Dr. Saul Ruvalcaba, MD.
For those of TL;DR (Too Long; Didn’t Read) disposition allow me to save you some scrolling by offering a summary here. This post is in reference to the HuffPost piece entitled “Salivary Testing for Hormone Levels: Good Idea or Not?” and can be broken down into the following points.
1. This review is based on the authors structure and use of facts, not her opinions.
2. A Gold Standard is a test which is available, accurate and long standing.
3. The perceived lack of accuracy is refuted by her own references.
4. Undocumented personal testimonials are invalid evidence in current
5. The recommendation is contradictory in nature.
This leaves us discussing an article made up of 1 fact, 1 argument refuted by the writers’ own references, a convenient story, and an unclear recommendation. As such the reviewed article is inaccurate in its reasoning and offers a contradictory recommendation.
The biggest failing of medicine today is the inability of doctors to provide a clear explanation and functional advice on the topic of our patients’ interest. I’m not saying this process is easy, but I am disappointed at the casual attitude displayed by the medical establishment when regarding communication. This attitude is even more confusing considering patient autonomy reigns supreme in todays’ medical philosophy. How does a person choose what is best for themselves, if they don’t understand the choice, its consequences, and the pros and cons of alternative options? The HuffPost piece is an excellent example of this common failing in practice today. The author gives a recommendation after stating an undefined fact, an inaccurate argument and convenient testimonials. I will explain below how the author made her mistakes but am unable to explain the why of it since the author did not include her motives. My motives are available at the end of this post.
In medicine, a Gold Standard is a test which is both: the most accurate and best available. This of course is an ideal definition, in practice a Gold Standard is also a test which has been around for a long time. “Been around for a long time” is what concerns us here. Salivary testing is new when you consider how long serum testing has been around. However, in terms of accuracy (and as a convenient segue to the next point) salivary testing is doing quite well.
In the 80’s, when salivary testing was young, the accuracy of this test was suspect. This is the driving force behind the reasoning of the author’s main claim. To state it clearly the author believes, if you have a test which isn’t exact you can’t rely on it as much as other tests which are more exact. The problem here is the author’s own sources claim salivary testing is accurate. Sources number: 8, 17, and 18 all agree salivary testing is both accurate and useful. This is because salivary testing, and its corresponding technology, has come forward by leaps and bounds in these last 30 years, a point which isn’t addressed by the author.
Furthermore – After stating salivary testing isn’t accurate, the author suggests it be used to determine the severity of disease. Since severity is a measure of how much dysfunction you have, this is when the use of an accurate test makes most sense (i.e. the Gold Standard). This contradiction shows us the senselessness of the recommendation.
Testimonials as Proof
You may notice I don’t spend any time refuting the testimonial, this is because undocumented testimonials are not used much in today’s medicine. As such the testimonial can be completely disregarded.
So where does all this leave us? The original article fails to provide any sound reasoning for its only argument, which casts salivary hormone testing in both an inaccurate and negative light. The sources used by the article actually refute its main argument further showcasing the faultiness of the claim. Finally, the recommendation provided is, as stated, senseless but it is, after all, a recommendation. I wouldn’t follow it but you’re free to make your own decisions.
The analysis I made here is based on the information provided within the referenced article. Feel free to read it and either agree or disagree with me. The only extra source I used was searching for the medical definition of Gold Standard. I did this for the sake of accuracy and not because I was unfamiliar with the term.
“I distrust those people who know so well what God wants them to do, because I notice it always coincides with their own desires.” Susan B. Anthony
When a friend of mine contacted me to write this piece I was hesitant. It made me think of the above quote. So, let me state in no unclear terms my motives behind this piece in their order of importance.
First: I believe in the clear and intelligent explanation of medical ideas.
Second: I’m getting paid.
The explanation and order of my motives should coincide explicitly with the next statement. No incentive is great enough for me to contradict what I understand to be the truth.
Dr. Saul Ruvalcaba earned his MD at the Tec de Monterrey in Nuevo Leon, Mexico. He currently spends his days studying, spoiling his pets and cringing at the current state of medical practice worldwide.