Daily Papers

Achieving robust performance and fairness across diverse patient populations remains a challenge in developing clinically deployable deep learning models for diagnostic imaging. Synthetic data generation has emerged as a promising strategy to address limitations in dataset scale and diversity. We introduce RoentGen-v2, a text-to-image diffusion model for chest radiographs that enables fine-grained control over both radiographic findings and patient demographic attributes, including sex, age, and race/ethnicity. RoentGen-v2 is the first model to generate clinically plausible images with demographic conditioning, facilitating the creation of a large, demographically balanced synthetic dataset comprising over 565,000 images. We use this large synthetic dataset to evaluate optimal training pipelines for downstream disease classification models. In contrast to prior work that combines real and synthetic data naively, we propose an improved training strategy that leverages synthetic data for supervised pretraining, followed by fine-tuning on real data. Through extensive evaluation on over 137,000 chest radiographs from five institutions, we demonstrate that synthetic pretraining consistently improves model performance, generalization to out-of-distribution settings, and fairness across demographic subgroups. Across datasets, synthetic pretraining led to a 6.5% accuracy increase in the performance of downstream classification models, compared to a modest 2.7% increase when naively combining real and synthetic data. We observe this performance improvement simultaneously with the reduction of the underdiagnosis fairness gap by 19.3%. These results highlight the potential of synthetic imaging to advance equitable and generalizable medical deep learning under real-world data constraints. We open source our code, trained models, and synthetic dataset at https://github.com/StanfordMIMI/RoentGen-v2 .

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.

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

Fairness in artificial intelligence models has gained significantly more attention in recent years, especially in the area of medicine, as fairness in medical models is critical to people's well-being and lives. High-quality medical fairness datasets are needed to promote fairness learning research. Existing medical fairness datasets are all for classification tasks, and no fairness datasets are available for medical segmentation, while medical segmentation is an equally important clinical task as classifications, which can provide detailed spatial information on organ abnormalities ready to be assessed by clinicians. In this paper, we propose the first fairness dataset for medical segmentation named Harvard-FairSeg with 10,000 subject samples. In addition, we propose a fair error-bound scaling approach to reweight the loss function with the upper error-bound in each identity group, using the segment anything model (SAM). We anticipate that the segmentation performance equity can be improved by explicitly tackling the hard cases with high training errors in each identity group. To facilitate fair comparisons, we utilize a novel equity-scaled segmentation performance metric to compare segmentation metrics in the context of fairness, such as the equity-scaled Dice coefficient. Through comprehensive experiments, we demonstrate that our fair error-bound scaling approach either has superior or comparable fairness performance to the state-of-the-art fairness learning models. The dataset and code are publicly accessible via https://ophai.hms.harvard.edu/datasets/harvard-fairseg10k.

Diabetic retinopathy (DR) is a leading cause of vision loss in working-age adults. While screening reduces the risk of blindness, traditional imaging is often costly and inaccessible. Artificial intelligence (AI) algorithms present a scalable diagnostic solution, but concerns regarding fairness and generalization persist. This work evaluates the fairness and performance of image-trained models in DR prediction, as well as the impact of disentanglement as a bias mitigation technique, using the diverse mBRSET fundus dataset. Three models, ConvNeXt V2, DINOv2, and Swin V2, were trained on macula images to predict DR and sensitive attributes (SAs) (e.g., age and gender/sex). Fairness was assessed between subgroups of SAs, and disentanglement was applied to reduce bias. All models achieved high DR prediction performance in diagnosing (up to 94% AUROC) and could reasonably predict age and gender/sex (91% and 77% AUROC, respectively). Fairness assessment suggests disparities, such as a 10% AUROC gap between age groups in DINOv2. Disentangling SAs from DR prediction had varying results, depending on the model selected. Disentanglement improved DINOv2 performance (2% AUROC gain), but led to performance drops in ConvNeXt V2 and Swin V2 (7% and 3%, respectively). These findings highlight the complexity of disentangling fine-grained features in fundus imaging and emphasize the importance of fairness in medical imaging AI to ensure equitable and reliable healthcare solutions.

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.

In critical decision-making scenarios, optimizing accuracy can lead to a biased classifier, hence past work recommends enforcing group-based fairness metrics in addition to maximizing accuracy. However, doing so exposes the classifier to another kind of bias called infra-marginality. This refers to individual-level bias where some individuals/subgroups can be worse off than under simply optimizing for accuracy. For instance, a classifier implementing race-based parity may significantly disadvantage women of the advantaged race. To quantify this bias, we propose a general notion of eta-infra-marginality that can be used to evaluate the extent of this bias. We prove theoretically that, unlike other fairness metrics, infra-marginality does not have a trade-off with accuracy: high accuracy directly leads to low infra-marginality. This observation is confirmed through empirical analysis on multiple simulated and real-world datasets. Further, we find that maximizing group fairness often increases infra-marginality, suggesting the consideration of both group-level fairness and individual-level infra-marginality. However, measuring infra-marginality requires knowledge of the true distribution of individual-level outcomes correctly and explicitly. We propose a practical method to measure infra-marginality, and a simple algorithm to maximize group-wise accuracy and avoid infra-marginality.

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.

Motivated by the strong performance of CLIP-based models in natural image-text domains, recent efforts have adapted these architectures to medical tasks, particularly in radiology, where large paired datasets of images and reports, such as chest X-rays, are available. While these models have shown encouraging results in terms of accuracy and discriminative performance, their fairness and robustness in the different clinical tasks remain largely underexplored. In this study, we extensively evaluate six widely used CLIP-based models on chest X-ray classification using three publicly available datasets: MIMIC-CXR, NIH-CXR14, and NEATX. We assess the models fairness across six conditions and patient subgroups based on age, sex, and race. Additionally, we assess the robustness to shortcut learning by evaluating performance on pneumothorax cases with and without chest drains. Our results indicate performance gaps between patients of different ages, but more equitable results for the other attributes. Moreover, all models exhibit lower performance on images without chest drains, suggesting reliance on spurious correlations. We further complement the performance analysis with a study of the embeddings generated by the models. While the sensitive attributes could be classified from the embeddings, we do not see such patterns using PCA, showing the limitations of these visualisation techniques when assessing models. Our code is available at https://github.com/TheoSourget/clip_cxr_fairness

Fair machine learning aims to prevent discrimination against individuals or sub-populations based on sensitive attributes such as gender and race. In recent years, causal inference methods have been increasingly used in fair machine learning to measure unfairness by causal effects. However, current methods assume that the true causal graph is given, which is often not true in real-world applications. To address this limitation, this paper proposes a framework for achieving causal fairness based on the notion of interventions when the true causal graph is partially known. The proposed approach involves modeling fair prediction using a Partially Directed Acyclic Graph (PDAG), specifically, a class of causal DAGs that can be learned from observational data combined with domain knowledge. The PDAG is used to measure causal fairness, and a constrained optimization problem is formulated to balance between fairness and accuracy. Results on both simulated and real-world datasets demonstrate the effectiveness of this method.

When the performance of a machine learning model varies over groups defined by sensitive attributes (e.g., gender or ethnicity), the performance disparity can be expressed in terms of the probability distributions of the input and output variables over each group. In this paper, we exploit this fact to reduce the disparate impact of a fixed classification model over a population of interest. Given a black-box classifier, we aim to eliminate the performance gap by perturbing the distribution of input variables for the disadvantaged group. We refer to the perturbed distribution as a counterfactual distribution, and characterize its properties for common fairness criteria. We introduce a descent algorithm to learn a counterfactual distribution from data. We then discuss how the estimated distribution can be used to build a data preprocessor that can reduce disparate impact without training a new model. We validate our approach through experiments on real-world datasets, showing that it can repair different forms of disparity without a significant drop in accuracy.

Algorithmic fairness has conventionally adopted the mathematically convenient perspective of racial color-blindness (i.e., difference unaware treatment). However, we contend that in a range of important settings, group difference awareness matters. For example, differentiating between groups may be necessary in legal contexts (e.g., the U.S. compulsory draft applies to men but not women) and harm assessments (e.g., referring to girls as ``terrorists'' may be less harmful than referring to Muslim people as such). Thus, in contrast to most fairness work, we study fairness through the perspective of treating people differently -- when it is contextually appropriate to. We first introduce an important distinction between descriptive (fact-based), normative (value-based), and correlation (association-based) benchmarks. This distinction is significant because each category requires separate interpretation and mitigation tailored to its specific characteristics. Then, we present a benchmark suite composed of eight different scenarios for a total of 16k questions that enables us to assess difference awareness. Finally, we show results across ten models that demonstrate difference awareness is a distinct dimension to fairness where existing bias mitigation strategies may backfire.

The growing capability and accessibility of machine learning has led to its application to many real-world domains and data about people. Despite the benefits algorithmic systems may bring, models can reflect, inject, or exacerbate implicit and explicit societal biases into their outputs, disadvantaging certain demographic subgroups. Discovering which biases a machine learning model has introduced is a great challenge, due to the numerous definitions of fairness and the large number of potentially impacted subgroups. We present FairVis, a mixed-initiative visual analytics system that integrates a novel subgroup discovery technique for users to audit the fairness of machine learning models. Through FairVis, users can apply domain knowledge to generate and investigate known subgroups, and explore suggested and similar subgroups. FairVis' coordinated views enable users to explore a high-level overview of subgroup performance and subsequently drill down into detailed investigation of specific subgroups. We show how FairVis helps to discover biases in two real datasets used in predicting income and recidivism. As a visual analytics system devoted to discovering bias in machine learning, FairVis demonstrates how interactive visualization may help data scientists and the general public understand and create more equitable algorithmic systems.

Addressing fairness in artificial intelligence (AI), particularly in medical AI, is crucial for ensuring equitable healthcare outcomes. Recent efforts to enhance fairness have introduced new methodologies and datasets in medical AI. However, the fairness issue under the setting of domain transfer is almost unexplored, while it is common that clinics rely on different imaging technologies (e.g., different retinal imaging modalities) for patient diagnosis. This paper presents FairDomain, a pioneering systemic study into algorithmic fairness under domain shifts, employing state-of-the-art domain adaptation (DA) and generalization (DG) algorithms for both medical segmentation and classification tasks to understand how biases are transferred between different domains. We also introduce a novel plug-and-play fair identity attention (FIA) module that adapts to various DA and DG algorithms to improve fairness by using self-attention to adjust feature importance based on demographic attributes. Additionally, we curate the first fairness-focused dataset with two paired imaging modalities for the same patient cohort on medical segmentation and classification tasks, to rigorously assess fairness in domain-shift scenarios. Excluding the confounding impact of demographic distribution variation between source and target domains will allow clearer quantification of the performance of domain transfer models. Our extensive evaluations reveal that the proposed FIA significantly enhances both model performance accounted for fairness across all domain shift settings (i.e., DA and DG) with respect to different demographics, which outperforms existing methods on both segmentation and classification. The code and data can be accessed at https://ophai.hms.harvard.edu/datasets/harvard-fairdomain20k.

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.

In recent years, multiple notions of algorithmic fairness have arisen. One such notion is individual fairness (IF), which requires that individuals who are similar receive similar treatment. In parallel, matrix estimation (ME) has emerged as a natural paradigm for handling noisy data with missing values. In this work, we connect the two concepts. We show that pre-processing data using ME can improve an algorithm's IF without sacrificing performance. Specifically, we show that using a popular ME method known as singular value thresholding (SVT) to pre-process the data provides a strong IF guarantee under appropriate conditions. We then show that, under analogous conditions, SVT pre-processing also yields estimates that are consistent and approximately minimax optimal. As such, the ME pre-processing step does not, under the stated conditions, increase the prediction error of the base algorithm, i.e., does not impose a fairness-performance trade-off. We verify these results on synthetic and real data.

Unfair treatment and discrimination are critical ethical concerns in AI systems, particularly as their adoption expands across diverse domains. Addressing these challenges, the recent introduction of the EU AI Act establishes a unified legal framework to ensure legal certainty for AI innovation and investment while safeguarding public interests, such as health, safety, fundamental rights, democracy, and the rule of law (Recital 8). The Act encourages stakeholders to initiate dialogue on existing AI fairness notions to address discriminatory outcomes of AI systems. However, these notions often overlook the critical role of Socio-Economic Status (SES), inadvertently perpetuating biases that favour the economically advantaged. This is concerning, given that principles of equalization advocate for equalizing resources or opportunities to mitigate disadvantages beyond an individual's control. While provisions for discrimination are laid down in the AI Act, specialized directions should be broadened, particularly in addressing economic disparities perpetuated by AI systems. In this work, we explore the limitations of popular AI fairness notions using a real-world dataset (Adult), highlighting their inability to address SES-driven disparities. To fill this gap, we propose a novel fairness notion, Socio-Economic Parity (SEP), which incorporates SES and promotes positive actions for underprivileged groups while accounting for factors within an individual's control, such as working hours, which can serve as a proxy for effort. We define a corresponding fairness measure and optimize a model constrained by SEP to demonstrate practical utility. Our results show the effectiveness of SEP in mitigating SES-driven biases. By analyzing the AI Act alongside our method, we lay a foundation for aligning AI fairness with SES factors while ensuring legal compliance.

While research on applications and evaluations of explanation methods continues to expand, fairness of the explanation methods concerning disparities in their performance across subgroups remains an often overlooked aspect. In this paper, we address this gap by showing that, across three tasks and five language models, widely used post-hoc feature attribution methods exhibit significant gender disparity with respect to their faithfulness, robustness, and complexity. These disparities persist even when the models are pre-trained or fine-tuned on particularly unbiased datasets, indicating that the disparities we observe are not merely consequences of biased training data. Our results highlight the importance of addressing disparities in explanations when developing and applying explainability methods, as these can lead to biased outcomes against certain subgroups, with particularly critical implications in high-stakes contexts. Furthermore, our findings underscore the importance of incorporating the fairness of explanations, alongside overall model fairness and explainability, as a requirement in regulatory frameworks.

