Veridical Data Science for Medical Foundation Models

The advent of foundation models (FMs) such as large language models (LLMs) has led to a cultural shift in data science, both in medicine and beyond. This shift involves moving away from specialized predictive models trained for specific, well-defined domain questions to generalist FMs pre-trained on vast amounts of unstructured data, which can then be adapted to various clinical tasks and questions. As a result, the standard data science workflow in medicine has been fundamentally altered; the foundation model lifecycle (FMLC) now includes distinct upstream and downstream processes, in which computational resources, model and data access, and decision-making power are distributed among multiple stakeholders. At their core, FMs are fundamentally statistical models, and this new workflow challenges the principles of Veridical Data Science (VDS), hindering the rigorous statistical analysis expected in transparent and scientifically reproducible data science practices. We critically examine the medical FMLC in light of the core principles of VDS: predictability, computability, and stability (PCS), and explain how it deviates from the standard data science workflow. Finally, we propose recommendations for a reimagined medical FMLC that expands and refines the PCS principles for VDS including considering the computational and accessibility constraints inherent to FMs.

Generative AI Enables Medical Image Segmentation in Ultra Low-Data Regimes

Semantic segmentation of medical images is pivotal in applications like disease diagnosis and treatment planning. While deep learning has excelled in automating this task, a major hurdle is the need for numerous annotated segmentation masks, which are resource-intensive to produce due to the required expertise and time. This scenario often leads to ultra low-data regimes, where annotated images are extremely limited, posing significant challenges for the generalization of conventional deep learning methods on test images. To address this, we introduce a generative deep learning framework, which uniquely generates high-quality paired segmentation masks and medical images, serving as auxiliary data for training robust models in data-scarce environments. Unlike traditional generative models that treat data generation and segmentation model training as separate processes, our method employs multi-level optimization for end-to-end data generation. This approach allows segmentation performance to directly influence the data generation process, ensuring that the generated data is specifically tailored to enhance the performance of the segmentation model. Our method demonstrated strong generalization performance across 9 diverse medical image segmentation tasks and on 16 datasets, in ultra-low data regimes, spanning various diseases, organs, and imaging modalities. When applied to various segmentation models, it achieved performance improvements of 10-20\% (absolute), in both same-domain and out-of-domain scenarios. Notably, it requires 8 to 20 times less training data than existing methods to achieve comparable results. This advancement significantly improves the feasibility and cost-effectiveness of applying deep learning in medical imaging, particularly in scenarios with limited data availability.

Large Language Models as Co-Pilots for Causal Inference in Medical Studies

The validity of medical studies based on real-world clinical data, such as observational studies, depends on critical assumptions necessary for drawing causal conclusions about medical interventions. Many published studies are flawed because they violate these assumptions and entail biases such as residual confounding, selection bias, and misalignment between treatment and measurement times. Although researchers are aware of these pitfalls, they continue to occur because anticipating and addressing them in the context of a specific study can be challenging without a large, often unwieldy, interdisciplinary team with extensive expertise. To address this expertise gap, we explore the use of large language models (LLMs) as co-pilot tools to assist researchers in identifying study design flaws that undermine the validity of causal inferences. We propose a conceptual framework for LLMs as causal co-pilots that encode domain knowledge across various fields, engaging with researchers in natural language interactions to provide contextualized assistance in study design. We provide illustrative examples of how LLMs can function as causal co-pilots, propose a structured framework for their grounding in existing causal inference frameworks, and highlight the unique challenges and opportunities in adapting LLMs for reliable use in epidemiological research.

Mean-field Chaos Diffusion Models

In this paper, we introduce a new class of score-based generative models (SGMs) designed to handle high-cardinality data distributions by leveraging concepts from mean-field theory. We present mean-field chaos diffusion models (MF-CDMs), which address the curse of dimensionality inherent in high-cardinality data by utilizing the propagation of chaos property of interacting particles. By treating high-cardinality data as a large stochastic system of interacting particles, we develop a novel score-matching method for infinite-dimensional chaotic particle systems and propose an approximation scheme that employs a subdivision strategy for efficient training. Our theoretical and empirical results demonstrate the scalability and effectiveness of MF-CDMs for managing large high-cardinality data structures, such as 3D point clouds.

Prediction-powered Generalization of Causal Inferences

Causal inferences from a randomized controlled trial (RCT) may not pertain to a target population where some effect modifiers have a different distribution. Prior work studies generalizing the results of a trial to a target population with no outcome but covariate data available. We show how the limited size of trials makes generalization a statistically infeasible task, as it requires estimating complex nuisance functions. We develop generalization algorithms that supplement the trial data with a prediction model learned from an additional observational study (OS), without making any assumptions on the OS. We theoretically and empirically show that our methods facilitate better generalization when the OS is high-quality, and remain robust when it is not, and e.g., have unmeasured confounding.

