arXiv subjects

Michael Oberst

Publications and source records attributed to Michael Oberst.

At least 19 recordsLinked to original sources

arXiv2026

Bounding the Causal Impact of ML-assisted Decision-Making via Counterfactual Correctness

Predictive machine learning (ML) models are increasingly used to aid human decision-makers across various high-risk domains such as healthcare and criminal justice. There is a growing recognition of the need to evaluate the causal impact of deploying these systems on downstream outcomes, such as patient survival or crime recidivism. Randomized control trials (RCTs) can provide high-quality evidence on the impact of a deployed model, but they run into a challenge: it is often infeasible to run repeated trials when models are updated or retrained to improve predictive performance. In this work, we present a partial-identification approach to using prior RCT data to construct bounds on the causal effect of a new model. The core innovation in our approach is to leverage assumptions relating fine-grained predictive accuracy to downstream outcomes. We do so via two monotonicity assumptions: first, on individual-level `counterfactual correctness' (all else being equal, a correct prediction leads to non-inferior outcomes); and second, on the relation between subgroup predictive performance and outcomes, interpretable as an assumption regarding trust in model outputs. We demonstrate our method with a simulation study, illustrating how incorporating this information can lead to more informative bounds compared to prior work.

cs.LG↗

arXiv2025

Revisiting Performance Claims for Chest X-Ray Models Using Clinical Context

Public datasets of Chest X-Rays (CXRs) have long been a popular benchmark for developing machine learning (ML) computer vision models in healthcare. However, the reported strong average-case performance of these models do not necessarily reflect their actual utility when used in heterogeneous clinical settings, potentially masking weaker performance in medically significant scenarios. In this work we use clinical context to provide a more holistic evaluation of models for CXR diagnosis. In particular, we use discharge summaries, recorded prior to each CXR, to derive a ``pre-CXR'' probability of each CXR label, as a proxy for existing contextual knowledge available to clinicians when interpreting CXRs. We use this measure to probe model performance along two dimensions: First, using a stratified analysis, we show that models tend to have lower performance (as measured by AUROC and other metrics) among individuals with higher pre-CXR probability. Second, by controlling for pre-CXR probability via matching and re-weighting, we demonstrate that performance degrades when the correlation is broken between prior context and the current CXR label, suggesting that model performance is highly sensitive to the underlying distribution of clinical context. Specifically, cases with high pre-test probabilities present a fundamentally more difficult visual classification task, highlighting a gap in clinical utility when models are applied to high-risk cohorts.

cs.LG↗

arXiv2025

No Free Lunch: Non-Asymptotic Analysis of Prediction-Powered Inference

Prediction-Powered Inference (PPI) is a popular strategy for combining gold-standard and possibly noisy pseudo-labels to perform statistical estimation. Prior work has shown an asymptotic \enquote{free lunch} for PPI++, an adaptive form of PPI, showing that the \textit{asymptotic} variance of PPI++ is always less than or equal to the variance obtained from using gold-standard labels alone. Notably, this result holds \textit{regardless of the quality of the pseudo-labels}. In this work, we demystify this result by conducting an exact finite-sample analysis of the estimation error of PPI++ on the mean estimation problem. We give a \enquote{no free lunch} result, characterizing the settings (and sample sizes) where PPI++ has provably worse estimation error than using gold-standard labels alone. Specifically, PPI++ will outperform if and only if the correlation between pseudo- and gold-standard is above a certain level that depends on the number of labeled samples ($n$). In some cases our results simplify considerably: For Gaussian data, for instance, the correlation must be at least $1/\sqrt{n - 2}$ in order to see improvement. More broadly, by providing exact non-asymptotic expressions for the variance of PPI++ under sample splitting, we aim to empower practitioners to transparently reason about the benefits of PPI++ in specific applications. In experiments, we illustrate that our theoretical findings hold on real-world datasets.