Ensuring equitable treatment (fairness) across protected attributes (such as gender or ethnicity) is a critical issue in machine learning. Most existing literature focuses on binary classification, but achieving fairness in regression tasks-such as insurance pricing or hiring score assessments-is equally important. Moreover, anti-discrimination laws also apply to continuous attributes, such as age, for which many existing methods are not applicable. In practice, multiple protected attributes can exist simultaneously; however, methods targeting fairness across several attributes often overlook so-called "fairness gerrymandering", thereby ignoring disparities among intersectional subgroups (e.g., African-American women or Hispanic men). In this paper, we propose a distance covariance regularisation framework that mitigates the association between model predictions and protected attributes, in line with the fairness definition of demographic parity, and that captures both linear and nonlinear dependencies. To enhance applicability in the presence of multiple protected attributes, we extend our framework by incorporating two multivariate dependence measures based on distance covariance: the previously proposed joint distance covariance (JdCov) and our novel concatenated distance covariance (CCdCov), which effectively address fairness gerrymandering in both regression and classification tasks involving protected attributes of various types. We discuss and illustrate how to calibrate regularisation strength, including a method based on Jensen-Shannon divergence, which quantifies dissimilarities in prediction distributions across groups. We apply our framework to the COMPAS recidivism dataset and a large motor insurance claims dataset.

Algorithmic decision-making has become deeply ingrained in many domains, yet biases in machine learning models can still produce discriminatory outcomes, often harming unprivileged groups. Achieving fair classification is inherently challenging, requiring a careful balance between predictive performance and ethical considerations. We present FairTTTS, a novel post-processing bias mitigation method inspired by the Tree Test Time Simulation (TTTS) method. Originally developed to enhance accuracy and robustness against adversarial inputs through probabilistic decision-path adjustments, TTTS serves as the foundation for FairTTTS. By building on this accuracy-enhancing technique, FairTTTS mitigates bias and improves predictive performance. FairTTTS uses a distance-based heuristic to adjust decisions at protected attribute nodes, ensuring fairness for unprivileged samples. This fairness-oriented adjustment occurs as a post-processing step, allowing FairTTTS to be applied to pre-trained models, diverse datasets, and various fairness metrics without retraining. Extensive evaluation on seven benchmark datasets shows that FairTTTS outperforms traditional methods in fairness improvement, achieving a 20.96% average increase over the baseline compared to 18.78% for related work, and further enhances accuracy by 0.55%. In contrast, competing methods typically reduce accuracy by 0.42%. These results confirm that FairTTTS effectively promotes more equitable decision-making while simultaneously improving predictive performance.

Fair machine learning seeks to identify and mitigate biases in predictions against unfavorable populations characterized by demographic attributes, such as race and gender. Recently, a few works have extended fairness to graph data, such as social networks, but most of them neglect the causal relationships among data instances. This paper addresses the prevalent challenge in fairness-aware ML algorithms, which typically assume Independent and Identically Distributed (IID) data. We tackle the overlooked domain of non-IID, graph-based settings where data instances are interconnected, influencing the outcomes of fairness interventions. We base our research on the Network Structural Causal Model (NSCM) framework and posit two main assumptions: Decomposability and Graph Independence, which enable the computation of interventional distributions in non-IID settings using the do-calculus. Based on that, we develop the Message Passing Variational Autoencoder for Causal Inference (MPVA) to compute interventional distributions and facilitate causally fair node classification through estimated interventional distributions. Empirical evaluations on semi-synthetic and real-world datasets demonstrate that MPVA outperforms conventional methods by effectively approximating interventional distributions and mitigating bias. The implications of our findings underscore the potential of causality-based fairness in complex ML applications, setting the stage for further research into relaxing the initial assumptions to enhance model fairness.

Unfairness in mortgage lending has created generational inequality among racial and ethnic groups in the US. Many studies address this problem, but most existing work focuses on correlation-based techniques. In our work, we use the framework of counterfactual fairness to train fair machine learning models. We propose a new causal graph for the variables available in the Home Mortgage Disclosure Act (HMDA) data. We use a matching-based approach instead of the latent variable modeling approach, because the former approach does not rely on any modeling assumptions. Furthermore, matching provides us with counterfactual pairs in which the race variable is isolated. We first demonstrate the unfairness in mortgage approval and interest rates between African-American and non-Hispanic White sub-populations. Then, we show that having balanced data using matching does not guarantee perfect counterfactual fairness of the machine learning models.

The popularity of machine learning has increased the risk of unfair models getting deployed in high-stake applications, such as justice system, drug/vaccination design, and medical diagnosis. Although there are effective methods to train fair models from scratch, how to automatically reveal and explain the unfairness of a trained model remains a challenging task. Revealing unfairness of machine learning models in interpretable fashion is a critical step towards fair and trustworthy AI. In this paper, we systematically tackle the novel task of revealing unfair models by mining interpretable evidence (RUMIE). The key idea is to find solid evidence in the form of a group of data instances discriminated most by the model. To make the evidence interpretable, we also find a set of human-understandable key attributes and decision rules that characterize the discriminated data instances and distinguish them from the other non-discriminated data. As demonstrated by extensive experiments on many real-world data sets, our method finds highly interpretable and solid evidence to effectively reveal the unfairness of trained models. Moreover, it is much more scalable than all of the baseline methods.

This thesis explores open-sourced machine learning (ML) model explanation tools to understand whether these tools can allow a layman to visualize, understand, and suggest intuitive remedies to unfairness in ML-based decision-support systems. Machine learning models trained on datasets biased against minority groups are increasingly used to guide life-altering social decisions, prompting the urgent need to study their logic for unfairness. Due to this problem's impact on vast populations of the general public, it is critical for the layperson -- not just subject matter experts in social justice or machine learning experts -- to understand the nature of unfairness within these algorithms and the potential trade-offs. Existing research on fairness in machine learning focuses mostly on the mathematical definitions and tools to understand and remedy unfair models, with some directly citing user-interactive tools as necessary for future work. This thesis presents FairLay-ML, a proof-of-concept GUI integrating some of the most promising tools to provide intuitive explanations for unfair logic in ML models by integrating existing research tools (e.g. Local Interpretable Model-Agnostic Explanations) with existing ML-focused GUI (e.g. Python Streamlit). We test FairLay-ML using models of various accuracy and fairness generated by an unfairness detector tool, Parfait-ML, and validate our results using Themis. Our study finds that the technology stack used for FairLay-ML makes it easy to install and provides real-time black-box explanations of pre-trained models to users. Furthermore, the explanations provided translate to actionable remedies.

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.

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.

This paper introduces the Fair Fairness Benchmark (FFB), a benchmarking framework for in-processing group fairness methods. Ensuring fairness in machine learning is critical for ethical and legal compliance. However, there exist challenges in comparing and developing of fairness methods due to inconsistencies in experimental settings, lack of accessible algorithmic implementations, and limited extensibility of current fairness packages and tools. To address these issues, we introduce an open-source, standardized benchmark for evaluating in-processing group fairness methods and provide a comprehensive analysis of state-of-the-art methods to ensure different notions of group fairness. This work offers the following key contributions: the provision of flexible, extensible, minimalistic, and research-oriented open-source code; the establishment of unified fairness method benchmarking pipelines; and extensive benchmarking, which yields key insights from 45,079 experiments. We believe our work will significantly facilitate the growth and development of the fairness research community. The benchmark, including code and running logs, is available at https://github.com/ahxt/fair_fairness_benchmark

Current tools for machine learning fairness only admit a limited range of fairness definitions and have seen little integration with automatic differentiation libraries, despite the central role these libraries play in modern machine learning pipelines. We introduce a framework of fairness regularization terms (fairrets) which quantify bias as modular objectives that are easily integrated in automatic differentiation pipelines. By employing a general definition of fairness in terms of linear-fractional statistics, a wide class of fairrets can be computed efficiently. Experiments show the behavior of their gradients and their utility in enforcing fairness with minimal loss of predictive power compared to baselines. Our contribution includes a PyTorch implementation of the fairret framework.

Urban assessments often compress diverse needs into single scores, which can obscure minority perspectives. We present a community-centered study in Montreal (n=35; wheelchair users, seniors, LGBTQIA2+ residents, and immigrants). Participants rated 20 streets (accessibility, inclusivity, aesthetics, practicality) and ranked 7 images on 12 interview-elicited criteria. Disagreement patterns were systematic in our sample: wheelchair users diverged most on accessibility and practicality; LGBTQIA2+ participants emphasized inclusion and liveliness; seniors prioritized security. Group discussion reduced information gaps but not value conflicts; ratings conveyed intensity, while rankings forced trade-offs. We then formalize negotiative alignment, a transparent, budget-aware bargaining procedure, and pilot it with role-played stakeholder agents plus a neutral mediator. Relative to the best base design under the same public rubric, the negotiated package increased total utility (21.10 to 24.55), raised the worst-group utility (3.20 to 3.90), improved twentieth percentile satisfaction (0.86 to 1.00; min-max normalized within the scenario), and reduced inequality (Gini 0.036 to 0.025). Treating disagreement as signal and reporting worst-group outcomes alongside totals may help planners and AI practitioners surface trade-offs and preserve minority priorities while maintaining efficiency.

The growing importance of understanding and addressing algorithmic bias in artificial intelligence (AI) has led to a surge in research on AI fairness, which often assumes that the underlying data is independent and identically distributed (IID). However, real-world data frequently exists in non-IID graph structures that capture connections among individual units. To effectively mitigate bias in AI systems, it is essential to bridge the gap between traditional fairness literature, designed for IID data, and the prevalence of non-IID graph data. This survey reviews recent advancements in fairness amidst non-IID graph data, including the newly introduced fair graph generation and the commonly studied fair graph classification. In addition, available datasets and evaluation metrics for future research are identified, the limitations of existing work are highlighted, and promising future directions are proposed.

Recognizing the prevalence of domain shift as a common challenge in machine learning, various domain generalization (DG) techniques have been developed to enhance the performance of machine learning systems when dealing with out-of-distribution (OOD) data. Furthermore, in real-world scenarios, data distributions can gradually change across a sequence of sequential domains. While current methodologies primarily focus on improving model effectiveness within these new domains, they often overlook fairness issues throughout the learning process. In response, we introduce an innovative framework called Counterfactual Fairness-Aware Domain Generalization with Sequential Autoencoder (CDSAE). This approach effectively separates environmental information and sensitive attributes from the embedded representation of classification features. This concurrent separation not only greatly improves model generalization across diverse and unfamiliar domains but also effectively addresses challenges related to unfair classification. Our strategy is rooted in the principles of causal inference to tackle these dual issues. To examine the intricate relationship between semantic information, sensitive attributes, and environmental cues, we systematically categorize exogenous uncertainty factors into four latent variables: 1) semantic information influenced by sensitive attributes, 2) semantic information unaffected by sensitive attributes, 3) environmental cues influenced by sensitive attributes, and 4) environmental cues unaffected by sensitive attributes. By incorporating fairness regularization, we exclusively employ semantic information for classification purposes. Empirical validation on synthetic and real-world datasets substantiates the effectiveness of our approach, demonstrating improved accuracy levels while ensuring the preservation of fairness in the evolving landscape of continuous domains.

While deep learning based approaches have demonstrated expert-level performance in dermatological diagnosis tasks, they have also been shown to exhibit biases toward certain demographic attributes, particularly skin types (e.g., light versus dark), a fairness concern that must be addressed. We propose CIRCLe, a skin color invariant deep representation learning method for improving fairness in skin lesion classification. CIRCLe is trained to classify images by utilizing a regularization loss that encourages images with the same diagnosis but different skin types to have similar latent representations. Through extensive evaluation and ablation studies, we demonstrate CIRCLe's superior performance over the state-of-the-art when evaluated on 16k+ images spanning 6 Fitzpatrick skin types and 114 diseases, using classification accuracy, equal opportunity difference (for light versus dark groups), and normalized accuracy range, a new measure we propose to assess fairness on multiple skin type groups.

In domains ranging from computer vision to natural language processing, machine learning models have been shown to exhibit stark disparities, often performing worse for members of traditionally underserved groups. One factor contributing to these performance gaps is a lack of representation in the data the models are trained on. It is often unclear, however, how to operationalize representativeness in specific applications. Here we formalize the problem of creating equitable training datasets, and propose a statistical framework for addressing this problem. We consider a setting where a model builder must decide how to allocate a fixed data collection budget to gather training data from different subgroups. We then frame dataset creation as a constrained optimization problem, in which one maximizes a function of group-specific performance metrics based on (estimated) group-specific learning rates and costs per sample. This flexible approach incorporates preferences of model-builders and other stakeholders, as well as the statistical properties of the learning task. When data collection decisions are made sequentially, we show that under certain conditions this optimization problem can be efficiently solved even without prior knowledge of the learning rates. To illustrate our approach, we conduct a simulation study of polygenic risk scores on synthetic genomic data -- an application domain that often suffers from non-representative data collection. We find that our adaptive sampling strategy outperforms several common data collection heuristics, including equal and proportional sampling, demonstrating the value of strategic dataset design for building equitable models.

Fairness in image restoration tasks is the desire to treat different sub-groups of images equally well. Existing definitions of fairness in image restoration are highly restrictive. They consider a reconstruction to be a correct outcome for a group (e.g., women) only if it falls within the group's set of ground truth images (e.g., natural images of women); otherwise, it is considered entirely incorrect. Consequently, such definitions are prone to controversy, as errors in image restoration can manifest in various ways. In this work we offer an alternative approach towards fairness in image restoration, by considering the Group Perceptual Index (GPI), which we define as the statistical distance between the distribution of the group's ground truth images and the distribution of their reconstructions. We assess the fairness of an algorithm by comparing the GPI of different groups, and say that it achieves perfect Perceptual Fairness (PF) if the GPIs of all groups are identical. We motivate and theoretically study our new notion of fairness, draw its connection to previous ones, and demonstrate its utility on state-of-the-art face image super-resolution algorithms.

