Discriminative classifiers have become a foundational tool in deep learning for medical imaging, excelling at learning separable features of complex data distributions. However, these models often need careful design, augmentation, and training techniques to ensure safe and reliable deployment. Recently, diffusion models have become synonymous with generative modeling in 2D. These models showcase robustness across a range of tasks including natural image classification, where classification is performed by comparing reconstruction errors across images generated for each possible conditioning input. This work presents the first exploration of the potential of class conditional diffusion models for 2D medical image classification. First, we develop a novel majority voting scheme shown to improve the performance of medical diffusion classifiers. Next, extensive experiments on the CheXpert and ISIC Melanoma skin cancer datasets demonstrate that foundation and trained-from-scratch diffusion models achieve competitive performance against SOTA discriminative classifiers without the need for explicit supervision. In addition, we show that diffusion classifiers are intrinsically explainable, and can be used to quantify the uncertainty of their predictions, increasing their trustworthiness and reliability in safety-critical, clinical contexts. Further information is available on our project page: https://faverogian.github.io/med-diffusion-classifier.github.io/

The Fr\'echet Video Distance (FVD) is a widely adopted metric for evaluating video generation distribution quality. However, its effectiveness relies on critical assumptions. Our analysis reveals three significant limitations: (1) the non-Gaussianity of the Inflated 3D Convnet (I3D) feature space; (2) the insensitivity of I3D features to temporal distortions; (3) the impractical sample sizes required for reliable estimation. These findings undermine FVD's reliability and show that FVD falls short as a standalone metric for video generation evaluation. After extensive analysis of a wide range of metrics and backbone architectures, we propose JEDi, the JEPA Embedding Distance, based on features derived from a Joint Embedding Predictive Architecture, measured using Maximum Mean Discrepancy with polynomial kernel. Our experiments on multiple open-source datasets show clear evidence that it is a superior alternative to the widely used FVD metric, requiring only 16% of the samples to reach its steady value, while increasing alignment with human evaluation by 34%, on average.