The rapid development of multimodal large language models (MLLMs), such as GPT-4V, has led to significant advancements. However, these models still face challenges in medical multimodal capabilities due to limitations in the quantity and quality of medical vision-text data, stemming from data privacy concerns and high annotation costs. While pioneering approaches utilize PubMed’s large-scale, de-identified medical image-text pairs to address these limitations, they often fall short due to inherent data noise. To tackle this, we refined medical image-text pairs from PubMed and employed MLLMs (GPT-4V) in an ‘unblinded’ capacity to denoise and reformat the data, resulting in the creation of the **PubMedVision** dataset with 1.3 million medical VQA samples. Our validation demonstrates that: (1) PubMedVision can significantly enhance the medical multimodal capabilities of MLLMs, showing significant improvement in benchmarks including the MMMU Health & Medicine track; (2) manual checks by medical experts and empirical results validate the superior data quality of our dataset compared to other data construction methods. Using PubMedVision, we train a 34B medical MLLM **HuatuoGPT-Vision**, which shows superior performance in medical multimodal scenarios among open-source MLLMs. Our code and data are available at https://github.com/FreedomIntelligence/HuatuoGPT-Vision.
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Deep Learning · Representation Learning
Phenotype imputation plays a crucial role in improving comprehensive and accurate medical evaluation, which in turn can optimize patient treatment and bolster the reliability of clinical research. Despite the adoption of various techniques, multi-modal biological data, which can provide crucial insights into a patient's overall health, is often overlooked. With multi-modal biological data, patient characterization can be enriched from two distinct views: the biological view and the phenotype view. However, the heterogeneity and imprecise nature of the multimodal data still pose challenges in developing an effective method to model from two views. In this paper, we propose a novel framework to incorporate multi-modal biological data via view decoupling. Specifically, we segregate the modeling of biological data from phenotype data in a graph-based learning framework. From the biological view, the latent factors in biological data are discovered to model patient correlation. From the phenotype view, phenotype co-occurrence can be modeled to reveal patterns across patients. Then patients are encoded from these two distinct views. To mitigate the influence of noise and irrelevant information in biological data, we devise a cross-view contrastive knowledge distillation aimed at distilling insights from the biological view to enhance phenotype imputation. We show that phenotype imputation with the proposed model significantly outperforms the state-of-the-art models on the real-world biomedical database.
Datasets and Benchmarks
Current benchmarks for evaluating large language models (LLMs) in medicine are primarily focused on question-answering involving domain knowledge and descriptive reasoning. While such qualitative capabilities are vital to medical diagnosis, in real-world scenarios, doctors frequently use clinical calculators that follow quantitative equations and rule-based reasoning paradigms for evidence-based decision support. To this end, we propose MedCalc-Bench, a first-of-its-kind dataset focused on evaluating the medical calculation capability of LLMs. MedCalc-Bench contains an evaluation set of over 1000 manually reviewed instances from 55 different medical calculation tasks. Each instance in MedCalc-Bench consists of a patient note, a question requesting to compute a specific medical value, a ground truth answer, and a step-by-step explanation showing how the answer is obtained. While our evaluation results show the potential of LLMs in this area, none of them are effective enough for clinical settings. Common issues include extracting the incorrect entities, not using the correct equation or rules for a calculation task, or incorrectly performing the arithmetic for the computation. We hope our study highlights the quantitative knowledge and reasoning gaps in LLMs within medical settings, encouraging future improvements of LLMs for various clinical calculation tasks. MedCalc-Bench is publicly available at: https://github.com/ncbi-nlp/MedCalc-Bench.