In the field of algorithmic fairness, significant attention has been put on group fairness criteria, such as Demographic Parity and Equalized Odds. Nevertheless, these objectives, measured as global averages, have raised concerns about persistent local disparities between sensitive groups. In this work, we address the problem of local fairness, which ensures that the predictor is unbiased not only in terms of expectations over the whole population, but also within any subregion of the feature space, unknown at training time. To enforce this objective, we introduce ROAD, a novel approach that leverages the Distributionally Robust Optimization (DRO) framework within a fair adversarial learning objective, where an adversary tries to infer the sensitive attribute from the predictions. Using an instance-level re-weighting strategy, ROAD is designed to prioritize inputs that are likely to be locally unfair, i.e. where the adversary faces the least difficulty in reconstructing the sensitive attribute. Numerical experiments demonstrate the effectiveness of our method: it achieves Pareto dominance with respect to local fairness and accuracy for a given global fairness level across three standard datasets, and also enhances fairness generalization under distribution shift.

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

Fairness in recommender systems (RSs) is commonly categorised into group fairness and individual fairness. However, there is no established scientific understanding of the relationship between the two fairness types, as prior work on both types has used different evaluation measures or evaluation objectives for each fairness type, thereby not allowing for a proper comparison of the two. As a result, it is currently not known how increasing one type of fairness may affect the other. To fill this gap, we study the relationship of group and individual fairness through a comprehensive comparison of evaluation measures that can be used for both fairness types. Our experiments with 8 runs across 3 datasets show that recommendations that are highly fair for groups can be very unfair for individuals. Our finding is novel and useful for RS practitioners aiming to improve the fairness of their systems. Our code is available at: https://github.com/theresiavr/stairway-to-fairness.

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.

This paper uses the MIMIC-IV dataset to examine the fairness and bias in an XGBoost binary classification model predicting the Intensive Care Unit (ICU) length of stay (LOS). Highlighting the critical role of the ICU in managing critically ill patients, the study addresses the growing strain on ICU capacity. It emphasizes the significance of LOS prediction for resource allocation. The research reveals class imbalances in the dataset across demographic attributes and employs data preprocessing and feature extraction. While the XGBoost model performs well overall, disparities across race and insurance attributes reflect the need for tailored assessments and continuous monitoring. The paper concludes with recommendations for fairness-aware machine learning techniques for mitigating biases and the need for collaborative efforts among healthcare professionals and data scientists.

Background: Health datasets from clinical sources do not reflect the breadth and diversity of disease in the real world, impacting research, medical education, and artificial intelligence (AI) tool development. Dermatology is a suitable area to develop and test a new and scalable method to create representative health datasets. Methods: We used Google Search advertisements to invite contributions to an open access dataset of images of dermatology conditions, demographic and symptom information. With informed contributor consent, we describe and release this dataset containing 10,408 images from 5,033 contributions from internet users in the United States over 8 months starting March 2023. The dataset includes dermatologist condition labels as well as estimated Fitzpatrick Skin Type (eFST) and Monk Skin Tone (eMST) labels for the images. Results: We received a median of 22 submissions/day (IQR 14-30). Female (66.72%) and younger (52% < age 40) contributors had a higher representation in the dataset compared to the US population, and 32.6% of contributors reported a non-White racial or ethnic identity. Over 97.5% of contributions were genuine images of skin conditions. Dermatologist confidence in assigning a differential diagnosis increased with the number of available variables, and showed a weaker correlation with image sharpness (Spearman's P values <0.001 and 0.01 respectively). Most contributions were short-duration (54% with onset < 7 days ago ) and 89% were allergic, infectious, or inflammatory conditions. eFST and eMST distributions reflected the geographical origin of the dataset. The dataset is available at github.com/google-research-datasets/scin . Conclusion: Search ads are effective at crowdsourcing images of health conditions. The SCIN dataset bridges important gaps in the availability of representative images of common skin conditions.

The acceleration in the adoption of AI-based automated decision-making systems poses a challenge for evaluating the fairness of algorithmic decisions, especially in the absence of ground truth. When designing interventions, uplift modeling is used extensively to identify candidates that are likely to benefit from treatment. However, these models remain particularly susceptible to fairness evaluation due to the lack of ground truth on the outcome measure since a candidate cannot be in both treatment and control simultaneously. In this article, we propose a framework that overcomes the missing ground truth problem by generating surrogates to serve as a proxy for counterfactual labels of uplift modeling campaigns. We then leverage the surrogate ground truth to conduct a more comprehensive binary fairness evaluation. We show how to apply the approach in a comprehensive study from a real-world marketing campaign for promotional offers and demonstrate its enhancement for fairness evaluation.

The Fair Graph Anomaly Detection (FairGAD) problem aims to accurately detect anomalous nodes in an input graph while ensuring fairness and avoiding biased predictions against individuals from sensitive subgroups such as gender or political leanings. Fairness in graphs is particularly crucial in anomaly detection areas such as misinformation detection in search/ranking systems, where decision outcomes can significantly affect individuals. However, the current literature does not comprehensively discuss this problem, nor does it provide realistic datasets that encompass actual graph structures, anomaly labels, and sensitive attributes for research in FairGAD. To bridge this gap, we introduce a formal definition of the FairGAD problem and present two novel graph datasets constructed from the globally prominent social media platforms Reddit and Twitter. These datasets comprise 1.2 million and 400,000 edges associated with 9,000 and 47,000 nodes, respectively, and leverage political leanings as sensitive attributes and misinformation spreaders as anomaly labels. We demonstrate that our FairGAD datasets significantly differ from the synthetic datasets used currently by the research community. These new datasets offer significant values for FairGAD by providing realistic data that captures the intricacies of social networks. Using our datasets, we investigate the performance-fairness trade-off in eleven existing GAD and non-graph AD methods on five state-of-the-art fairness methods, which sheds light on their effectiveness and limitations in addressing the FairGAD problem.

Organizations cannot address demographic disparities that they cannot see. Recent research on machine learning and fairness has emphasized that awareness of sensitive attributes, such as race and sex, is critical to the development of interventions. However, on the ground, the existence of these data cannot be taken for granted. This paper uses the domains of employment, credit, and healthcare in the United States to surface conditions that have shaped the availability of sensitive attribute data. For each domain, we describe how and when private companies collect or infer sensitive attribute data for antidiscrimination purposes. An inconsistent story emerges: Some companies are required by law to collect sensitive attribute data, while others are prohibited from doing so. Still others, in the absence of legal mandates, have determined that collection and imputation of these data are appropriate to address disparities. This story has important implications for fairness research and its future applications. If companies that mediate access to life opportunities are unable or hesitant to collect or infer sensitive attribute data, then proposed techniques to detect and mitigate bias in machine learning models might never be implemented outside the lab. We conclude that today's legal requirements and corporate practices, while highly inconsistent across domains, offer lessons for how to approach the collection and inference of sensitive data in appropriate circumstances. We urge stakeholders, including machine learning practitioners, to actively help chart a path forward that takes both policy goals and technical needs into account.

Debiasing methods in NLP models traditionally focus on isolating information related to a sensitive attribute (e.g., gender or race). We instead argue that a favorable debiasing method should use sensitive information 'fairly,' with explanations, rather than blindly eliminating it. This fair balance is often subjective and can be challenging to achieve algorithmically. We explore two interactive setups with a frozen predictive model and show that users able to provide feedback can achieve a better and fairer balance between task performance and bias mitigation. In one setup, users, by interacting with test examples, further decreased bias in the explanations (5-8%) while maintaining the same prediction accuracy. In the other setup, human feedback was able to disentangle associated bias and predictive information from the input leading to superior bias mitigation and improved task performance (4-5%) simultaneously.

Speech patterns have been identified as potential diagnostic markers for neuropsychiatric conditions. However, most studies only compare a single clinical group to healthy controls, whereas clinical practice often requires differentiating between multiple potential diagnoses (multiclass settings). To address this, we assembled a dataset of repeated recordings from 420 participants (67 with major depressive disorder, 106 with schizophrenia and 46 with autism, as well as matched controls), and tested the performance of a range of conventional machine learning models and advanced Transformer models on both binary and multiclass classification, based on voice and text features. While binary models performed comparably to previous research (F1 scores between 0.54-0.75 for autism spectrum disorder, ASD; 0.67-0.92 for major depressive disorder, MDD; and 0.71-0.83 for schizophrenia); when differentiating between multiple diagnostic groups performance decreased markedly (F1 scores between 0.35-0.44 for ASD, 0.57-0.75 for MDD, 0.15-0.66 for schizophrenia, and 0.38-0.52 macro F1). Combining voice and text-based models yielded increased performance, suggesting that they capture complementary diagnostic information. Our results indicate that models trained on binary classification may learn to rely on markers of generic differences between clinical and non-clinical populations, or markers of clinical features that overlap across conditions, rather than identifying markers specific to individual conditions. We provide recommendations for future research in the field, suggesting increased focus on developing larger transdiagnostic datasets that include more fine-grained clinical features, and that can support the development of models that better capture the complexity of neuropsychiatric conditions and naturalistic diagnostic assessment.

Chest X-rays (CXRs) are the most frequently performed imaging test in clinical practice. Recent advances in the development of vision-language foundation models (FMs) give rise to the possibility of performing automated CXR interpretation, which can assist physicians with clinical decision-making and improve patient outcomes. However, developing FMs that can accurately interpret CXRs is challenging due to the (1) limited availability of large-scale vision-language datasets in the medical image domain, (2) lack of vision and language encoders that can capture the complexities of medical data, and (3) absence of evaluation frameworks for benchmarking the abilities of FMs on CXR interpretation. In this work, we address these challenges by first introducing CheXinstruct - a large-scale instruction-tuning dataset curated from 28 publicly-available datasets. We then present CheXagent - an instruction-tuned FM capable of analyzing and summarizing CXRs. To build CheXagent, we design a clinical large language model (LLM) for parsing radiology reports, a vision encoder for representing CXR images, and a network to bridge the vision and language modalities. Finally, we introduce CheXbench - a novel benchmark designed to systematically evaluate FMs across 8 clinically-relevant CXR interpretation tasks. Extensive quantitative evaluations and qualitative reviews with five expert radiologists demonstrate that CheXagent outperforms previously-developed general- and medical-domain FMs on CheXbench tasks. Furthermore, in an effort to improve model transparency, we perform a fairness evaluation across factors of sex, race and age to highlight potential performance disparities. Our project is at https://stanford-aimi.github.io/chexagent.html.

We present a new approach for mitigating unfairness in learned classifiers. In particular, we focus on binary classification tasks over individuals from two populations, where, as our criterion for fairness, we wish to achieve similar false positive rates in both populations, and similar false negative rates in both populations. As a proof of concept, we implement our approach and empirically evaluate its ability to achieve both fairness and accuracy, using datasets from the fields of criminal risk assessment, credit, lending, and college admissions.

Dataset bias is one of the prevailing causes of unfairness in machine learning. Addressing fairness at the data collection and dataset preparation stages therefore becomes an essential part of training fairer algorithms. In particular, active learning (AL) algorithms show promise for the task by drawing importance to the most informative training samples. However, the effect and interaction between existing AL algorithms and algorithmic fairness remain under-explored. In this paper, we study whether models trained with uncertainty-based AL heuristics such as BALD are fairer in their decisions with respect to a protected class than those trained with identically independently distributed (i.i.d.) sampling. We found a significant improvement on predictive parity when using BALD, while also improving accuracy compared to i.i.d. sampling. We also explore the interaction of algorithmic fairness methods such as gradient reversal (GRAD) and BALD. We found that, while addressing different fairness issues, their interaction further improves the results on most benchmarks and metrics we explored.

Skin diseases affect millions of people worldwide, across all ethnicities. Increasing diagnosis accessibility requires fair and accurate segmentation and classification of dermatology images. However, the scarcity of annotated medical images, especially for rare diseases and underrepresented skin tones, poses a challenge to the development of fair and accurate models. In this study, we introduce a Fair, Efficient, and Diverse Diffusion-based framework for skin lesion segmentation and malignancy classification. FEDD leverages semantically meaningful feature embeddings learned through a denoising diffusion probabilistic backbone and processes them via linear probes to achieve state-of-the-art performance on Diverse Dermatology Images (DDI). We achieve an improvement in intersection over union of 0.18, 0.13, 0.06, and 0.07 while using only 5%, 10%, 15%, and 20% labeled samples, respectively. Additionally, FEDD trained on 10% of DDI demonstrates malignancy classification accuracy of 81%, 14% higher compared to the state-of-the-art. We showcase high efficiency in data-constrained scenarios while providing fair performance for diverse skin tones and rare malignancy conditions. Our newly annotated DDI segmentation masks and training code can be found on https://github.com/hectorcarrion/fedd.

With the rapid growth in language processing applications, fairness has emerged as an important consideration in data-driven solutions. Although various fairness definitions have been explored in the recent literature, there is lack of consensus on which metrics most accurately reflect the fairness of a system. In this work, we propose a new formulation : ACCUMULATED PREDICTION SENSITIVITY, which measures fairness in machine learning models based on the model's prediction sensitivity to perturbations in input features. The metric attempts to quantify the extent to which a single prediction depends on a protected attribute, where the protected attribute encodes the membership status of an individual in a protected group. We show that the metric can be theoretically linked with a specific notion of group fairness (statistical parity) and individual fairness. It also correlates well with humans' perception of fairness. We conduct experiments on two text classification datasets : JIGSAW TOXICITY, and BIAS IN BIOS, and evaluate the correlations between metrics and manual annotations on whether the model produced a fair outcome. We observe that the proposed fairness metric based on prediction sensitivity is statistically significantly more correlated with human annotation than the existing counterfactual fairness metric.

