en este incre\u00edble acto. Solo tres a\u00f1os m\u00e1s tarde, el fen\u00f3meno pudo ser explicado por el bi\u00f3logo y psic\u00f3logo Oskar Pfungst. No hab\u00eda ning\u00fan truco. De hecho, Von Osten estaba convencido de que su caballo era inteligente y capaz de razonar, conocer y calcular. Hans no era capaz de nada de eso, solo era extremadamente sensible al lenguaje corporal de su entrenador. Supongamos que al caballo se le presentaba la suma 2 + 1. Inmediatamente, comenzar\u00eda a golpetear el suelo con su pezu\u00f1a. Una vez, dos veces... Cuando llegaba a la tercera, la respuesta correcta, la postura o el gesto facial de Von Osten le dec\u00edan al caballo que ese golpe deb\u00eda ser el \u00faltimo si es que quer\u00eda obtener una recompensa. Era tan espectacularmente sutil la capacidad del caballo para reconocer estas pistas, que no solo las captaba de su entrenador. Otras personas tambi\u00e9n pod\u00edan hacerle preguntas que contestaba correctamente. \u00bfC\u00f3mo sabemos entonces que Hans no era realmente listo? Porque el instinto cient\u00edfico indica que esta no es la predicci\u00f3n m\u00e1s l\u00f3gica y Pfungst ide\u00f3 el experimento que lo comprobaba: intentar que el caballo responda una pregunta cuya respuesta desconoce quien se la hace. Por ejemplo, desafi\u00e1ndolo a reconocer una pieza musical que el interrogador nunca escuch\u00f3 y de la que, por lo tanto, no podr\u00e1 entregarle pista alguna. Si Hans solo pod\u00eda responder preguntas cuando la persona que ten\u00eda al frente conoc\u00eda la respuesta, entonces es evidente que esta persona estaba, inconscientemente, entreg\u00e1ndosela.\u00a0<\/p><p>Este caso extremo de comunicaci\u00f3n no verbal entre humano y caballo muestra claramente por qu\u00e9 los estudios cl\u00ednicos deben ser doble ciegos. Si podemos entregar informaci\u00f3n no verbal, inconscientemente, a un animal, con mucha mayor probabilidad podemos hacerlo a un ser humano. Por eso, quien entrega el medicamento al paciente podr\u00eda, sin siquiera darse cuenta, darle pistas sobre lo que realmente hay dentro de cada c\u00e1psula, interfiriendo con la respuesta placebo y con todo el experimento.\u00a0<\/p><p>Despu\u00e9s de este largo desv\u00edo podemos volver a la pregunta inicial y responderla con rigor cient\u00edfico. Existen muchos estudios aleatorizados, doble ciegos y controlados por placebo que estudian la eficacia de medicamentos homeop\u00e1ticos. Porque, aunque para muchos pueda parecer inveros\u00edmil, no hay distinci\u00f3n real entre medicina y \u00abmedicina alternativa\u00bb. Sin importar las opiniones, el sentido com\u00fan o las preferencias te\u00f3ricas, cualquier tratamiento seguro y eficaz es medicina. La curiosidad humana, la urgencia por la salud y la cantidad de cient\u00edficos en el mundo hacen que se pongan a prueba hasta los tratamientos m\u00e1s inveros\u00edmiles. El Oscillococcinum no es una excepci\u00f3n y la respuesta es que no existe evidencia alguna que respalde que estos gl\u00f3bulos de az\u00facar, impregnados en una soluci\u00f3n ultradiluida de coraz\u00f3n e h\u00edgado de pato, sean m\u00e1s efectivos que el placebo para tratar la gripe (Mathie, 2015).\u00a0<\/p><p>La homeopat\u00eda puede haber sido una buena idea en 1796, pero hoy no lo es. De hecho, todas sus concepciones te\u00f3ricas est\u00e1n descartadas (ver nota al pie: 1) Tampoco suele mostrar eficacia en estudios cl\u00ednicos, aunque no podemos generalizar, ya que hay algunos productos homeop\u00e1ticos cuyos ingredientes activos no vienen en las disoluciones extremas que vimos en el caso del Oscillococcinum y, por lo tanto, no se puede descartar que tengan alg\u00fan efecto. Claro que hay que decir que es improbable, ya que su supuesta eficacia se basa en una idea sin ning\u00fan sustento.<\/p><p>La historia de la ciencia est\u00e1 llena de buenas ideas que el tiempo, el escrutinio p\u00fablico y el advenimiento de otras mejores van diluyendo hasta no dejar ninguna mol\u00e9cula de ellas.<br \/><br \/>---<\/p><p><em>Nota al pie: 1. Alguien podr\u00eda argumentar que las vacunas son precisamente un caso de \u00e9xito de esta idea. No es as\u00ed. Las vacunas usan partes del microrganismo que produce la enfermedad o una versi\u00f3n inactiva de este para entrenar al sistema inmune. Pero no es lo \u00absimilar curando lo similar\u00bb. El virus o bacteria que produce la enfermedad se utilizan para que el sistema inmune pueda reconocer y combatir al pat\u00f3geno invasor cuando se presente en su versi\u00f3n activa.