Gold standard is a made-up term borrowed from the world of finance.1 Of the many articles submitted to the Journal of Neuroscience Nursing every month, at least one will use the term "gold standard" to describe an intervention, test, or treatment regimen. Over time, we have created many different definitions to support this misdirected phrase. Unfortunately, the definitions themselves vary by author and use. The definitions used to define the term amount to little more than agreed-upon lies.2 To put it bluntly, there is no gold standard. Or at least, there is currently not a gold standard, and even when there was a gold standard, that standard was different than the standard several years prior.
Gold has been used as currency in the form of coins for more than 2000 years. However, because not all coins were of the same size and shape, they contained different amounts of gold. Rulers throughout history have created many different standards governing gold exchange. Queen Anne's Standard, the American Eagle, the German Mark, Guinea, and the British Gold Sovereign are among the many standards for gold at some time in the past 350 years. As regards gold as a precious metal, numerous countries have accepted and abandoned many different gold standards over the centuries. In the United States, the use of a gold standard was abandoned in 1971; as of 2020, there are no major countries that use a gold standard.3
A standard is something with adequate quality of correctness such that some agency designates it as a comparative measure.1 We measure things against a standard. In healthcare, I interpret a standard as follows: "[horizontal ellipsis]this is what we're doing today because the evidence supports that it is currently the best practice." When I read that an intervention, test, or treatment regimen is the gold standard, I question the assumption. Conceptually, we think of the gold standard as something that has stood the test of time and research.
Gold standard in healthcare is a relatively recent term. I found zero articles published in PubMed before 1979 citing a gold standard. I found roughly 8000 in 2021, at least 45 of which propose new gold standards. Wondering how a standard becomes gold, I dug deeper. Authors enjoy using adjectives and "gold" is an attractive adjective. Gold is associated with best (eg, winning a gold medal) and enduring (gold is an element; it does not decay). The author gets to choose the adjective and may designate anything as a gold standard, a silver standard, or even an adamantium standard.
Linking "gold" to "standard" is flawed. Testing a standard provides new evidence that will either support or refute that standard. Science thrives on the concept that we accept something as standard only until the evidence against that standard is so overwhelming that we must reject the null hypothesis and accept the alternative. Science embraces the concept that what we accept today will change when we have sufficient new evidence. If a standard is truly gold, it can never change. If science were not open to changing standards of care, we would still endorse bloodletting and nutritional enemas.
Neuroscience nurses should not be timid when questioning practice. There are neither vibranium standards nor gold standards. Scientists want you to test their conclusions, and the Journal of Neuroscience Nursing wants to publish your results.
D.M.O. declares that he is the Editor of the Journal of Neuroscience Nursing.
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