Applications
Recent approaches to vision-language tasks are built on the remarkable capabilities of large vision-language models (VLMs). These models excel in zero-shot and few-shot learning, enabling them to learn new tasks without parameter updates. However, their primary challenge lies in their design, which primarily accommodates 2D input, thus limiting their effectiveness for medical images, particularly radiological images like MRI and CT, which are typically 3D. To bridge the gap between state-of-the-art 2D VLMs and 3D medical image data, we developed an innovative, one-pass, unsupervised representative slice selection method called Vote-MI, which selects representative 2D slices from 3D medical imaging. To evaluate the effectiveness of vote-MI when implemented with VLMs, we introduce BrainMD, a robust, multimodal dataset comprising 2,453 annotated 3D MRI brain scans with corresponding textual radiology reports and electronic health records. Based on BrainMD, we further develop two benchmarks, BrainMD-select (including the most representative 2D slice of 3D image) and BrainBench (including various vision-language downstream tasks). Extensive experiments on the BrainMD dataset and its two corresponding benchmarks demonstrate that our representative selection method significantly improves performance in zero-shot and few-shot learning tasks. On average, Vote-MI achieves a 14.6\% and 16.6\% absolute gain for zero-shot and few-shot learning, respectively, compared to randomly selecting examples. Our studies represent a significant step toward integrating AI in medical imaging to enhance patient care and facilitate medical research. We hope this work will serve as a foundation for data selection as vision-language models are increasingly applied to new tasks.
Current benchmarks for evaluating large language models (LLMs) in medicine are primarily focused on question-answering involving domain knowledge and descriptive reasoning. While such qualitative capabilities are vital to medical diagnosis, in real-world scenarios, doctors frequently use clinical calculators that follow quantitative equations and rule-based reasoning paradigms for evidence-based decision support. To this end, we propose MedCalc-Bench, a first-of-its-kind dataset focused on evaluating the medical calculation capability of LLMs. MedCalc-Bench contains an evaluation set of over 1000 manually reviewed instances from 55 different medical calculation tasks. Each instance in MedCalc-Bench consists of a patient note, a question requesting to compute a specific medical value, a ground truth answer, and a step-by-step explanation showing how the answer is obtained. While our evaluation results show the potential of LLMs in this area, none of them are effective enough for clinical settings. Common issues include extracting the incorrect entities, not using the correct equation or rules for a calculation task, or incorrectly performing the arithmetic for the computation. We hope our study highlights the quantitative knowledge and reasoning gaps in LLMs within medical settings, encouraging future improvements of LLMs for various clinical calculation tasks. MedCalc-Bench is publicly available at: https://github.com/ncbi-nlp/MedCalc-Bench.
Trustworthy Machine Learning
As large language models (LLMs) develop increasingly sophisticated capabilities and find applications in medical settings, it becomes important to assess their medical safety due to their far-reaching implications for personal and public health, patient safety, and human rights. However, there is little to no understanding of the notion of medical safety in the context of LLMs, let alone how to evaluate and improve it. To address this gap, we first define the notion of medical safety in LLMs based on the Principles of Medical Ethics set forth by the American Medical Association. We then leverage this understanding to introduce MedSafetyBench, the first benchmark dataset designed to measure the medical safety of LLMs. We demonstrate the utility of MedSafetyBench by using it to evaluate and improve the medical safety of LLMs. Our results show that publicly-available medical LLMs do not meet standards of medical safety and that fine-tuning them using MedSafetyBench improves their medical safety while preserving their medical performance. By introducing this new benchmark dataset, our work enables a systematic study of the state of medical safety in LLMs and motivates future work in this area, paving the way to mitigate the safety risks of LLMs in medicine. The benchmark dataset and code are available at https://github.com/AI4LIFE-GROUP/med-safety-bench.
