{"id":36345,"date":"2016-03-16T12:39:19","date_gmt":"2016-03-16T11:39:19","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=36345"},"modified":"2016-03-16T12:39:19","modified_gmt":"2016-03-16T11:39:19","slug":"time-to-come-off-the-gold-standard","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/03\/16\/time-to-come-off-the-gold-standard\/","title":{"rendered":"Neville Goodman’s Metaphor Watch: Time to come off the gold standard"},"content":{"rendered":"

\"neville_goodman\"<\/a>This blog started with epidemic proportions<\/em>. There are nearly 1800 PubMed articles written in English that have epidemic proportions<\/em> in the title or abstract. Of the other metaphors I\u2019ve dealt with, some are more common and some are less: there are 5000 drawback<\/em>s, 900 Holy Grails<\/em>, 100 red herrings<\/em>. But these pale before the gold standard<\/em>: there are over 36 000. From its first appearance in 1979\u2014interesting given that most countries came off the gold standard in the 1930s and the United States in 1971\u2014its popularity just keeps on rising.<\/p>\n

There were 671 gold standards in the year 2000; there were over 2000 in 2010, which was 0.35% of all articles published that year. By 2015 it was 0.45%.<\/p>\n

The gold standard was a monetary instrument, by which the value of a country\u2019s currency was defined by an existing and fixed amount of gold. By extension, the expression came to mean a \u201cwell established and widely accepted model or paradigm of excellence by which similar things are judged or measured.\u201d This definition is taken from The Free Dictionary by Farlex (http:\/\/www.thefreedictionary.com<\/a>), which has tabs allowing the same word or expression to be sought in a dictionary, thesaurus, or in specialised dictionaries, including a medical dictionary and a dictionary of idioms. So what is wrong with writing gold standard<\/em>, if it is such a well established paradigm of excellence?<\/p>\n

The Free Dictionary takes its definitions from (and credits) other dictionaries: its medical dictionary uses Farlex Partner, Mosby\u2019s, Segen\u2019s, and McGraw-Hill, which all give some variation of paradigm of excellence; but the Medical Dictionary for the Health Professions and Nursing<\/em> (\u00a9 Farlex 2012) nails it: \u201cjargonistic term meaning ideal or basic measurement; usage best avoided.\u201d So best avoided\u2014in my view\u2014that gold standard<\/em>, much like the business metaphors decried in my previous blog<\/a>\u00a0should never be used.<\/p>\n

A quick scan of the many examples in PubMed soon shows that many of the gold standards are nowhere near. I found one article in which a new test was being compared with a gold standard that consisted of either one test or a different test. That is nonsense: the whole point of the gold standard was that gold was immutable gold (although even by its own definition the standard failed because the value of gold turned out not to be immutable).<\/p>\n

The inappropriateness of the expression is inherent in its definition, \u201cAny standardised clinical assessment, method, procedure, intervention, or measurement of known validity and reliability, which is generally taken to be the best available, against which new tests or results and protocols are compared.\u201d But if the new tests or protocols are better, they become the gold standard\u2014except that not everyone will necessarily agree.<\/p>\n

The gold standard<\/em> in medicine is a criterion standard<\/em>; it is a standard against which a criterion is measured. If what you mean is the best method then write \u201cbest method.\u201d<\/p>\n

\u201cAutogenous tissue is the gold standard for grafting materials\u201d: no\u2014autogenous tissue is the best grafting material.<\/p>\n

\u201cHowever, no intervention was identified as a gold standard\u201d: no\u2014no intervention was ideal.<\/p>\n

\u201c . . . still acknowledged to be the gold-standard therapy for benign prostatic hyperplasia\u201d: no\u2014still acknowledged to be the best therapy for benign prostatic hyperplasia.<\/p>\n

For more advice on the gold standard, see:<\/p>\n