Supporting the health and well-being of dynamic populations around the world requires governmental agencies, organizations and researchers to understand and reason over complex relationships between human behavior and local contexts in order to identify high-risk groups and strategically allocate limited resources. Traditional approaches to these classes of problems often entail developing manually curated, task-specific features and models to represent human behavior and the natural and built environment, which can be challenging to adapt to new, or even, related tasks. To address this, we introduce a Population Dynamics Foundation Model (PDFM) that aims to capture the relationships between diverse data modalities and is applicable to a broad range of geospatial tasks. We first construct a geo-indexed dataset for postal codes and counties across the United States, capturing rich aggregated information on human behavior from maps, busyness, and aggregated search trends, and environmental factors such as weather and air quality. We then model this data and the complex relationships between locations using a graph neural network, producing embeddings that can be adapted to a wide range of downstream tasks using relatively simple models. We evaluate the effectiveness of our approach by benchmarking it on 27 downstream tasks spanning three distinct domains: health indicators, socioeconomic factors, and environmental measurements. The approach achieves state-of-the-art performance on all 27 geospatial interpolation tasks, and on 25 out of the 27 extrapolation and super-resolution tasks. We combined the PDFM with a state-of-the-art forecasting foundation model, TimesFM, to predict unemployment and poverty, achieving performance that surpasses fully supervised forecasting. The full set of embeddings and sample code are publicly available for researchers.

Many clinical tasks require an understanding of specialized data, such as medical images and genomics, which is not typically found in general-purpose large multimodal models. Building upon Gemini's multimodal models, we develop several models within the new Med-Gemini family that inherit core capabilities of Gemini and are optimized for medical use via fine-tuning with 2D and 3D radiology, histopathology, ophthalmology, dermatology and genomic data. Med-Gemini-2D sets a new standard for AI-based chest X-ray (CXR) report generation based on expert evaluation, exceeding previous best results across two separate datasets by an absolute margin of 1% and 12%, where 57% and 96% of AI reports on normal cases, and 43% and 65% on abnormal cases, are evaluated as "equivalent or better" than the original radiologists' reports. We demonstrate the first ever large multimodal model-based report generation for 3D computed tomography (CT) volumes using Med-Gemini-3D, with 53% of AI reports considered clinically acceptable, although additional research is needed to meet expert radiologist reporting quality. Beyond report generation, Med-Gemini-2D surpasses the previous best performance in CXR visual question answering (VQA) and performs well in CXR classification and radiology VQA, exceeding SoTA or baselines on 17 of 20 tasks. In histopathology, ophthalmology, and dermatology image classification, Med-Gemini-2D surpasses baselines across 18 out of 20 tasks and approaches task-specific model performance. Beyond imaging, Med-Gemini-Polygenic outperforms the standard linear polygenic risk score-based approach for disease risk prediction and generalizes to genetically correlated diseases for which it has never been trained. Although further development and evaluation are necessary in the safety-critical medical domain, our results highlight the potential of Med-Gemini across a wide range of medical tasks.

Excellence in a wide variety of medical applications poses considerable challenges for AI, requiring advanced reasoning, access to up-to-date medical knowledge and understanding of complex multimodal data. Gemini models, with strong general capabilities in multimodal and long-context reasoning, offer exciting possibilities in medicine. Building on these core strengths of Gemini, we introduce Med-Gemini, a family of highly capable multimodal models that are specialized in medicine with the ability to seamlessly use web search, and that can be efficiently tailored to novel modalities using custom encoders. We evaluate Med-Gemini on 14 medical benchmarks, establishing new state-of-the-art (SoTA) performance on 10 of them, and surpass the GPT-4 model family on every benchmark where a direct comparison is viable, often by a wide margin. On the popular MedQA (USMLE) benchmark, our best-performing Med-Gemini model achieves SoTA performance of 91.1% accuracy, using a novel uncertainty-guided search strategy. On 7 multimodal benchmarks including NEJM Image Challenges and MMMU (health & medicine), Med-Gemini improves over GPT-4V by an average relative margin of 44.5%. We demonstrate the effectiveness of Med-Gemini's long-context capabilities through SoTA performance on a needle-in-a-haystack retrieval task from long de-identified health records and medical video question answering, surpassing prior bespoke methods using only in-context learning. Finally, Med-Gemini's performance suggests real-world utility by surpassing human experts on tasks such as medical text summarization, alongside demonstrations of promising potential for multimodal medical dialogue, medical research and education. Taken together, our results offer compelling evidence for Med-Gemini's potential, although further rigorous evaluation will be crucial before real-world deployment in this safety-critical domain.

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.

