Generative AI in Medicine

The increased capabilities of generative AI have dramatically expanded its possible use cases in medicine. We provide a comprehensive overview of generative AI use cases for clinicians, patients, clinical trial organizers, researchers, and trainees. We then discuss the many challenges -- including maintaining privacy and security, improving transparency and interpretability, upholding equity, and rigorously evaluating models -- which must be overcome to realize this potential, and the open research directions they give rise to.

MaskMedPaint: Masked Medical Image Inpainting with Diffusion Models for Mitigation of Spurious Correlations

Spurious features associated with class labels can lead image classifiers to rely on shortcuts that don't generalize well to new domains. This is especially problematic in medical settings, where biased models fail when applied to different hospitals or systems. In such cases, data-driven methods to reduce spurious correlations are preferred, as clinicians can directly validate the modified images. While Denoising Diffusion Probabilistic Models (Diffusion Models) show promise for natural images, they are impractical for medical use due to the difficulty of describing spurious medical features. To address this, we propose Masked Medical Image Inpainting (MaskMedPaint), which uses text-to-image diffusion models to augment training images by inpainting areas outside key classification regions to match the target domain. We demonstrate that MaskMedPaint enhances generalization to target domains across both natural (Waterbirds, iWildCam) and medical (ISIC 2018, Chest X-ray) datasets, given limited unlabeled target images.

Identifying Differential Patient Care Through Inverse Intent Inference

Sepsis is a life-threatening condition defined by end-organ dysfunction due to a dysregulated host response to infection. Although the Surviving Sepsis Campaign has launched and has been releasing sepsis treatment guidelines to unify and normalize the care for sepsis patients, it has been reported in numerous studies that disparities in care exist across the trajectory of patient stay in the emergency department and intensive care unit. Here, we apply a number of reinforcement learning techniques including behavioral cloning, imitation learning, and inverse reinforcement learning, to learn the optimal policy in the management of septic patient subgroups using expert demonstrations. Then we estimate the counterfactual optimal policies by applying the model to another subset of unseen medical populations and identify the difference in cure by comparing it to the real policy. Our data comes from the sepsis cohort of MIMIC-IV and the clinical data warehouses of the Mass General Brigham healthcare system. The ultimate objective of this work is to use the optimal learned policy function to estimate the counterfactual treatment policy and identify deviations across sub-populations of interest. We hope this approach would help us identify any disparities in care and also changes in cure in response to the publication of national sepsis treatment guidelines.

BendVLM: Test-Time Debiasing of Vision-Language Embeddings

Vision-language model (VLM) embeddings have been shown to encode biases present in their training data, such as societal biases that prescribe negative characteristics to members of various racial and gender identities. VLMs are being quickly adopted for a variety of tasks ranging from few-shot classification to text-guided image generation, making debiasing VLM embeddings crucial. Debiasing approaches that fine-tune the VLM often suffer from catastrophic forgetting. On the other hand, fine-tuning-free methods typically utilize a "one-size-fits-all" approach that assumes that correlation with the spurious attribute can be explained using a single linear direction across all possible inputs. In this work, we propose Bend-VLM, a nonlinear, fine-tuning-free approach for VLM embedding debiasing that tailors the debiasing operation to each unique input. This allows for a more flexible debiasing approach. Additionally, we do not require knowledge of the set of inputs a priori to inference time, making our method more appropriate for online, open-set tasks such as retrieval and text guided image generation.

Identifying Implicit Social Biases in Vision-Language Models

Vision-language models, like CLIP (Contrastive Language Image Pretraining), are becoming increasingly popular for a wide range of multimodal retrieval tasks. However, prior work has shown that large language and deep vision models can learn historical biases contained in their training sets, leading to perpetuation of stereotypes and potential downstream harm. In this work, we conduct a systematic analysis of the social biases that are present in CLIP, with a focus on the interaction between image and text modalities. We first propose a taxonomy of social biases called So-B-IT, which contains 374 words categorized across ten types of bias. Each type can lead to societal harm if associated with a particular demographic group. Using this taxonomy, we examine images retrieved by CLIP from a facial image dataset using each word as part of a prompt. We find that CLIP frequently displays undesirable associations between harmful words and specific demographic groups, such as retrieving mostly pictures of Middle Eastern men when asked to retrieve images of a "terrorist". Finally, we conduct an analysis of the source of such biases, by showing that the same harmful stereotypes are also present in a large image-text dataset used to train CLIP models for examples of biases that we find. Our findings highlight the importance of evaluating and addressing bias in vision-language models, and suggest the need for transparency and fairness-aware curation of large pre-training datasets.

