Daily Papers

Large language models (LLMs) are increasingly applied to clinical decision-making. However, their potential to exhibit bias poses significant risks to clinical equity. Currently, there is a lack of benchmarks that systematically evaluate such clinical bias in LLMs. While in downstream tasks, some biases of LLMs can be avoided such as by instructing the model to answer "I'm not sure...", the internal bias hidden within the model still lacks deep studies. We introduce CLIMB (shorthand for A Benchmark of Clinical Bias in Large Language Models), a pioneering comprehensive benchmark to evaluate both intrinsic (within LLMs) and extrinsic (on downstream tasks) bias in LLMs for clinical decision tasks. Notably, for intrinsic bias, we introduce a novel metric, AssocMAD, to assess the disparities of LLMs across multiple demographic groups. Additionally, we leverage counterfactual intervention to evaluate extrinsic bias in a task of clinical diagnosis prediction. Our experiments across popular and medically adapted LLMs, particularly from the Mistral and LLaMA families, unveil prevalent behaviors with both intrinsic and extrinsic bias. This work underscores the critical need to mitigate clinical bias and sets a new standard for future evaluations of LLMs' clinical bias.

Large language models offer transformative potential for healthcare, yet their responsible and equitable development depends critically on a deeper understanding of how training data characteristics influence model behavior, including the potential for bias. Current practices in dataset curation and bias assessment often lack the necessary transparency, creating an urgent need for comprehensive evaluation frameworks to foster trust and guide improvements. In this study, we present an in-depth analysis of potential downstream biases in clinical language models, with a focus on differential opioid prescription tendencies across diverse demographic groups, such as ethnicity, gender, and age. As part of this investigation, we introduce HC4: Healthcare Comprehensive Commons Corpus, a novel and extensively curated pretraining dataset exceeding 89 billion tokens. Our evaluation leverages both established general benchmarks and a novel, healthcare-specific methodology, offering crucial insights to support fairness and safety in clinical AI applications.

This research tests the role of Large Language Models (LLMs) as formal second opinion tools in professional decision-making, particularly focusing on complex medical cases where even experienced physicians seek peer consultation. The work analyzed 183 challenging medical cases from Medscape over a 20-month period, testing multiple LLMs' performance against crowd-sourced physician responses. A key finding was the high overall score possible in the latest foundational models (>80% accuracy compared to consensus opinion), which exceeds most human metrics reported on the same clinical cases (450 pages of patient profiles, test results). The study rates the LLMs' performance disparity between straightforward cases (>81% accuracy) and complex scenarios (43% accuracy), particularly in these cases generating substantial debate among human physicians. The research demonstrates that LLMs may be valuable as generators of comprehensive differential diagnoses rather than as primary diagnostic tools, potentially helping to counter cognitive biases in clinical decision-making, reduce cognitive loads, and thus remove some sources of medical error. The inclusion of a second comparative legal dataset (Supreme Court cases, N=21) provides added empirical context to the AI use to foster second opinions, though these legal challenges proved considerably easier for LLMs to analyze. In addition to the original contributions of empirical evidence for LLM accuracy, the research aggregated a novel benchmark for others to score highly contested question and answer reliability between both LLMs and disagreeing human practitioners. These results suggest that the optimal deployment of LLMs in professional settings may differ substantially from current approaches that emphasize automation of routine tasks.

Bias in Large Language Models (LLMs) significantly undermines their reliability and fairness. We focus on a common form of bias: when two reference concepts in the model's concept space, such as sentiment polarities (e.g., "positive" and "negative"), are asymmetrically correlated with a third, target concept, such as a reviewing aspect, the model exhibits unintended bias. For instance, the understanding of "food" should not skew toward any particular sentiment. Existing bias evaluation methods assess behavioral differences of LLMs by constructing labeled data for different social groups and measuring model responses across them, a process that requires substantial human effort and captures only a limited set of social concepts. To overcome these limitations, we propose BiasLens, a test-set-free bias analysis framework based on the structure of the model's vector space. BiasLens combines Concept Activation Vectors (CAVs) with Sparse Autoencoders (SAEs) to extract interpretable concept representations, and quantifies bias by measuring the variation in representational similarity between the target concept and each of the reference concepts. Even without labeled data, BiasLens shows strong agreement with traditional bias evaluation metrics (Spearman correlation r > 0.85). Moreover, BiasLens reveals forms of bias that are difficult to detect using existing methods. For example, in simulated clinical scenarios, a patient's insurance status can cause the LLM to produce biased diagnostic assessments. Overall, BiasLens offers a scalable, interpretable, and efficient paradigm for bias discovery, paving the way for improving fairness and transparency in LLMs.

There is increasing interest in the application large language models (LLMs) to the medical field, in part because of their impressive performance on medical exam questions. While promising, exam questions do not reflect the complexity of real patient-doctor interactions. In reality, physicians' decisions are shaped by many complex factors, such as patient compliance, personal experience, ethical beliefs, and cognitive bias. Taking a step toward understanding this, our hypothesis posits that when LLMs are confronted with clinical questions containing cognitive biases, they will yield significantly less accurate responses compared to the same questions presented without such biases. In this study, we developed BiasMedQA, a benchmark for evaluating cognitive biases in LLMs applied to medical tasks. Using BiasMedQA we evaluated six LLMs, namely GPT-4, Mixtral-8x70B, GPT-3.5, PaLM-2, Llama 2 70B-chat, and the medically specialized PMC Llama 13B. We tested these models on 1,273 questions from the US Medical Licensing Exam (USMLE) Steps 1, 2, and 3, modified to replicate common clinically-relevant cognitive biases. Our analysis revealed varying effects for biases on these LLMs, with GPT-4 standing out for its resilience to bias, in contrast to Llama 2 70B-chat and PMC Llama 13B, which were disproportionately affected by cognitive bias. Our findings highlight the critical need for bias mitigation in the development of medical LLMs, pointing towards safer and more reliable applications in healthcare.

Africa has a very low doctor-to-patient ratio. At very busy clinics, doctors could see 30+ patients per day -- a heavy patient burden compared with developed countries -- but productivity tools such as clinical automatic speech recognition (ASR) are lacking for these overworked clinicians. However, clinical ASR is mature, even ubiquitous, in developed nations, and clinician-reported performance of commercial clinical ASR systems is generally satisfactory. Furthermore, the recent performance of general domain ASR is approaching human accuracy. However, several gaps exist. Several publications have highlighted racial bias with speech-to-text algorithms and performance on minority accents lags significantly. To our knowledge, there is no publicly available research or benchmark on accented African clinical ASR, and speech data is non-existent for the majority of African accents. We release AfriSpeech, 200hrs of Pan-African English speech, 67,577 clips from 2,463 unique speakers across 120 indigenous accents from 13 countries for clinical and general domain ASR, a benchmark test set, with publicly available pre-trained models with SOTA performance on the AfriSpeech benchmark.

Diagnosing and managing a patient is a complex, sequential decision making process that requires physicians to obtain information -- such as which tests to perform -- and to act upon it. Recent advances in artificial intelligence (AI) and large language models (LLMs) promise to profoundly impact clinical care. However, current evaluation schemes overrely on static medical question-answering benchmarks, falling short on interactive decision-making that is required in real-life clinical work. Here, we present AgentClinic: a multimodal benchmark to evaluate LLMs in their ability to operate as agents in simulated clinical environments. In our benchmark, the doctor agent must uncover the patient's diagnosis through dialogue and active data collection. We present two open medical agent benchmarks: a multimodal image and dialogue environment, AgentClinic-NEJM, and a dialogue-only environment, AgentClinic-MedQA. We embed cognitive and implicit biases both in patient and doctor agents to emulate realistic interactions between biased agents. We find that introducing bias leads to large reductions in diagnostic accuracy of the doctor agents, as well as reduced compliance, confidence, and follow-up consultation willingness in patient agents. Evaluating a suite of state-of-the-art LLMs, we find that several models that excel in benchmarks like MedQA are performing poorly in AgentClinic-MedQA. We find that the LLM used in the patient agent is an important factor for performance in the AgentClinic benchmark. We show that both having limited interactions as well as too many interaction reduces diagnostic accuracy in doctor agents. The code and data for this work is publicly available at https://AgentClinic.github.io.

This paper investigates algorithmic bias in language-based models for automated depression detection, focusing on socio-demographic disparities related to gender and race/ethnicity. Models trained using deep neural networks (DNN) based embeddings are compared to few-shot learning approaches with large language models (LLMs), evaluating both performance and fairness on clinical interview transcripts from the Distress Analysis Interview Corpus/Wizard-of-Oz (DAIC-WOZ). To mitigate bias, fairness-aware loss functions are applied to DNN-based models, while in-context learning with varied prompt framing and shot counts is explored for LLMs. Results indicate that LLMs outperform DNN-based models in depression classification, particularly for underrepresented groups such as Hispanic participants. LLMs also exhibit reduced gender bias compared to DNN-based embeddings, though racial disparities persist. Among fairness-aware techniques for mitigating bias in DNN-based embeddings, the worst-group loss, which is designed to minimize loss for the worst-performing demographic group, achieves a better balance between performance and fairness. In contrast, the fairness-regularized loss minimizes loss across all groups but performs less effectively. In LLMs, guided prompting with ethical framing helps mitigate gender bias in the 1-shot setting. However, increasing the number of shots does not lead to further reductions in disparities. For race/ethnicity, neither prompting strategy nor increasing N in N-shot learning effectively reduces disparities.

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

Large Language Models (LLMs) have attained human-level accuracy on medical question-answer (QA) benchmarks. However, their limitations in navigating open-ended clinical scenarios have recently been shown, raising concerns about the robustness and generalizability of LLM reasoning across diverse, real-world medical tasks. To probe potential LLM failure modes in clinical problem-solving, we present the medical abstraction and reasoning corpus (M-ARC). M-ARC assesses clinical reasoning through scenarios designed to exploit the Einstellung effect -- the fixation of thought arising from prior experience, targeting LLM inductive biases toward inflexible pattern matching from their training data rather than engaging in flexible reasoning. We find that LLMs, including current state-of-the-art o1 and Gemini models, perform poorly compared to physicians on M-ARC, often demonstrating lack of commonsense medical reasoning and a propensity to hallucinate. In addition, uncertainty estimation analyses indicate that LLMs exhibit overconfidence in their answers, despite their limited accuracy. The failure modes revealed by M-ARC in LLM medical reasoning underscore the need to exercise caution when deploying these models in clinical settings.

The meaningful use of electronic health records (EHR) continues to progress in the digital era with clinical decision support systems augmented by artificial intelligence. A priority in improving provider experience is to overcome information overload and reduce the cognitive burden so fewer medical errors and cognitive biases are introduced during patient care. One major type of medical error is diagnostic error due to systematic or predictable errors in judgment that rely on heuristics. The potential for clinical natural language processing (cNLP) to model diagnostic reasoning in humans with forward reasoning from data to diagnosis and potentially reduce the cognitive burden and medical error has not been investigated. Existing tasks to advance the science in cNLP have largely focused on information extraction and named entity recognition through classification tasks. We introduce a novel suite of tasks coined as Diagnostic Reasoning Benchmarks, DR.BENCH, as a new benchmark for developing and evaluating cNLP models with clinical diagnostic reasoning ability. The suite includes six tasks from ten publicly available datasets addressing clinical text understanding, medical knowledge reasoning, and diagnosis generation. DR.BENCH is the first clinical suite of tasks designed to be a natural language generation framework to evaluate pre-trained language models. Experiments with state-of-the-art pre-trained generative language models using large general domain models and models that were continually trained on a medical corpus demonstrate opportunities for improvement when evaluated in DR. BENCH. We share DR. BENCH as a publicly available GitLab repository with a systematic approach to load and evaluate models for the cNLP community.

Predictive artificial intelligence (AI) offers an opportunity to improve clinical practice and patient outcomes, but risks perpetuating biases if fairness is inadequately addressed. However, the definition of "fairness" remains unclear. We conducted a scoping review to identify and critically appraise fairness metrics for clinical predictive AI. We defined a "fairness metric" as a measure quantifying whether a model discriminates (societally) against individuals or groups defined by sensitive attributes. We searched five databases (2014-2024), screening 820 records, to include 41 studies, and extracted 62 fairness metrics. Metrics were classified by performance-dependency, model output level, and base performance metric, revealing a fragmented landscape with limited clinical validation and overreliance on threshold-dependent measures. Eighteen metrics were explicitly developed for healthcare, including only one clinical utility metric. Our findings highlight conceptual challenges in defining and quantifying fairness and identify gaps in uncertainty quantification, intersectionality, and real-world applicability. Future work should prioritise clinically meaningful metrics.

The rapid development of Large Language Models (LLMs) for healthcare applications has spurred calls for holistic evaluation beyond frequently-cited benchmarks like USMLE, to better reflect real-world performance. While real-world assessments are valuable indicators of utility, they often lag behind the pace of LLM evolution, likely rendering findings obsolete upon deployment. This temporal disconnect necessitates a comprehensive upfront evaluation that can guide model selection for specific clinical applications. We introduce MEDIC, a framework assessing LLMs across five critical dimensions of clinical competence: medical reasoning, ethics and bias, data and language understanding, in-context learning, and clinical safety. MEDIC features a novel cross-examination framework quantifying LLM performance across areas like coverage and hallucination detection, without requiring reference outputs. We apply MEDIC to evaluate LLMs on medical question-answering, safety, summarization, note generation, and other tasks. Our results show performance disparities across model sizes, baseline vs medically finetuned models, and have implications on model selection for applications requiring specific model strengths, such as low hallucination or lower cost of inference. MEDIC's multifaceted evaluation reveals these performance trade-offs, bridging the gap between theoretical capabilities and practical implementation in healthcare settings, ensuring that the most promising models are identified and adapted for diverse healthcare applications.

Automatic depression detection from conversational data has gained significant interest in recent years. The DAIC-WOZ dataset, interviews conducted by a human-controlled virtual agent, has been widely used for this task. Recent studies have reported enhanced performance when incorporating interviewer's prompts into the model. In this work, we hypothesize that this improvement might be mainly due to a bias present in these prompts, rather than the proposed architectures and methods. Through ablation experiments and qualitative analysis, we discover that models using interviewer's prompts learn to focus on a specific region of the interviews, where questions about past experiences with mental health issues are asked, and use them as discriminative shortcuts to detect depressed participants. In contrast, models using participant responses gather evidence from across the entire interview. Finally, to highlight the magnitude of this bias, we achieve a 0.90 F1 score by intentionally exploiting it, the highest result reported to date on this dataset using only textual information. Our findings underline the need for caution when incorporating interviewers' prompts into models, as they may inadvertently learn to exploit targeted prompts, rather than learning to characterize the language and behavior that are genuinely indicative of the patient's mental health condition.

