The Lancet: The history and fate of the gold standard

open access

.....The past several years have seen increasing calls for an ecumenical approach to clinical research, with more flexible standards for what counts as acceptable study designs. Physicians have developed new methods to extract robust analyses from patient registries and from the ever-growing databases provided by electronic medical records. Will this erode the status of RCTs as a gold standard? The rise of personalised medicine, meanwhile, might make it more difficult to defend gold standards in diagnostic and therapeutic practice. Personalised medicine refocuses clinical attention away from the “typical” patients analysed by RCTs and onto the idiosyncrasies, genetic or otherwise, of individual patients. Has the phrase outlived its usefulness in medicine? It is too soon to tell. Yet even as some physicians turn away from their commitment to medical gold standards, some politicians, newly wary about global financial turbulence, talk of restoring the financial gold standard. Gold standards, whether actual or figurative, represent structures of exchange and aspirations toward stability, despite developments that threaten both.