While large language models (LLMs) have achieved state-of-the-art performance on a wide range of medical question answering (QA) tasks, they still face challenges with hallucinations and outdated knowledge. Retrieval-augmented generation (RAG) is a promising solution and has been widely adopted. However, a RAG system can involve multiple flexible components, and there is a lack of best practices regarding the optimal RAG setting for various medical purposes. To systematically evaluate such systems, we propose the Medical Information Retrieval-Augmented Generation Evaluation (MIRAGE), a first-of-its-kind benchmark including 7,663 questions from five medical QA datasets. Using MIRAGE, we conducted large-scale experiments with over 1.8 trillion prompt tokens on 41 combinations of different corpora, retrievers, and backbone LLMs through the MedRAG toolkit introduced in this work. Overall, MedRAG improves the accuracy of six different LLMs by up to 18% over chain-of-thought prompting, elevating the performance of GPT-3.5 and Mixtral to GPT-4-level. Our results show that the combination of various medical corpora and retrievers achieves the best performance. In addition, we discovered a log-linear scaling property and the “lost-in-the-middle” effects in medical RAG. We believe our comprehensive evaluations can serve as practical guidelines for implementing RAG systems for medicine.
Large Language Models (LLMs) have demonstrated remarkable versatility in recent years, offering potential applications across specialized domains such as healthcare and medicine. Despite the availability of various open-source LLMs tailored for health contexts, adapting general-purpose LLMs to the medical domain presents significant challenges.In this paper, we introduce BioMistral, an open-source LLM tailored for the biomedical domain, utilizing Mistral as its foundation model and further pre-trained on PubMed Central. We conduct a comprehensive evaluation of BioMistral on a benchmark comprising 10 established medical question-answering (QA) tasks in English. We also explore lightweight models obtained through quantization and model merging approaches. Our results demonstrate BioMistral’s superior performance compared to existing open-source medical models and its competitive edge against proprietary counterparts. Finally, to address the limited availability of data beyond English and to assess the multilingual generalization of medical LLMs, we automatically translated and evaluated this benchmark into 7 other languages. This marks the first large-scale multilingual evaluation of LLMs in the medical domain. Datasets, multilingual evaluation benchmarks, scripts, and all the models obtained during our experiments are freely released.
Miscellaneous Aspects of Machine Learning · Causality
We study inference on the long-term causal effect of a continual exposure to a novel intervention, which we term a long-term treatment, based on an experiment involving only short-term observations. Key examples include the long-term health effects of regularly-taken medicine or of environmental hazards and the long-term effects on users of changes to an online platform. This stands in contrast to short-term treatments or "shocks," whose long-term effect can reasonably be mediated by short-term observations, enabling the use of surrogate methods. Long-term treatments by definition have direct effects on long-term outcomes via continual exposure, so surrogacy conditions cannot reasonably hold. We connect the problem with offline reinforcement learning, leveraging doubly-robust estimators to estimate long-term causal effects for long-term treatments and construct confidence intervals.
Miscellaneous Aspects of Machine Learning · Causality
We study inference on the long-term causal effect of a continual exposure to a novel intervention, which we term a long-term treatment, based on an experiment involving only short-term observations. Key examples include the long-term health effects of regularly-taken medicine or of environmental hazards and the long-term effects on users of changes to an online platform. This stands in contrast to short-term treatments or "shocks," whose long-term effect can reasonably be mediated by short-term observations, enabling the use of surrogate methods. Long-term treatments by definition have direct effects on long-term outcomes via continual exposure, so surrogacy conditions cannot reasonably hold. We connect the problem with offline reinforcement learning, leveraging doubly-robust estimators to estimate long-term causal effects for long-term treatments and construct confidence intervals.