Recent advances in Natural Language Processing (NLP), and specifically automated Question Answering (QA) systems, have demonstrated both impressive linguistic fluency and a pernicious tendency to reflect social biases. In this study, we introduce Q-Pain, a dataset for assessing bias in medical QA in the context of pain management, one of the most challenging forms of clinical decision-making. Along with the dataset, we propose a new, rigorous framework, including a sample experimental design, to measure the potential biases present when making treatment decisions. We demonstrate its use by assessing two reference Question-Answering systems, GPT-2 and GPT-3, and find statistically significant differences in treatment between intersectional race-gender subgroups, thus reaffirming the risks posed by AI in medical settings, and the need for datasets like ours to ensure safety before medical AI applications are deployed.

The recent introduction of synthetic correlated diffusion (CDI^s) imaging has demonstrated significant potential in the realm of clinical decision support for prostate cancer (PCa). CDI^s is a new form of magnetic resonance imaging (MRI) designed to characterize tissue characteristics through the joint correlation of diffusion signal attenuation across different Brownian motion sensitivities. Despite the performance improvement, the CDI^s data for PCa has not been previously made publicly available. In our commitment to advance research efforts for PCa, we introduce Cancer-Net PCa-Data, an open-source benchmark dataset of volumetric CDI^s imaging data of PCa patients. Cancer-Net PCa-Data consists of CDI^s volumetric images from a patient cohort of 200 patient cases, along with full annotations (gland masks, tumor masks, and PCa diagnosis for each tumor). We also analyze the demographic and label region diversity of Cancer-Net PCa-Data for potential biases. Cancer-Net PCa-Data is the first-ever public dataset of CDI^s imaging data for PCa, and is a part of the global open-source initiative dedicated to advancement in machine learning and imaging research to aid clinicians in the global fight against cancer.

Gait analysis is crucial for the diagnosis and monitoring of movement disorders like Parkinson's Disease. While computer vision models have shown potential for objectively evaluating parkinsonian gait, their effectiveness is limited by scarce clinical datasets and the challenge of collecting large and well-labelled data, impacting model accuracy and risk of bias. To address these gaps, we propose GAITGen, a novel framework that generates realistic gait sequences conditioned on specified pathology severity levels. GAITGen employs a Conditional Residual Vector Quantized Variational Autoencoder to learn disentangled representations of motion dynamics and pathology-specific factors, coupled with Mask and Residual Transformers for conditioned sequence generation. GAITGen generates realistic, diverse gait sequences across severity levels, enriching datasets and enabling large-scale model training in parkinsonian gait analysis. Experiments on our new PD-GaM (real) dataset demonstrate that GAITGen outperforms adapted state-of-the-art models in both reconstruction fidelity and generation quality, accurately capturing critical pathology-specific gait features. A clinical user study confirms the realism and clinical relevance of our generated sequences. Moreover, incorporating GAITGen-generated data into downstream tasks improves parkinsonian gait severity estimation, highlighting its potential for advancing clinical gait analysis.

Integrating large language models (LLMs) like DeepSeek R1 into healthcare requires rigorous evaluation of their reasoning alignment with clinical expertise. This study assesses DeepSeek R1's medical reasoning against expert patterns using 100 MedQA clinical cases. The model achieved 93% diagnostic accuracy, demonstrating systematic clinical judgment through differential diagnosis, guideline-based treatment selection, and integration of patient-specific factors. However, error analysis of seven incorrect cases revealed persistent limitations: anchoring bias, challenges reconciling conflicting data, insufficient exploration of alternatives, overthinking, knowledge gaps, and premature prioritization of definitive treatment over intermediate care. Crucially, reasoning length correlated with accuracy - shorter responses (<5,000 characters) were more reliable, suggesting extended explanations may signal uncertainty or rationalization of errors. While DeepSeek R1 exhibits foundational clinical reasoning capabilities, recurring flaws highlight critical areas for refinement, including bias mitigation, knowledge updates, and structured reasoning frameworks. These findings underscore LLMs' potential to augment medical decision-making through artificial reasoning but emphasize the need for domain-specific validation, interpretability safeguards, and confidence metrics (e.g., response length thresholds) to ensure reliability in real-world applications.

Objective: To improve prediction of Chronic Kidney Disease (CKD) progression to End Stage Renal Disease (ESRD) using machine learning (ML) and deep learning (DL) models applied to an integrated clinical and claims dataset of varying observation windows, supported by explainable AI (XAI) to enhance interpretability and reduce bias. Materials and Methods: We utilized data about 10,326 CKD patients, combining their clinical and claims information from 2009 to 2018. Following data preprocessing, cohort identification, and feature engineering, we evaluated multiple statistical, ML and DL models using data extracted from five distinct observation windows. Feature importance and Shapley value analysis were employed to understand key predictors. Models were tested for robustness, clinical relevance, misclassification errors and bias issues. Results: Integrated data models outperformed those using single data sources, with the Long Short-Term Memory (LSTM) model achieving the highest AUC (0.93) and F1 score (0.65). A 24-month observation window was identified as optimal for balancing early detection and prediction accuracy. The 2021 eGFR equation improved prediction accuracy and reduced racial bias, notably for African American patients. Discussion: Improved ESRD prediction accuracy, results interpretability and bias mitigation strategies presented in this study have the potential to significantly enhance CKD and ESRD management, support targeted early interventions and reduce healthcare disparities. Conclusion: This study presents a robust framework for predicting ESRD outcomes in CKD patients, improving clinical decision-making and patient care through multi-sourced, integrated data and AI/ML methods. Future research will expand data integration and explore the application of this framework to other chronic diseases.

Patient data from real-world clinical practice often suffers from data scarcity and long-tail imbalances, leading to biased outcomes or algorithmic unfairness. This study addresses these challenges by generating lesion-containing image-segmentation pairs from lesion-free images. Previous efforts in medical imaging synthesis have struggled with separating lesion information from background, resulting in low-quality backgrounds and limited control over the synthetic output. Inspired by diffusion-based image inpainting, we propose LeFusion, a lesion-focused diffusion model. By redesigning the diffusion learning objectives to focus on lesion areas, we simplify the learning process and improve control over the output while preserving high-fidelity backgrounds by integrating forward-diffused background contexts into the reverse diffusion process. Additionally, we tackle two major challenges in lesion texture synthesis: 1) multi-peak and 2) multi-class lesions. We introduce two effective strategies: histogram-based texture control and multi-channel decomposition, enabling the controlled generation of high-quality lesions in difficult scenarios. Furthermore, we incorporate lesion mask diffusion, allowing control over lesion size, location, and boundary, thus increasing lesion diversity. Validated on 3D cardiac lesion MRI and lung nodule CT datasets, LeFusion-generated data significantly improves the performance of state-of-the-art segmentation models, including nnUNet and SwinUNETR. Code and model are available at https://github.com/M3DV/LeFusion.

Current ophthalmology clinical workflows are plagued by over-referrals, long waits, and complex and heterogeneous medical records. Large language models (LLMs) present a promising solution to automate various procedures such as triaging, preliminary tests like visual acuity assessment, and report summaries. However, LLMs have demonstrated significantly varied performance across different languages in natural language question-answering tasks, potentially exacerbating healthcare disparities in Low and Middle-Income Countries (LMICs). This study introduces the first multilingual ophthalmological question-answering benchmark with manually curated questions parallel across languages, allowing for direct cross-lingual comparisons. Our evaluation of 6 popular LLMs across 7 different languages reveals substantial bias across different languages, highlighting risks for clinical deployment of LLMs in LMICs. Existing debiasing methods such as Translation Chain-of-Thought or Retrieval-augmented generation (RAG) by themselves fall short of closing this performance gap, often failing to improve performance across all languages and lacking specificity for the medical domain. To address this issue, We propose CLARA (Cross-Lingual Reflective Agentic system), a novel inference time de-biasing method leveraging retrieval augmented generation and self-verification. Our approach not only improves performance across all languages but also significantly reduces the multilingual bias gap, facilitating equitable LLM application across the globe.

The deployment of large language models (LLMs) in mental health and other sensitive domains raises urgent questions about ethical reasoning, fairness, and responsible alignment. Yet, existing benchmarks for moral and clinical decision-making do not adequately capture the unique ethical dilemmas encountered in mental health practice, where confidentiality, autonomy, beneficence, and bias frequently intersect. To address this gap, we introduce Ethical Reasoning in Mental Health (EthicsMH), a pilot dataset of 125 scenarios designed to evaluate how AI systems navigate ethically charged situations in therapeutic and psychiatric contexts. Each scenario is enriched with structured fields, including multiple decision options, expert-aligned reasoning, expected model behavior, real-world impact, and multi-stakeholder viewpoints. This structure enables evaluation not only of decision accuracy but also of explanation quality and alignment with professional norms. Although modest in scale and developed with model-assisted generation, EthicsMH establishes a task framework that bridges AI ethics and mental health decision-making. By releasing this dataset, we aim to provide a seed resource that can be expanded through community and expert contributions, fostering the development of AI systems capable of responsibly handling some of society's most delicate decisions.

Hypertension, defined as blood pressure (BP) that is above normal, holds paramount significance in the realm of public health, as it serves as a critical precursor to various cardiovascular diseases (CVDs) and significantly contributes to elevated mortality rates worldwide. However, many existing BP measurement technologies and standards might be biased because they do not consider clinical outcomes, comorbidities, or demographic factors, making them inconclusive for diagnostic purposes. There is limited data-driven research focused on studying the variance in BP measurements across these variables. In this work, we employed GPT-35-turbo, a large language model (LLM), to automatically extract the mean and standard deviation values of BP for both males and females from a dataset comprising 25 million abstracts sourced from PubMed. 993 article abstracts met our predefined inclusion criteria (i.e., presence of references to blood pressure, units of blood pressure such as mmHg, and mention of biological sex). Based on the automatically-extracted information from these articles, we conducted an analysis of the variations of BP values across biological sex. Our results showed the viability of utilizing LLMs to study the BP variations across different demographic factors.

The emerging area of computational pathology (CPath) is ripe ground for the application of deep learning (DL) methods to healthcare due to the sheer volume of raw pixel data in whole-slide images (WSIs) of cancerous tissue slides. However, it is imperative for the DL algorithms relying on nuclei-level details to be able to cope with data from `the clinical wild', which tends to be quite challenging. We study, and extend recently released PanNuke dataset consisting of ~200,000 nuclei categorized into 5 clinically important classes for the challenging tasks of segmenting and classifying nuclei in WSIs. Previous pan-cancer datasets consisted of only up to 9 different tissues and up to 21,000 unlabeled nuclei and just over 24,000 labeled nuclei with segmentation masks. PanNuke consists of 19 different tissue types that have been semi-automatically annotated and quality controlled by clinical pathologists, leading to a dataset with statistics similar to the clinical wild and with minimal selection bias. We study the performance of segmentation and classification models when applied to the proposed dataset and demonstrate the application of models trained on PanNuke to whole-slide images. We provide comprehensive statistics about the dataset and outline recommendations and research directions to address the limitations of existing DL tools when applied to real-world CPath applications.

The emergence of advanced reasoning capabilities in Large Language Models (LLMs) marks a transformative development in healthcare applications. Beyond merely expanding functional capabilities, these reasoning mechanisms enhance decision transparency and explainability-critical requirements in medical contexts. This survey examines the transformation of medical LLMs from basic information retrieval tools to sophisticated clinical reasoning systems capable of supporting complex healthcare decisions. We provide a thorough analysis of the enabling technological foundations, with a particular focus on specialized prompting techniques like Chain-of-Thought and recent breakthroughs in Reinforcement Learning exemplified by DeepSeek-R1. Our investigation evaluates purpose-built medical frameworks while also examining emerging paradigms such as multi-agent collaborative systems and innovative prompting architectures. The survey critically assesses current evaluation methodologies for medical validation and addresses persistent challenges in field interpretation limitations, bias mitigation strategies, patient safety frameworks, and integration of multimodal clinical data. Through this survey, we seek to establish a roadmap for developing reliable LLMs that can serve as effective partners in clinical practice and medical research.

Ensuring the safety and reliability of large language models (LLMs) in clinical practice is critical to prevent patient harm and promote trustworthy healthcare applications of AI. However, LLMs are advancing so rapidly that static safety benchmarks often become obsolete upon publication, yielding only an incomplete and sometimes misleading picture of model trustworthiness. We demonstrate that a Dynamic, Automatic, and Systematic (DAS) red-teaming framework that continuously stress-tests LLMs can reveal significant weaknesses of current LLMs across four safety-critical domains: robustness, privacy, bias/fairness, and hallucination. A suite of adversarial agents is applied to autonomously mutate test cases, identify/evolve unsafe-triggering strategies, and evaluate responses, uncovering vulnerabilities in real time without human intervention. Applying DAS to 15 proprietary and open-source LLMs revealed a stark contrast between static benchmark performance and vulnerability under adversarial pressure. Despite a median MedQA accuracy exceeding 80\%, 94\% of previously correct answers failed our dynamic robustness tests. We observed similarly high failure rates across other domains: privacy leaks were elicited in 86\% of scenarios, cognitive-bias priming altered clinical recommendations in 81\% of fairness tests, and we identified hallucination rates exceeding 66\% in widely used models. Such profound residual risks are incompatible with routine clinical practice. By converting red-teaming from a static checklist into a dynamic stress-test audit, DAS red-teaming offers the surveillance that hospitals/regulators/technology vendors require as LLMs become embedded in patient chatbots, decision-support dashboards, and broader healthcare workflows. Our framework delivers an evolvable, scalable, and reliable safeguard for the next generation of medical AI.

Social determinants of health (SDoH) have an important impact on patient outcomes but are incompletely collected from the electronic health records (EHR). This study researched the ability of large language models to extract SDoH from free text in EHRs, where they are most commonly documented, and explored the role of synthetic clinical text for improving the extraction of these scarcely documented, yet extremely valuable, clinical data. 800 patient notes were annotated for SDoH categories, and several transformer-based models were evaluated. The study also experimented with synthetic data generation and assessed for algorithmic bias. Our best-performing models were fine-tuned Flan-T5 XL (macro-F1 0.71) for any SDoH, and Flan-T5 XXL (macro-F1 0.70). The benefit of augmenting fine-tuning with synthetic data varied across model architecture and size, with smaller Flan-T5 models (base and large) showing the greatest improvements in performance (delta F1 +0.12 to +0.23). Model performance was similar on the in-hospital system dataset but worse on the MIMIC-III dataset. Our best-performing fine-tuned models outperformed zero- and few-shot performance of ChatGPT-family models for both tasks. These fine-tuned models were less likely than ChatGPT to change their prediction when race/ethnicity and gender descriptors were added to the text, suggesting less algorithmic bias (p<0.05). At the patient-level, our models identified 93.8% of patients with adverse SDoH, while ICD-10 codes captured 2.0%. Our method can effectively extracted SDoH information from clinic notes, performing better compare to GPT zero- and few-shot settings. These models could enhance real-world evidence on SDoH and aid in identifying patients needing social support.