Foundation large language models (LLMs) have shown an impressive ability to solve tasks across a wide range of fields including health. To effectively solve personalized health tasks, LLMs need the ability to ingest a diversity of data modalities that are relevant to an individual's health status. In this paper, we take a step towards creating multimodal LLMs for health that are grounded in individual-specific data by developing a framework (HeLM: Health Large Language Model for Multimodal Understanding) that enables LLMs to use high-dimensional clinical modalities to estimate underlying disease risk. HeLM encodes complex data modalities by learning an encoder that maps them into the LLM's token embedding space and for simple modalities like tabular data by serializing the data into text. Using data from the UK Biobank, we show that HeLM can effectively use demographic and clinical features in addition to high-dimensional time-series data to estimate disease risk. For example, HeLM achieves an AUROC of 0.75 for asthma prediction when combining tabular and spirogram data modalities compared with 0.49 when only using tabular data. Overall, we find that HeLM outperforms or performs at parity with classical machine learning approaches across a selection of eight binary traits. Furthermore, we investigate the downstream uses of this model such as its generalizability to out-of-distribution traits and its ability to power conversations around individual health and wellness.

Much work aims to explain a model's prediction on a static input. We consider explanations in a temporal setting where a stateful dynamical model produces a sequence of risk estimates given an input at each time step. When the estimated risk increases, the goal of the explanation is to attribute the increase to a few relevant inputs from the past. While our formal setup and techniques are general, we carry out an in-depth case study in a clinical setting. The goal here is to alert a clinician when a patient's risk of deterioration rises. The clinician then has to decide whether to intervene and adjust the treatment. Given a potentially long sequence of new events since she last saw the patient, a concise explanation helps her to quickly triage the alert. We develop methods to lift static attribution techniques to the dynamical setting, where we identify and address challenges specific to dynamics. We then experimentally assess the utility of different explanations of clinical alerts through expert evaluation.

On a variety of high-stakes tasks, machine learning algorithms are on the threshold of doing what human experts do with such high fidelity that we are contemplating using their predictions as a substitute for human output. For example, convolutional neural networks are close to diagnosing pneumonia from chest X-rays better than radiologists can [14, 15]; examples like these underpin much of the widespread discussion of algorithmic automation in these tasks. In assessing the potential for algorithms, however, the community has implicitly equated the specific task of prediction with the general task of automation. We argue here that this implicit correspondence misses key aspects of the automation problem; a broader conceptualization of automation can lead directly to concrete benefits in some of the key application areas where this process is unfolding. We start from the premise that automation is more than just the replacement of human effort on a task; it is also the meta-decision of which instances of the task to automate. And it is here that algorithms distinguish themselves from earlier technology used for automation, because they can actively take part in this decision of what to automate. But as currently constructed, they are not set up to help with this second part of the problem. The automation problem, then, should involve an algorithm that on any given instance both (i) produces a prediction output; and (ii) additionally also produces a triage judgment of its effectiveness relative to the human effort it would replace on that instance.

Generalized linear models with nonlinear feature transformations are widely used for large-scale regression and classification problems with sparse inputs. Memorization of feature interactions through a wide set of cross-product feature transformations are effective and interpretable, while generalization requires more feature engineering effort. With less feature engineering, deep neural networks can generalize better to unseen feature combinations through low-dimensional dense embeddings learned for the sparse features. However, deep neural networks with embeddings can over-generalize and recommend less relevant items when the user-item interactions are sparse and high-rank. In this paper, we present Wide & Deep learning---jointly trained wide linear models and deep neural networks---to combine the benefits of memorization and generalization for recommender systems. We productionized and evaluated the system on Google Play, a commercial mobile app store with over one billion active users and over one million apps. Online experiment results show that Wide & Deep significantly increased app acquisitions compared with wide-only and deep-only models. We have also open-sourced our implementation in TensorFlow.

The recently introduced continuous Skip-gram model is an efficient method for learning high-quality distributed vector representations that capture a large number of precise syntactic and semantic word relationships. In this paper we present several extensions that improve both the quality of the vectors and the training speed. By subsampling of the frequent words we obtain significant speedup and also learn more regular word representations. We also describe a simple alternative to the hierarchical softmax called negative sampling. An inherent limitation of word representations is their indifference to word order and their inability to represent idiomatic phrases. For example, the meanings of "Canada" and "Air" cannot be easily combined to obtain "Air Canada". Motivated by this example, we present a simple method for finding phrases in text, and show that learning good vector representations for millions of phrases is possible.

Recent work in unsupervised feature learning and deep learning has shown that being able to train large models can dramatically improve performance. In this paper, we consider the problem of training a deep network with billions of parameters using tens of thousands of CPU cores. We have developed a software framework called DistBelief that can utilize computing clusters with thousands of machines to train large models. Within this framework, we have developed two algorithms for large-scale distributed training: (i) Downpour SGD, an asynchronous stochastic gradient descent procedure supporting a large number of model replicas, and (ii) Sandblaster, a framework that supports for a variety of distributed batch optimization procedures, including a distributed implementation of L-BFGS. Downpour SGD and Sandblaster L-BFGS both increase the scale and speed of deep network training. We have successfully used our system to train a deep network 100x larger than previously reported in the literature, and achieves state-of-the-art performance on ImageNet, a visual object recognition task with 16 million images and 21k categories. We show that these same techniques dramatically accelerate the training of a more modestly sized deep network for a commercial speech recognition service. Although we focus on and report performance of these methods as applied to training large neural networks, the underlying algorithms are applicable to any gradient-based machine learning algorithm.