All that glisters is not gold

The “gold standard” is a pervasive metaphor in health research. Whether it is an argument about establishing a standard for quality of care or a debate about the relative merits of diagnostic investigations, the term is universally used to describe the best care, the best test, or the most certain medical knowledge. A Medline search on the phrase produces 7891 results.

But is it a good metaphor? The gold standard refers to …