Large language models (LLMs) hold immense promise to serve complex health information needs but also have the potential to introduce harm and exacerbate health disparities. Reliably evaluating equity-related model failures is a critical step toward developing systems that promote health equity. In this work, we present resources and methodologies for surfacing biases with potential to precipitate equity-related harms in long-form, LLM-generated answers to medical questions and then conduct an empirical case study with Med-PaLM 2, resulting in the largest human evaluation study in this area to date. Our contributions include a multifactorial framework for human assessment of LLM-generated answers for biases, and EquityMedQA, a collection of seven newly-released datasets comprising both manually-curated and LLM-generated questions enriched for adversarial queries. Both our human assessment framework and dataset design process are grounded in an iterative participatory approach and review of possible biases in Med-PaLM 2 answers to adversarial queries. Through our empirical study, we find that the use of a collection of datasets curated through a variety of methodologies, coupled with a thorough evaluation protocol that leverages multiple assessment rubric designs and diverse rater groups, surfaces biases that may be missed via narrower evaluation approaches. Our experience underscores the importance of using diverse assessment methodologies and involving raters of varying backgrounds and expertise. We emphasize that while our framework can identify specific forms of bias, it is not sufficient to holistically assess whether the deployment of an AI system promotes equitable health outcomes. We hope the broader community leverages and builds on these tools and methods towards realizing a shared goal of LLMs that promote accessible and equitable healthcare for all.

We employ an audit design to investigate biases in state-of-the-art large language models, including GPT-4. In our study, we prompt the models for advice involving a named individual across a variety of scenarios, such as during car purchase negotiations or election outcome predictions. We find that the advice systematically disadvantages names that are commonly associated with racial minorities and women. Names associated with Black women receive the least advantageous outcomes. The biases are consistent across 42 prompt templates and several models, indicating a systemic issue rather than isolated incidents. While providing numerical, decision-relevant anchors in the prompt can successfully counteract the biases, qualitative details have inconsistent effects and may even increase disparities. Our findings underscore the importance of conducting audits at the point of LLM deployment and implementation to mitigate their potential for harm against marginalized communities.

State-of-the-art question answering (QA) models exhibit a variety of social biases (e.g., with respect to sex or race), generally explained by similar issues in their training data. However, what has been overlooked so far is that in the critical domain of biomedicine, any unjustified change in model output due to patient demographics is problematic: it results in the unfair treatment of patients. Selecting only questions on biomedical topics whose answers do not depend on ethnicity, sex, or sexual orientation, we ask the following research questions: (RQ1) Do the answers of QA models change when being provided with irrelevant demographic information? (RQ2) Does the answer of RQ1 differ between knowledge graph (KG)-grounded and text-based QA systems? We find that irrelevant demographic information change up to 15% of the answers of a KG-grounded system and up to 23% of the answers of a text-based system, including changes that affect accuracy. We conclude that unjustified answer changes caused by patient demographics are a frequent phenomenon, which raises fairness concerns and should be paid more attention to.

Depression has proven to be a significant public health issue, profoundly affecting the psychological well-being of individuals. If it remains undiagnosed, depression can lead to severe health issues, which can manifest physically and even lead to suicide. Generally, Diagnosing depression or any other mental disorder involves conducting semi-structured interviews alongside supplementary questionnaires, including variants of the Patient Health Questionnaire (PHQ) by Clinicians and mental health professionals. This approach places significant reliance on the experience and judgment of trained physicians, making the diagnosis susceptible to personal biases. Given that the underlying mechanisms causing depression are still being actively researched, physicians often face challenges in diagnosing and treating the condition, particularly in its early stages of clinical presentation. Recently, significant strides have been made in Artificial neural computing to solve problems involving text, image, and speech in various domains. Our analysis has aimed to leverage these state-of-the-art (SOTA) models in our experiments to achieve optimal outcomes leveraging multiple modalities. The experiments were performed on the Extended Distress Analysis Interview Corpus Wizard of Oz dataset (E-DAIC) corpus presented in the Audio/Visual Emotion Challenge (AVEC) 2019 Challenge. The proposed solutions demonstrate better results achieved by Proprietary and Open-source Large Language Models (LLMs), which achieved a Root Mean Square Error (RMSE) score of 3.98 on Textual Modality, beating the AVEC 2019 challenge baseline results and current SOTA regression analysis architectures. Additionally, the proposed solution achieved an accuracy of 71.43% in the classification task. The paper also includes a novel audio-visual multi-modal network that predicts PHQ-8 scores with an RMSE of 6.51.

Bias in textual data can lead to skewed interpretations and outcomes when the data is used. These biases could perpetuate stereotypes, discrimination, or other forms of unfair treatment. An algorithm trained on biased data may end up making decisions that disproportionately impact a certain group of people. Therefore, it is crucial to detect and remove these biases to ensure the fair and ethical use of data. To this end, we develop a comprehensive and robust framework NBIAS that consists of four main layers: data, corpus construction, model development and an evaluation layer. The dataset is constructed by collecting diverse data from various domains, including social media, healthcare, and job hiring portals. As such, we applied a transformer-based token classification model that is able to identify bias words/ phrases through a unique named entity BIAS. In the evaluation procedure, we incorporate a blend of quantitative and qualitative measures to gauge the effectiveness of our models. We achieve accuracy improvements ranging from 1% to 8% compared to baselines. We are also able to generate a robust understanding of the model functioning. The proposed approach is applicable to a variety of biases and contributes to the fair and ethical use of textual data.

A comparison of the distances to the Huanan Seafood Market of early Covid cases with known links to the market versus cases without known links shows results apparently incompatible with a location model lacking proximity ascertainment bias. The sign of the difference instead agrees with a model in which such ascertainment bias is large. In the presence of such bias inferences based on the clustering of case locations become unreliable.

Large Language Models (LLMs) in mental healthcare risk propagating biases that reinforce stigma and harm marginalized groups. While previous research identified concerning trends, systematic methods for detecting intersectional biases remain limited. This work introduces a multi-hop question answering (MHQA) framework to explore LLM response biases in mental health discourse. We analyze content from the Interpretable Mental Health Instruction (IMHI) dataset across symptom presentation, coping mechanisms, and treatment approaches. Using systematic tagging across age, race, gender, and socioeconomic status, we investigate bias patterns at demographic intersections. We evaluate four LLMs: Claude 3.5 Sonnet, Jamba 1.6, Gemma 3, and Llama 4, revealing systematic disparities across sentiment, demographics, and mental health conditions. Our MHQA approach demonstrates superior detection compared to conventional methods, identifying amplification points where biases magnify through sequential reasoning. We implement two debiasing techniques: Roleplay Simulation and Explicit Bias Reduction, achieving 66-94% bias reductions through few-shot prompting with BBQ dataset examples. These findings highlight critical areas where LLMs reproduce mental healthcare biases, providing actionable insights for equitable AI development.

Synthetic data generation offers a promising solution to enhance the usefulness of Electronic Healthcare Records (EHR) by generating realistic de-identified data. However, the existing literature primarily focuses on the quality of synthetic health data, neglecting the crucial aspect of fairness in downstream predictions. Consequently, models trained on synthetic EHR have faced criticism for producing biased outcomes in target tasks. These biases can arise from either spurious correlations between features or the failure of models to accurately represent sub-groups. To address these concerns, we present Bias-transforming Generative Adversarial Networks (Bt-GAN), a GAN-based synthetic data generator specifically designed for the healthcare domain. In order to tackle spurious correlations (i), we propose an information-constrained Data Generation Process that enables the generator to learn a fair deterministic transformation based on a well-defined notion of algorithmic fairness. To overcome the challenge of capturing exact sub-group representations (ii), we incentivize the generator to preserve sub-group densities through score-based weighted sampling. This approach compels the generator to learn from underrepresented regions of the data manifold. We conduct extensive experiments using the MIMIC-III database. Our results demonstrate that Bt-GAN achieves SOTA accuracy while significantly improving fairness and minimizing bias amplification. We also perform an in-depth explainability analysis to provide additional evidence supporting the validity of our study. In conclusion, our research introduces a novel and professional approach to addressing the limitations of synthetic data generation in the healthcare domain. By incorporating fairness considerations and leveraging advanced techniques such as GANs, we pave the way for more reliable and unbiased predictions in healthcare applications.

Models of various NLP tasks have been shown to exhibit stereotypes, and the bias in the question answering (QA) models is especially harmful as the output answers might be directly consumed by the end users. There have been datasets to evaluate bias in QA models, while bias mitigation technique for the QA models is still under-explored. In this work, we propose BMBI, an approach to mitigate the bias of multiple-choice QA models. Based on the intuition that a model would lean to be more biased if it learns from a biased example, we measure the bias level of a query instance by observing its influence on another instance. If the influenced instance is more biased, we derive that the query instance is biased. We then use the bias level detected as an optimization objective to form a multi-task learning setting in addition to the original QA task. We further introduce a new bias evaluation metric to quantify bias in a comprehensive and sensitive way. We show that our method could be applied to multiple QA formulations across multiple bias categories. It can significantly reduce the bias level in all 9 bias categories in the BBQ dataset while maintaining comparable QA accuracy.

Bias in training datasets must be managed for various groups in classification tasks to ensure parity or equal treatment. With the recent growth in artificial intelligence models and their expanding role in automated decision-making, ensuring that these models are not biased is vital. There is an abundance of evidence suggesting that these models could contain or even amplify the bias present in the data on which they are trained, inherent to their objective function and learning algorithms; Many researchers direct their attention to this issue in different directions, namely, changing data to be statistically independent, adversarial training for restricting the capabilities of a particular competitor who aims to maximize parity, etc. These methods result in information loss and do not provide a suitable balance between accuracy and fairness or do not ensure limiting the biases in training. To this end, we propose a powerful strategy for training deep learning models called the Distraction module, which can be theoretically proven effective in controlling bias from affecting the classification results. This method can be utilized with different data types (e.g., Tabular, images, graphs, etc.). We demonstrate the potency of the proposed method by testing it on UCI Adult and Heritage Health datasets (tabular), POKEC-Z, POKEC-N and NBA datasets (graph), and CelebA dataset (vision). Using state-of-the-art methods proposed in the fairness literature for each dataset, we exhibit our model is superior to these proposed methods in minimizing bias and maintaining accuracy.

A stereotype is an over-generalized belief about a particular group of people, e.g., Asians are good at math or Asians are bad drivers. Such beliefs (biases) are known to hurt target groups. Since pretrained language models are trained on large real world data, they are known to capture stereotypical biases. In order to assess the adverse effects of these models, it is important to quantify the bias captured in them. Existing literature on quantifying bias evaluates pretrained language models on a small set of artificially constructed bias-assessing sentences. We present StereoSet, a large-scale natural dataset in English to measure stereotypical biases in four domains: gender, profession, race, and religion. We evaluate popular models like BERT, GPT-2, RoBERTa, and XLNet on our dataset and show that these models exhibit strong stereotypical biases. We also present a leaderboard with a hidden test set to track the bias of future language models at https://stereoset.mit.edu

Gender bias in machine translation (MT) is recognized as an issue that can harm people and society. And yet, advancements in the field rarely involve people, the final MT users, or inform how they might be impacted by biased technologies. Current evaluations are often restricted to automatic methods, which offer an opaque estimate of what the downstream impact of gender disparities might be. We conduct an extensive human-centered study to examine if and to what extent bias in MT brings harms with tangible costs, such as quality of service gaps across women and men. To this aim, we collect behavioral data from 90 participants, who post-edited MT outputs to ensure correct gender translation. Across multiple datasets, languages, and types of users, our study shows that feminine post-editing demands significantly more technical and temporal effort, also corresponding to higher financial costs. Existing bias measurements, however, fail to reflect the found disparities. Our findings advocate for human-centered approaches that can inform the societal impact of bias.

LLMs are increasingly powerful and widely used to assist users in a variety of tasks. This use risks the introduction of LLM biases to consequential decisions such as job hiring, human performance evaluation, and criminal sentencing. Bias in NLP systems along the lines of gender and ethnicity has been widely studied, especially for specific stereotypes (e.g., Asians are good at math). In this paper, we investigate bias along less-studied but still consequential, dimensions, such as age and beauty, measuring subtler correlated decisions that LLMs make between social groups and unrelated positive and negative attributes. We ask whether LLMs hold wide-reaching biases of positive or negative sentiment for specific social groups similar to the ``what is beautiful is good'' bias found in people in experimental psychology. We introduce a template-generated dataset of sentence completion tasks that asks the model to select the most appropriate attribute to complete an evaluative statement about a person described as a member of a specific social group. We also reverse the completion task to select the social group based on an attribute. We report the correlations that we find for 4 cutting-edge LLMs. This dataset can be used as a benchmark to evaluate progress in more generalized biases and the templating technique can be used to expand the benchmark with minimal additional human annotation.

This publication describes the motivation and generation of Q_{bias}, a large dataset of Google and Bing search queries, a scraping tool and dataset for biased news articles, as well as language models for the investigation of bias in online search. Web search engines are a major factor and trusted source in information search, especially in the political domain. However, biased information can influence opinion formation and lead to biased opinions. To interact with search engines, users formulate search queries and interact with search query suggestions provided by the search engines. A lack of datasets on search queries inhibits research on the subject. We use Q_{bias} to evaluate different approaches to fine-tuning transformer-based language models with the goal of producing models capable of biasing text with left and right political stance. Additionally to this work we provided datasets and language models for biasing texts that allow further research on bias in online information search.

Multimodal language models (MLMs) show promise for clinical decision support and diagnostic reasoning, raising the prospect of end-to-end automated medical image interpretation. However, clinicians are highly selective in adopting AI tools; a model that makes errors on seemingly simple perception tasks such as determining image orientation or identifying whether a CT scan is contrast-enhance are unlikely to be adopted for clinical tasks. We introduce Medblink, a benchmark designed to probe these models for such perceptual abilities. Medblink spans eight clinically meaningful tasks across multiple imaging modalities and anatomical regions, totaling 1,429 multiple-choice questions over 1,605 images. We evaluate 19 state-of-the-art MLMs, including general purpose (GPT4o, Claude 3.5 Sonnet) and domain specific (Med Flamingo, LLaVA Med, RadFM) models. While human annotators achieve 96.4% accuracy, the best-performing model reaches only 65%. These results show that current MLMs frequently fail at routine perceptual checks, suggesting the need to strengthen their visual grounding to support clinical adoption. Data is available on our project page.