Automatic medical report generation (MRG) is of great research value as it has the potential to relieve radiologists from the heavy burden of report writing. Despite recent advancements, accurate MRG remains challenging due to the need for precise clinical understanding and the identification of clinical findings. Moreover, the imbalanced distribution of diseases makes the challenge even more pronounced, as rare diseases are underrepresented in training data, making their diagnostic performance unreliable. To address these challenges, we propose diagnosis-driven prompts for medical report generation (PromptMRG), a novel framework that aims to improve the diagnostic accuracy of MRG with the guidance of diagnosis-aware prompts. Specifically, PromptMRG is based on encoder-decoder architecture with an extra disease classification branch. When generating reports, the diagnostic results from the classification branch are converted into token prompts to explicitly guide the generation process. To further improve the diagnostic accuracy, we design cross-modal feature enhancement, which retrieves similar reports from the database to assist the diagnosis of a query image by leveraging the knowledge from a pre-trained CLIP. Moreover, the disease imbalanced issue is addressed by applying an adaptive logit-adjusted loss to the classification branch based on the individual learning status of each disease, which overcomes the barrier of text decoder's inability to manipulate disease distributions. Experiments on two MRG benchmarks show the effectiveness of the proposed method, where it obtains state-of-the-art clinical efficacy performance on both datasets.

Spurious correlations allow flexible models to predict well during training but poorly on related test distributions. Recent work has shown that models that satisfy particular independencies involving correlation-inducing nuisance variables have guarantees on their test performance. Enforcing such independencies requires nuisances to be observed during training. However, nuisances, such as demographics or image background labels, are often missing. Enforcing independence on just the observed data does not imply independence on the entire population. Here we derive mmd estimators used for invariance objectives under missing nuisances. On simulations and clinical data, optimizing through these estimates achieves test performance similar to using estimators that make use of the full data.

The advancement of large language models (LLMs) has made it difficult to differentiate human-written text from AI-generated text. Several AI-text detectors have been developed in response, which typically utilize a fixed global threshold (e.g., {\theta} = 0.5) to classify machine-generated text. However, we find that one universal threshold can fail to account for subgroup-specific distributional variations. For example, when using a fixed threshold, detectors make more false positive errors on shorter human-written text than longer, and more positive classifications on neurotic writing styles than open among long text. These discrepancies can lead to misclassification that disproportionately affects certain groups. We address this critical limitation by introducing FairOPT, an algorithm for group-specific threshold optimization in AI-generated content classifiers. Our approach partitions data into subgroups based on attributes (e.g., text length and writing style) and learns decision thresholds for each group, which enables careful balancing of performance and fairness metrics within each subgroup. In experiments with four AI text classifiers on three datasets, FairOPT enhances overall F1 score and decreases balanced error rate (BER) discrepancy across subgroups. Our framework paves the way for more robust and fair classification criteria in AI-generated output detection.

The rapid adoption of text-to-image diffusion models in society underscores an urgent need to address their biases. Without interventions, these biases could propagate a skewed worldview and restrict opportunities for minority groups. In this work, we frame fairness as a distributional alignment problem. Our solution consists of two main technical contributions: (1) a distributional alignment loss that steers specific characteristics of the generated images towards a user-defined target distribution, and (2) adjusted direct finetuning of diffusion model's sampling process (adjusted DFT), which leverages an adjusted gradient to directly optimize losses defined on the generated images. Empirically, our method markedly reduces gender, racial, and their intersectional biases for occupational prompts. Gender bias is significantly reduced even when finetuning just five soft tokens. Crucially, our method supports diverse perspectives of fairness beyond absolute equality, which is demonstrated by controlling age to a 75% young and 25% old distribution while simultaneously debiasing gender and race. Finally, our method is scalable: it can debias multiple concepts at once by simply including these prompts in the finetuning data. We share code and various fair diffusion model adaptors at https://sail-sg.github.io/finetune-fair-diffusion/.

An approach to the construction of classifiers from imbalanced datasets is described. A dataset is imbalanced if the classification categories are not approximately equally represented. Often real-world data sets are predominately composed of "normal" examples with only a small percentage of "abnormal" or "interesting" examples. It is also the case that the cost of misclassifying an abnormal (interesting) example as a normal example is often much higher than the cost of the reverse error. Under-sampling of the majority (normal) class has been proposed as a good means of increasing the sensitivity of a classifier to the minority class. This paper shows that a combination of our method of over-sampling the minority (abnormal) class and under-sampling the majority (normal) class can achieve better classifier performance (in ROC space) than only under-sampling the majority class. This paper also shows that a combination of our method of over-sampling the minority class and under-sampling the majority class can achieve better classifier performance (in ROC space) than varying the loss ratios in Ripper or class priors in Naive Bayes. Our method of over-sampling the minority class involves creating synthetic minority class examples. Experiments are performed using C4.5, Ripper and a Naive Bayes classifier. The method is evaluated using the area under the Receiver Operating Characteristic curve (AUC) and the ROC convex hull strategy.

Existing studies on fairness are largely Western-focused, making them inadequate for culturally diverse countries such as India. To address this gap, we introduce INDIC-BIAS, a comprehensive India-centric benchmark designed to evaluate fairness of LLMs across 85 identity groups encompassing diverse castes, religions, regions, and tribes. We first consult domain experts to curate over 1,800 socio-cultural topics spanning behaviors and situations, where biases and stereotypes are likely to emerge. Grounded in these topics, we generate and manually validate 20,000 real-world scenario templates to probe LLMs for fairness. We structure these templates into three evaluation tasks: plausibility, judgment, and generation. Our evaluation of 14 popular LLMs on these tasks reveals strong negative biases against marginalized identities, with models frequently reinforcing common stereotypes. Additionally, we find that models struggle to mitigate bias even when explicitly asked to rationalize their decision. Our evaluation provides evidence of both allocative and representational harms that current LLMs could cause towards Indian identities, calling for a more cautious usage in practical applications. We release INDIC-BIAS as an open-source benchmark to advance research on benchmarking and mitigating biases and stereotypes in the Indian context.

Generalist Large Language Models (LLMs), such as GPT-4, have shown considerable promise in various domains, including medical diagnosis. Rare diseases, affecting approximately 300 million people worldwide, often have unsatisfactory clinical diagnosis rates primarily due to a lack of experienced physicians and the complexity of differentiating among many rare diseases. In this context, recent news such as "ChatGPT correctly diagnosed a 4-year-old's rare disease after 17 doctors failed" underscore LLMs' potential, yet underexplored, role in clinically diagnosing rare diseases. To bridge this research gap, we introduce RareBench, a pioneering benchmark designed to systematically evaluate the capabilities of LLMs on 4 critical dimensions within the realm of rare diseases. Meanwhile, we have compiled the largest open-source dataset on rare disease patients, establishing a benchmark for future studies in this domain. To facilitate differential diagnosis of rare diseases, we develop a dynamic few-shot prompt methodology, leveraging a comprehensive rare disease knowledge graph synthesized from multiple knowledge bases, significantly enhancing LLMs' diagnostic performance. Moreover, we present an exhaustive comparative study of GPT-4's diagnostic capabilities against those of specialist physicians. Our experimental findings underscore the promising potential of integrating LLMs into the clinical diagnostic process for rare diseases. This paves the way for exciting possibilities in future advancements in this field.

With the proliferation of algorithmic decision-making, increased scrutiny has been placed on these systems. This paper explores the relationship between the quality of the training data and the overall fairness of the models trained with such data in the context of supervised classification. We measure key fairness metrics across a range of algorithms over multiple image classification datasets that have a varying level of noise in both the labels and the training data itself. We describe noise in the labels as inaccuracies in the labelling of the data in the training set and noise in the data as distortions in the data, also in the training set. By adding noise to the original datasets, we can explore the relationship between the quality of the training data and the fairness of the output of the models trained on that data.

We reveal and address the frequently overlooked yet important issue of disguised procedural unfairness, namely, the potentially inadvertent alterations on the behavior of neutral (i.e., not problematic) aspects of data generating process, and/or the lack of procedural assurance of the greatest benefit of the least advantaged individuals. Inspired by John Rawls's advocacy for pure procedural justice, we view automated decision-making as a microcosm of social institutions, and consider how the data generating process itself can satisfy the requirements of procedural fairness. We propose a framework that decouples the objectionable data generating components from the neutral ones by utilizing reference points and the associated value instantiation rule. Our findings highlight the necessity of preventing disguised procedural unfairness, drawing attention not only to the objectionable data generating components that we aim to mitigate, but also more importantly, to the neutral components that we intend to keep unaffected.

The fairness of machine learning-based decisions has become an increasingly important focus in the design of supervised machine learning methods. Most fairness approaches optimize a specified trade-off between performance measure(s) (e.g., accuracy, log loss, or AUC) and fairness metric(s) (e.g., demographic parity, equalized odds). This begs the question: are the right performance-fairness trade-offs being specified? We instead re-cast fair machine learning as an imitation learning task by introducing superhuman fairness, which seeks to simultaneously outperform human decisions on multiple predictive performance and fairness measures. We demonstrate the benefits of this approach given suboptimal decisions.

Tabular data is prevalent in many high-stakes domains, such as financial services or public policy. Gradient Boosted Decision Trees (GBDT) are popular in these settings due to their scalability, performance, and low training cost. While fairness in these domains is a foremost concern, existing in-processing Fair ML methods are either incompatible with GBDT, or incur in significant performance losses while taking considerably longer to train. We present FairGBM, a dual ascent learning framework for training GBDT under fairness constraints, with little to no impact on predictive performance when compared to unconstrained GBDT. Since observational fairness metrics are non-differentiable, we propose smooth convex error rate proxies for common fairness criteria, enabling gradient-based optimization using a ``proxy-Lagrangian'' formulation. Our implementation shows an order of magnitude speedup in training time relative to related work, a pivotal aspect to foster the widespread adoption of FairGBM by real-world practitioners.

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.

Federated learning is an emerging framework that builds centralized machine learning models with training data distributed across multiple devices. Most of the previous works about federated learning focus on the privacy protection and communication cost reduction. However, how to achieve fairness in federated learning is under-explored and challenging especially when testing data distribution is different from training distribution or even unknown. Introducing simple fairness constraints on the centralized model cannot achieve model fairness on unknown testing data. In this paper, we develop a fairness-aware agnostic federated learning framework (AgnosticFair) to deal with the challenge of unknown testing distribution. We use kernel reweighing functions to assign a reweighing value on each training sample in both loss function and fairness constraint. Therefore, the centralized model built from AgnosticFair can achieve high accuracy and fairness guarantee on unknown testing data. Moreover, the built model can be directly applied to local sites as it guarantees fairness on local data distributions. To our best knowledge, this is the first work to achieve fairness in federated learning. Experimental results on two real datasets demonstrate the effectiveness in terms of both utility and fairness under data shift scenarios.

Fairness is essential for machine learning systems deployed in high-stake applications. Among all fairness notions, individual fairness, deriving from a consensus that `similar individuals should be treated similarly,' is a vital notion to describe fair treatment for individual cases. Previous studies typically characterize individual fairness as a prediction-invariant problem when perturbing sensitive attributes on samples, and solve it by Distributionally Robust Optimization (DRO) paradigm. However, such adversarial perturbations along a direction covering sensitive information used in DRO do not consider the inherent feature correlations or innate data constraints, therefore could mislead the model to optimize at off-manifold and unrealistic samples. In light of this drawback, in this paper, we propose to learn and generate antidote data that approximately follows the data distribution to remedy individual unfairness. These generated on-manifold antidote data can be used through a generic optimization procedure along with original training data, resulting in a pure pre-processing approach to individual unfairness, or can also fit well with the in-processing DRO paradigm. Through extensive experiments on multiple tabular datasets, we demonstrate our method resists individual unfairness at a minimal or zero cost to predictive utility compared to baselines.

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.

Machine learning models are often trained to predict the outcome resulting from a human decision. For example, if a doctor decides to test a patient for disease, will the patient test positive? A challenge is that historical decision-making determines whether the outcome is observed: we only observe test outcomes for patients doctors historically tested. Untested patients, for whom outcomes are unobserved, may differ from tested patients along observed and unobserved dimensions. We propose a Bayesian model class which captures this setting. The purpose of the model is to accurately estimate risk for both tested and untested patients. Estimating this model is challenging due to the wide range of possibilities for untested patients. To address this, we propose two domain constraints which are plausible in health settings: a prevalence constraint, where the overall disease prevalence is known, and an expertise constraint, where the human decision-maker deviates from purely risk-based decision-making only along a constrained feature set. We show theoretically and on synthetic data that domain constraints improve parameter inference. We apply our model to a case study of cancer risk prediction, showing that the model's inferred risk predicts cancer diagnoses, its inferred testing policy captures known public health policies, and it can identify suboptimalities in test allocation. Though our case study is in healthcare, our analysis reveals a general class of domain constraints which can improve model estimation in many settings.

This work presents an information-theoretic perspective to group fairness trade-offs in federated learning (FL) with respect to sensitive attributes, such as gender, race, etc. Existing works often focus on either global fairness (overall disparity of the model across all clients) or local fairness (disparity of the model at each client), without always considering their trade-offs. There is a lack of understanding regarding the interplay between global and local fairness in FL, particularly under data heterogeneity, and if and when one implies the other. To address this gap, we leverage a body of work in information theory called partial information decomposition (PID), which first identifies three sources of unfairness in FL, namely, Unique Disparity, Redundant Disparity, and Masked Disparity. We demonstrate how these three disparities contribute to global and local fairness using canonical examples. This decomposition helps us derive fundamental limits on the trade-off between global and local fairness, highlighting where they agree or disagree. We introduce the Accuracy and Global-Local Fairness Optimality Problem (AGLFOP), a convex optimization that defines the theoretical limits of accuracy and fairness trade-offs, identifying the best possible performance any FL strategy can attain given a dataset and client distribution. We also present experimental results on synthetic datasets and the ADULT dataset to support our theoretical findings.