Applications · Health
Clinical predictive models often rely on patients’ electronic health records (EHR), but integrating medical knowledge to enhance predictions and decision-making is challenging. This is because personalized predictions require personalized knowledgegraphs (KGs), which are difficult to generate from patient EHR data. To address this, we propose GraphCare, an open-world framework that uses external KGs to improve EHR-based predictions. Our method extracts knowledge from large language models (LLMs) and external biomedical KGs to build patient-specific KGs, which are then used to train our proposed Bi-attention AugmenTed(BAT) graph neural network (GNN) for healthcare predictions. On two public datasets, MIMIC-III and MIMIC-IV, GraphCare surpasses baselines in four vital healthcare prediction tasks: mortality, readmission, length of stay (LOS), and drug recommendation. On MIMIC-III, it boosts AUROC by 17.6% and 6.6% for mortality and readmission, and F1-score by 7.9% and 10.8% for LOS and drug recommendation, respectively. Notably, GraphCare demonstrates a substantial edge in scenarios with limited data availability. Our findings highlight the potential of using external KGs in healthcare prediction tasks and demonstrate the promise of GraphCare in generating personalized KGs for promoting personalized medicine.
An Integrative Survey on Mental Health Conversational Agents to Bridge Computer Science and Medical Perspectives
PDF ↗Mental health conversational agents (a.k.a. chatbots) are widely studied for their potential to offer accessible support to those experiencing mental health challenges. Previous surveys on the topic primarily consider papers published in either computer science or medicine, leading to a divide in understanding and hindering the sharing of beneficial knowledge between both domains. To bridge this gap, we conduct a comprehensive literature review using the PRISMA framework, reviewing 534 papers published in both computer science and medicine. Our systematic review reveals 136 key papers on building mental health-related conversational agents with diverse characteristics of modeling and experimental design techniques. We find that computer science papers focus on LLM techniques and evaluating response quality using automated metrics with little attention to the application while medical papers use rule-based conversational agents and outcome metrics to measure the health outcomes of participants. Based on our findings on transparency, ethics, and cultural heterogeneity in this review, we provide a few recommendations to help bridge the disciplinary divide and enable the cross-disciplinary development of mental health conversational agents.
Applications/Health
While the general machine learning (ML) community has benefited from public datasets, tasks, and models, the progress of ML in healthcare has been hampered by a lack of such shared assets. The success of foundation models creates new challenges for healthcare ML by requiring access to shared pretrained models to validate performance benefits. We help address these challenges through three contributions. First, we publish a new dataset, EHRSHOT, which contains de-identified structured data from the electronic health records (EHRs) of 6,739 patients from Stanford Medicine. Unlike MIMIC-III/IV and other popular EHR datasets, EHRSHOT is longitudinal and not restricted to ICU/ED patients. Second, we publish the weights of CLMBR-T-base, a 141M parameter clinical foundation model pretrained on the structured EHR data of 2.57M patients. We are one of the first to fully release such a model for coded EHR data; in contrast, most prior models released for clinical data (e.g. GatorTron, ClinicalBERT) only work with unstructured text and cannot process the rich, structured data within an EHR. We provide an end-to-end pipeline for the community to validate and build upon its performance. Third, we define 15 few-shot clinical prediction tasks, enabling evaluation of foundation models on benefits such as sample efficiency and task adaptation. Our model and dataset are available via a research data use agreement from here: https://stanfordaimi.azurewebsites.net/. Code to reproduce our results is available here: https://github.com/som-shahlab/ehrshot-benchmark.
Applications/Health
Synthesizing information from various data sources plays a crucial role in the practice of modern medicine. Current applications of artificial intelligence in medicine often focus on single-modality data due to a lack of publicly available, multimodal medical datasets. To address this limitation, we introduce INSPECT, which contains de-identified longitudinal records from a large cohort of pulmonary embolism (PE) patients, along with ground truth labels for multiple outcomes. INSPECT contains data from 19,402 patients, including CT images, sections of radiology reports, and structured electronic health record (EHR) data (including demographics, diagnoses, procedures, and vitals). Using our provided dataset, we develop and release a benchmark for evaluating several baseline modeling approaches on a variety of important PE related tasks. We evaluate image-only, EHR-only, and fused models. Trained models and the de-identified dataset are made available for non-commercial use under a data use agreement. To the best our knowledge, INSPECT is the largest multimodal dataset for enabling reproducible research on strategies for integrating 3D medical imaging and EHR data.