Large Language Models (LLMs) have great potential in the field of health care, yet they face great challenges in adapting to rapidly evolving medical knowledge. This can lead to outdated or contradictory treatment suggestions. This study investigated how LLMs respond to evolving clinical guidelines, focusing on concept drift and internal inconsistencies. We developed the DriftMedQA benchmark to simulate guideline evolution and assessed the temporal reliability of various LLMs. Our evaluation of seven state-of-the-art models across 4,290 scenarios demonstrated difficulties in rejecting outdated recommendations and frequently endorsing conflicting guidance. Additionally, we explored two mitigation strategies: Retrieval-Augmented Generation and preference fine-tuning via Direct Preference Optimization. While each method improved model performance, their combination led to the most consistent and reliable results. These findings underscore the need to improve LLM robustness to temporal shifts to ensure more dependable applications in clinical practice.

Large Language Models (LLMs) have recently emerged as an effective tool to assist individuals in writing various types of content, including professional documents such as recommendation letters. Though bringing convenience, this application also introduces unprecedented fairness concerns. Model-generated reference letters might be directly used by users in professional scenarios. If underlying biases exist in these model-constructed letters, using them without scrutinization could lead to direct societal harms, such as sabotaging application success rates for female applicants. In light of this pressing issue, it is imminent and necessary to comprehensively study fairness issues and associated harms in this real-world use case. In this paper, we critically examine gender biases in LLM-generated reference letters. Drawing inspiration from social science findings, we design evaluation methods to manifest biases through 2 dimensions: (1) biases in language style and (2) biases in lexical content. We further investigate the extent of bias propagation by analyzing the hallucination bias of models, a term that we define to be bias exacerbation in model-hallucinated contents. Through benchmarking evaluation on 2 popular LLMs- ChatGPT and Alpaca, we reveal significant gender biases in LLM-generated recommendation letters. Our findings not only warn against using LLMs for this application without scrutinization, but also illuminate the importance of thoroughly studying hidden biases and harms in LLM-generated professional documents.

Databases of electronic health records (EHRs) are increasingly used to inform clinical decisions. Machine learning methods can find patterns in EHRs that are predictive of future adverse outcomes. However, statistical models may be built upon patterns of health-seeking behavior that vary across patient subpopulations, leading to poor predictive performance when training on one patient population and predicting on another. This note proposes two tests to better measure and understand model generalization. We use these tests to compare models derived from two data sources: (i) historical medical records, and (ii) electrocardiogram (EKG) waveforms. In a predictive task, we show that EKG-based models can be more stable than EHR-based models across different patient populations.

Fairness or equity in machine learning is profoundly important for societal well-being, but limited public datasets hinder its progress, especially in the area of medicine. It is undeniable that fairness in medicine is one of the most important areas for fairness learning's applications. Currently, no large-scale public medical datasets with 3D imaging data for fairness learning are available, while 3D imaging data in modern clinics are standard tests for disease diagnosis. In addition, existing medical fairness datasets are actually repurposed datasets, and therefore they typically have limited demographic identity attributes with at most three identity attributes of age, gender, and race for fairness modeling. To address this gap, we introduce our Eye Fairness dataset with 30,000 subjects (Harvard-EF) covering three major eye diseases including age-related macular degeneration, diabetic retinopathy, and glaucoma affecting 380 million patients globally. Our Harvard-EF dataset includes both 2D fundus photos and 3D optical coherence tomography scans with six demographic identity attributes including age, gender, race, ethnicity, preferred language, and marital status. We also propose a fair identity scaling (FIS) approach combining group and individual scaling together to improve model fairness. Our FIS approach is compared with various state-of-the-art fairness learning methods with superior performance in the racial, gender, and ethnicity fairness tasks with 2D and 3D imaging data, which demonstrate the utilities of our Harvard-EF dataset for fairness learning. To facilitate fairness comparisons between different models, we propose performance-scaled disparity measures, which can be used to compare model fairness accounting for overall performance levels. The dataset and code are publicly accessible via https://ophai.hms.harvard.edu/datasets/harvard-ef30k.

Machine learning models are often personalized with categorical attributes that are protected, sensitive, self-reported, or costly to acquire. In this work, we show models that are personalized with group attributes can reduce performance at a group level. We propose formal conditions to ensure the "fair use" of group attributes in prediction tasks by training one additional model -- i.e., collective preference guarantees to ensure that each group who provides personal data will receive a tailored gain in performance in return. We present sufficient conditions to ensure fair use in empirical risk minimization and characterize failure modes that lead to fair use violations due to standard practices in model development and deployment. We present a comprehensive empirical study of fair use in clinical prediction tasks. Our results demonstrate the prevalence of fair use violations in practice and illustrate simple interventions to mitigate their harm.

Several popular computer vision (CV) datasets, specifically employed for Object Detection (OD) in autonomous driving tasks exhibit biases due to a range of factors including weather and lighting conditions. These biases may impair a model's generalizability, rendering it ineffective for OD in novel and unseen datasets. Especially, in autonomous driving, it may prove extremely high risk and unsafe for the vehicle and its surroundings. This work focuses on understanding these datasets better by identifying such "good-weather" bias. Methods to mitigate such bias which allows the OD models to perform better and improve the robustness are also demonstrated. A simple yet effective OD framework for studying bias mitigation is proposed. Using this framework, the performance on popular datasets is analyzed and a significant difference in model performance is observed. Additionally, a knowledge transfer technique and a synthetic image corruption technique are proposed to mitigate the identified bias. Finally, using the DAWN dataset, the findings are validated on the OD task, demonstrating the effectiveness of our techniques in mitigating real-world "good-weather" bias. The experiments show that the proposed techniques outperform baseline methods by averaged fourfold improvement.

We survey 146 papers analyzing "bias" in NLP systems, finding that their motivations are often vague, inconsistent, and lacking in normative reasoning, despite the fact that analyzing "bias" is an inherently normative process. We further find that these papers' proposed quantitative techniques for measuring or mitigating "bias" are poorly matched to their motivations and do not engage with the relevant literature outside of NLP. Based on these findings, we describe the beginnings of a path forward by proposing three recommendations that should guide work analyzing "bias" in NLP systems. These recommendations rest on a greater recognition of the relationships between language and social hierarchies, encouraging researchers and practitioners to articulate their conceptualizations of "bias"---i.e., what kinds of system behaviors are harmful, in what ways, to whom, and why, as well as the normative reasoning underlying these statements---and to center work around the lived experiences of members of communities affected by NLP systems, while interrogating and reimagining the power relations between technologists and such communities.

We study regressions with multiple treatments and a set of controls that is flexible enough to purge omitted variable bias. We show that these regressions generally fail to estimate convex averages of heterogeneous treatment effects -- instead, estimates of each treatment's effect are contaminated by non-convex averages of the effects of other treatments. We discuss three estimation approaches that avoid such contamination bias, including the targeting of easiest-to-estimate weighted average effects. A re-analysis of nine empirical applications finds economically and statistically meaningful contamination bias in observational studies; contamination bias in experimental studies is more limited due to smaller variability in propensity scores.

False assumptions about sex and gender are deeply embedded in the medical system, including that they are binary, static, and concordant. Machine learning researchers must understand the nature of these assumptions in order to avoid perpetuating them. In this perspectives piece, we identify three common mistakes that researchers make when dealing with sex/gender data: "sex confusion", the failure to identity what sex in a dataset does or doesn't mean; "sex obsession", the belief that sex, specifically sex assigned at birth, is the relevant variable for most applications; and "sex/gender slippage", the conflation of sex and gender even in contexts where only one or the other is known. We then discuss how these pitfalls show up in machine learning studies based on electronic health record data, which is commonly used for everything from retrospective analysis of patient outcomes to the development of algorithms to predict risk and administer care. Finally, we offer a series of recommendations about how machine learning researchers can produce both research and algorithms that more carefully engage with questions of sex/gender, better serving all patients, including transgender people.

Many machine learning algorithms are trained and evaluated by splitting data from a single source into training and test sets. While such focus on in-distribution learning scenarios has led to interesting advancement, it has not been able to tell if models are relying on dataset biases as shortcuts for successful prediction (e.g., using snow cues for recognising snowmobiles), resulting in biased models that fail to generalise when the bias shifts to a different class. The cross-bias generalisation problem has been addressed by de-biasing training data through augmentation or re-sampling, which are often prohibitive due to the data collection cost (e.g., collecting images of a snowmobile on a desert) and the difficulty of quantifying or expressing biases in the first place. In this work, we propose a novel framework to train a de-biased representation by encouraging it to be different from a set of representations that are biased by design. This tactic is feasible in many scenarios where it is much easier to define a set of biased representations than to define and quantify bias. We demonstrate the efficacy of our method across a variety of synthetic and real-world biases; our experiments show that the method discourages models from taking bias shortcuts, resulting in improved generalisation. Source code is available at https://github.com/clovaai/rebias.

Large Language Models(LLMs) have revolutionized various applications in natural language processing (NLP) by providing unprecedented text generation, translation, and comprehension capabilities. However, their widespread deployment has brought to light significant concerns regarding biases embedded within these models. This paper presents a comprehensive survey of biases in LLMs, aiming to provide an extensive review of the types, sources, impacts, and mitigation strategies related to these biases. We systematically categorize biases into several dimensions. Our survey synthesizes current research findings and discusses the implications of biases in real-world applications. Additionally, we critically assess existing bias mitigation techniques and propose future research directions to enhance fairness and equity in LLMs. This survey serves as a foundational resource for researchers, practitioners, and policymakers concerned with addressing and understanding biases in LLMs.

Mental health disorders are one of the most serious diseases in the world. Most people with such a disease lack access to adequate care, which highlights the importance of training models for the diagnosis and treatment of mental health disorders. However, in the mental health domain, privacy concerns limit the accessibility of personalized treatment data, making it challenging to build powerful models. In this paper, we introduce MentalArena, a self-play framework to train language models by generating domain-specific personalized data, where we obtain a better model capable of making a personalized diagnosis and treatment (as a therapist) and providing information (as a patient). To accurately model human-like mental health patients, we devise Symptom Encoder, which simulates a real patient from both cognition and behavior perspectives. To address intent bias during patient-therapist interactions, we propose Symptom Decoder to compare diagnosed symptoms with encoded symptoms, and dynamically manage the dialogue between patient and therapist according to the identified deviations. We evaluated MentalArena against 6 benchmarks, including biomedicalQA and mental health tasks, compared to 6 advanced models. Our models, fine-tuned on both GPT-3.5 and Llama-3-8b, significantly outperform their counterparts, including GPT-4o. We hope that our work can inspire future research on personalized care. Code is available in https://github.com/Scarelette/MentalArena/tree/main

Human biases are ubiquitous but not uniform: disparities exist across linguistic, cultural, and societal borders. As large amounts of recent literature suggest, language models (LMs) trained on human data can reflect and often amplify the effects of these social biases. However, the vast majority of existing studies on bias are heavily skewed towards Western and European languages. In this work, we scale the Word Embedding Association Test (WEAT) to 24 languages, enabling broader studies and yielding interesting findings about LM bias. We additionally enhance this data with culturally relevant information for each language, capturing local contexts on a global scale. Further, to encompass more widely prevalent societal biases, we examine new bias dimensions across toxicity, ableism, and more. Moreover, we delve deeper into the Indian linguistic landscape, conducting a comprehensive regional bias analysis across six prevalent Indian languages. Finally, we highlight the significance of these social biases and the new dimensions through an extensive comparison of embedding methods, reinforcing the need to address them in pursuit of more equitable language models. All code, data and results are available here: https://github.com/iamshnoo/weathub.

Ensuring equitable Artificial Intelligence (AI) in healthcare demands systems that make unbiased decisions across all demographic groups, bridging technical innovation with ethical principles. Foundation Models (FMs), trained on vast datasets through self-supervised learning, enable efficient adaptation across medical imaging tasks while reducing dependency on labeled data. These models demonstrate potential for enhancing fairness, though significant challenges remain in achieving consistent performance across demographic groups. Our review indicates that effective bias mitigation in FMs requires systematic interventions throughout all stages of development. While previous approaches focused primarily on model-level bias mitigation, our analysis reveals that fairness in FMs requires integrated interventions throughout the development pipeline, from data documentation to deployment protocols. This comprehensive framework advances current knowledge by demonstrating how systematic bias mitigation, combined with policy engagement, can effectively address both technical and institutional barriers to equitable AI in healthcare. The development of equitable FMs represents a critical step toward democratizing advanced healthcare technologies, particularly for underserved populations and regions with limited medical infrastructure and computational resources.

Negative bias refers to the tendency of large language models (LLMs) to excessively generate negative responses in binary decision tasks (e.g., yes-no question answering). Previous research has focused on detecting and addressing negative attention heads that induce negative bias. However, the underlying detailed factors influencing negative bias remain underexplored. In this paper, we demonstrate that LLMs exhibit format-level negative bias, meaning the prompt format more influences their responses than the semantics of the negative response. For the fine-grained study of the negative bias, we introduce a pipeline for constructing the evaluation set, which systematically categorizes the dataset into three subsets based on the model's parametric knowledge: correct, incorrect, and insufficient relevant knowledge. Through analysis of this evaluation set, we identify a shortcut behavior in which models tend to generate negative responses when they lack sufficient knowledge to answer a yes-no question, leading to negative bias. We further examine how negative bias changes under various prompting scenarios related to parametric knowledge. We observe that providing relevant context and offering an "I don't know" option generally reduces negative bias, whereas chain-of-thought prompting tends to amplify the bias. Finally, we demonstrate that the degree of negative bias can vary depending on the type of prompt, which influences the direction of the response. Our work reveals the various factors that influence negative bias, providing critical insights for mitigating it in LLMs.

State-of-the-art natural language processing (NLP) models often learn to model dataset biases and surface form correlations instead of features that target the intended underlying task. Previous work has demonstrated effective methods to circumvent these issues when knowledge of the bias is available. We consider cases where the bias issues may not be explicitly identified, and show a method for training models that learn to ignore these problematic correlations. Our approach relies on the observation that models with limited capacity primarily learn to exploit biases in the dataset. We can leverage the errors of such limited capacity models to train a more robust model in a product of experts, thus bypassing the need to hand-craft a biased model. We show the effectiveness of this method to retain improvements in out-of-distribution settings even if no particular bias is targeted by the biased model.

