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Mar 11

Towards Generalist Biomedical AI

Medicine is inherently multimodal, with rich data modalities spanning text, imaging, genomics, and more. Generalist biomedical artificial intelligence (AI) systems that flexibly encode, integrate, and interpret this data at scale can potentially enable impactful applications ranging from scientific discovery to care delivery. To enable the development of these models, we first curate MultiMedBench, a new multimodal biomedical benchmark. MultiMedBench encompasses 14 diverse tasks such as medical question answering, mammography and dermatology image interpretation, radiology report generation and summarization, and genomic variant calling. We then introduce Med-PaLM Multimodal (Med-PaLM M), our proof of concept for a generalist biomedical AI system. Med-PaLM M is a large multimodal generative model that flexibly encodes and interprets biomedical data including clinical language, imaging, and genomics with the same set of model weights. Med-PaLM M reaches performance competitive with or exceeding the state of the art on all MultiMedBench tasks, often surpassing specialist models by a wide margin. We also report examples of zero-shot generalization to novel medical concepts and tasks, positive transfer learning across tasks, and emergent zero-shot medical reasoning. To further probe the capabilities and limitations of Med-PaLM M, we conduct a radiologist evaluation of model-generated (and human) chest X-ray reports and observe encouraging performance across model scales. In a side-by-side ranking on 246 retrospective chest X-rays, clinicians express a pairwise preference for Med-PaLM M reports over those produced by radiologists in up to 40.50% of cases, suggesting potential clinical utility. While considerable work is needed to validate these models in real-world use cases, our results represent a milestone towards the development of generalist biomedical AI systems.

Towards Expert-Level Medical Question Answering with Large Language Models

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

Large Language Models Encode Clinical Knowledge

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

ActionBert: Leveraging User Actions for Semantic Understanding of User Interfaces

As mobile devices are becoming ubiquitous, regularly interacting with a variety of user interfaces (UIs) is a common aspect of daily life for many people. To improve the accessibility of these devices and to enable their usage in a variety of settings, building models that can assist users and accomplish tasks through the UI is vitally important. However, there are several challenges to achieve this. First, UI components of similar appearance can have different functionalities, making understanding their function more important than just analyzing their appearance. Second, domain-specific features like Document Object Model (DOM) in web pages and View Hierarchy (VH) in mobile applications provide important signals about the semantics of UI elements, but these features are not in a natural language format. Third, owing to a large diversity in UIs and absence of standard DOM or VH representations, building a UI understanding model with high coverage requires large amounts of training data. Inspired by the success of pre-training based approaches in NLP for tackling a variety of problems in a data-efficient way, we introduce a new pre-trained UI representation model called ActionBert. Our methodology is designed to leverage visual, linguistic and domain-specific features in user interaction traces to pre-train generic feature representations of UIs and their components. Our key intuition is that user actions, e.g., a sequence of clicks on different UI components, reveals important information about their functionality. We evaluate the proposed model on a wide variety of downstream tasks, ranging from icon classification to UI component retrieval based on its natural language description. Experiments show that the proposed ActionBert model outperforms multi-modal baselines across all downstream tasks by up to 15.5%.

LaMDA: Language Models for Dialog Applications

We present LaMDA: Language Models for Dialog Applications. LaMDA is a family of Transformer-based neural language models specialized for dialog, which have up to 137B parameters and are pre-trained on 1.56T words of public dialog data and web text. While model scaling alone can improve quality, it shows less improvements on safety and factual grounding. We demonstrate that fine-tuning with annotated data and enabling the model to consult external knowledge sources can lead to significant improvements towards the two key challenges of safety and factual grounding. The first challenge, safety, involves ensuring that the model's responses are consistent with a set of human values, such as preventing harmful suggestions and unfair bias. We quantify safety using a metric based on an illustrative set of human values, and we find that filtering candidate responses using a LaMDA classifier fine-tuned with a small amount of crowdworker-annotated data offers a promising approach to improving model safety. The second challenge, factual grounding, involves enabling the model to consult external knowledge sources, such as an information retrieval system, a language translator, and a calculator. We quantify factuality using a groundedness metric, and we find that our approach enables the model to generate responses grounded in known sources, rather than responses that merely sound plausible. Finally, we explore the use of LaMDA in the domains of education and content recommendations, and analyze their helpfulness and role consistency.