The Advent of Precision Medicine

By Gary Sojka

The advent of precision medicine is the direct result of the ability to sequence the human genome and identify significant alterations is specific genes. We are beginning to see physicians look at some of their patients as unique individuals rather than members of a class—for example, “all white males over the age of 60 with a total cholesterol level over 250,” or “women of reproductive age who have relatives who have exhibited breast cancer.” Because such precision is now possible, it is reasonable to believe that an increasing number of maladies will succumb to procedures designed precisely for the afflicted individual. It should also be possible to provide some patients with the peace of mind that comes from knowing that they have a very low probability of exhibiting the symptoms or passing on the causative agent of a given disease condition.

Imagine the boon to society, and to individuals, if psychometrics could develop analytical methods akin to DNA sequencing. For decades investigators have been developing various “instruments” to “probe” cognitive ability and innate neural processes that result in the complex property know as personality. Even though such sweeping achievements may be far in the future, it may now be possible to be reasonably sanguine about the abilities of investigators to measure more precisely certain tendencies or mind sets that that can have profound impact on an individual likelihood to be successful at a given set of tasks or adjust successfully to a specific environment or set of career options.

Psychometrics has certainly evolved as a field to the extent that virtually everyone who has progressed through an educational system, joined a particular company, entered the military or sought career counseling has been the subject of a psychometric test or battery of testing instruments. The widely-used Myers/Briggs test has been in service for over 60 years and it has purported be able to “map” individuals to a specific place on a quadrant of broadly-described personality types. Even though it suffers from low test-to-test consistency and appears to have only limited predictive capacity, it has been the “gold standard” for such testing for decades.

More recently, investigators and research teams have been developing instruments designed to identify and evaluate more restricted and clearly defined aspects of an individual’s personality. One area under intense investigation, not surprisingly, is the entrepreneurial mind set. There have been scientific studies and commercial endeavors aimed at measuring an individual’s tendencies toward entrepreneurial activities, his/her abilities to deal with the rigors of such a career style and even to attempt to predict the likelihood that a given subject will have success as an entrepreneur or an “intrepreneur.”

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The instruments being developed to measure inclinations toward entrepreneurism are of two general types. One utilizes the concept that it is possible to develop common-language descriptors that are often associated with successful entrepreneurs and then test an individual to determine whether or not that person expresses such traits. There are several problems inherent in such testing methods. In the first place, there is no widespread agreement on which common-language traits such as grit, self-confidence, risk-tolerance and resilience uniquely describe those that find success as entrepreneurs. In fact, it is generally accepted that there are different types of successful entrepreneurs that are best described by common-language terms that do not apply to others who have found success as entrepreneurs. Additionally, it is very difficult to design instruments based on common-language traits that are not “transparent” or easily “gamed” by the test taker. In many of those testing methods, a person who wishes to be viewed as an entrepreneur can select answers that he or she can rightly assume will lead to the result wished for by the test taker. Instruction on such tests to “answer honestly” have little effect on an individual bent on achieving a personally beneficial outcome.

The other major approach to measuring entrepreneurial mind-set or entrepreneurial tendencies is based on comparing the answers given by the test subject with those provided by a “standard” group of proven entrepreneurs. In such tests, a control group of non-entrepreneurial types is also usually included in an effort to see which questions differentiate entrepreneurs from the control group. The evaluation of the subject is then based on those questions that best separate the standard from the controls.

This approach to evaluation of a subject’s abilities, tendencies or mind-set have the advantage that if the questions used are sufficiently open-ended or provide a variety of plausible answers, it can be almost impossible for a subject to “game” the test by supplying answers that he/she feels will provide the wished-for result.

One group, Entremetric, even includes a neurocognitive component based on an implicit assumption test to determine whether the subject’s reactions better match the standard group of entrepreneurs or the control group of non-entrepreneurs.

Given the intense activity in this field it is reasonable to predict that in the not-too-distant future there may be instruments and probes that may do for psychometrics what DNA sequencing has done for internal medicine. Such an advance would be a boon to those seeking a career, or evaluating others with regard to educational opportunities or the receipt of financial support.