Foundation Models that are capable of processing and generating multi-modal data have transformed AI's role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety. We define medical hallucination as any instance in which a model generates misleading medical content. This paper examines the unique characteristics, causes, and implications of medical hallucinations, with a particular focus on how these errors manifest themselves in real-world clinical scenarios. Our contributions include (1) a taxonomy for understanding and addressing medical hallucinations, (2) benchmarking models using medical hallucination dataset and physician-annotated LLM responses to real medical cases, providing direct insight into the clinical impact of hallucinations, and (3) a multi-national clinician survey on their experiences with medical hallucinations. Our results reveal that inference techniques such as Chain-of-Thought (CoT) and Search Augmented Generation can effectively reduce hallucination rates. However, despite these improvements, non-trivial levels of hallucination persist. These findings underscore the ethical and practical imperative for robust detection and mitigation strategies, establishing a foundation for regulatory policies that prioritize patient safety and maintain clinical integrity as AI becomes more integrated into healthcare. The feedback from clinicians highlights the urgent need for not only technical advances but also for clearer ethical and regulatory guidelines to ensure patient safety. A repository organizing the paper resources, summaries, and additional information is available at https://github.com/mitmedialab/medical hallucination.

Understanding biases and stereotypes encoded in the weights of Large Language Models (LLMs) is crucial for developing effective mitigation strategies. Biased behaviour is often subtle and non-trivial to isolate, even when deliberately elicited, making systematic analysis and debiasing particularly challenging. To address this, we introduce BiasGym, a simple, cost-effective, and generalizable framework for reliably injecting, analyzing, and mitigating conceptual associations within LLMs. BiasGym consists of two components: BiasInject, which injects specific biases into the model via token-based fine-tuning while keeping the model frozen, and BiasScope, which leverages these injected signals to identify and steer the components responsible for biased behavior. Our method enables consistent bias elicitation for mechanistic analysis, supports targeted debiasing without degrading performance on downstream tasks, and generalizes to biases unseen during training. We demonstrate the effectiveness of BiasGym in reducing real-world stereotypes (e.g., people from a country being `reckless drivers') and in probing fictional associations (e.g., people from a country having `blue skin'), showing its utility for both safety interventions and interpretability research.

Convolutional Neural Networks have demonstrated dermatologist-level performance in the classification of melanoma from skin lesion images, but prediction irregularities due to biases seen within the training data are an issue that should be addressed before widespread deployment is possible. In this work, we robustly remove bias and spurious variation from an automated melanoma classification pipeline using two leading bias unlearning techniques. We show that the biases introduced by surgical markings and rulers presented in previous studies can be reasonably mitigated using these bias removal methods. We also demonstrate the generalisation benefits of unlearning spurious variation relating to the imaging instrument used to capture lesion images. Our experimental results provide evidence that the effects of each of the aforementioned biases are notably reduced, with different debiasing techniques excelling at different tasks.

Media bias is a multi-faceted construct influencing individual behavior and collective decision-making. Slanted news reporting is the result of one-sided and polarized writing which can occur in various forms. In this work, we focus on an important form of media bias, i.e. bias by word choice. Detecting biased word choices is a challenging task due to its linguistic complexity and the lack of representative gold-standard corpora. We present DA-RoBERTa, a new state-of-the-art transformer-based model adapted to the media bias domain which identifies sentence-level bias with an F1 score of 0.814. In addition, we also train, DA-BERT and DA-BART, two more transformer models adapted to the bias domain. Our proposed domain-adapted models outperform prior bias detection approaches on the same data.

Introduction: Electronic health records (EHR) are a critical medium through which patient stigmatization is perpetuated among healthcare teams. Methods: We identified linguistic features of doubt markers and stigmatizing labels in MIMIC-III EHR via expanded lexicon matching and supervised learning classifiers. Predictors of rates of linguistic features were assessed using Poisson regression models. Results: We found higher rates of stigmatizing labels per chart among patients who were Black or African American (RR: 1.16), patients with Medicare/Medicaid or government-run insurance (RR: 2.46), self-pay (RR: 2.12), and patients with a variety of stigmatizing disease and mental health conditions. Patterns among doubt markers were similar, though male patients had higher rates of doubt markers (RR: 1.25). We found increased stigmatizing labels used by nurses (RR: 1.40), and social workers (RR: 2.25), with similar patterns of doubt markers. Discussion: Stigmatizing language occurred at higher rates among historically stigmatized patients, perpetuated by multiple provider types.

Survey data are self-reported data collected directly from respondents by a questionnaire or an interview and are commonly used in epidemiology. Such data are traditionally collected via a single mode (e.g. face-to-face interview alone), but use of mixed-mode designs (e.g. offering face-to-face interview or online survey) has become more common. This introduces two key challenges. First, individuals may respond differently to the same question depending on the mode; these differences due to measurement are known as 'mode effects'. Second, different individuals may participate via different modes; these differences in sample composition between modes are known as 'mode selection'. Where recognised, mode effects are often handled by straightforward approaches such as conditioning on survey mode. However, while reducing mode effects, this and other equivalent approaches may introduce collider bias in the presence of mode selection. The existence of mode effects and the consequences of na\"ive conditioning may be underappreciated in epidemiology. This paper offers a simple introduction to these challenges using directed acyclic graphs by exploring a range of possible data structures. We discuss the potential implications of using conditioning- or imputation-based approaches and outline the advantages of quantitative bias analyses for dealing with mode effects.

The proliferation of machine learning models in critical decision making processes has underscored the need for bias discovery and mitigation strategies. Identifying the reasons behind a biased system is not straightforward, since in many occasions they are associated with hidden spurious correlations which are not easy to spot. Standard approaches rely on bias audits performed by analyzing model performance in pre-defined subgroups of data samples, usually characterized by common attributes like gender or ethnicity when it comes to people, or other specific attributes defining semantically coherent groups of images. However, it is not always possible to know a-priori the specific attributes defining the failure modes of visual recognition systems. Recent approaches propose to discover these groups by leveraging large vision language models, which enable the extraction of cross-modal embeddings and the generation of textual descriptions to characterize the subgroups where a certain model is underperforming. In this work, we argue that incorporating visual explanations (e.g. heatmaps generated via GradCAM or other approaches) can boost the performance of such bias discovery and mitigation frameworks. To this end, we introduce Visually Grounded Bias Discovery and Mitigation (ViG-Bias), a simple yet effective technique which can be integrated to a variety of existing frameworks to improve both, discovery and mitigation performance. Our comprehensive evaluation shows that incorporating visual explanations enhances existing techniques like DOMINO, FACTS and Bias-to-Text, across several challenging datasets, including CelebA, Waterbirds, and NICO++.

Mitigating bias in machine learning systems requires refining our understanding of bias propagation pathways: from societal structures to large-scale data to trained models to impact on society. In this work, we focus on one aspect of the problem, namely bias amplification: the tendency of models to amplify the biases present in the data they are trained on. A metric for measuring bias amplification was introduced in the seminal work by Zhao et al. (2017); however, as we demonstrate, this metric suffers from a number of shortcomings including conflating different types of bias amplification and failing to account for varying base rates of protected attributes. We introduce and analyze a new, decoupled metric for measuring bias amplification, BiasAmp_{rightarrow} (Directional Bias Amplification). We thoroughly analyze and discuss both the technical assumptions and normative implications of this metric. We provide suggestions about its measurement by cautioning against predicting sensitive attributes, encouraging the use of confidence intervals due to fluctuations in the fairness of models across runs, and discussing the limitations of what this metric captures. Throughout this paper, we work to provide an interrogative look at the technical measurement of bias amplification, guided by our normative ideas of what we want it to encompass. Code is located at https://github.com/princetonvisualai/directional-bias-amp

Neural networks trained with ERM (empirical risk minimization) sometimes learn unintended decision rules, in particular when their training data is biased, i.e., when training labels are strongly correlated with undesirable features. To prevent a network from learning such features, recent methods augment training data such that examples displaying spurious correlations (i.e., bias-aligned examples) become a minority, whereas the other, bias-conflicting examples become prevalent. However, these approaches are sometimes difficult to train and scale to real-world data because they rely on generative models or disentangled representations. We propose an alternative based on mixup, a popular augmentation that creates convex combinations of training examples. Our method, coined SelecMix, applies mixup to contradicting pairs of examples, defined as showing either (i) the same label but dissimilar biased features, or (ii) different labels but similar biased features. Identifying such pairs requires comparing examples with respect to unknown biased features. For this, we utilize an auxiliary contrastive model with the popular heuristic that biased features are learned preferentially during training. Experiments on standard benchmarks demonstrate the effectiveness of the method, in particular when label noise complicates the identification of bias-conflicting examples.

Large language models (LLMs) are increasingly essential in processing natural languages, yet their application is frequently compromised by biases and inaccuracies originating in their training data. In this study, we introduce Cross-Care, the first benchmark framework dedicated to assessing biases and real world knowledge in LLMs, specifically focusing on the representation of disease prevalence across diverse demographic groups. We systematically evaluate how demographic biases embedded in pre-training corpora like ThePile influence the outputs of LLMs. We expose and quantify discrepancies by juxtaposing these biases against actual disease prevalences in various U.S. demographic groups. Our results highlight substantial misalignment between LLM representation of disease prevalence and real disease prevalence rates across demographic subgroups, indicating a pronounced risk of bias propagation and a lack of real-world grounding for medical applications of LLMs. Furthermore, we observe that various alignment methods minimally resolve inconsistencies in the models' representation of disease prevalence across different languages. For further exploration and analysis, we make all data and a data visualization tool available at: www.crosscare.net.

As LLMs are increasingly integrated into user-facing applications, addressing biases that perpetuate societal inequalities is crucial. While much work has gone into measuring or mitigating biases in these models, fewer studies have investigated their origins. Therefore, this study examines the correlation between gender-occupation bias in pre-training data and their manifestation in LLMs, focusing on the Dolma dataset and the OLMo model. Using zero-shot prompting and token co-occurrence analyses, we explore how biases in training data influence model outputs. Our findings reveal that biases present in pre-training data are amplified in model outputs. The study also examines the effects of prompt types, hyperparameters, and instruction-tuning on bias expression, finding instruction-tuning partially alleviating representational bias while still maintaining overall stereotypical gender associations, whereas hyperparameters and prompting variation have a lesser effect on bias expression. Our research traces bias throughout the LLM development pipeline and underscores the importance of mitigating bias at the pretraining stage.

As Large Language Models (LLMs) are increasingly deployed to handle various natural language processing (NLP) tasks, concerns regarding the potential negative societal impacts of LLM-generated content have also arisen. To evaluate the biases exhibited by LLMs, researchers have recently proposed a variety of datasets. However, existing bias evaluation efforts often focus on only a particular type of bias and employ inconsistent evaluation metrics, leading to difficulties in comparison across different datasets and LLMs. To address these limitations, we collect a variety of datasets designed for the bias evaluation of LLMs, and further propose CEB, a Compositional Evaluation Benchmark that covers different types of bias across different social groups and tasks. The curation of CEB is based on our newly proposed compositional taxonomy, which characterizes each dataset from three dimensions: bias types, social groups, and tasks. By combining the three dimensions, we develop a comprehensive evaluation strategy for the bias in LLMs. Our experiments demonstrate that the levels of bias vary across these dimensions, thereby providing guidance for the development of specific bias mitigation methods.

This paper evaluates geopolitical biases in LLMs with respect to various countries though an analysis of their interpretation of historical events with conflicting national perspectives (USA, UK, USSR, and China). We introduce a novel dataset with neutral event descriptions and contrasting viewpoints from different countries. Our findings show significant geopolitical biases, with models favoring specific national narratives. Additionally, simple debiasing prompts had a limited effect in reducing these biases. Experiments with manipulated participant labels reveal models' sensitivity to attribution, sometimes amplifying biases or recognizing inconsistencies, especially with swapped labels. This work highlights national narrative biases in LLMs, challenges the effectiveness of simple debiasing methods, and offers a framework and dataset for future geopolitical bias research.

Finding relevant literature underpins the practice of evidence-based medicine. From 2014 to 2016, TREC conducted a clinical decision support track, wherein participants were tasked with finding articles relevant to clinical questions posed by physicians. In total, 87 teams have participated over the past three years, generating 395 runs. During this period, each team has trialled a variety of methods. While there was significant overlap in the methods employed by different teams, the results were varied. Due to the diversity of the platforms used, the results arising from the different techniques are not directly comparable, reducing the ability to build on previous work. By using a stable platform, we have been able to compare different document and query processing techniques, allowing us to experiment with different search parameters. We have used our system to reproduce leading teams runs, and compare the results obtained. By benchmarking our indexing and search techniques, we can statistically test a variety of hypotheses, paving the way for further research.

Observational studies require adjustment for confounding factors that are correlated with both the treatment and outcome. In the setting where the observed variables are tabular quantities such as average income in a neighborhood, tools have been developed for addressing such confounding. However, in many parts of the developing world, features about local communities may be scarce. In this context, satellite imagery can play an important role, serving as a proxy for the confounding variables otherwise unobserved. In this paper, we study confounder adjustment in this non-tabular setting, where patterns or objects found in satellite images contribute to the confounder bias. Using the evaluation of anti-poverty aid programs in Africa as our running example, we formalize the challenge of performing causal adjustment with such unstructured data -- what conditions are sufficient to identify causal effects, how to perform estimation, and how to quantify the ways in which certain aspects of the unstructured image object are most predictive of the treatment decision. Via simulation, we also explore the sensitivity of satellite image-based observational inference to image resolution and to misspecification of the image-associated confounder. Finally, we apply these tools in estimating the effect of anti-poverty interventions in African communities from satellite imagery.

Combating bias in NLP requires bias measurement. Bias measurement is almost always achieved by using lexicons of seed terms, i.e. sets of words specifying stereotypes or dimensions of interest. This reproducibility study focuses on the original authors' main claim that the rationale for the construction of these lexicons needs thorough checking before usage, as the seeds used for bias measurement can themselves exhibit biases. The study aims to evaluate the reproducibility of the quantitative and qualitative results presented in the paper and the conclusions drawn thereof. We reproduce most of the results supporting the original authors' general claim: seed sets often suffer from biases that affect their performance as a baseline for bias metrics. Generally, our results mirror the original paper's. They are slightly different on select occasions, but not in ways that undermine the paper's general intent to show the fragility of seed sets.

The impressive performance of language models is undeniable. However, the presence of biases based on gender, race, socio-economic status, physical appearance, and sexual orientation makes the deployment of language models challenging. This paper studies the effect of chain-of-thought prompting, a recent approach that studies the steps followed by the model before it responds, on fairness. More specifically, we ask the following question: Do biased models have biased thoughts? To answer our question, we conduct experiments on 5 popular large language models using fairness metrics to quantify 11 different biases in the model's thoughts and output. Our results show that the bias in the thinking steps is not highly correlated with the output bias (less than 0.6 correlation with a p-value smaller than 0.001 in most cases). In other words, unlike human beings, the tested models with biased decisions do not always possess biased thoughts.