When deploying machine learning models in high-stakes real-world environments such as health care, it is crucial to accurately assess the uncertainty concerning a model's prediction on abnormal inputs. However, there is a scarcity of literature analyzing this problem on medical data, especially on mixed-type tabular data such as Electronic Health Records. We close this gap by presenting a series of tests including a large variety of contemporary uncertainty estimation techniques, in order to determine whether they are able to identify out-of-distribution (OOD) patients. In contrast to previous work, we design tests on realistic and clinically relevant OOD groups, and run experiments on real-world medical data. We find that almost all techniques fail to achieve convincing results, partly disagreeing with earlier findings.

We consider a binary classification problem under group fairness constraints, which can be one of Demographic Parity (DP), Equalized Opportunity (EOp), or Equalized Odds (EO). We propose an explicit characterization of Bayes optimal classifier under the fairness constraints, which turns out to be a simple modification rule of the unconstrained classifier. Namely, we introduce a novel instance-level measure of bias, which we call bias score, and the modification rule is a simple linear rule on top of the finite amount of bias scores.Based on this characterization, we develop a post-hoc approach that allows us to adapt to fairness constraints while maintaining high accuracy. In the case of DP and EOp constraints, the modification rule is thresholding a single bias score, while in the case of EO constraints we are required to fit a linear modification rule with 2 parameters. The method can also be applied for composite group-fairness criteria, such as ones involving several sensitive attributes.

Despite the development of effective deepfake detectors in recent years, recent studies have demonstrated that biases in the data used to train these detectors can lead to disparities in detection accuracy across different races and genders. This can result in different groups being unfairly targeted or excluded from detection, allowing undetected deepfakes to manipulate public opinion and erode trust in a deepfake detection model. While existing studies have focused on evaluating fairness of deepfake detectors, to the best of our knowledge, no method has been developed to encourage fairness in deepfake detection at the algorithm level. In this work, we make the first attempt to improve deepfake detection fairness by proposing novel loss functions that handle both the setting where demographic information (eg, annotations of race and gender) is available as well as the case where this information is absent. Fundamentally, both approaches can be used to convert many existing deepfake detectors into ones that encourages fairness. Extensive experiments on four deepfake datasets and five deepfake detectors demonstrate the effectiveness and flexibility of our approach in improving deepfake detection fairness. Our code is available at https://github.com/littlejuyan/DF_Fairness.

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.

Randomized controlled trials (RCTs) are the benchmark for causal inference, yet field implementation can deviate. We here present a remote audit - a design-based, preregistrable diagnostic that uses only pre-treatment satellite imagery to test whether assignment is independent of local conditions. The conditional randomization test of the remote audit evaluates whether treatment assignment is more predictable from pre-treatment satellite features than expected under the experiment's registered mechanism, providing a finite-sample valid, design-based diagnostic that requires no parametric assumptions. The procedure is finite-sample valid, honors blocks and clusters, and controls multiplicity across image models and resolutions via a max-statistic. We illustrate with two RCTs: Uganda's Youth Opportunities Program, where the audit corroborates randomization and flags selection and missing-data risks; and a school-based trial in Bangladesh, where assignment is highly predictable from pre-treatment features relative to the stated design, consistent with independent concerns about irregularities. Remote audits complement balance tests, lower early-stage costs, and enable rapid design checks when baseline surveys are expensive or infeasible.

Ranking and scoring are ubiquitous. We consider the setting in which an institution, called a ranker, evaluates a set of individuals based on demographic, behavioral or other characteristics. The final output is a ranking that represents the relative quality of the individuals. While automatic and therefore seemingly objective, rankers can, and often do, discriminate against individuals and systematically disadvantage members of protected groups. This warrants a careful study of the fairness of a ranking scheme. In this paper we propose fairness measures for ranked outputs. We develop a data generation procedure that allows us to systematically control the degree of unfairness in the output, and study the behavior of our measures on these datasets. We then apply our proposed measures to several real datasets, and demonstrate cases of unfairness. Finally, we show preliminary results of incorporating our ranked fairness measures into an optimization framework, and show potential for improving fairness of ranked outputs while maintaining accuracy.

Two different approaches exist to handle missing values for prediction: either imputation, prior to fitting any predictive algorithms, or dedicated methods able to natively incorporate missing values. While imputation is widely (and easily) use, it is unfortunately biased when low-capacity predictors (such as linear models) are applied afterward. However, in practice, naive imputation exhibits good predictive performance. In this paper, we study the impact of imputation in a high-dimensional linear model with MCAR missing data. We prove that zero imputation performs an implicit regularization closely related to the ridge method, often used in high-dimensional problems. Leveraging on this connection, we establish that the imputation bias is controlled by a ridge bias, which vanishes in high dimension. As a predictor, we argue in favor of the averaged SGD strategy, applied to zero-imputed data. We establish an upper bound on its generalization error, highlighting that imputation is benign in the d sqrt n regime. Experiments illustrate our findings.

Skin conditions affect an estimated 1.9 billion people worldwide. A shortage of dermatologists causes long wait times and leads patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in referral errors, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories). The DLS distinguishes between 26 skin conditions that represent roughly 80% of the volume of skin conditions seen in primary care. The DLS was developed and validated using de-identified cases from a teledermatology practice serving 17 clinical sites via a temporal split: the first 14,021 cases for development and the last 3,756 cases for validation. On the validation set, where a panel of three board-certified dermatologists defined the reference standard for every case, the DLS achieved 0.71 and 0.93 top-1 and top-3 accuracies respectively. For a random subset of the validation set (n=963 cases), 18 clinicians reviewed the cases for comparison. On this subset, the DLS achieved a 0.67 top-1 accuracy, non-inferior to board-certified dermatologists (0.63, p<0.001), and higher than primary care physicians (PCPs, 0.45) and nurse practitioners (NPs, 0.41). The top-3 accuracy showed a similar trend: 0.90 DLS, 0.75 dermatologists, 0.60 PCPs, and 0.55 NPs. These results highlight the potential of the DLS to augment general practitioners to accurately diagnose skin conditions by suggesting differential diagnoses that may not have been considered. Future work will be needed to prospectively assess the clinical impact of using this tool in actual clinical workflows.

The effect of underrepresentation on the performance of minority groups is known to be a serious problem in supervised learning settings; however, it has been underexplored so far in the context of self-supervised learning (SSL). In this paper, we demonstrate that contrastive learning (CL), a popular variant of SSL, tends to collapse representations of minority groups with certain majority groups. We refer to this phenomenon as representation harm and demonstrate it on image and text datasets using the corresponding popular CL methods. Furthermore, our causal mediation analysis of allocation harm on a downstream classification task reveals that representation harm is partly responsible for it, thus emphasizing the importance of studying and mitigating representation harm. Finally, we provide a theoretical explanation for representation harm using a stochastic block model that leads to a representational neural collapse in a contrastive learning setting.

In critical applications, it is vital for classifiers to defer decision-making to humans. We propose a post-hoc method that makes existing classifiers selectively abstain from predicting certain samples. Our abstaining classifier is incentivized to maintain the original accuracy for each sub-population (i.e. no harm) while achieving a set of group fairness definitions to a user specified degree. To this end, we design an Integer Programming (IP) procedure that assigns abstention decisions for each training sample to satisfy a set of constraints. To generalize the abstaining decisions to test samples, we then train a surrogate model to learn the abstaining decisions based on the IP solutions in an end-to-end manner. We analyze the feasibility of the IP procedure to determine the possible abstention rate for different levels of unfairness tolerance and accuracy constraint for achieving no harm. To the best of our knowledge, this work is the first to identify the theoretical relationships between the constraint parameters and the required abstention rate. Our theoretical results are important since a high abstention rate is often infeasible in practice due to a lack of human resources. Our framework outperforms existing methods in terms of fairness disparity without sacrificing accuracy at similar abstention rates.

Evaluating fairness can be challenging in practice because the sensitive attributes of data are often inaccessible due to privacy constraints. The go-to approach that the industry frequently adopts is using off-the-shelf proxy models to predict the missing sensitive attributes, e.g. Meta [Alao et al., 2021] and Twitter [Belli et al., 2022]. Despite its popularity, there are three important questions unanswered: (1) Is directly using proxies efficacious in measuring fairness? (2) If not, is it possible to accurately evaluate fairness using proxies only? (3) Given the ethical controversy over inferring user private information, is it possible to only use weak (i.e. inaccurate) proxies in order to protect privacy? Our theoretical analyses show that directly using proxy models can give a false sense of (un)fairness. Second, we develop an algorithm that is able to measure fairness (provably) accurately with only three properly identified proxies. Third, we show that our algorithm allows the use of only weak proxies (e.g. with only 68.85%accuracy on COMPAS), adding an extra layer of protection on user privacy. Experiments validate our theoretical analyses and show our algorithm can effectively measure and mitigate bias. Our results imply a set of practical guidelines for practitioners on how to use proxies properly. Code is available at github.com/UCSC-REAL/fair-eval.

Although the fairness community has recognized the importance of data, researchers in the area primarily rely on UCI Adult when it comes to tabular data. Derived from a 1994 US Census survey, this dataset has appeared in hundreds of research papers where it served as the basis for the development and comparison of many algorithmic fairness interventions. We reconstruct a superset of the UCI Adult data from available US Census sources and reveal idiosyncrasies of the UCI Adult dataset that limit its external validity. Our primary contribution is a suite of new datasets derived from US Census surveys that extend the existing data ecosystem for research on fair machine learning. We create prediction tasks relating to income, employment, health, transportation, and housing. The data span multiple years and all states of the United States, allowing researchers to study temporal shift and geographic variation. We highlight a broad initial sweep of new empirical insights relating to trade-offs between fairness criteria, performance of algorithmic interventions, and the role of distribution shift based on our new datasets. Our findings inform ongoing debates, challenge some existing narratives, and point to future research directions. Our datasets are available at https://github.com/zykls/folktables.

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.

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.

University rankings are increasingly adopted for academic comparison and success quantification, even to establish performance-based criteria for funding assignment. However, rankings are not neutral tools, and their use frequently overlooks disparities in the starting conditions of institutions. In this research, we detect and measure structural biases that affect in inhomogeneous ways the ranking outcomes of universities from diversified territorial and educational contexts. Moreover, we develop a fairer rating system based on a fully data-driven debiasing strategy that returns an equity-oriented redefinition of the achieved scores. The key idea consists in partitioning universities in similarity groups, determined from multifaceted data using complex network analysis, and referring the performance of each institution to an expectation based on its peers. Significant evidence of territorial biases emerges for official rankings concerning both the OECD and Italian university systems, hence debiasing provides relevant insights suggesting the design of fairer strategies for performance-based funding allocations.

The explosion in the use of software in important sociotechnical systems has renewed focus on the study of the way technical constructs reflect policies, norms, and human values. This effort requires the engagement of scholars and practitioners from many disciplines. And yet, these disciplines often conceptualize the operative values very differently while referring to them using the same vocabulary. The resulting conflation of ideas confuses discussions about values in technology at disciplinary boundaries. In the service of improving this situation, this paper examines the value of shared vocabularies, analytics, and other tools that facilitate conversations about values in light of these disciplinary specific conceptualizations, the role such tools play in furthering research and practice, outlines different conceptions of "fairness" deployed in discussions about computer systems, and provides an analytic tool for interdisciplinary discussions and collaborations around the concept of fairness. We use a case study of risk assessments in criminal justice applications to both motivate our effort--describing how conflation of different concepts under the banner of "fairness" led to unproductive confusion--and illustrate the value of the fairness analytic by demonstrating how the rigorous analysis it enables can assist in identifying key areas of theoretical, political, and practical misunderstanding or disagreement, and where desired support alignment or collaboration in the absence of consensus.

The FAIR Guiding Principles aim to improve the findability, accessibility, interoperability, and reusability of digital content by making them both human and machine actionable. However, these principles have not yet been broadly adopted in the domain of machine learning-based program analyses and optimizations for High-Performance Computing (HPC). In this paper, we design a methodology to make HPC datasets and machine learning models FAIR after investigating existing FAIRness assessment and improvement techniques. Our methodology includes a comprehensive, quantitative assessment for elected data, followed by concrete, actionable suggestions to improve FAIRness with respect to common issues related to persistent identifiers, rich metadata descriptions, license and provenance information. Moreover, we select a representative training dataset to evaluate our methodology. The experiment shows the methodology can effectively improve the dataset and model's FAIRness from an initial score of 19.1% to the final score of 83.0%.

Variances in ad impression outcomes across demographic groups are increasingly considered to be potentially indicative of algorithmic bias in personalized ads systems. While there are many definitions of fairness that could be applicable in the context of personalized systems, we present a framework which we call the Variance Reduction System (VRS) for achieving more equitable outcomes in Meta's ads systems. VRS seeks to achieve a distribution of impressions with respect to selected protected class (PC) attributes that more closely aligns the demographics of an ad's eligible audience (a function of advertiser targeting criteria) with the audience who sees that ad, in a privacy-preserving manner. We first define metrics to quantify fairness gaps in terms of ad impression variances with respect to PC attributes including gender and estimated race. We then present the VRS for re-ranking ads in an impression variance-aware manner. We evaluate VRS via extensive simulations over different parameter choices and study the effect of the VRS on the chosen fairness metric. We finally present online A/B testing results from applying VRS to Meta's ads systems, concluding with a discussion of future work. We have deployed the VRS to all users in the US for housing ads, resulting in significant improvement in our fairness metric. VRS is the first large-scale deployed framework for pursuing fairness for multiple PC attributes in online advertising.

