Tuesday, March 3, 2009

The Gold Standard

Introduction: Ask the experts at TheBody.com!

Gold Standard
Aug 4, 2001

Hey Doc,

Why is there no Gold Standard when testing for the presence of HIV? Instead of looking for antibodies thought to be exclusive to HIV, wouldn't it be better to isolate actual virus in a suspected HIV+ person?

Why are the standards of testing and diagnosis different in most countries to that of the US? If I test positive in the US, I may not test postive in let's say Canada or the UK. Don't you think that's odd?

Are the tests standard in most countries for diseases like, let's say, Chicken Pox or Hepatitis?

Response from Dr. Holodniy

I cannot answer why testing is not standardized.

It surprises me again and again how the defenders of the HIV/AIDS theory fail to understand the simple logic of the gold standard problem and respond properly with reasonable arguments. I'll put this as clearly as I can right now:

* Think about it like the gold standard used for pregnancy tests: The development of an embryo/baby, the state of pregnancy.

* Pregnancy is the gold standard for the pregnancy tests, to put it simply. So you can verify the quality of a pregnancy test by checking whether or not the women who test positive are pregnant, and those who test negative are not. This can easily be controlled by following the women and examining which give birth/have a miscarriage etc. and which women live normally without any biological activities related to pregnancy. [like hcG production levels, which is used as a basis for pregnancy tests] For example experience shows that sonograms like this are very strong evidence for pregnancy, unlikely to be a false positive: http://en.wikipedia.org/wiki/File:Embryo_at_14_weeks_profile.JPG

* Similarly, in order to verify the quality of the HIV test you have to check whether or not the person who tests positive really has a virus in his/her blood. That's what's missing and it is a huge problem. Literally, nobody ever purified HIV directly from a so called "AIDS patient" and compared the real presence of a virus to the test results.

That's it!

That's the most fundamental thing scientists should've been paying attention to since 1984, yet to this day they're either unaware of this problem or they pretend/claim that it's not a problem without giving any rational reason. The process the virologists refer to as "isolation" is scientifically not sufficient to claim that a virus is present.


UPDATE (March 20, 2009 - after comment no 5):

I noticed that some people still have a hard time grasping all this. I'll directly quote from Wikipedia now:

In medicine, gold standard test refers to a diagnostic test or benchmark that is regarded as definitive. This can refer to diagnosing a disease process, or the criteria by which scientific evidence is evaluated. For example, in resuscitation research, the "gold standard" test of a medication or procedure is whether or not it leads to an increase in the number of neurologically intact survivors that walk out of the hospital.[1] Other types of medical research might regard a significant decrease in 30-day mortality as the gold standard.


A hypothetical ideal "gold standard" test has a sensitivity, or statistical power, of 100% (it identifies all individuals with a disease process; it does not have any false-negative results) and a specificity of 100% (it does not falsely identify someone with a condition that does not have the condition; it does not have any false-positive results). In practice, there are no ideal "gold standard" tests.

Because tests can be incorrect (either a false-negative or a false-positive result), results should be interpreted in the context of the history, physical findings, and other test results in the individual that is being tested. It is within this context that the sensitivity and specificity of the "gold standard" test is determined.

Sometimes it takes a lot of effort for people to be able to stretch their awareness a bit. Here's another definition:

gold standard,

1 an accepted test that is assumed to be able to determine the true disease state of a patient regardless of positive or negative test findings or sensitivities or specificities of other diagnostic tests used.

2 an acknowledged measure of comparison of the superior effectiveness or value of a particular medication or other therapy as compared with that of other drugs or treatments.

Getting clearer now? Is there "an accepted test that is assumed to be able to determine the true disease state of a patient regardless of positive or negative test findings or sensitivities or specificities of other diagnostic tests used" for the so called "HIV" ? Like perhaps EMs of the purified virus?

UPDATE (May 12th): This is quite relevant. Darin Brown takes a critical look at the usage and the perception of the term "gold standard":
...By its very nature, a “gold standard” is a decision procedure which can actually be implemented to produce a binary result (yes/no). The only way a “gold standard” can be “hypothetical” or “ideal” is if it represents some figurative, imaginative, or ill-formed impression of a pathological state in the mind of the clinician...

He is right and he makes important points. Read his entire comment if you care about the topic. I don't know how I can implement his arguments into the above text just yet. Plus I don't have time.

More yet again:


jtdeshong said...

You really should delete this and start over!!
It really makes you look stupid!!
Gold Standard for pregnancy is when the baby pops out?? Is that really your logic???
Then when EJ died and tested positive for HIV in her brain, CM should have realized her big mistake!!
Baby = pregnancy
Death = AIDS
There, all is solved. Now you can stop spreadiing your ignorance!!

jtdeshong said...