Recently, the increasing demand for superior medical services has highlighted the discrepancies in the medical infrastructure. With big data, especially texts, forming the foundation of medical services, there is an exigent need for effective natural language processing (NLP) solutions tailored to the healthcare domain. Conventional approaches leveraging pre-trained models present promising results in this domain and current large language models (LLMs) offer advanced foundation for medical text processing. However, most medical LLMs are trained only with supervised fine-tuning (SFT), even though it efficiently empowers LLMs to understand and respond to medical instructions but is ineffective in learning domain knowledge and aligning with human preference. Another engineering barrier that prevents current medical LLM from better text processing ability is their restricted context length (e.g., 2,048 tokens), making it hard for the LLMs to process long context, which is frequently required in the medical domain. In this work, we propose ChiMed-GPT, a new benchmark LLM designed explicitly for Chinese medical domain, with enlarged context length to 4,096 tokens and undergoes a comprehensive training regime with pre-training, SFT, and RLHF. Evaluations on real-world tasks including information extraction, question answering, and dialogue generation demonstrate ChiMed-GPT's superior performance over general domain LLMs. Furthermore, we analyze possible biases through prompting ChiMed-GPT to perform attitude scales regarding discrimination of patients, so as to contribute to further responsible development of LLMs in the medical domain. The code and model are released at https://github.com/synlp/ChiMed-GPT.

In response to the pressing need for advanced clinical problem-solving tools in healthcare, we introduce BooksMed, a novel framework based on a Large Language Model (LLM). BooksMed uniquely emulates human cognitive processes to deliver evidence-based and reliable responses, utilizing the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework to effectively quantify evidence strength. For clinical decision-making to be appropriately assessed, an evaluation metric that is clinically aligned and validated is required. As a solution, we present ExpertMedQA, a multispecialty clinical benchmark comprised of open-ended, expert-level clinical questions, and validated by a diverse group of medical professionals. By demanding an in-depth understanding and critical appraisal of up-to-date clinical literature, ExpertMedQA rigorously evaluates LLM performance. BooksMed outperforms existing state-of-the-art models Med-PaLM 2, Almanac, and ChatGPT in a variety of medical scenarios. Therefore, a framework that mimics human cognitive stages could be a useful tool for providing reliable and evidence-based responses to clinical inquiries.

Large language models (LLMs) can exhibit bias in a variety of ways. Such biases can create or exacerbate unfair outcomes for certain groups within a protected attribute, including, but not limited to sex, race, sexual orientation, or age. In this paper, we propose a decision framework that allows practitioners to determine which bias and fairness metrics to use for a specific LLM use case. To establish the framework, we define bias and fairness risks for LLMs, map those risks to a taxonomy of LLM use cases, and then define various metrics to assess each type of risk. Instead of focusing solely on the model itself, we account for both prompt-specific- and model-specific-risk by defining evaluations at the level of an LLM use case, characterized by a model and a population of prompts. Furthermore, because all of the evaluation metrics are calculated solely using the LLM output, our proposed framework is highly practical and easily actionable for practitioners. For streamlined implementation, all evaluation metrics included in the framework are offered in this paper's companion Python toolkit, LangFair. Finally, our experiments demonstrate substantial variation in bias and fairness across use cases, underscoring the importance of use-case-level assessments.

LLM-as-a-Judge has emerged as a promising tool for automatically evaluating generated outputs, but its reliability is often undermined by potential biases in judgment. Existing efforts to mitigate these biases face key limitations: in-context learning-based methods fail to address rooted biases due to the evaluator's limited capacity for self-reflection, whereas fine-tuning is not applicable to all evaluator types, especially closed-source models. To address this challenge, we introduce the Reasoning-based Bias Detector (RBD), which is a plug-in module that identifies biased evaluations and generates structured reasoning to guide evaluator self-correction. Rather than modifying the evaluator itself, RBD operates externally and engages in an iterative process of bias detection and feedback-driven revision. To support its development, we design a complete pipeline consisting of biased dataset construction, supervision collection, distilled reasoning-based fine-tuning of RBD, and integration with LLM evaluators. We fine-tune four sizes of RBD models, ranging from 1.5B to 14B, and observe consistent performance improvements across all scales. Experimental results on 4 bias types--verbosity, position, bandwagon, and sentiment--evaluated using 8 LLM evaluators demonstrate RBD's strong effectiveness. For example, the RBD-8B model improves evaluation accuracy by an average of 18.5% and consistency by 10.9%, and surpasses prompting-based baselines and fine-tuned judges by 12.8% and 17.2%, respectively. These results highlight RBD's effectiveness and scalability. Additional experiments further demonstrate its strong generalization across biases and domains, as well as its efficiency.

It stands to reason that the amount and the quality of data is of key importance for setting up accurate AI-driven models. Among others, a fundamental aspect to consider is the bias introduced during sample selection in database generation. This is particularly relevant when a model is trained on a specialized dataset to predict a property of interest, and then applied to forecast the same property over samples having a completely different genesis. Indeed, the resulting biased model will likely produce unreliable predictions for many of those out-of-the-box samples. Neglecting such an aspect may hinder the AI-based discovery process, even when high quality, sufficiently large and highly reputable data sources are available. In this regard, with superconducting and thermoelectric materials as two prototypical case studies in the field of energy material discovery, we present and validate a new method (based on a classification strategy) capable of detecting, quantifying and circumventing the presence of cross-domain data bias.

Instruction-tuned Large Language Models (LLMs) have recently showcased remarkable ability to generate fitting responses to natural language instructions. However, an open research question concerns the inherent biases of trained models and their responses. For instance, if the data used to tune an LLM is dominantly written by persons with a specific political bias, we might expect generated answers to share this bias. Current research work seeks to de-bias such models, or suppress potentially biased answers. With this demonstration, we take a different view on biases in instruction-tuning: Rather than aiming to suppress them, we aim to make them explicit and transparent. To this end, we present OpinionGPT, a web demo in which users can ask questions and select all biases they wish to investigate. The demo will answer this question using a model fine-tuned on text representing each of the selected biases, allowing side-by-side comparison. To train the underlying model, we identified 11 different biases (political, geographic, gender, age) and derived an instruction-tuning corpus in which each answer was written by members of one of these demographics. This paper presents OpinionGPT, illustrates how we trained the bias-aware model and showcases the web application (available at https://opiniongpt.informatik.hu-berlin.de).

Face recognition systems are widely deployed in safety-critical applications, including law enforcement, yet they exhibit bias across a range of socio-demographic dimensions, such as gender and race. Conventional wisdom dictates that model biases arise from biased training data. As a consequence, previous works on bias mitigation largely focused on pre-processing the training data, adding penalties to prevent bias from effecting the model during training, or post-processing predictions to debias them, yet these approaches have shown limited success on hard problems such as face recognition. In our work, we discover that biases are actually inherent to neural network architectures themselves. Following this reframing, we conduct the first neural architecture search for fairness, jointly with a search for hyperparameters. Our search outputs a suite of models which Pareto-dominate all other high-performance architectures and existing bias mitigation methods in terms of accuracy and fairness, often by large margins, on the two most widely used datasets for face identification, CelebA and VGGFace2. Furthermore, these models generalize to other datasets and sensitive attributes. We release our code, models and raw data files at https://github.com/dooleys/FR-NAS.

Large language models (LLMs) are now widely deployed in user-facing applications, reaching hundreds of millions worldwide. As they become integrated into everyday tasks, growing reliance on their outputs raises significant concerns. In particular, users may unknowingly be exposed to model-inherent biases that systematically disadvantage or stereotype certain groups. However, existing bias benchmarks continue to rely on templated prompts or restrictive multiple-choice questions that are suggestive, simplistic, and fail to capture the complexity of real-world user interactions. In this work, we address this gap by introducing a counterfactual bias evaluation framework that automatically generates realistic, open-ended questions over sensitive attributes such as sex, race, or religion. By iteratively mutating and selecting bias-inducing questions, our approach systematically explores areas where models are most susceptible to biased behavior. Beyond detecting harmful biases, we also capture distinct response dimensions that are increasingly relevant in user interactions, such as asymmetric refusals and explicit acknowledgment of bias. Leveraging our framework, we construct CAB, a human-verified benchmark spanning diverse topics, designed to enable cross-model comparisons. Using CAB, we analyze a range of LLMs across multiple bias dimensions, revealing nuanced insights into how different models manifest bias. For instance, while GPT-5 outperforms other models, it nonetheless exhibits persistent biases in specific scenarios. These findings underscore the need for continual improvements to ensure fair model behavior.

With the introduction of ChatGPT, Large Language Models (LLMs) have received enormous attention in healthcare. Despite their potential benefits, researchers have underscored various ethical implications. While individual instances have drawn much attention, the debate lacks a systematic overview of practical applications currently researched and ethical issues connected to them. Against this background, this work aims to map the ethical landscape surrounding the current stage of deployment of LLMs in medicine and healthcare. Electronic databases and preprint servers were queried using a comprehensive search strategy. Studies were screened and extracted following a modified rapid review approach. Methodological quality was assessed using a hybrid approach. For 53 records, a meta-aggregative synthesis was performed. Four fields of applications emerged and testify to a vivid exploration phase. Advantages of using LLMs are attributed to their capacity in data analysis, personalized information provisioning, support in decision-making, mitigating information loss and enhancing information accessibility. However, we also identifies recurrent ethical concerns connected to fairness, bias, non-maleficence, transparency, and privacy. A distinctive concern is the tendency to produce harmful misinformation or convincingly but inaccurate content. A recurrent plea for ethical guidance and human oversight is evident. Given the variety of use cases, it is suggested that the ethical guidance debate be reframed to focus on defining what constitutes acceptable human oversight across the spectrum of applications. This involves considering diverse settings, varying potentials for harm, and different acceptable thresholds for performance and certainty in healthcare. In addition, a critical inquiry is necessary to determine the extent to which the current experimental use of LLMs is necessary and justified.

In machine learning (ML), a widespread adage is that the area under the precision-recall curve (AUPRC) is a superior metric for model comparison to the area under the receiver operating characteristic (AUROC) for binary classification tasks with class imbalance. This paper challenges this notion through novel mathematical analysis, illustrating that AUROC and AUPRC can be concisely related in probabilistic terms. We demonstrate that AUPRC, contrary to popular belief, is not superior in cases of class imbalance and might even be a harmful metric, given its inclination to unduly favor model improvements in subpopulations with more frequent positive labels. This bias can inadvertently heighten algorithmic disparities. Prompted by these insights, a thorough review of existing ML literature was conducted, utilizing large language models to analyze over 1.5 million papers from arXiv. Our investigation focused on the prevalence and substantiation of the purported AUPRC superiority. The results expose a significant deficit in empirical backing and a trend of misattributions that have fuelled the widespread acceptance of AUPRC's supposed advantages. Our findings represent a dual contribution: a significant technical advancement in understanding metric behaviors and a stark warning about unchecked assumptions in the ML community. All experiments are accessible at https://github.com/mmcdermott/AUC_is_all_you_need.

Large Language Models (LLMs) are prone to inheriting and amplifying societal biases embedded within their training data, potentially reinforcing harmful stereotypes related to gender, occupation, and other sensitive categories. This issue becomes particularly problematic as biased LLMs can have far-reaching consequences, leading to unfair practices and exacerbating social inequalities across various domains, such as recruitment, online content moderation, or even the criminal justice system. Although prior research has focused on detecting bias in LLMs using specialized datasets designed to highlight intrinsic biases, there has been a notable lack of investigation into how these findings correlate with authoritative datasets, such as those from the U.S. National Bureau of Labor Statistics (NBLS). To address this gap, we conduct empirical research that evaluates LLMs in a ``bias-out-of-the-box" setting, analyzing how the generated outputs compare with the distributions found in NBLS data. Furthermore, we propose a straightforward yet effective debiasing mechanism that directly incorporates NBLS instances to mitigate bias within LLMs. Our study spans seven different LLMs, including instructable, base, and mixture-of-expert models, and reveals significant levels of bias that are often overlooked by existing bias detection techniques. Importantly, our debiasing method, which does not rely on external datasets, demonstrates a substantial reduction in bias scores, highlighting the efficacy of our approach in creating fairer and more reliable LLMs.

Within the context of Natural Language Processing (NLP), fairness evaluation is often associated with the assessment of bias and reduction of associated harm. In this regard, the evaluation is usually carried out by using a benchmark dataset, for a task such as Question Answering, created for the measurement of bias in the model's predictions along various dimensions, including gender identity. In our work, we evaluate gender bias in German Large Language Models (LLMs) using the Bias Benchmark for Question Answering by Parrish et al. (2022) as a reference. Specifically, the templates in the gender identity subset of this English dataset were machine translated into German. The errors in the machine translated templates were then manually reviewed and corrected with the help of a language expert. We find that manual revision of the translation is crucial when creating datasets for gender bias evaluation because of the limitations of machine translation from English to a language such as German with grammatical gender. Our final dataset is comprised of two subsets: Subset-I, which consists of group terms related to gender identity, and Subset-II, where group terms are replaced with proper names. We evaluate several LLMs used for German NLP on this newly created dataset and report the accuracy and bias scores. The results show that all models exhibit bias, both along and against existing social stereotypes.

Developing models with robust group fairness properties is paramount, particularly in ethically sensitive domains such as medical diagnosis. Recent approaches to achieving fairness in machine learning require a substantial amount of training data and depend on model retraining, which may not be practical in real-world scenarios. To mitigate these challenges, we propose Bias-based Weight Masking Fine-Tuning (BMFT), a novel post-processing method that enhances the fairness of a trained model in significantly fewer epochs without requiring access to the original training data. BMFT produces a mask over model parameters, which efficiently identifies the weights contributing the most towards biased predictions. Furthermore, we propose a two-step debiasing strategy, wherein the feature extractor undergoes initial fine-tuning on the identified bias-influenced weights, succeeded by a fine-tuning phase on a reinitialised classification layer to uphold discriminative performance. Extensive experiments across four dermatological datasets and two sensitive attributes demonstrate that BMFT outperforms existing state-of-the-art (SOTA) techniques in both diagnostic accuracy and fairness metrics. Our findings underscore the efficacy and robustness of BMFT in advancing fairness across various out-of-distribution (OOD) settings. Our code is available at: https://github.com/vios-s/BMFT

Recommendation systems (RS) aim to provide personalized content, but they face a challenge in unbiased learning due to selection bias, where users only interact with items they prefer. This bias leads to a distorted representation of user preferences, which hinders the accuracy and fairness of recommendations. To address the issue, various methods such as error imputation based, inverse propensity scoring, and doubly robust techniques have been developed. Despite the progress, from the structural causal model perspective, previous debiasing methods in RS assume the independence of the exogenous variables. In this paper, we release this assumption and propose a learning algorithm based on likelihood maximization to learn a prediction model. We first discuss the correlation and difference between unmeasured confounding and our scenario, then we propose a unified method that effectively handles latent exogenous variables. Specifically, our method models the data generation process with latent exogenous variables under mild normality assumptions. We then develop a Monte Carlo algorithm to numerically estimate the likelihood function. Extensive experiments on synthetic datasets and three real-world datasets demonstrate the effectiveness of our proposed method. The code is at https://github.com/WallaceSUI/kdd25-background-variable.