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.

Intersectionality is a critical framework that, through inquiry and praxis, allows us to examine how social inequalities persist through domains of structure and discipline. Given AI fairness' raison d'etre of "fairness", we argue that adopting intersectionality as an analytical framework is pivotal to effectively operationalizing fairness. Through a critical review of how intersectionality is discussed in 30 papers from the AI fairness literature, we deductively and inductively: 1) map how intersectionality tenets operate within the AI fairness paradigm and 2) uncover gaps between the conceptualization and operationalization of intersectionality. We find that researchers overwhelmingly reduce intersectionality to optimizing for fairness metrics over demographic subgroups. They also fail to discuss their social context and when mentioning power, they mostly situate it only within the AI pipeline. We: 3) outline and assess the implications of these gaps for critical inquiry and praxis, and 4) provide actionable recommendations for AI fairness researchers to engage with intersectionality in their work by grounding it in AI epistemology.

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.

LLMs can exhibit age biases, resulting in unequal treatment of individuals across age groups. While much research has addressed racial and gender biases, age bias remains little explored. The scarcity of instruction-tuning and preference datasets for age bias hampers its detection and measurement, and existing fine-tuning methods seldom address age-related fairness. In this paper, we construct age bias preference datasets and instruction-tuning datasets for RLHF. We introduce ARG, an age fairness reward to reduce differences in the response quality of LLMs across different age groups. Extensive experiments demonstrate that this reward significantly improves response accuracy and reduces performance disparities across age groups. Our source code and datasets are available at the anonymous https://anonymous.4open.science/r/FairRLHF-D445/readme.md{link}.

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.

Graph Neural Networks (GNNs) have become increasingly important due to their representational power and state-of-the-art predictive performance on many fundamental learning tasks. Despite this success, GNNs suffer from fairness issues that arise as a result of the underlying graph data and the fundamental aggregation mechanism that lies at the heart of the large class of GNN models. In this article, we examine and categorize fairness techniques for improving the fairness of GNNs. Previous work on fair GNN models and techniques are discussed in terms of whether they focus on improving fairness during a preprocessing step, during training, or in a post-processing phase. Furthermore, we discuss how such techniques can be used together whenever appropriate, and highlight the advantages and intuition as well. We also introduce an intuitive taxonomy for fairness evaluation metrics including graph-level fairness, neighborhood-level fairness, embedding-level fairness, and prediction-level fairness metrics. In addition, graph datasets that are useful for benchmarking the fairness of GNN models are summarized succinctly. Finally, we highlight key open problems and challenges that remain to be addressed.

With the widespread use of AI systems and applications in our everyday lives, it is important to take fairness issues into consideration while designing and engineering these types of systems. Such systems can be used in many sensitive environments to make important and life-changing decisions; thus, it is crucial to ensure that the decisions do not reflect discriminatory behavior toward certain groups or populations. We have recently seen work in machine learning, natural language processing, and deep learning that addresses such challenges in different subdomains. With the commercialization of these systems, researchers are becoming aware of the biases that these applications can contain and have attempted to address them. In this survey we investigated different real-world applications that have shown biases in various ways, and we listed different sources of biases that can affect AI applications. We then created a taxonomy for fairness definitions that machine learning researchers have defined in order to avoid the existing bias in AI systems. In addition to that, we examined different domains and subdomains in AI showing what researchers have observed with regard to unfair outcomes in the state-of-the-art methods and how they have tried to address them. There are still many future directions and solutions that can be taken to mitigate the problem of bias in AI systems. We are hoping that this survey will motivate researchers to tackle these issues in the near future by observing existing work in their respective fields.

How to ensure fairness is an important topic in federated learning (FL). Recent studies have investigated how to reward clients based on their contribution (collaboration fairness), and how to achieve uniformity of performance across clients (performance fairness). Despite achieving progress on either one, we argue that it is critical to consider them together, in order to engage and motivate more diverse clients joining FL to derive a high-quality global model. In this work, we propose a novel method to optimize both types of fairness simultaneously. Specifically, we propose to estimate client contribution in gradient and data space. In gradient space, we monitor the gradient direction differences of each client with respect to others. And in data space, we measure the prediction error on client data using an auxiliary model. Based on this contribution estimation, we propose a FL method, federated training via contribution estimation (FedCE), i.e., using estimation as global model aggregation weights. We have theoretically analyzed our method and empirically evaluated it on two real-world medical datasets. The effectiveness of our approach has been validated with significant performance improvements, better collaboration fairness, better performance fairness, and comprehensive analytical studies.

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.

Previous work has highlighted that existing post-hoc explanation methods exhibit disparities in explanation fidelity (across 'race' and 'gender' as sensitive attributes), and while a large body of work focuses on mitigating these issues at the explanation metric level, the role of the data generating process and black box model in relation to explanation disparities remains largely unexplored. Accordingly, through both simulations as well as experiments on a real-world dataset, we specifically assess challenges to explanation disparities that originate from properties of the data: limited sample size, covariate shift, concept shift, omitted variable bias, and challenges based on model properties: inclusion of the sensitive attribute and appropriate functional form. Through controlled simulation analyses, our study demonstrates that increased covariate shift, concept shift, and omission of covariates increase explanation disparities, with the effect pronounced higher for neural network models that are better able to capture the underlying functional form in comparison to linear models. We also observe consistent findings regarding the effect of concept shift and omitted variable bias on explanation disparities in the Adult income dataset. Overall, results indicate that disparities in model explanations can also depend on data and model properties. Based on this systematic investigation, we provide recommendations for the design of explanation methods that mitigate undesirable disparities.

Machine learning models for medical image analysis often suffer from poor performance on important subsets of a population that are not identified during training or testing. For example, overall performance of a cancer detection model may be high, but the model still consistently misses a rare but aggressive cancer subtype. We refer to this problem as hidden stratification, and observe that it results from incompletely describing the meaningful variation in a dataset. While hidden stratification can substantially reduce the clinical efficacy of machine learning models, its effects remain difficult to measure. In this work, we assess the utility of several possible techniques for measuring and describing hidden stratification effects, and characterize these effects on multiple medical imaging datasets. We find evidence that hidden stratification can occur in unidentified imaging subsets with low prevalence, low label quality, subtle distinguishing features, or spurious correlates, and that it can result in relative performance differences of over 20% on clinically important subsets. Finally, we explore the clinical implications of our findings, and suggest that evaluation of hidden stratification should be a critical component of any machine learning deployment in medical imaging.

While the evaluation of explanations is an important step towards trustworthy models, it needs to be done carefully, and the employed metrics need to be well-understood. Specifically model randomization testing is often overestimated and regarded as a sole criterion for selecting or discarding certain explanation methods. To address shortcomings of this test, we start by observing an experimental gap in the ranking of explanation methods between randomization-based sanity checks [1] and model output faithfulness measures (e.g. [25]). We identify limitations of model-randomization-based sanity checks for the purpose of evaluating explanations. Firstly, we show that uninformative attribution maps created with zero pixel-wise covariance easily achieve high scores in this type of checks. Secondly, we show that top-down model randomization preserves scales of forward pass activations with high probability. That is, channels with large activations have a high probility to contribute strongly to the output, even after randomization of the network on top of them. Hence, explanations after randomization can only be expected to differ to a certain extent. This explains the observed experimental gap. In summary, these results demonstrate the inadequacy of model-randomization-based sanity checks as a criterion to rank attribution methods.

Recent work has explored how to train machine learning models which do not discriminate against any subgroup of the population as determined by sensitive attributes such as gender or race. To avoid disparate treatment, sensitive attributes should not be considered. On the other hand, in order to avoid disparate impact, sensitive attributes must be examined, e.g., in order to learn a fair model, or to check if a given model is fair. We introduce methods from secure multi-party computation which allow us to avoid both. By encrypting sensitive attributes, we show how an outcome-based fair model may be learned, checked, or have its outputs verified and held to account, without users revealing their sensitive attributes.

We introduce a fairness-aware dataset for job recommendation in advertising, designed to foster research in algorithmic fairness within real-world scenarios. It was collected and prepared to comply with privacy standards and business confidentiality. An additional challenge is the lack of access to protected user attributes such as gender, for which we propose a solution to obtain a proxy estimate. Despite being anonymized and including a proxy for a sensitive attribute, our dataset preserves predictive power and maintains a realistic and challenging benchmark. This dataset addresses a significant gap in the availability of fairness-focused resources for high-impact domains like advertising -- the actual impact being having access or not to precious employment opportunities, where balancing fairness and utility is a common industrial challenge. We also explore various stages in the advertising process where unfairness can occur and introduce a method to compute a fair utility metric for the job recommendations in online systems case from a biased dataset. Experimental evaluations of bias mitigation techniques on the released dataset demonstrate potential improvements in fairness and the associated trade-offs with utility.

Three key properties that are desired of trustworthy machine learning models deployed in high-stakes environments are fairness, explainability, and an ability to account for various kinds of "drift". While drifts in model accuracy, for example due to covariate shift, have been widely investigated, drifts in fairness metrics over time remain largely unexplored. In this paper, we propose FEAMOE, a novel "mixture-of-experts" inspired framework aimed at learning fairer, more explainable/interpretable models that can also rapidly adjust to drifts in both the accuracy and the fairness of a classifier. We illustrate our framework for three popular fairness measures and demonstrate how drift can be handled with respect to these fairness constraints. Experiments on multiple datasets show that our framework as applied to a mixture of linear experts is able to perform comparably to neural networks in terms of accuracy while producing fairer models. We then use the large-scale HMDA dataset and show that while various models trained on HMDA demonstrate drift with respect to both accuracy and fairness, FEAMOE can ably handle these drifts with respect to all the considered fairness measures and maintain model accuracy as well. We also prove that the proposed framework allows for producing fast Shapley value explanations, which makes computationally efficient feature attribution based explanations of model decisions readily available via FEAMOE.

Model fairness is an essential element for Trustworthy AI. While many techniques for model fairness have been proposed, most of them assume that the training and deployment data distributions are identical, which is often not true in practice. In particular, when the bias between labels and sensitive groups changes, the fairness of the trained model is directly influenced and can worsen. We make two contributions for solving this problem. First, we analytically show that existing in-processing fair algorithms have fundamental limits in accuracy and group fairness. We introduce the notion of correlation shifts, which can explicitly capture the change of the above bias. Second, we propose a novel pre-processing step that samples the input data to reduce correlation shifts and thus enables the in-processing approaches to overcome their limitations. We formulate an optimization problem for adjusting the data ratio among labels and sensitive groups to reflect the shifted correlation. A key benefit of our approach lies in decoupling the roles of pre- and in-processing approaches: correlation adjustment via pre-processing and unfairness mitigation on the processed data via in-processing. Experiments show that our framework effectively improves existing in-processing fair algorithms w.r.t. accuracy and fairness, both on synthetic and real datasets.

Face biometrics are playing a key role in making modern smart city applications more secure and usable. Commonly, the recognition threshold of a face recognition system is adjusted based on the degree of security for the considered use case. The likelihood of a match can be for instance decreased by setting a high threshold in case of a payment transaction verification. Prior work in face recognition has unfortunately showed that error rates are usually higher for certain demographic groups. These disparities have hence brought into question the fairness of systems empowered with face biometrics. In this paper, we investigate the extent to which disparities among demographic groups change under different security levels. Our analysis includes ten face recognition models, three security thresholds, and six demographic groups based on gender and ethnicity. Experiments show that the higher the security of the system is, the higher the disparities in usability among demographic groups are. Compelling unfairness issues hence exist and urge countermeasures in real-world high-stakes environments requiring severe security levels.

An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.

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.

With the increasing availability of wearable devices, photoplethysmography (PPG) has emerged as a promising non-invasive tool for monitoring human hemodynamics. We propose a deep learning framework to estimate vascular age (AI-vascular age) from PPG signals, incorporating a distribution-aware loss to address biases caused by imbalanced data. The model was developed using data from the UK Biobank (UKB), with 98,672 participants in the development cohort and 113,559 participants (144,683 data pairs) for clinical evaluation. After adjusting for key confounders, individuals with a vascular age gap (AI-vascular age minus calendar age) exceeding 9 years had a significantly higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) (HR = 2.37, p < 0.005) and secondary outcomes, including diabetes (HR = 2.69, p < 0.005), hypertension (HR = 2.88, p < 0.005), coronary heart disease (HR = 2.20, p < 0.005), heart failure (HR = 2.15, p < 0.005), myocardial infarction (HR = 2.51, p < 0.005), stroke (HR = 2.55, p < 0.005), and all-cause mortality (HR = 2.51, p < 0.005). Conversely, participants with a vascular age gap below -9 years exhibited a significantly lower incidence of these outcomes. We further evaluated the longitudinal applicability of AI-vascular age using serial PPG data from the UKB, demonstrating its value in risk stratification by leveraging AI-vascular age at two distinct time points to predict future MACCE incidence. External validation was performed on a MIMIC-III-derived cohort (n = 2,343), where each one-year increase in vascular age gap was significantly associated with elevated in-hospital mortality risk (OR = 1.02, p < 0.005). In conclusion, our study establishes AI-vascular age as a novel, non-invasive digital biomarker for cardiovascular health assessment.

Being able to provide explanations for a model's decision has become a central requirement for the development, deployment, and adoption of machine learning models. However, we are yet to understand what explanation methods can and cannot do. How do upstream factors such as data, model prediction, hyperparameters, and random initialization influence downstream explanations? While previous work raised concerns that explanations (E) may have little relationship with the prediction (Y), there is a lack of conclusive study to quantify this relationship. Our work borrows tools from causal inference to systematically assay this relationship. More specifically, we study the relationship between E and Y by measuring the treatment effect when intervening on their causal ancestors, i.e., on hyperparameters and inputs used to generate saliency-based Es or Ys. Our results suggest that the relationships between E and Y is far from ideal. In fact, the gap between 'ideal' case only increase in higher-performing models -- models that are likely to be deployed. Our work is a promising first step towards providing a quantitative measure of the relationship between E and Y, which could also inform the future development of methods for E with a quantitative metric.