If you really don't believe that Kochs's Postulate has been fulfilled, go to Quackwatch and they have an excellent article complete with a ton of papers to back up everything.
P.S. Many Scientists believe that Western Blot is the gold standard for HIV.
However, PCR is fast becoming the gold standard.
With PCR, no one in their right mind should claim HIV does not exist!!

sadunkal said...

You're a strange "HIV positive" Todd, in fact considering your past deceit attempts, I doubt that's even true right now. But if we assume that it really is true, you said:

"Death = AIDS"

Do you really live with that thought in your mind all day long? Is that how you perceive your own life? That sounds worrying. Perhaps this might help you free yourself: A Positive Life: Damaries Cruz

If you disagree with the logic above, then let's discuss it in detail. How, you believe, were the pregnancy tests verified? Why do we think that they're somewhat reliable?

I think it's because we can verify the results by comparing the positive/negative results with real life observations. Through things like this for example: HCG is a glycoprotein hormone produced in pregnancy

What's your take?

jtdeshong said...

You need to get a sense of humor.
The "AIDS=Death" comment was a shot at your "logic" of the pregnancy test: i.e. Poz Preg Test=Birth, The Poz HIV Test=Death!
No, I do not think about death all day. As a matter of fact, from the minute I got the HIV diagnosis, I knew something other than HIV was going to kill me.
As I have written elsewhere in contrast to your friends who claim HIV Drugs are sooooooo toxic that people just vomit and shit themselves all day, I have countered with my own personal experience of taking HIV meds for 14 years with almost zero side effects.
You need to learn that the Re-Thinkers are the ones putting the spin on all of this.
Where have you ever read that an "orthodox" scientist says the HIV drugs are a bed of roses?
No where!! Even the mfg states ALL the potential side effects.
Come on, give us back the old Sudankal who had an open mind. Remember him?

sadunkal said...

I don't really disagree too much with your last comment. But I don't really get your critique about this blog post either.

It is true that I simplified a bit what pregnancy is about, so that I can communicate the logic more clearly. Is that what disturbed you? The logic is still there even if you ignore the "baby" and just focus on the HCG levels as I mentioned in my last comment. But you still have to establish a connection with the HCG levels and the baby before you do that. That's what the gold standard is about. The pregnancy test is about the baby in the end.

jtdeshong said...

Yes, you more than simplified the pregnancy test.
Think about it. According to you, if a woman gets a positive pregnancy, HcG test, she has to wait until she has the kid before she truly knows if her belly is growing because of a baby and not a tumor, or hey, even gas!! (BTW, The Learning Channel has a new show coming out all about women who did not know they were pregnant until they gave birth!! NO KIDDING!!...now that's my kind of TV show!!) Anyway, so if the woman has to wait so long before she is certain she is pregnant, then she has missed her OB/GYN appointments, has had no pre-natal vitamins, and has been smoking and drinking every weekend! And then she has a retarded child that is no longer called "Down's Syndrome" but becomes a well noted HIV/AIDS Denialist! SORRY, Kidding!
Anyway, do you see why yours is not a Gold Standard preg test? Did you know that even men can test positive on HcG tests due to hydatid moles and even prostate issues!!??
The Term Gold Standard is basically an old term that is used more in conjunction with older style chemistry tests with bunsen burners, and erlhynmeyer flasks and boiling chips!! These were very slow, methodical tests which would take hours and lots of tech time. They usually had a great reproducibility IF done correctly and they gave great percentage yield of product. However, the reproducibility was completely contingent upon accurate tech work. Now, tests have come so far and are so diverse, that the "gold standard" for many of them are still BASED on the old methods. However, many machines now use such advanced methods, there is not an old method to base them on. Just look at PCR. Or Flow Cytometry. Especially flow is being used in increasing applications. You would probably be blown away by how flow cytometry works. Look up Flow Cytometry and Clusters of Differentiation, and you might have a better understanding of just how far these tests have come with speed, specificity and sensitivity.

sadunkal said...

You ridiculous comment shows that you still won't get it, and I find that a little sad since it's really not that complicated. I guess you're just too biased. What you're missing is that we're talking about how to design the tests. It's not the woman's job to use the gold standard, the gold standard has already been taken into consideration during the design process of the tests. The gold standard is only necessary for that process. It's not something you rely on each time you want to test for something. You just need it to understand the quality of the test you're going to use independently from the gold standard after that, but you have to compare your test with the gold standard before you declare that it works.

How do you believe that the tests were designed?

Think about it...

jtdeshong said...

No, Sadunkal, my comment shows that I know and understand the science. I may have made it too simple, and perhaps used my sense of humor, which you have already demonstrated you are entirely lacking!
Really, Sadunkal, what this exchange shows it your very real misuderstanding of even basic science concepts. It is extremely frustrating for those of us who do "get it" from literally years of study, to read crazy crap like this.
So how about just do us all a favor and try to act a little less arrogant and acquiesce to those of us who do know!!
Thanks for playing!

sadunkal said...

Once again:

How do you believe that the pregnancy tests were designed?

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