A Demonstration of Adaptive Collaboration of Large Language Models for Medical Decision-Making

Medical Decision-Making (MDM) is a multi-faceted process that requires clinicians to assess complex multi-modal patient data patient, often collaboratively. Large Language Models (LLMs) promise to streamline this process by synthesizing vast medical knowledge and multi-modal health data. However, single-agent are often ill-suited for nuanced medical contexts requiring adaptable, collaborative problem-solving. Our MDAgents addresses this need by dynamically assigning collaboration structures to LLMs based on task complexity, mimicking real-world clinical collaboration and decision-making. This framework improves diagnostic accuracy and supports adaptive responses in complex, real-world medical scenarios, making it a valuable tool for clinicians in various healthcare settings, and at the same time, being more efficient in terms of computing cost than static multi-agent decision making methods.

MisinfoEval: Generative AI in the Era of "Alternative Facts"

The spread of misinformation on social media platforms threatens democratic processes, contributes to massive economic losses, and endangers public health. Many efforts to address misinformation focus on a knowledge deficit model and propose interventions for improving users' critical thinking through access to facts. Such efforts are often hampered by challenges with scalability, and by platform users' personal biases. The emergence of generative AI presents promising opportunities for countering misinformation at scale across ideological barriers. In this paper, we introduce a framework (MisinfoEval) for generating and comprehensively evaluating large language model (LLM) based misinformation interventions. We present (1) an experiment with a simulated social media environment to measure effectiveness of misinformation interventions, and (2) a second experiment with personalized explanations tailored to the demographics and beliefs of users with the goal of countering misinformation by appealing to their pre-existing values. Our findings confirm that LLM-based interventions are highly effective at correcting user behavior (improving overall user accuracy at reliability labeling by up to 41.72%). Furthermore, we find that users favor more personalized interventions when making decisions about news reliability and users shown personalized interventions have significantly higher accuracy at identifying misinformation.

SFTMix: Elevating Language Model Instruction Tuning with Mixup Recipe

To induce desired behaviors in large language models (LLMs) for interaction-driven tasks, the instruction-tuning stage typically trains LLMs on instruction-response pairs using the next-token prediction (NTP) loss. Previous work aiming to improve instruction-tuning performance often emphasizes the need for higher-quality supervised fine-tuning (SFT) datasets, which typically involves expensive data filtering with proprietary LLMs or labor-intensive data generation by human annotators. However, these approaches do not fully leverage the datasets' intrinsic properties, resulting in high computational and labor costs, thereby limiting scalability and performance gains. In this paper, we propose SFTMix, a novel recipe that elevates instruction-tuning performance beyond the conventional NTP paradigm, without the need for well-curated datasets. Observing that LLMs exhibit uneven confidence across the semantic representation space, we argue that examples with different confidence levels should play distinct roles during the instruction-tuning process. Based on this insight, SFTMix leverages training dynamics to identify examples with varying confidence levels, then applies a Mixup-based regularization to mitigate overfitting on confident examples while propagating supervision signals to improve learning on relatively unconfident ones. This approach enables SFTMix to significantly outperform NTP across a wide range of instruction-following and healthcare domain-specific SFT tasks, demonstrating its adaptability to diverse LLM families and scalability to datasets of any size. Comprehensive ablation studies further verify the robustness of SFTMix's design choices, underscoring its versatility in consistently enhancing performance across different LLMs and datasets in broader natural language processing applications.

FedMedICL: Towards Holistic Evaluation of Distribution Shifts in Federated Medical Imaging

For medical imaging AI models to be clinically impactful, they must generalize. However, this goal is hindered by (i) diverse types of distribution shifts, such as temporal, demographic, and label shifts, and (ii) limited diversity in datasets that are siloed within single medical institutions. While these limitations have spurred interest in federated learning, current evaluation benchmarks fail to evaluate different shifts simultaneously. However, in real healthcare settings, multiple types of shifts co-exist, yet their impact on medical imaging performance remains unstudied. In response, we introduce FedMedICL, a unified framework and benchmark to holistically evaluate federated medical imaging challenges, simultaneously capturing label, demographic, and temporal distribution shifts. We comprehensively evaluate several popular methods on six diverse medical imaging datasets (totaling 550 GPU hours). Furthermore, we use FedMedICL to simulate COVID-19 propagation across hospitals and evaluate whether methods can adapt to pandemic changes in disease prevalence. We find that a simple batch balancing technique surpasses advanced methods in average performance across FedMedICL experiments. This finding questions the applicability of results from previous, narrow benchmarks in real-world medical settings.

Data Debiasing with Datamodels (D3M): Improving Subgroup Robustness via Data Selection

Machine learning models can fail on subgroups that are underrepresented during training. While techniques such as dataset balancing can improve performance on underperforming groups, they require access to training group annotations and can end up removing large portions of the dataset. In this paper, we introduce Data Debiasing with Datamodels (D3M), a debiasing approach which isolates and removes specific training examples that drive the model's failures on minority groups. Our approach enables us to efficiently train debiased classifiers while removing only a small number of examples, and does not require training group annotations or additional hyperparameter tuning.