Fair representation learning (FRL) is a popular class of methods aiming to produce fair classifiers via data preprocessing. Recent regulatory directives stress the need for FRL methods that provide practical certificates, i.e., provable upper bounds on the unfairness of any downstream classifier trained on preprocessed data, which directly provides assurance in a practical scenario. Creating such FRL methods is an important challenge that remains unsolved. In this work, we address that challenge and introduce FARE (Fairness with Restricted Encoders), the first FRL method with practical fairness certificates. FARE is based on our key insight that restricting the representation space of the encoder enables the derivation of practical guarantees, while still permitting favorable accuracy-fairness tradeoffs for suitable instantiations, such as one we propose based on fair trees. To produce a practical certificate, we develop and apply a statistical procedure that computes a finite sample high-confidence upper bound on the unfairness of any downstream classifier trained on FARE embeddings. In our comprehensive experimental evaluation, we demonstrate that FARE produces practical certificates that are tight and often even comparable with purely empirical results obtained by prior methods, which establishes the practical value of our approach.

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.

Differential privacy (DP) is a popular mechanism for training machine learning models with bounded leakage about the presence of specific points in the training data. The cost of differential privacy is a reduction in the model's accuracy. We demonstrate that in the neural networks trained using differentially private stochastic gradient descent (DP-SGD), this cost is not borne equally: accuracy of DP models drops much more for the underrepresented classes and subgroups. For example, a gender classification model trained using DP-SGD exhibits much lower accuracy for black faces than for white faces. Critically, this gap is bigger in the DP model than in the non-DP model, i.e., if the original model is unfair, the unfairness becomes worse once DP is applied. We demonstrate this effect for a variety of tasks and models, including sentiment analysis of text and image classification. We then explain why DP training mechanisms such as gradient clipping and noise addition have disproportionate effect on the underrepresented and more complex subgroups, resulting in a disparate reduction of model accuracy.

Automatic medical report generation (MRG), which possesses significant research value as it can aid radiologists in clinical diagnosis and report composition, has garnered increasing attention. Despite recent progress, generating accurate reports remains arduous due to the requirement for precise clinical comprehension and disease diagnosis inference. Furthermore, owing to the limited accessibility of medical data and the imbalanced distribution of diseases, the underrepresentation of rare diseases in training data makes large-scale medical visual language models (LVLMs) prone to hallucinations, such as omissions or fabrications, severely undermining diagnostic performance and further intensifying the challenges for MRG in practice. In this study, to effectively mitigate hallucinations in medical report generation, we propose a chain-of-medical-thought approach (CoMT), which intends to imitate the cognitive process of human doctors by decomposing diagnostic procedures. The radiological features with different importance are structured into fine-grained medical thought chains to enhance the inferential ability during diagnosis, thereby alleviating hallucination problems and enhancing the diagnostic accuracy of MRG. The code and dataset have been released at https://github.com/FRENKIE-CHIANG/CoMT.

The COVID-19 pandemic has posed a heavy burden to the healthcare system worldwide and caused huge social disruption and economic loss. Many deep learning models have been proposed to conduct clinical predictive tasks such as mortality prediction for COVID-19 patients in intensive care units using Electronic Health Record (EHR) data. Despite their initial success in certain clinical applications, there is currently a lack of benchmarking results to achieve a fair comparison so that we can select the optimal model for clinical use. Furthermore, there is a discrepancy between the formulation of traditional prediction tasks and real-world clinical practice in intensive care. To fill these gaps, we propose two clinical prediction tasks, Outcome-specific length-of-stay prediction and Early mortality prediction for COVID-19 patients in intensive care units. The two tasks are adapted from the naive length-of-stay and mortality prediction tasks to accommodate the clinical practice for COVID-19 patients. We propose fair, detailed, open-source data-preprocessing pipelines and evaluate 17 state-of-the-art predictive models on two tasks, including 5 machine learning models, 6 basic deep learning models and 6 deep learning predictive models specifically designed for EHR data. We provide benchmarking results using data from two real-world COVID-19 EHR datasets. One dataset is publicly available without needing any inquiry and another dataset can be accessed on request. We provide fair, reproducible benchmarking results for two tasks. We deploy all experiment results and models on an online platform. We also allow clinicians and researchers to upload their data to the platform and get quick prediction results using our trained models. We hope our efforts can further facilitate deep learning and machine learning research for COVID-19 predictive modeling.

Fair representation learning provides an effective way of enforcing fairness constraints without compromising utility for downstream users. A desirable family of such fairness constraints, each requiring similar treatment for similar individuals, is known as individual fairness. In this work, we introduce the first method that enables data consumers to obtain certificates of individual fairness for existing and new data points. The key idea is to map similar individuals to close latent representations and leverage this latent proximity to certify individual fairness. That is, our method enables the data producer to learn and certify a representation where for a data point all similar individuals are at ell_infty-distance at most epsilon, thus allowing data consumers to certify individual fairness by proving epsilon-robustness of their classifier. Our experimental evaluation on five real-world datasets and several fairness constraints demonstrates the expressivity and scalability of our approach.

A prominent challenge of offline reinforcement learning (RL) is the issue of hidden confounding: unobserved variables may influence both the actions taken by the agent and the observed outcomes. Hidden confounding can compromise the validity of any causal conclusion drawn from data and presents a major obstacle to effective offline RL. In the present paper, we tackle the problem of hidden confounding in the nonidentifiable setting. We propose a definition of uncertainty due to hidden confounding bias, termed delphic uncertainty, which uses variation over world models compatible with the observations, and differentiate it from the well-known epistemic and aleatoric uncertainties. We derive a practical method for estimating the three types of uncertainties, and construct a pessimistic offline RL algorithm to account for them. Our method does not assume identifiability of the unobserved confounders, and attempts to reduce the amount of confounding bias. We demonstrate through extensive experiments and ablations the efficacy of our approach on a sepsis management benchmark, as well as on electronic health records. Our results suggest that nonidentifiable hidden confounding bias can be mitigated to improve offline RL solutions in practice.

Doctors and patients alike increasingly use Large Language Models (LLMs) to diagnose clinical cases. However, unlike domains such as math or coding, where correctness can be objectively defined by the final answer, medical diagnosis requires both the outcome and the reasoning process to be accurate. Currently, widely used medical benchmarks like MedQA and MMLU assess only accuracy in the final answer, overlooking the quality and faithfulness of the clinical reasoning process. To address this limitation, we introduce MedCaseReasoning, the first open-access dataset for evaluating LLMs on their ability to align with clinician-authored diagnostic reasoning. The dataset includes 14,489 diagnostic question-and-answer cases, each paired with detailed reasoning statements derived from open-access medical case reports. We evaluate state-of-the-art reasoning LLMs on MedCaseReasoning and find significant shortcomings in their diagnoses and reasoning: for instance, the top-performing open-source model, DeepSeek-R1, achieves only 48% 10-shot diagnostic accuracy and mentions only 64% of the clinician reasoning statements (recall). However, we demonstrate that fine-tuning LLMs on the reasoning traces derived from MedCaseReasoning significantly improves diagnostic accuracy and clinical reasoning recall by an average relative gain of 29% and 41%, respectively. The open-source dataset, code, and models are available at https://github.com/kevinwu23/Stanford-MedCaseReasoning.

Online medical consultation (OMC) restricts doctors to gathering patient information solely through inquiries, making the already complex sequential decision-making process of diagnosis even more challenging. Recently, the rapid advancement of large language models has demonstrated a significant potential to transform OMC. However, most studies have primarily focused on improving diagnostic accuracy under conditions of relatively sufficient information, while paying limited attention to the "inquiry" phase of the consultation process. This lack of focus has left the relationship between "inquiry" and "diagnosis" insufficiently explored. In this paper, we first extract real patient interaction strategies from authentic doctor-patient conversations and use these strategies to guide the training of a patient simulator that closely mirrors real-world behavior. By inputting medical records into our patient simulator to simulate patient responses, we conduct extensive experiments to explore the relationship between "inquiry" and "diagnosis" in the consultation process. Experimental results demonstrate that inquiry and diagnosis adhere to the Liebig's law: poor inquiry quality limits the effectiveness of diagnosis, regardless of diagnostic capability, and vice versa. Furthermore, the experiments reveal significant differences in the inquiry performance of various models. To investigate this phenomenon, we categorize the inquiry process into four types: (1) chief complaint inquiry; (2) specification of known symptoms; (3) inquiry about accompanying symptoms; and (4) gathering family or medical history. We analyze the distribution of inquiries across the four types for different models to explore the reasons behind their significant performance differences. We plan to open-source the weights and related code of our patient simulator at https://github.com/LIO-H-ZEN/PatientSimulator.

There has been a rapidly growing interest in Automatic Symptom Detection (ASD) and Automatic Diagnosis (AD) systems in the machine learning research literature, aiming to assist doctors in telemedicine services. These systems are designed to interact with patients, collect evidence about their symptoms and relevant antecedents, and possibly make predictions about the underlying diseases. Doctors would review the interactions, including the evidence and the predictions, collect if necessary additional information from patients, before deciding on next steps. Despite recent progress in this area, an important piece of doctors' interactions with patients is missing in the design of these systems, namely the differential diagnosis. Its absence is largely due to the lack of datasets that include such information for models to train on. In this work, we present a large-scale synthetic dataset of roughly 1.3 million patients that includes a differential diagnosis, along with the ground truth pathology, symptoms and antecedents for each patient. Unlike existing datasets which only contain binary symptoms and antecedents, this dataset also contains categorical and multi-choice symptoms and antecedents useful for efficient data collection. Moreover, some symptoms are organized in a hierarchy, making it possible to design systems able to interact with patients in a logical way. As a proof-of-concept, we extend two existing AD and ASD systems to incorporate the differential diagnosis, and provide empirical evidence that using differentials as training signals is essential for the efficiency of such systems or for helping doctors better understand the reasoning of those systems.

We present FairX, an open-source Python-based benchmarking tool designed for the comprehensive analysis of models under the umbrella of fairness, utility, and eXplainability (XAI). FairX enables users to train benchmarking bias-mitigation models and evaluate their fairness using a wide array of fairness metrics, data utility metrics, and generate explanations for model predictions, all within a unified framework. Existing benchmarking tools do not have the way to evaluate synthetic data generated from fair generative models, also they do not have the support for training fair generative models either. In FairX, we add fair generative models in the collection of our fair-model library (pre-processing, in-processing, post-processing) and evaluation metrics for evaluating the quality of synthetic fair data. This version of FairX supports both tabular and image datasets. It also allows users to provide their own custom datasets. The open-source FairX benchmarking package is publicly available at https://github.com/fahim-sikder/FairX.

As machine learning (ML) systems increasingly impact critical sectors such as hiring, financial risk assessments, and criminal justice, the imperative to ensure fairness has intensified due to potential negative implications. While much ML fairness research has focused on enhancing training data and processes, addressing the outputs of already deployed systems has received less attention. This paper introduces 'BiasGuard', a novel approach designed to act as a fairness guardrail in production ML systems. BiasGuard leverages Test-Time Augmentation (TTA) powered by Conditional Generative Adversarial Network (CTGAN), a cutting-edge generative AI model, to synthesize data samples conditioned on inverted protected attribute values, thereby promoting equitable outcomes across diverse groups. This method aims to provide equal opportunities for both privileged and unprivileged groups while significantly enhancing the fairness metrics of deployed systems without the need for retraining. Our comprehensive experimental analysis across diverse datasets reveals that BiasGuard enhances fairness by 31% while only reducing accuracy by 0.09% compared to non-mitigated benchmarks. Additionally, BiasGuard outperforms existing post-processing methods in improving fairness, positioning it as an effective tool to safeguard against biases when retraining the model is impractical.

Machine learning plays a role in many deployed decision systems, often in ways that are difficult or impossible to understand by human stakeholders. Explaining, in a human-understandable way, the relationship between the input and output of machine learning models is essential to the development of trustworthy machine learning based systems. A burgeoning body of research seeks to define the goals and methods of explainability in machine learning. In this paper, we seek to review and categorize research on counterfactual explanations, a specific class of explanation that provides a link between what could have happened had input to a model been changed in a particular way. Modern approaches to counterfactual explainability in machine learning draw connections to the established legal doctrine in many countries, making them appealing to fielded systems in high-impact areas such as finance and healthcare. Thus, we design a rubric with desirable properties of counterfactual explanation algorithms and comprehensively evaluate all currently proposed algorithms against that rubric. Our rubric provides easy comparison and comprehension of the advantages and disadvantages of different approaches and serves as an introduction to major research themes in this field. We also identify gaps and discuss promising research directions in the space of counterfactual explainability.

A membership inference attack (MIA) against a machine-learning model enables an attacker to determine whether a given data record was part of the model's training data or not. In this paper, we provide an in-depth study of the phenomenon of disparate vulnerability against MIAs: unequal success rate of MIAs against different population subgroups. We first establish necessary and sufficient conditions for MIAs to be prevented, both on average and for population subgroups, using a notion of distributional generalization. Second, we derive connections of disparate vulnerability to algorithmic fairness and to differential privacy. We show that fairness can only prevent disparate vulnerability against limited classes of adversaries. Differential privacy bounds disparate vulnerability but can significantly reduce the accuracy of the model. We show that estimating disparate vulnerability to MIAs by na\"ively applying existing attacks can lead to overestimation. We then establish which attacks are suitable for estimating disparate vulnerability, and provide a statistical framework for doing so reliably. We conduct experiments on synthetic and real-world data finding statistically significant evidence of disparate vulnerability in realistic settings. The code is available at https://github.com/spring-epfl/disparate-vulnerability

Clustering is a fundamental building block of modern statistical analysis pipelines. Fair clustering has seen much attention from the machine learning community in recent years. We are some of the first to study fairness in the context of hierarchical clustering, after the results of Ahmadian et al. from NeurIPS in 2020. We evaluate our results using Dasgupta's cost function, perhaps one of the most prevalent theoretical metrics for hierarchical clustering evaluation. Our work vastly improves the previous O(n^{5/6}polylog(n)) fair approximation for cost to a near polylogarithmic O(n^delta polylog(n)) fair approximation for any constant deltain(0,1). This result establishes a cost-fairness tradeoff and extends to broader fairness constraints than the previous work. We also show how to alter existing hierarchical clusterings to guarantee fairness and cluster balance across any level in the hierarchy.