We use tools from geometric statistics to analyze the usual estimation procedure of a template shape. This applies to shapes from landmarks, curves, surfaces, images etc. We demonstrate the asymptotic bias of the template shape estimation using the stratified geometry of the shape space. We give a Taylor expansion of the bias with respect to a parameter sigma describing the measurement error on the data. We propose two bootstrap procedures that quantify the bias and correct it, if needed. They are applicable for any type of shape data. We give a rule of thumb to provide intuition on whether the bias has to be corrected. This exhibits the parameters that control the bias' magnitude. We illustrate our results on simulated and real shape data.

Large Language Models (LLMs) are aligned to meet ethical standards and safety requirements by training them to refuse answering harmful or unsafe prompts. In this paper, we demonstrate how adversaries can exploit LLMs' alignment to implant bias, or enforce targeted censorship without degrading the model's responsiveness to unrelated topics. Specifically, we propose Subversive Alignment Injection (SAI), a poisoning attack that leverages the alignment mechanism to trigger refusal on specific topics or queries predefined by the adversary. Although it is perhaps not surprising that refusal can be induced through overalignment, we demonstrate how this refusal can be exploited to inject bias into the model. Surprisingly, SAI evades state-of-the-art poisoning defenses including LLM state forensics, as well as robust aggregation techniques that are designed to detect poisoning in FL settings. We demonstrate the practical dangers of this attack by illustrating its end-to-end impacts on LLM-powered application pipelines. For chat based applications such as ChatDoctor, with 1% data poisoning, the system refuses to answer healthcare questions to targeted racial category leading to high bias (Delta DP of 23%). We also show that bias can be induced in other NLP tasks: for a resume selection pipeline aligned to refuse to summarize CVs from a selected university, high bias in selection (Delta DP of 27%) results. Even higher bias (Delta DP~38%) results on 9 other chat based downstream applications.

LLMs have demonstrated impressive performance in answering medical questions, such as passing scores on medical licensing examinations. However, medical board exam questions or general clinical questions do not capture the complexity of realistic clinical cases. Moreover, the lack of reference explanations means we cannot easily evaluate the reasoning of model decisions, a crucial component of supporting doctors in making complex medical decisions. To address these challenges, we construct two new datasets: JAMA Clinical Challenge and Medbullets. JAMA Clinical Challenge consists of questions based on challenging clinical cases, while Medbullets comprises USMLE Step 2&3 style clinical questions. Both datasets are structured as multiple-choice question-answering tasks, where each question is accompanied by an expert-written explanation. We evaluate four LLMs on the two datasets using various prompts. Experiments demonstrate that our datasets are harder than previous benchmarks. The inconsistency between automatic and human evaluations of model-generated explanations highlights the need to develop new metrics to support future research on explainable medical QA.

Misinformation - false or misleading information - is considered a significant societal concern due to its associated "misinformation effects," such as political polarization, erosion of trust in institutions, problematic behavior, and public health challenges. However, the prevailing concept is misaligned with what is studied. While misinformation focuses on instances of information about factual matters, the broad spectrum of effects often manifests at a societal level and is shaped by a wide range of interdependent factors such as identity, values, opinions, epistemologies, and disagreements. Unsurprisingly, misinformation effects can occur without the prevalence of misinformation, and misinformation does not necessarily increase the effects studied. Here, we propose using disagreement - conflicting attitudes and beliefs between individuals and communities - as a way to study misinformation effects because it addresses the identified conceptual limitations of misinformation. Furthermore, unlike misinformation, disagreement does not require researchers to determine whether a given information is false or misleading. Thus, it can be studied and, more importantly, measured without the need to make a normative judgment about a given information, even when the specific topic is entirely removed, as we show in a longitudinal disagreement measurement. We demonstrate that disagreement, as a holistic concept, provides better explanations for the occurrence of misinformation effects, enhances precision in developing appropriate interventions, and offers a promising approach for evaluating them through quantification. Finally, we show how disagreement addresses current misinformation research questions and conclude with recommendations for research practice.

The technique of data augmentation (DA) is often used in machine learning for regularization purposes to better generalize under i.i.d. settings. In this work, we present a unifying framework with topics in causal inference to make a case for the use of DA beyond just the i.i.d. setting, but for generalization across interventions as well. Specifically, we argue that when the outcome generating mechanism is invariant to our choice of DA, then such augmentations can effectively be thought of as interventions on the treatment generating mechanism itself. This can potentially help to reduce bias in causal effect estimation arising from hidden confounders. In the presence of such unobserved confounding we typically make use of instrumental variables (IVs) -- sources of treatment randomization that are conditionally independent of the outcome. However, IVs may not be as readily available as DA for many applications, which is the main motivation behind this work. By appropriately regularizing IV based estimators, we introduce the concept of IV-like (IVL) regression for mitigating confounding bias and improving predictive performance across interventions even when certain IV properties are relaxed. Finally, we cast parameterized DA as an IVL regression problem and show that when used in composition can simulate a worst-case application of such DA, further improving performance on causal estimation and generalization tasks beyond what simple DA may offer. This is shown both theoretically for the population case and via simulation experiments for the finite sample case using a simple linear example. We also present real data experiments to support our case.

A dangerous assumption that can be made from prior work on the bias transfer hypothesis (BTH) is that biases do not transfer from pre-trained large language models (LLMs) to adapted models. We invalidate this assumption by studying the BTH in causal models under prompt adaptations, as prompting is an extremely popular and accessible adaptation strategy used in real-world applications. In contrast to prior work, we find that biases can transfer through prompting and that popular prompt-based mitigation methods do not consistently prevent biases from transferring. Specifically, the correlation between intrinsic biases and those after prompt adaptation remain moderate to strong across demographics and tasks -- for example, gender (rho >= 0.94) in co-reference resolution, and age (rho >= 0.98) and religion (rho >= 0.69) in question answering. Further, we find that biases remain strongly correlated when varying few-shot composition parameters, such as sample size, stereotypical content, occupational distribution and representational balance (rho >= 0.90). We evaluate several prompt-based debiasing strategies and find that different approaches have distinct strengths, but none consistently reduce bias transfer across models, tasks or demographics. These results demonstrate that correcting bias, and potentially improving reasoning ability, in intrinsic models may prevent propagation of biases to downstream tasks.

Counterfactual data augmentation has recently emerged as a method to mitigate confounding biases in the training data for a machine learning model. These biases, such as spurious correlations, arise due to various observed and unobserved confounding variables in the data generation process. In this paper, we formally analyze how confounding biases impact downstream classifiers and present a causal viewpoint to the solutions based on counterfactual data augmentation. We explore how removing confounding biases serves as a means to learn invariant features, ultimately aiding in generalization beyond the observed data distribution. Additionally, we present a straightforward yet powerful algorithm for generating counterfactual images, which effectively mitigates the influence of confounding effects on downstream classifiers. Through experiments on MNIST variants and the CelebA datasets, we demonstrate the effectiveness and practicality of our approach.

While chain-of-thought prompting (CoT) has the potential to improve the explainability of language model reasoning, it can systematically misrepresent the factors influencing models' behavior--for example, rationalizing answers in line with a user's opinion without mentioning this bias. To mitigate this biased reasoning problem, we introduce bias-augmented consistency training (BCT), an unsupervised fine-tuning scheme that trains models to give consistent reasoning across prompts with and without biasing features. We construct a suite testing nine forms of biased reasoning on seven question-answering tasks, and find that applying BCT to GPT-3.5-Turbo with one bias reduces the rate of biased reasoning by 86% on held-out tasks. Moreover, this model generalizes to other forms of bias, reducing biased reasoning on held-out biases by an average of 37%. As BCT generalizes to held-out biases and does not require gold labels, this method may hold promise for reducing biased reasoning from as-of-yet unknown biases and on tasks where supervision for ground truth reasoning is unavailable.

Large language models (LLMs) can pass explicit social bias tests but still harbor implicit biases, similar to humans who endorse egalitarian beliefs yet exhibit subtle biases. Measuring such implicit biases can be a challenge: as LLMs become increasingly proprietary, it may not be possible to access their embeddings and apply existing bias measures; furthermore, implicit biases are primarily a concern if they affect the actual decisions that these systems make. We address both challenges by introducing two new measures of bias: LLM Implicit Bias, a prompt-based method for revealing implicit bias; and LLM Decision Bias, a strategy to detect subtle discrimination in decision-making tasks. Both measures are based on psychological research: LLM Implicit Bias adapts the Implicit Association Test, widely used to study the automatic associations between concepts held in human minds; and LLM Decision Bias operationalizes psychological results indicating that relative evaluations between two candidates, not absolute evaluations assessing each independently, are more diagnostic of implicit biases. Using these measures, we found pervasive stereotype biases mirroring those in society in 8 value-aligned models across 4 social categories (race, gender, religion, health) in 21 stereotypes (such as race and criminality, race and weapons, gender and science, age and negativity). Our prompt-based LLM Implicit Bias measure correlates with existing language model embedding-based bias methods, but better predicts downstream behaviors measured by LLM Decision Bias. These new prompt-based measures draw from psychology's long history of research into measuring stereotype biases based on purely observable behavior; they expose nuanced biases in proprietary value-aligned LLMs that appear unbiased according to standard benchmarks.

Large language models (LLMs) are increasingly used in healthcare, but their reliability is heavily influenced by user-driven factors such as question phrasing and the completeness of clinical information. In this study, we examined how misinformation framing, source authority, model persona, and omission of key clinical details affect the diagnostic accuracy and reliability of LLM outputs. We conducted two experiments: one introducing misleading external opinions with varying assertiveness (perturbation test), and another removing specific categories of patient information (ablation test). Using public datasets (MedQA and Medbullets), we evaluated proprietary models (GPT-4o, Claude 3.5 Sonnet, Claude 3.5 Haiku, Gemini 1.5 Pro, Gemini 1.5 Flash) and open-source models (LLaMA 3 8B, LLaMA 3 Med42 8B, DeepSeek R1 8B). All models were vulnerable to user-driven misinformation, with proprietary models especially affected by definitive and authoritative language. Assertive tone had the greatest negative impact on accuracy. In the ablation test, omitting physical exam findings and lab results caused the most significant performance drop. Although proprietary models had higher baseline accuracy, their performance declined sharply under misinformation. These results highlight the need for well-structured prompts and complete clinical context. Users should avoid authoritative framing of misinformation and provide full clinical details, especially for complex cases.

Large Language Models (LLMs) are trained on extensive web corpora, which enable them to understand and generate human-like text. However, this training process also results in inherent biases within the models. These biases arise from web data's diverse and often uncurated nature, containing various stereotypes and prejudices. Previous works on debiasing models rely on benchmark datasets to measure their method's performance. However, these datasets suffer from several pitfalls due to the highly subjective understanding of bias, highlighting a critical need for contextual exploration. We propose understanding the context of inputs by considering the diverse situations in which they may arise. Our contribution is two-fold: (i) we augment 2,291 stereotyped statements from two existing bias-benchmark datasets with points for adding context; (ii) we develop the Context-Oriented Bias Indicator and Assessment Score (COBIAS) to assess a statement's contextual reliability in measuring bias. Our metric aligns with human judgment on contextual reliability of statements (Spearman's rho = 0.65, p = 3.4 * 10^{-60}) and can be used to create reliable datasets, which would assist bias mitigation works.

Training models with robust group fairness properties is crucial in ethically sensitive application areas such as medical diagnosis. Despite the growing body of work aiming to minimise demographic bias in AI, this problem remains challenging. A key reason for this challenge is the fairness generalisation gap: High-capacity deep learning models can fit all training data nearly perfectly, and thus also exhibit perfect fairness during training. In this case, bias emerges only during testing when generalisation performance differs across subgroups. This motivates us to take a bi-level optimisation perspective on fair learning: Optimising the learning strategy based on validation fairness. Specifically, we consider the highly effective workflow of adapting pre-trained models to downstream medical imaging tasks using parameter-efficient fine-tuning (PEFT) techniques. There is a trade-off between updating more parameters, enabling a better fit to the task of interest vs. fewer parameters, potentially reducing the generalisation gap. To manage this tradeoff, we propose FairTune, a framework to optimise the choice of PEFT parameters with respect to fairness. We demonstrate empirically that FairTune leads to improved fairness on a range of medical imaging datasets. The code is available at https://github.com/Raman1121/FairTune

Accurate breast lesion risk estimation can significantly reduce unnecessary biopsies and help doctors decide optimal treatment plans. Most existing computer-aided systems rely solely on mammogram features to classify breast lesions. While this approach is convenient, it does not fully exploit useful information in clinical reports to achieve the optimal performance. Would clinical features significantly improve breast lesion classification compared to using mammograms alone? How to handle missing clinical information caused by variation in medical practice? What is the best way to combine mammograms and clinical features? There is a compelling need for a systematic study to address these fundamental questions. This paper investigates several multimodal deep networks based on feature concatenation, cross-attention, and co-attention to combine mammograms and categorical clinical variables. We show that the proposed architectures significantly increase the lesion classification performance (average area under ROC curves from 0.89 to 0.94). We also evaluate the model when clinical variables are missing.

Unintended bias in Machine Learning can manifest as systemic differences in performance for different demographic groups, potentially compounding existing challenges to fairness in society at large. In this paper, we introduce a suite of threshold-agnostic metrics that provide a nuanced view of this unintended bias, by considering the various ways that a classifier's score distribution can vary across designated groups. We also introduce a large new test set of online comments with crowd-sourced annotations for identity references. We use this to show how our metrics can be used to find new and potentially subtle unintended bias in existing public models.

Instrumental variable methods have been widely used to identify causal effects in the presence of unmeasured confounding. A key identification condition known as the exclusion restriction states that the instrument cannot have a direct effect on the outcome which is not mediated by the exposure in view. In the health and social sciences, such an assumption is often not credible. To address this concern, we consider identification conditions of the population average treatment effect with an invalid instrumental variable which does not satisfy the exclusion restriction, and derive the efficient influence function targeting the identifying functional under a nonparametric observed data model. We propose a novel multiply robust locally efficient estimator of the average treatment effect that is consistent in the union of multiple parametric nuisance models, as well as a multiply debiased machine learning estimator for which the nuisance parameters are estimated using generic machine learning methods, that effectively exploit various forms of linear or nonlinear structured sparsity in the nuisance parameter space. When one cannot be confident that any of these machine learners is consistent at sufficiently fast rates to ensure n-consistency for the average treatment effect, we introduce a new criteria for selective machine learning which leverages the multiple robustness property in order to ensure small bias. The proposed methods are illustrated through extensive simulations and a data analysis evaluating the causal effect of 401(k) participation on savings.

