Machine learning (ML) holds great promise for improving healthcare, but it is critical to ensure that its use will not propagate or amplify health disparities. An important step is to characterize the (un)fairness of ML models - their tendency to perform differently across subgroups of the population - and to understand its underlying mechanisms. One potential driver of algorithmic unfairness, shortcut learning, arises when ML models base predictions on improper correlations in the training data. However, diagnosing this phenomenon is difficult, especially when sensitive attributes are causally linked with disease. Using multi-task learning, we propose the first method to assess and mitigate shortcut learning as a part of the fairness assessment of clinical ML systems, and demonstrate its application to clinical tasks in radiology and dermatology. Finally, our approach reveals instances when shortcutting is not responsible for unfairness, highlighting the need for a holistic approach to fairness mitigation in medical AI.

Recent artificial intelligence (AI) systems have reached milestones in "grand challenges" ranging from Go to protein-folding. The capability to retrieve medical knowledge, reason over it, and answer medical questions comparably to physicians has long been viewed as one such grand challenge. Large language models (LLMs) have catalyzed significant progress in medical question answering; Med-PaLM was the first model to exceed a "passing" score in US Medical Licensing Examination (USMLE) style questions with a score of 67.2% on the MedQA dataset. However, this and other prior work suggested significant room for improvement, especially when models' answers were compared to clinicians' answers. Here we present Med-PaLM 2, which bridges these gaps by leveraging a combination of base LLM improvements (PaLM 2), medical domain finetuning, and prompting strategies including a novel ensemble refinement approach. Med-PaLM 2 scored up to 86.5% on the MedQA dataset, improving upon Med-PaLM by over 19% and setting a new state-of-the-art. We also observed performance approaching or exceeding state-of-the-art across MedMCQA, PubMedQA, and MMLU clinical topics datasets. We performed detailed human evaluations on long-form questions along multiple axes relevant to clinical applications. In pairwise comparative ranking of 1066 consumer medical questions, physicians preferred Med-PaLM 2 answers to those produced by physicians on eight of nine axes pertaining to clinical utility (p < 0.001). We also observed significant improvements compared to Med-PaLM on every evaluation axis (p < 0.001) on newly introduced datasets of 240 long-form "adversarial" questions to probe LLM limitations. While further studies are necessary to validate the efficacy of these models in real-world settings, these results highlight rapid progress towards physician-level performance in medical question answering.

Learning from large amounts of unsupervised data and a small amount of supervision is an important open problem in computer vision. We propose a new semi-supervised learning method, Semantic Positives via Pseudo-Labels (SemPPL), that combines labelled and unlabelled data to learn informative representations. Our method extends self-supervised contrastive learning -- where representations are shaped by distinguishing whether two samples represent the same underlying datum (positives) or not (negatives) -- with a novel approach to selecting positives. To enrich the set of positives, we leverage the few existing ground-truth labels to predict the missing ones through a $k$-nearest neighbours classifier by using the learned embeddings of the labelled data. We thus extend the set of positives with datapoints having the same pseudo-label and call these semantic positives. We jointly learn the representation and predict bootstrapped pseudo-labels. This creates a reinforcing cycle. Strong initial representations enable better pseudo-label predictions which then improve the selection of semantic positives and lead to even better representations. SemPPL outperforms competing semi-supervised methods setting new state-of-the-art performance of $68.5\%$ and $76\%$ top-$1$ accuracy when using a ResNet-$50$ and training on $1\%$ and $10\%$ of labels on ImageNet, respectively. Furthermore, when using selective kernels, SemPPL significantly outperforms previous state-of-the-art achieving $72.3\%$ and $78.3\%$ top-$1$ accuracy on ImageNet with $1\%$ and $10\%$ labels, respectively, which improves absolute $+7.8\%$ and $+6.2\%$ over previous work. SemPPL also exhibits state-of-the-art performance over larger ResNet models as well as strong robustness, out-of-distribution and transfer performance.

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.

We introduce a new real-valued invariant called the natural slope of a hyperbolic knot in the 3-sphere, which is defined in terms of its cusp geometry. We show that twice the knot signature and the natural slope differ by at most a constant times the hyperbolic volume divided by the cube of the injectivity radius. This inequality was discovered using machine learning to detect relationships between various knot invariants. It has applications to Dehn surgery and to 4-ball genus. We also show a refined version of the inequality where the upper bound is a linear function of the volume, and the slope is corrected by terms corresponding to short geodesics that link the knot an odd number of times.

Advances in algorithmic fairness have largely omitted sexual orientation and gender identity. We explore queer concerns in privacy, censorship, language, online safety, health, and employment to study the positive and negative effects of artificial intelligence on queer communities. These issues underscore the need for new directions in fairness research that take into account a multiplicity of considerations, from privacy preservation, context sensitivity and process fairness, to an awareness of sociotechnical impact and the increasingly important role of inclusive and participatory research processes. Most current approaches for algorithmic fairness assume that the target characteristics for fairness--frequently, race and legal gender--can be observed or recorded. Sexual orientation and gender identity are prototypical instances of unobserved characteristics, which are frequently missing, unknown or fundamentally unmeasurable. This paper highlights the importance of developing new approaches for algorithmic fairness that break away from the prevailing assumption of observed characteristics.