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.

Fairness, especially group fairness, is an important consideration in the context of machine learning systems. The most commonly adopted group fairness-enhancing techniques are in-processing methods that rely on a mixture of a fairness objective (e.g., demographic parity) and a task-specific objective (e.g., cross-entropy) during the training process. However, when data arrives in an online fashion -- one instance at a time -- optimizing such fairness objectives poses several challenges. In particular, group fairness objectives are defined using expectations of predictions across different demographic groups. In the online setting, where the algorithm has access to a single instance at a time, estimating the group fairness objective requires additional storage and significantly more computation (e.g., forward/backward passes) than the task-specific objective at every time step. In this paper, we propose Aranyani, an ensemble of oblique decision trees, to make fair decisions in online settings. The hierarchical tree structure of Aranyani enables parameter isolation and allows us to efficiently compute the fairness gradients using aggregate statistics of previous decisions, eliminating the need for additional storage and forward/backward passes. We also present an efficient framework to train Aranyani and theoretically analyze several of its properties. We conduct empirical evaluations on 5 publicly available benchmarks (including vision and language datasets) to show that Aranyani achieves a better accuracy-fairness trade-off compared to baseline approaches.

Studies involving soundscape perception often exclude participants with hearing loss to prevent impaired perception from affecting experimental results. Participants are typically screened with pure tone audiometry, the "gold standard" for identifying and quantifying hearing loss at specific frequencies, and excluded if a study-dependent threshold is not met. However, procuring professional audiometric equipment for soundscape studies may be cost-ineffective, and manually performing audiometric tests is labour-intensive. Moreover, testing requirements for soundscape studies may not require sensitivities and specificities as high as that in a medical diagnosis setting. Hence, in this study, we investigate the effectiveness of the uHear app, an iOS application, as an affordable and automatic alternative to a conventional audiometer in screening participants for hearing loss for the purpose of soundscape studies or listening tests in general. Based on audiometric comparisons with the audiometer of 163 participants, the uHear app was found to have high precision (98.04%) when using the World Health Organization (WHO) grading scheme for assessing normal hearing. Precision is further improved (98.69%) when all frequencies assessed with the uHear app is considered in the grading, which lends further support to this cost-effective, automated alternative to screen for normal hearing.

Fairness is an emerging and challenging topic in recommender systems. In recent years, various ways of evaluating and therefore improving fairness have emerged. In this study, we examine existing evaluation measures of fairness in recommender systems. Specifically, we focus solely on exposure-based fairness measures of individual items that aim to quantify the disparity in how individual items are recommended to users, separate from item relevance to users. We gather all such measures and we critically analyse their theoretical properties. We identify a series of limitations in each of them, which collectively may render the affected measures hard or impossible to interpret, to compute, or to use for comparing recommendations. We resolve these limitations by redefining or correcting the affected measures, or we argue why certain limitations cannot be resolved. We further perform a comprehensive empirical analysis of both the original and our corrected versions of these fairness measures, using real-world and synthetic datasets. Our analysis provides novel insights into the relationship between measures based on different fairness concepts, and different levels of measure sensitivity and strictness. We conclude with practical suggestions of which fairness measures should be used and when. Our code is publicly available. To our knowledge, this is the first critical comparison of individual item fairness measures in recommender systems.

Large language models (LLMs) offer a promising pre-screening tool, improving early disease detection and providing enhanced healthcare access for underprivileged communities. The early diagnosis of various diseases continues to be a significant challenge in healthcare, primarily due to the nonspecific nature of early symptoms, the shortage of expert medical practitioners, and the need for prolonged clinical evaluations, all of which can delay treatment and adversely affect patient outcomes. With impressive accuracy in prediction across a range of diseases, LLMs have the potential to revolutionize clinical pre-screening and decision-making for various medical conditions. In this work, we study the diagnostic capability of LLMs for Rheumatoid Arthritis (RA) with real world patients data. Patient data was collected alongside diagnoses from medical experts, and the performance of LLMs was evaluated in comparison to expert diagnoses for RA disease prediction. We notice an interesting pattern in disease diagnosis and find an unexpected misalignment between prediction and explanation. We conduct a series of multi-round analyses using different LLM agents. The best-performing model accurately predicts rheumatoid arthritis (RA) diseases approximately 95\% of the time. However, when medical experts evaluated the reasoning generated by the model, they found that nearly 68\% of the reasoning was incorrect. This study highlights a clear misalignment between LLMs high prediction accuracy and its flawed reasoning, raising important questions about relying on LLM explanations in clinical settings. LLMs provide incorrect reasoning to arrive at the correct answer for RA disease diagnosis.

Artificial intelligence holds great promise for expanding access to expert medical knowledge and reasoning. However, most evaluations of language models rely on static vignettes and multiple-choice questions that fail to reflect the complexity and nuance of evidence-based medicine in real-world settings. In clinical practice, physicians iteratively formulate and revise diagnostic hypotheses, adapting each subsequent question and test to what they've just learned, and weigh the evolving evidence before committing to a final diagnosis. To emulate this iterative process, we introduce the Sequential Diagnosis Benchmark, which transforms 304 diagnostically challenging New England Journal of Medicine clinicopathological conference (NEJM-CPC) cases into stepwise diagnostic encounters. A physician or AI begins with a short case abstract and must iteratively request additional details from a gatekeeper model that reveals findings only when explicitly queried. Performance is assessed not just by diagnostic accuracy but also by the cost of physician visits and tests performed. We also present the MAI Diagnostic Orchestrator (MAI-DxO), a model-agnostic orchestrator that simulates a panel of physicians, proposes likely differential diagnoses and strategically selects high-value, cost-effective tests. When paired with OpenAI's o3 model, MAI-DxO achieves 80% diagnostic accuracy--four times higher than the 20% average of generalist physicians. MAI-DxO also reduces diagnostic costs by 20% compared to physicians, and 70% compared to off-the-shelf o3. When configured for maximum accuracy, MAI-DxO achieves 85.5% accuracy. These performance gains with MAI-DxO generalize across models from the OpenAI, Gemini, Claude, Grok, DeepSeek, and Llama families. We highlight how AI systems, when guided to think iteratively and act judiciously, can advance diagnostic precision and cost-effectiveness in clinical care.

Cyberbullying is a widespread adverse phenomenon among online social interactions in today's digital society. While numerous computational studies focus on enhancing the cyberbullying detection performance of machine learning algorithms, proposed models tend to carry and reinforce unintended social biases. In this study, we try to answer the research question of "Can we mitigate the unintended bias of cyberbullying detection models by guiding the model training with fairness constraints?". For this purpose, we propose a model training scheme that can employ fairness constraints and validate our approach with different datasets. We demonstrate that various types of unintended biases can be successfully mitigated without impairing the model quality. We believe our work contributes to the pursuit of unbiased, transparent, and ethical machine learning solutions for cyber-social health.

Glaucoma is the number one cause of irreversible blindness globally. A major challenge for accurate glaucoma detection and progression forecasting is the bottleneck of limited labeled patients with the state-of-the-art (SOTA) 3D retinal imaging data of optical coherence tomography (OCT). To address the data scarcity issue, this paper proposes two solutions. First, we develop a novel generalization-reinforced semi-supervised learning (SSL) model called pseudo supervisor to optimally utilize unlabeled data. Compared with SOTA models, the proposed pseudo supervisor optimizes the policy of predicting pseudo labels with unlabeled samples to improve empirical generalization. Our pseudo supervisor model is evaluated with two clinical tasks consisting of glaucoma detection and progression forecasting. The progression forecasting task is evaluated both unimodally and multimodally. Our pseudo supervisor model demonstrates superior performance than SOTA SSL comparison models. Moreover, our model also achieves the best results on the publicly available LAG fundus dataset. Second, we introduce the Harvard Glaucoma Detection and Progression (Harvard-GDP) Dataset, a multimodal multitask dataset that includes data from 1,000 patients with OCT imaging data, as well as labels for glaucoma detection and progression. This is the largest glaucoma detection dataset with 3D OCT imaging data and the first glaucoma progression forecasting dataset that is publicly available. Detailed sex and racial analysis are provided, which can be used by interested researchers for fairness learning studies. Our released dataset is benchmarked with several SOTA supervised CNN and transformer deep learning models. The dataset and code are made publicly available via https://ophai.hms.harvard.edu/datasets/harvard-gdp1000.

The COVID-19 pandemic has accentuated socioeconomic disparities across various racial and ethnic groups in the United States. While previous studies have utilized traditional survey methods like the Household Pulse Survey (HPS) to elucidate these disparities, this paper explores the role of social media platforms in both highlighting and addressing these challenges. Drawing from real-time data sourced from Twitter, we analyzed language patterns related to four major types of adverse experiences: loss of employment income (LI), food scarcity (FS), housing insecurity (HI), and unmet needs for mental health services (UM). We first formulate a sparsity optimization problem that extracts low-level language features from social media data sources. Second, we propose novel constraints on feature similarity exploiting prior knowledge about the similarity of the language patterns among the adverse experiences. The proposed problem is challenging to solve due to the non-convexity objective and non-smoothness penalties. We develop an algorithm based on the alternating direction method of multipliers (ADMM) framework to solve the proposed formulation. Extensive experiments and comparisons to other models on real-world social media and the detection of adverse experiences justify the efficacy of our model.

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.

We introduce a boosting algorithm to pre-process data for fairness. Starting from an initial fair but inaccurate distribution, our approach shifts towards better data fitting while still ensuring a minimal fairness guarantee. To do so, it learns the sufficient statistics of an exponential family with boosting-compliant convergence. Importantly, we are able to theoretically prove that the learned distribution will have a representation rate and statistical rate data fairness guarantee. Unlike recent optimization based pre-processing methods, our approach can be easily adapted for continuous domain features. Furthermore, when the weak learners are specified to be decision trees, the sufficient statistics of the learned distribution can be examined to provide clues on sources of (un)fairness. Empirical results are present to display the quality of result on real-world data.

The PI-CAI (Prostate Imaging: Cancer AI) challenge led to expert-level diagnostic algorithms for clinically significant prostate cancer detection. The algorithms receive biparametric MRI scans as input, which consist of T2-weighted and diffusion-weighted scans. These scans can be misaligned due to multiple factors in the scanning process. Image registration can alleviate this issue by predicting the deformation between the sequences. We investigate the effect of image registration on the diagnostic performance of AI-based prostate cancer diagnosis. First, the image registration algorithm, developed in MeVisLab, is analyzed using a dataset with paired lesion annotations. Second, the effect on diagnosis is evaluated by comparing case-level cancer diagnosis performance between using the original dataset, rigidly aligned diffusion-weighted scans, or deformably aligned diffusion-weighted scans. Rigid registration showed no improvement. Deformable registration demonstrated a substantial improvement in lesion overlap (+10% median Dice score) and a positive yet non-significant improvement in diagnostic performance (+0.3% AUROC, p=0.18). Our investigation shows that a substantial improvement in lesion alignment does not directly lead to a significant improvement in diagnostic performance. Qualitative analysis indicated that jointly developing image registration methods and diagnostic AI algorithms could enhance diagnostic accuracy and patient outcomes.

Differential diagnosis is crucial for medicine as it helps healthcare providers systematically distinguish between conditions that share similar symptoms. This study assesses the impact of lab test results on differential diagnoses (DDx) made by large language models (LLMs). Clinical vignettes from 50 case reports from PubMed Central were created incorporating patient demographics, symptoms, and lab results. Five LLMs GPT-4, GPT-3.5, Llama-2-70b, Claude-2, and Mixtral-8x7B were tested to generate Top 10, Top 5, and Top 1 DDx with and without lab data. A comprehensive evaluation involving GPT-4, a knowledge graph, and clinicians was conducted. GPT-4 performed best, achieving 55% accuracy for Top 1 diagnoses and 60% for Top 10 with lab data, with lenient accuracy up to 80%. Lab results significantly improved accuracy, with GPT-4 and Mixtral excelling, though exact match rates were low. Lab tests, including liver function, metabolic/toxicology panels, and serology/immune tests, were generally interpreted correctly by LLMs for differential diagnosis.

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.

Small sample sizes are common in many disciplines, which necessitates pooling roughly similar datasets across multiple institutions to study weak but relevant associations between images and disease outcomes. Such data often manifest shift/imbalance in covariates (i.e., secondary non-imaging data). Controlling for such nuisance variables is common within standard statistical analysis, but the ideas do not directly apply to overparameterized models. Consequently, recent work has shown how strategies from invariant representation learning provides a meaningful starting point, but the current repertoire of methods is limited to accounting for shifts/imbalances in just a couple of covariates at a time. In this paper, we show how viewing this problem from the perspective of Category theory provides a simple and effective solution that completely avoids elaborate multi-stage training pipelines that would otherwise be needed. We show the effectiveness of this approach via extensive experiments on real datasets. Further, we discuss how this style of formulation offers a unified perspective on at least 5+ distinct problem settings, from self-supervised learning to matching problems in 3D reconstruction.