<\/em><\/p>\",\"section_style\":\"\",\"align\":\"\",\"align_tablet\":\"\",\"align_mobile\":\"\",\"text_color\":\"#1a1a1a\",\"typography_typography\":\"custom\",\"typography_font_size\":{\"unit\":\"px\",\"size\":\"18\"},\"typography_font_size_tablet\":{\"unit\":\"px\",\"size\":\"\"},\"typography_font_size_mobile\":{\"unit\":\"px\",\"size\":\"\"},\"typography_font_family\":\"custom\",\"typography_font_family_custom\":\"Fort-Book\",\"typography_font_weight\":\"\",\"typography_text_transform\":\"\",\"typography_font_style\":\"\",\"typography_line_height\":{\"unit\":\"px\",\"size\":\"27\"},\"typography_line_height_tablet\":{\"unit\":\"em\",\"size\":\"\"},\"typography_line_height_mobile\":{\"unit\":\"em\",\"size\":\"\"},\"typography_letter_spacing\":{\"unit\":\"px\",\"size\":\"\"},\"typography_letter_spacing_tablet\":{\"unit\":\"px\",\"size\":\"\"},\"typography_letter_spacing_mobile\":{\"unit\":\"px\",\"size\":\"\"},\"_section_style\":\"\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"58\",\"left\":\"0\",\"isLinked\":false},\"_margin_tablet\":{\"unit\":\"px\",\"top\":\"\",\"right\":\"\",\"bottom\":\"\",\"left\":\"\",\"isLinked\":true},\"_margin_mobile\":{\"unit\":\"px\",\"top\":\"\",\"right\":\"\",\"bottom\":\"\",\"left\":\"\",\"isLinked\":true},\"_padding\":{\"unit\":\"px\",\"top\":\"\",\"right\":\"\",\"bottom\":\"\",\"left\":\"\",\"isLinked\":true},\"_padding_tablet\":{\"unit\":\"px\",\"top\":\"\",\"right\":\"\",\"bottom\":\"\",\"left\":\"\",\"isLinked\":true},\"_padding_mobile\":{\"unit\":\"px\",\"top\":\"\",\"right\":\"\",\"bottom\":\"\",\"left\":\"\",\"isLinked\":true},\"_animation\":\"\",\"animation_duration\":\"\",\"_css_classes\":\"\",\"_section_background\":\"\",\"_background_background\":\"\",\"_background_color\":\"\",\"_background_image\":{\"url\":\"\",\"id\":\"\"},\"_background_position\":\"\",\"_background_attachment\":\"\",\"_background_repeat\":\"\",\"_background_size\":\"\",\"_background_video_link\":\"\",\"_background_video_fallback\":{\"url\":\"\",\"id\":\"\"},\"_border_border\":\"\",\"_border_width\":{\"unit\":\"px\",\"top\":\"\",\"right\":\"\",\"bottom\":\"\",\"left\":\"\",\"isLinked\":true},\"_border_color\":\"\",\"_border_radius\":{\"unit\":\"px\",\"top\":\"\",\"right\":\"\",\"bottom\":\"\",\"left\":\"\",\"isLinked\":true},\"_box_shadow_box_shadow_type\":\"\",\"_box_shadow_box_shadow\":{\"horizontal\":0,\"vertical\":0,\"blur\":10,\"spread\":0,\"inset\":\"\",\"color\":\"rgba(0,0,0,0.5)\"},\"_section_responsive\":\"\",\"responsive_description\":\"\",\"hide_desktop\":\"\",\"hide_tablet\":\"\",\"hide_mobile\":\"\"},\"defaultEditSettings\":[],\"widgetType\":\"text-editor\",\"editSettings\":{}},{\"id\":\"e297o14\",\"elType\":\"widget\",\"isInner\":false,\"settings\":{\"section_editor\":\"\",\"editor\":\"<p class=\\\"MsoNormal\\\"><strong>OTROS\u00a0CONTENIDOS DE INTER\u00c9S:<\/strong><\/p><p><span style=\\\"text-decoration: underline;\\\"><a href=\\\"https:\/\/www.penguinlibros.com\/es\/revista-lengua\/no-ficcion\/siddharta-mukherjee-celulas-depresion\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Una orquesta desafinada: las c\u00e9lulas y el demonio de la depresi\u00f3n<\/a><\/span><\/p><p><span style=\\\"text-decoration: underline;\\\"><a href=\\\"https:\/\/www.penguinlibros.com\/es\/revista-lengua\/no-ficcion\/walter-isaacson-el-codigo-de-la-vida\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Walter Isaacson: gen\u00e9tica, covid y el futuro de la humanidad<\/a><\/span><\/p><p><span style=\\\"text-decoration: underline;\\\"><a href=\\\"https:\/\/www.penguinlibros.com\/es\/revista-lengua\/no-ficcion\/hector-garcia-barnes-futurofobia-sergio-del-molino\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">V\u00edctimas de la \u00abfuturofobia\u00bb: una generaci\u00f3n triste con fotos felices.<\/a><\/span><\/p><p><span style=\\\"text-decoration: underline;\\\"><a href=\\\"https:\/\/www.penguinlibros.com\/es\/revista-lengua\/no-ficcion\/javier-cercas-paradojas-pandemia\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">Javier Cercas: paradojas de la pandemia.<\/a><\/span><\/p><p><a href=\\\"https:\/\/www.penguinlibros.com\/es\/revista-lengua\/fenomenos\/la-peste-vendra-la-muerte-y-tendra-tus-ojos\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\"><span style=\\\"text-decoration: underline;\\\">La peste: vendr\u00e1 la muerte y tendr\u00e1 tus ojos<\/span><\/a><span style=\\\"text-decoration: 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10 minutos
Varias pastillas sobre fondo rosa. Crédito: Getty Images.

