A toolbox for surfacing health equity harms and biases in large language models.

Large language models (LLMs) hold 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. 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 conduct a large-scale empirical case study with the Med-PaLM 2 LLM. Our contributions include a multifactorial framework for human assessment of LLM-generated answers for biases and EquityMedQA, a collection of seven datasets enriched for adversarial queries. Both our human assessment framework and our dataset design process are grounded in an iterative participatory approach and review of Med-PaLM 2 answers. Through our empirical study, we find that our approach surfaces biases that may be missed by narrower evaluation approaches. Our experience underscores the importance of using diverse assessment methodologies and involving raters of varying backgrounds and expertise. While our approach is not sufficient to holistically assess whether the deployment of an artificial intelligence (AI) system promotes equitable health outcomes, we hope that it can be leveraged and built upon toward a shared goal of LLMs that promote accessible and equitable healthcare.

Interpretable Almost-Exact Matching for Causal Inference.

Matching methods are heavily used in the social and health sciences due to their interpretability. We aim to create the highest possible quality of treatment-control matches for categorical data in the potential outcomes framework. The method proposed in this work aims to match units on a weighted Hamming distance, taking into account the relative importance of the covariates; the algorithm aims to match units on as many relevant variables as possible. To do this, the algorithm creates a hierarchy of covariate combinations on which to match (similar to downward closure), in the process solving an optimization problem for each unit in order to construct the optimal matches. The algorithm uses a single dynamic program to solve all of the units' optimization problems simultaneously. Notable advantages of our method over existing matching procedures are its high-quality interpretable matches, versatility in handling different data distributions that may have irrelevant variables, and ability to handle missing data by matching on as many available covariates as possible.