Access to the right evidence does not guarantee that large language models (LLMs) will reason with it correctly. This gap between retrieval and reasoning is especially concerning in clinical settings, where outputs must align with structured protocols. We study this gap using Written Exposure Therapy (WET) guidelines as a testbed. In evaluating model responses to curated clinician-vetted questions, we find that errors persist even when authoritative passages are provided. To address this, we propose an evaluation framework that measures accuracy, consistency, and fidelity of reasoning. Our results highlight both the potential and the risks: retrieval-augmented generation (RAG) can constrain outputs, but safe deployment requires assessing reasoning as rigorously as retrieval.

Powered by advanced Artificial Intelligence (AI) techniques, conversational AI systems, such as ChatGPT and digital assistants like Siri, have been widely deployed in daily life. However, such systems may still produce content containing biases and stereotypes, causing potential social problems. Due to the data-driven, black-box nature of modern AI techniques, comprehensively identifying and measuring biases in conversational systems remains a challenging task. Particularly, it is hard to generate inputs that can comprehensively trigger potential bias due to the lack of data containing both social groups as well as biased properties. In addition, modern conversational systems can produce diverse responses (e.g., chatting and explanation), which makes existing bias detection methods simply based on the sentiment and the toxicity hardly being adopted. In this paper, we propose BiasAsker, an automated framework to identify and measure social bias in conversational AI systems. To obtain social groups and biased properties, we construct a comprehensive social bias dataset, containing a total of 841 groups and 8,110 biased properties. Given the dataset, BiasAsker automatically generates questions and adopts a novel method based on existence measurement to identify two types of biases (i.e., absolute bias and related bias) in conversational systems. Extensive experiments on 8 commercial systems and 2 famous research models, such as ChatGPT and GPT-3, show that 32.83% of the questions generated by BiasAsker can trigger biased behaviors in these widely deployed conversational systems. All the code, data, and experimental results have been released to facilitate future research.

Advances in large language models (LLMs) provide new opportunities in healthcare for improved patient care, clinical decision-making, and enhancement of physician and administrator workflows. However, the potential of these models importantly depends on their ability to generalize effectively across clinical environments and populations, a challenge often underestimated in early development. To better understand reasons for these challenges and inform mitigation approaches, we evaluated ClinicLLM, an LLM trained on [HOSPITAL]'s clinical notes, analyzing its performance on 30-day all-cause readmission prediction focusing on variability across hospitals and patient characteristics. We found poorer generalization particularly in hospitals with fewer samples, among patients with government and unspecified insurance, the elderly, and those with high comorbidities. To understand reasons for lack of generalization, we investigated sample sizes for fine-tuning, note content (number of words per note), patient characteristics (comorbidity level, age, insurance type, borough), and health system aspects (hospital, all-cause 30-day readmission, and mortality rates). We used descriptive statistics and supervised classification to identify features. We found that, along with sample size, patient age, number of comorbidities, and the number of words in notes are all important factors related to generalization. Finally, we compared local fine-tuning (hospital specific), instance-based augmented fine-tuning and cluster-based fine-tuning for improving generalization. Among these, local fine-tuning proved most effective, increasing AUC by 0.25% to 11.74% (most helpful in settings with limited data). Overall, this study provides new insights for enhancing the deployment of large language models in the societally important domain of healthcare, and improving their performance for broader populations.

In natural language processing, a recently popular line of work explores how to best report the experimental results of neural networks. One exemplar publication, titled "Show Your Work: Improved Reporting of Experimental Results," advocates for reporting the expected validation effectiveness of the best-tuned model, with respect to the computational budget. In the present work, we critically examine this paper. As far as statistical generalizability is concerned, we find unspoken pitfalls and caveats with this approach. We analytically show that their estimator is biased and uses error-prone assumptions. We find that the estimator favors negative errors and yields poor bootstrapped confidence intervals. We derive an unbiased alternative and bolster our claims with empirical evidence from statistical simulation. Our codebase is at http://github.com/castorini/meanmax.

In recent years, there is strong emphasis on mining medical data using machine learning techniques. A common problem is to obtain a noiseless set of textual documents, with a relevant content for the research question, and developing a Question Answering (QA) model for a specific medical field. The purpose of this paper is to present a new methodology for building a medical dataset and obtain a QA model for analysis of symptoms and impact on daily life for a specific disease domain. The ``Mental Health'' forum was used, a forum dedicated to people suffering from schizophrenia and different mental disorders. Relevant posts of active users, who regularly participate, were extrapolated providing a new method of obtaining low-bias content and without privacy issues. Furthermore, it is shown how to pre-process the dataset to convert it into a QA dataset. The Bidirectional Encoder Representations from Transformers (BERT), DistilBERT, RoBERTa, and BioBERT models were fine-tuned and evaluated via F1-Score, Exact Match, Precision and Recall. Accurate empirical experiments demonstrated the effectiveness of the proposed method for obtaining an accurate dataset for QA model implementation. By fine-tuning the BioBERT QA model, we achieved an F1 score of 0.885, showing a considerable improvement and outperforming the state-of-the-art model for mental disorders domain.

We generalize the notion of social biases from language embeddings to grounded vision and language embeddings. Biases are present in grounded embeddings, and indeed seem to be equally or more significant than for ungrounded embeddings. This is despite the fact that vision and language can suffer from different biases, which one might hope could attenuate the biases in both. Multiple ways exist to generalize metrics measuring bias in word embeddings to this new setting. We introduce the space of generalizations (Grounded-WEAT and Grounded-SEAT) and demonstrate that three generalizations answer different yet important questions about how biases, language, and vision interact. These metrics are used on a new dataset, the first for grounded bias, created by augmenting extending standard linguistic bias benchmarks with 10,228 images from COCO, Conceptual Captions, and Google Images. Dataset construction is challenging because vision datasets are themselves very biased. The presence of these biases in systems will begin to have real-world consequences as they are deployed, making carefully measuring bias and then mitigating it critical to building a fair society.

Large Language Models (LLMs) have been observed to exhibit bias in numerous ways, potentially creating or worsening outcomes for specific groups identified by protected attributes such as sex, race, sexual orientation, or age. To help address this gap, we introduce LangFair, an open-source Python package that aims to equip LLM practitioners with the tools to evaluate bias and fairness risks relevant to their specific use cases. The package offers functionality to easily generate evaluation datasets, comprised of LLM responses to use-case-specific prompts, and subsequently calculate applicable metrics for the practitioner's use case. To guide in metric selection, LangFair offers an actionable decision framework.

Implicit bias refers to automatic or spontaneous mental processes that shape perceptions, judgments, and behaviors. Previous research examining `implicit bias' in large language models (LLMs) has often approached the phenomenon differently than how it is studied in humans by focusing primarily on model outputs rather than on model processing. To examine model processing, we present a method called the Reasoning Model Implicit Association Test (RM-IAT) for studying implicit bias-like patterns in reasoning models: LLMs that employ step-by-step reasoning to solve complex tasks. Using this method, we find that reasoning models require more tokens when processing association-incompatible information compared to association-compatible information. These findings suggest AI systems harbor patterns in processing information that are analogous to human implicit bias. We consider the implications of these implicit bias-like patterns for their deployment in real-world applications.

Much recent research has uncovered and discussed serious concerns of bias in facial analysis technologies, finding performance disparities between groups of people based on perceived gender, skin type, lighting condition, etc. These audits are immensely important and successful at measuring algorithmic bias but have two major challenges: the audits (1) use facial recognition datasets which lack quality metadata, like LFW and CelebA, and (2) do not compare their observed algorithmic bias to the biases of their human alternatives. In this paper, we release improvements to the LFW and CelebA datasets which will enable future researchers to obtain measurements of algorithmic bias that are not tainted by major flaws in the dataset (e.g. identical images appearing in both the gallery and test set). We also use these new data to develop a series of challenging facial identification and verification questions that we administered to various algorithms and a large, balanced sample of human reviewers. We find that both computer models and human survey participants perform significantly better at the verification task, generally obtain lower accuracy rates on dark-skinned or female subjects for both tasks, and obtain higher accuracy rates when their demographics match that of the question. Computer models are observed to achieve a higher level of accuracy than the survey participants on both tasks and exhibit bias to similar degrees as the human survey participants.

Deep neural networks often learn unintended bias during training, which might have harmful effects when deployed in real-world settings. This work surveys 214 papers related to sociodemographic bias in natural language processing (NLP). In this study, we aim to provide a more comprehensive understanding of the similarities and differences among approaches to sociodemographic bias in NLP. To better understand the distinction between bias and real-world harm, we turn to ideas from psychology and behavioral economics to propose a definition for sociodemographic bias. We identify three main categories of NLP bias research: types of bias, quantifying bias, and debiasing techniques. We highlight the current trends in quantifying bias and debiasing techniques, offering insights into their strengths and weaknesses. We conclude that current approaches on quantifying bias face reliability issues, that many of the bias metrics do not relate to real-world bias, and that debiasing techniques need to focus more on training methods. Finally, we provide recommendations for future work.

Large language models (LLMs) offer an inexpensive yet powerful way to annotate text, but are often inconsistent when compared with experts. These errors can bias downstream estimates of population parameters such as regression coefficients and causal effects. To mitigate this bias, researchers have developed debiasing methods such as Design-based Supervised Learning (DSL) and Prediction-Powered Inference (PPI), which promise valid estimation by combining LLM annotations with a limited number of expensive expert annotations. Although these methods produce consistent estimates under theoretical assumptions, it is unknown how they compare in finite samples of sizes encountered in applied research. We make two contributions: First, we study how each method's performance scales with the number of expert annotations, highlighting regimes where LLM bias or limited expert labels significantly affect results. Second, we compare DSL and PPI across a range of tasks, finding that although both achieve low bias with large datasets, DSL often outperforms PPI on bias reduction and empirical efficiency, but its performance is less consistent across datasets. Our findings indicate that there is a bias-variance tradeoff at the level of debiasing methods, calling for more research on developing metrics for quantifying their efficiency in finite samples.

Fairness for machine learning predictions is widely required in practice for legal, ethical, and societal reasons. Existing work typically focuses on settings without unobserved confounding, even though unobserved confounding can lead to severe violations of causal fairness and, thus, unfair predictions. In this work, we analyze the sensitivity of causal fairness to unobserved confounding. Our contributions are three-fold. First, we derive bounds for causal fairness metrics under different sources of unobserved confounding. This enables practitioners to examine the sensitivity of their machine learning models to unobserved confounding in fairness-critical applications. Second, we propose a novel neural framework for learning fair predictions, which allows us to offer worst-case guarantees of the extent to which causal fairness can be violated due to unobserved confounding. Third, we demonstrate the effectiveness of our framework in a series of experiments, including a real-world case study about predicting prison sentences. To the best of our knowledge, ours is the first work to study causal fairness under unobserved confounding. To this end, our work is of direct practical value as a refutation strategy to ensure the fairness of predictions in high-stakes applications.

Machine learning (ML) holds great potential for accurately forecasting treatment outcomes over time, which could ultimately enable the adoption of more individualized treatment strategies in many practical applications. However, a significant challenge that has been largely overlooked by the ML literature on this topic is the presence of informative sampling in observational data. When instances are observed irregularly over time, sampling times are typically not random, but rather informative -- depending on the instance's characteristics, past outcomes, and administered treatments. In this work, we formalize informative sampling as a covariate shift problem and show that it can prohibit accurate estimation of treatment outcomes if not properly accounted for. To overcome this challenge, we present a general framework for learning treatment outcomes in the presence of informative sampling using inverse intensity-weighting, and propose a novel method, TESAR-CDE, that instantiates this framework using Neural CDEs. Using a simulation environment based on a clinical use case, we demonstrate the effectiveness of our approach in learning under informative sampling.

Large language models (LLMs) are increasingly integrated into applications ranging from review summarization to medical diagnosis support, where they affect human decisions. Even though LLMs perform well in many tasks, they may also inherit societal or cognitive biases, which can inadvertently transfer to humans. We investigate when and how LLMs expose users to biased content and quantify its severity. Specifically, we assess three LLM families in summarization and news fact-checking tasks, evaluating how much LLMs stay consistent with their context and/or hallucinate. Our findings show that LLMs expose users to content that changes the sentiment of the context in 21.86% of the cases, hallucinates on post-knowledge-cutoff data questions in 57.33% of the cases, and primacy bias in 5.94% of the cases. We evaluate 18 distinct mitigation methods across three LLM families and find that targeted interventions can be effective. Given the prevalent use of LLMs in high-stakes domains, such as healthcare or legal analysis, our results highlight the need for robust technical safeguards and for developing user-centered interventions that address LLM limitations.

As large language models (LLMs) are increasingly applied to various NLP tasks, their inherent biases are gradually disclosed. Therefore, measuring biases in LLMs is crucial to mitigate its ethical risks. However, most existing bias evaluation datasets focus on English and North American culture, and their bias categories are not fully applicable to other cultures. The datasets grounded in the Chinese language and culture are scarce. More importantly, these datasets usually only support single evaluation tasks and cannot evaluate the bias from multiple aspects in LLMs. To address these issues, we present a Multi-task Chinese Bias Evaluation Benchmark (McBE) that includes 4,077 bias evaluation instances, covering 12 single bias categories, 82 subcategories and introducing 5 evaluation tasks, providing extensive category coverage, content diversity, and measuring comprehensiveness. Additionally, we evaluate several popular LLMs from different series and with parameter sizes. In general, all these LLMs demonstrated varying degrees of bias. We conduct an in-depth analysis of results, offering novel insights into bias in LLMs.

Developing clinical prediction models (e.g., mortality prediction) based on electronic health records (EHRs) typically relies on expert opinion for feature selection and adjusting observation window size. This burdens experts and creates a bottleneck in the development process. We propose Retrieval-Enhanced Medical prediction model (REMed) to address such challenges. REMed can essentially evaluate an unlimited number of clinical events, select the relevant ones, and make predictions. This approach effectively eliminates the need for manual feature selection and enables an unrestricted observation window. We verified these properties through experiments on 27 clinical tasks and two independent cohorts from publicly available EHR datasets, where REMed outperformed other contemporary architectures that aim to handle as many events as possible. Notably, we found that the preferences of REMed align closely with those of medical experts. We expect our approach to significantly expedite the development of EHR prediction models by minimizing clinicians' need for manual involvement.