Crédito: Getty Images.

En el recuento de autoengaños en la ciencia médica vale la pena referirse a otro tratamiento que se popularizó en el siglo XIX y que nos acompaña hasta nuestros días. Me refiero a la homeopatía. Muy superior a las sangrías, la homeopatía comparte con esa técnica el basar su eficacia en la respuesta placebo, pero difiere de estas en su seguridad y en la simpleza de su administración, en forma de comprimidos o gotas orales. Las píldoras homeopáticas suelen ser muy seguras, ya que su composición es casi idéntica a la de nuestro Neuritax, esto es, 100 % azúcar. Dado que la homeopatía es un tratamiento muy popular, quisiera detenerme un poco en él. Quizás muchos lectores lo utilizan y por eso quisiera apelar a su instinto científico y explicar en detalle por qué digo que es ineficaz. Emplear tratamientos ineficaces es una cosa personal; no lo juzgo. De hecho, cada vez que me duela un poco el estómago, yo jamás abandonaré la tradición de acudir a un contundente plato de la sopa de mi madre.

La homeopatía nace de una buena idea. Al menos era buena en 1796, cuando fue concebida por el médico alemán Samuel Hahnemann. La idea era que «lo similar cura lo similar», es decir, si una sustancia provoca un síntoma, esta misma sustancia tiene el poder de curar las dolencias que lo provocan. Eran tiempos en que prevalecían ideas no menos exóticas e infundadas sobre las causas de las enfermedades: la teoría de los humores; la teoría miasmática, que decía que las enfermedades se transmitían a través de «miasmas», vapores tóxicos que emanaban de la tierra o de sustancias en descomposición. De este modo, la homeopatía era una idea tan buena como cualquier otra, al menos hasta fines del siglo xix, cuando se comienza a aceptar la teoría microbiana de la enfermedad a partir de los trabajos de varios científicos, particularmente Louis Pasteur y posteriormente Robert Koch, colocando así la primera piedra que sostiene la medicina moderna. Esta teoría afirma que un gran número de enfermedades es provocado por organismos microscópicos y que se contagian de una persona contaminada a otra sana.

