Inspired by the Olympic Games, where the best athlete wins the gold medal, people who use “golden standard” think the term denotes the best standard in the world. Not bronze, not silver, but gold. Of course, this is incorrect.
Gold standard is a historical term borrowed from economists. It signifies a monetary standard, under which the basic unit of currency was defined by a stated quantity of gold. The analogy should be clear: the value of each country's method of payment (currency) was weighed against the gold standard, which made it possible to compare these different currencies for international trading.
In a Medline search from 1955 onwards, the first emergence of the term—albeit in a different meaning—was in 1962, in an anonymous commentary in the Lancet. Entitled “Towards a gold standard,” it pleaded to set a standard for the use of gold salts in patients with rheumatoid arthritis. It may well have been Rudd who first introduced the “gold standard” in medicine in its current sense in 1979.
In the following years, the number of publications that employed the term grew rapidly. This was much to the dismay of one biochemist, who thought the term was “presumptuous” for a biological test, since “the subject is in perpetual evolution [and] gold standards are by definition never reached.” He proposed abolishing the term “because the phrase smacks of dogma. After all, the financiers gave up on the idea of a gold standard decades ago.” He failed in his mission, however: since 1995, over 10 000 publications mentioned “gold standard.”
So why is there also a “golden standard,” a term used in over 600 publications since 1995 in English and in many more in foreign languages? I think this is because it is tempting to interpret the word “gold” in gold standard as an adjective, as in gold medal, and then to replace it with “golden,” which simply sounds better if English is not your first language. In addition, “golden standard” is a persuasive term that makes sense: if a standard is the one test by which all others are judged, then the golden standard must be perfect.
Herein lies, I think, the importance of this discussion. The concept of a “golden standard” implies a level of perfection that can never be attained by any biological test, and will provoke criticism like that ventilated by Duggan. In contrast, a gold standard in its true meaning, derived from the monetary gold standard, merely denotes the best tool available at that time to compare different measures. Even in its glory days, the monetary gold standard was never considered perfect. It was subject to endless debate, and in the end it was abandoned for a better system. Similarly, today's gold standard tests will be replaced by better ones. As was eloquently stated by Versi: “It is the absolute truth that is never reached; gold standards are constantly challenged and superseded when appropriate.”