Dr-LLaVA: Visual Instruction Tuning with Symbolic Clinical Grounding

Vision-Language Models (VLM) can support clinicians by analyzing medical images and engaging in natural language interactions to assist in diagnostic and treatment tasks. However, VLMs often exhibit "hallucinogenic" behavior, generating textual outputs not grounded in contextual multimodal information. This challenge is particularly pronounced in the medical domain, where we do not only require VLM outputs to be accurate in single interactions but also to be consistent with clinical reasoning and diagnostic pathways throughout multi-turn conversations. For this purpose, we propose a new alignment algorithm that uses symbolic representations of clinical reasoning to ground VLMs in medical knowledge. These representations are utilized to (i) generate GPT-4-guided visual instruction tuning data at scale, simulating clinician-VLM conversations with demonstrations of clinical reasoning, and (ii) create an automatic reward function that evaluates the clinical validity of VLM generations throughout clinician-VLM interactions. Our algorithm eliminates the need for human involvement in training data generation or reward model construction, reducing costs compared to standard reinforcement learning with human feedback (RLHF). We apply our alignment algorithm to develop Dr-LLaVA, a conversational VLM finetuned for analyzing bone marrow pathology slides, demonstrating strong performance in multi-turn medical conversations.

EEG-GPT: Exploring Capabilities of Large Language Models for EEG Classification and Interpretation

In conventional machine learning (ML) approaches applied to electroencephalography (EEG), this is often a limited focus, isolating specific brain activities occurring across disparate temporal scales (from transient spikes in milliseconds to seizures lasting minutes) and spatial scales (from localized high-frequency oscillations to global sleep activity). This siloed approach limits the development EEG ML models that exhibit multi-scale electrophysiological understanding and classification capabilities. Moreover, typical ML EEG approaches utilize black-box approaches, limiting their interpretability and trustworthiness in clinical contexts. Thus, we propose EEG-GPT, a unifying approach to EEG classification that leverages advances in large language models (LLM). EEG-GPT achieves excellent performance comparable to current state-of-the-art deep learning methods in classifying normal from abnormal EEG in a few-shot learning paradigm utilizing only 2% of training data. Furthermore, it offers the distinct advantages of providing intermediate reasoning steps and coordinating specialist EEG tools across multiple scales in its operation, offering transparent and interpretable step-by-step verification, thereby promoting trustworthiness in clinical contexts.

DMLR: Data-centric Machine Learning Research -- Past, Present and Future

Drawing from discussions at the inaugural DMLR workshop at ICML 2023 and meetings prior, in this report we outline the relevance of community engagement and infrastructure development for the creation of next-generation public datasets that will advance machine learning science. We chart a path forward as a collective effort to sustain the creation and maintenance of these datasets and methods towards positive scientific, societal and business impact.

Generating Drug Repurposing Hypotheses through the Combination of Disease-Specific Hypergraphs

The drug development pipeline for a new compound can last 10-20 years and cost over 10 billion. Drug repurposing offers a more time- and cost-effective alternative. Computational approaches based on biomedical knowledge graph representations have recently yielded new drug repurposing hypotheses. In this study, we present a novel, disease-specific hypergraph representation learning technique to derive contextual embeddings of biological pathways of various lengths but that all start at any given drug and all end at the disease of interest. Further, we extend this method to multi-disease hypergraphs. To determine the repurposing potential of each of the 1,522 drugs, we derive drug-specific distributions of cosine similarity values and ultimately consider the median for ranking. Cosine similarity values are computed between (1) all biological pathways starting at the considered drug and ending at the disease of interest and (2) all biological pathways starting at drugs currently prescribed against that disease and ending at the disease of interest. We illustrate our approach with Alzheimer's disease (AD) and two of its risk factors: hypertension (HTN) and type 2 diabetes (T2D). We compare each drug's rank across four hypergraph settings (single- or multi-disease): AD only, AD + HTN, AD + T2D, and AD + HTN + T2D. Notably, our framework led to the identification of two promising drugs whose repurposing potential was significantly higher in hypergraphs combining two diseases: dapagliflozin (antidiabetic; moved up, from top 32$\%$ to top 7$\%$, across all considered drugs) and debrisoquine (antihypertensive; moved up, from top 76$\%$ to top 23$\%$). Our approach serves as a hypothesis generation tool, to be paired with a validation pipeline relying on laboratory experiments and semi-automated parsing of the biomedical literature.

Conformal Meta-learners for Predictive Inference of Individual Treatment Effects

We investigate the problem of machine learning-based (ML) predictive inference on individual treatment effects (ITEs). Previous work has focused primarily on developing ML-based meta-learners that can provide point estimates of the conditional average treatment effect (CATE); these are model-agnostic approaches for combining intermediate nuisance estimates to produce estimates of CATE. In this paper, we develop conformal meta-learners, a general framework for issuing predictive intervals for ITEs by applying the standard conformal prediction (CP) procedure on top of CATE meta-learners. We focus on a broad class of meta-learners based on two-stage pseudo-outcome regression and develop a stochastic ordering framework to study their validity. We show that inference with conformal meta-learners is marginally valid if their (pseudo outcome) conformity scores stochastically dominate oracle conformity scores evaluated on the unobserved ITEs. Additionally, we prove that commonly used CATE meta-learners, such as the doubly-robust learner, satisfy a model- and distribution-free stochastic (or convex) dominance condition, making their conformal inferences valid for practically-relevant levels of target coverage. Whereas existing procedures conduct inference on nuisance parameters (i.e., potential outcomes) via weighted CP, conformal meta-learners enable direct inference on the target parameter (ITE). Numerical experiments show that conformal meta-learners provide valid intervals with competitive efficiency while retaining the favorable point estimation properties of CATE meta-learners.