Por supuesto, la homeopatía no pretende causar síntomas, sino, por el contrario, calmarlos. En consecuencia, la sustancia que provoca estos síntomas se administra de manera particular: se diluye. Se diluye tanto que en oportunidades no queda ni una sola molécula del producto inicial. Veamos un ejemplo, para que usted juzgue. Tomemos un producto homeopático popular que se puede conseguir fácilmente en cualquier farmacia, digamos, el Oscillococcinum, que se vende como antigripal en pequeños comprimidos. ¿De qué están hechos? Según la caja, cada 100 g, contiene 100 g de sucrosa y lactosa (azúcares). Parece que no quedara ya más espacio, pero cada glóbulo está impregnado en 1 ml de una solución de «extracto de corazón e hígado de pato anaes barbarie 200 CK», la sustancia supuestamente activa. Podríamos discutir si estas vísceras de ave pueden o no producir o aliviar los síntomas de la gripe. El instinto científico, como mínimo, debiese poner en alerta máxima el escepticismo. Pero la discusión es innecesaria cuando reparamos en el número que sigue al ingrediente: 200 CK. En este reside la esencia de la homeopatía: la dilución. Ese número indica el número de veces que el homeópata diluye en agua pura la sustancia inicial en un factor 100 (de allí la letra C después del 200). En este caso, el procedimiento ocurre 200 veces. Esto significa que la solución final tendrá una concentración de una parte en 10 elevado a 400, es decir, una vez en:

10.000.000.000.000.000.000.000.000.000.000.000.000.000.

000.000.000.000.000.000.000.000.000.000.000.000.000.000.

000.000.000.000.000.000.000.000.000.000.000.000.000.000.

000.000.000.000.000.000.000.000.000.000.000.000.000.000.

000.000.000.000.000.000.000.000.000.000.000.000.000.000.

000.000.000.000.000.000.000.000.000.000.000.000.000.000.

000.000.000.000.000.000.000.000.000.000.000.000.000.000.

000.000.000.000.000.000.000.000.000.000.000.000.000.000.

000.000.000.000.000.000.000.000.000.000.000.000.000.000.

000.000.000.000.000.000.000.000.

Para que se den cuenta de lo inconmensurable de este número, en 1 ml de agua, es decir, en la pequeña gota con que impregnan cada glóbulo, solo hay unas 10 elevado a 22 moléculas de agua. Para tener alguna probabilidad de encontrar una sola molécula de la sustancia inicial en esta dilución, debemos juntar un volumen tan grande que no cabe en el universo observable. En resumen, las píldoras de Oscillococcinum, como nuestro Neuritax, no contienen más que azúcar. Por supuesto, el homeópata tiene una respuesta a esto. Nos dirá que la base teórica de la homeopatía alude a la «memoria del agua». Es decir, a pesar de que no hay vestigio alguno del hígado y corazón de pato en el medicamento, el agua en que fue impregnado es capaz de recordar el contacto que alguna vez tuvo con la sustancia activa. ¿Hay alguna razón para creer que esto es cierto? Ninguna. La fisicoquímica del agua se ha estudiado por siglos. Hoy los cálculos teóricos pueden explicar con delicioso detalle cada una de sus espectaculares propiedades. No hay teoría ni experimento que dé cuenta de memoria alguna. En resumen, y para poner a prueba nuestro instinto científico: primero, tenemos una teoría «lo similar cura lo similar», que no solo no tiene asidero alguno, sino que, además, es incompatible con los avances de las ciencias médicas que se desarrollaron en los siglos siguientes. Segundo, tenemos un principio activo —hígado y corazón de pato— que no parece ni provocar ni prevenir los síntomas de la gripe. Tercero, ese principio activo está tan disuelto en agua que es más probable encontrar una molécula proveniente de un hígado de pato en el agua del grifo de su casa que en el líquido en que se impregnan estos glóbulos homeopáticos. Cuarto, no hay evidencia de que el agua recuerde nada, y hablamos de una sustancia que ha sido detalladamente estudiada desde todos sus ángulos. 

El procedimiento homeopático, convengamos, no parece muy convincente. Esa intuición de que algo no resulta del todo lógico, de que el argumento es débil, incoherente, es la primera defensa del pensamiento crítico, del instinto científico. Ahora bien, alguien podría, con razón, contradecir mi escepticismo teórico, afirmando que, por muy extraño que todo esto parezca, las píldoras funcionan. Afortunadamente, esa afirmación es fácil de poner a prueba. Veamos cómo. 

