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Do Reference Standards Hold Back the Progress of Medicine?
- Yvo M. Smulders, MD; and
- Abel Thijs, MD
- From VU University Medical Center, 1007MB Amsterdam, the Netherlands.
TO THE EDITOR:
We read with interest the article by Glasziou and colleagues (1) addressing criteria for new diagnostic tests to become reference standards for specific diseases. We believe the emphasis in the evaluation of new tests should not be on how to incorporate them in the existing diagnostic framework, but on their potential to alter disease classification, in particular severity grading and taxonomy. The term “reference (gold) standard” distracts from these opportunities and should be avoided.
A new test can alter diagnosis in 3 ways. First, a new test might diagnose exactly the same disease with better accuracy, in which case, it qualifies as a new reference test. Second, a new test may detect the disease in …