Para verificar la eficacia de un medicamento debemos tener en cuenta todos los posibles autoengaños. Evitarlos a la luz de las trampas cognitivas que el pasado nos ha revelado. Fue el médico norteamericano Henry Beecher quien en 1955 encendió todas las alarmas de la investigación médica en su artículo «The powerful placebo» «el poderoso placebo» en 1955 (Beecher, 1955). A pesar de los varios errores estadísticos que hoy se sabe que este artículo contiene, su influencia fue tremenda. Puso todas las luces sobre los fallos que se estaban cometiendo al evaluar los efectos de un tratamiento, particularmente sobre la importancia de la respuesta placebo. Fue el comienzo de un nuevo estándar en la realización de ensayos clínicos. Hoy se exige que estos estudios sean aleatorizados, doble ciegos y controlados con placebo. Paso a explicar estos términos usando el ejemplo de nuestros glóbulos homeopáticos. 

Para verificar si el Oscillococcinum es efectivo para combatir los síntomas de la gripe, debemos partir, por supuesto, con un grupo de personas con gripe y observar el efecto que el medicamento tiene sobre el desarrollo de la enfermedad. Sabemos que la inmensa mayoría de nuestros voluntarios se recuperarán con o sin tratamiento; después de todo, es solo una gripe. Por lo tanto, debemos tener también un «grupo de control». Este es otro grupo de agripados, a los que en lugar del Oscillococcinum se les administrará un placebo. El placebo debe tener idéntica apariencia, venir en idéntico envase y ser recetado en las mismas condiciones que a quienes se les entregó el medicamento en estudio. Es claro que la eficacia de cualquier medicamento solo podrá ser validada si aquellos que lo recibieron tienen, estadísticamente, una mejoría más rápida que aquellos que recibieron el placebo. A esto nos referimos cuando decimos que el estudio es «controlado por placebo».

Varias pastillas sobre fondo rosa. Crédito: Getty Images.

Crédito: Getty Images.

Hay que tener algunos cuidados, sin embargo, con el conjunto de voluntarios. Primero, debe ser una muestra representativa. Si queremos validar el uso de un medicamento, digamos, en todo Chile, no podemos usar solo pacientes hombres que vivan en Antofagasta. La muestra debe ser representativa, considerar todos los sexos, regiones geográficas, niveles socioeconómicos, etc. 

Pero más importante aún, la división de los voluntarios en dos grupos se debe realizar en forma aleatoria. Solo así podremos argumentar que cualquier distinción en el desarrollo de la enfermedad entre los grupos se debe a los distintos tratamientos y no, por ejemplo, a una diferencia en sus hábitos alimenticios o en el clima de la región en donde residen. A todo esto nos referimos cuando decimos que el estudio es «aleatorizado». 

Finalmente, «doble ciego» significa que ni los pacientes en el estudio ni los científicos que les entregaron sus píldoras saben a qué grupo pertenece cada uno. La idea es que los voluntarios no tengan ninguna sospecha de qué es lo que están tomando. Ahora bien, ¿por qué tampoco el médico tratante puede saberlo? Porque el lenguaje corporal es tremendamente poderoso y es muy fácil que inconscientemente exista una comunicación entre las dos partes que permita al paciente obtener alguna pista. Una historia muy notable que evidencia este poder de la comunicación corporal inconsciente y nos alerta sobre el cuidado que debemos tener al hacer observaciones en las que pueda darse, es la de Hans el listo. 

Hans el listo era un caballo que a comienzos del siglo xx, en Berlín, impresionaba a sus audiencias haciendo operaciones matemáticas, identificando al autor de piezas musicales, contando el número de personas en una audiencia o leyendo la hora en un reloj (Samhita y Gross, 2013). Hans había sido entrenado cuatro años por el profesor de matemáticas Wilhelm von Osten, quien se ganaba la vida presentándolo al público por toda Alemania. En cada espectáculo, el caballo respondía las preguntas numéricas golpeando sus pezuñas en el suelo un número de veces. Para responder texto, Von Osten asignaba a cada letra un número y exhibía las reglas en una pizarra. La precisión del caballo en sus respuestas era tan alta que la fama de Hans y de su entrenador crecieron rápidamente, tanto en Alemania como en todo el mundo. Fue tan grande el revuelo que en 1904 el Consejo de Educación alemán creó una comisión para averiguar qué era lo que realmente estaba ocurriendo en este increíble acto. Solo tres años más tarde, el fenómeno pudo ser explicado por el biólogo y psicólogo Oskar Pfungst. No había ningún truco. De hecho, Von Osten estaba convencido de que su caballo era inteligente y capaz de razonar, conocer y calcular. Hans no era capaz de nada de eso, solo era extremadamente sensible al lenguaje corporal de su entrenador. Supongamos que al caballo se le presentaba la suma 2 + 1. Inmediatamente, comenzaría a golpetear el suelo con su pezuña. Una vez, dos veces... Cuando llegaba a la tercera, la respuesta correcta, la postura o el gesto facial de Von Osten le decían al caballo que ese golpe debía ser el último si es que quería obtener una recompensa. Era tan espectacularmente sutil la capacidad del caballo para reconocer estas pistas, que no solo las captaba de su entrenador. Otras personas también podían hacerle preguntas que contestaba correctamente. ¿Cómo sabemos entonces que Hans no era realmente listo? Porque el instinto científico indica que esta no es la predicción más lógica y Pfungst ideó el experimento que lo comprobaba: intentar que el caballo responda una pregunta cuya respuesta desconoce quien se la hace. Por ejemplo, desafiándolo a reconocer una pieza musical que el interrogador nunca escuchó y de la que, por lo tanto, no podrá entregarle pista alguna. Si Hans solo podía responder preguntas cuando la persona que tenía al frente conocía la respuesta, entonces es evidente que esta persona estaba, inconscientemente, entregándosela. 

Este caso extremo de comunicación no verbal entre humano y caballo muestra claramente por qué los estudios clínicos deben ser doble ciegos. Si podemos entregar información no verbal, inconscientemente, a un animal, con mucha mayor probabilidad podemos hacerlo a un ser humano. Por eso, quien entrega el medicamento al paciente podría, sin siquiera darse cuenta, darle pistas sobre lo que realmente hay dentro de cada cápsula, interfiriendo con la respuesta placebo y con todo el experimento. 

Después de este largo desvío podemos volver a la pregunta inicial y responderla con rigor científico. Existen muchos estudios aleatorizados, doble ciegos y controlados por placebo que estudian la eficacia de medicamentos homeopáticos. Porque, aunque para muchos pueda parecer inverosímil, no hay distinción real entre medicina y «medicina alternativa». Sin importar las opiniones, el sentido común o las preferencias teóricas, cualquier tratamiento seguro y eficaz es medicina. La curiosidad humana, la urgencia por la salud y la cantidad de científicos en el mundo hacen que se pongan a prueba hasta los tratamientos más inverosímiles. El Oscillococcinum no es una excepción y la respuesta es que no existe evidencia alguna que respalde que estos glóbulos de azúcar, impregnados en una solución ultradiluida de corazón e hígado de pato, sean más efectivos que el placebo para tratar la gripe (Mathie, 2015). 

La homeopatía puede haber sido una buena idea en 1796, pero hoy no lo es. De hecho, todas sus concepciones teóricas están descartadas (ver nota al pie: 1) Tampoco suele mostrar eficacia en estudios clínicos, aunque no podemos generalizar, ya que hay algunos productos homeopáticos cuyos ingredientes activos no vienen en las disoluciones extremas que vimos en el caso del Oscillococcinum y, por lo tanto, no se puede descartar que tengan algún efecto. Claro que hay que decir que es improbable, ya que su supuesta eficacia se basa en una idea sin ningún sustento.

La historia de la ciencia está llena de buenas ideas que el tiempo, el escrutinio público y el advenimiento de otras mejores van diluyendo hasta no dejar ninguna molécula de ellas.

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Nota al pie: 1. Alguien podría argumentar que las vacunas son precisamente un caso de éxito de esta idea. No es así. Las vacunas usan partes del microrganismo que produce la enfermedad o una versión inactiva de este para entrenar al sistema inmune. Pero no es lo «similar curando lo similar». El virus o bacteria que produce la enfermedad se utilizan para que el sistema inmune pueda reconocer y combatir al patógeno invasor cuando se presente en su versión activa.

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