stat.ML↗

arXiv2025

Just Trial Once: Ongoing Causal Validation of Machine Learning Models

Machine learning (ML) models are increasingly used as decision-support tools in high-risk domains. Evaluating the causal impact of deploying such models can be done with a randomized controlled trial (RCT) that randomizes users to ML vs. control groups and assesses the effect on relevant outcomes. However, ML models are inevitably updated over time, and we often lack evidence for the causal impact of these updates. While the causal effect could be repeatedly validated with ongoing RCTs, such experiments are expensive and time-consuming to run. In this work, we present an alternative solution: using only data from a prior RCT, we give conditions under which the causal impact of a new ML model can be precisely bounded or estimated, even if it was not included in the RCT. Our assumptions incorporate two realistic constraints: ML predictions are often deterministic, and their impacts depend on user trust in the model. Based on our analysis, we give recommendations for trial designs that maximize our ability to assess future versions of an ML model. Our hope is that our trial design recommendations will save practitioners time and resources while allowing for quicker deployments of updates to ML models.

stat.ME↗

arXiv2025

Towards Virtual Clinical Trials of Radiology AI with Conditional Generative Modeling

Artificial intelligence (AI) is poised to transform healthcare by enabling personalized and efficient care through data-driven insights. Although radiology is at the forefront of AI adoption, in practice, the potential of AI models is often overshadowed by severe failures to generalize: AI models can have performance degradation of up to 20% when transitioning from controlled test environments to clinical use by radiologists. This mismatch raises concerns that radiologists will be misled by incorrect AI predictions in practice and/or grow to distrust AI, rendering these promising technologies practically ineffectual. Exhaustive clinical trials of AI models on abundant and diverse data is thus critical to anticipate AI model degradation when encountering varied data samples. Achieving these goals, however, is challenging due to the high costs of collecting diverse data samples and corresponding annotations. To overcome these limitations, we introduce a novel conditional generative AI model designed for virtual clinical trials (VCTs) of radiology AI, capable of realistically synthesizing full-body CT images of patients with specified attributes. By learning the joint distribution of images and anatomical structures, our model enables precise replication of real-world patient populations with unprecedented detail at this scale. We demonstrate meaningful evaluation of radiology AI models through VCTs powered by our synthetic CT study populations, revealing model degradation and facilitating algorithmic auditing for bias-inducing data attributes. Our generative AI approach to VCTs is a promising avenue towards a scalable solution to assess model robustness, mitigate biases, and safeguard patient care by enabling simpler testing and evaluation of AI models in any desired range of diverse patient populations.

cs.CV↗

arXiv2024

Expert Routing with Synthetic Data for Continual Learning

In many real-world settings, regulations and economic incentives permit the sharing of models but not data across institutional boundaries. In such scenarios, practitioners might hope to adapt models to new domains, without losing performance on previous domains (so-called catastrophic forgetting). While any single model may struggle to achieve this goal, learning an ensemble of domain-specific experts offers the potential to adapt more closely to each individual institution. However, a core challenge in this context is determining which expert to deploy at test time. In this paper, we propose Generate to Discriminate (G2D), a domain-incremental continual learning method that leverages synthetic data to train a domain-discriminator that routes samples at inference time to the appropriate expert. Surprisingly, we find that leveraging synthetic data in this capacity is more effective than using the samples to \textit{directly} train the downstream classifier (the more common approach to leveraging synthetic data in the lifelong learning literature). We observe that G2D outperforms competitive domain-incremental learning methods on tasks in both vision and language modalities, providing a new perspective on the use of synthetic data in the lifelong learning literature.

cs.LG↗

arXiv2024

The Limited Impact of Medical Adaptation of Large Language and Vision-Language Models

Several recent works seek to adapt general-purpose large language models (LLMs) and vision-language models (VLMs) for medical applications through continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining improves performance on various downstream medical tasks, such as answering medical exam questions. In this paper, we compare ten "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting and supervised fine-tuning regimes for medical question answering (QA). For instance, on clinical-note-based QA tasks in the 3-shot setting, medical LLMs outperform their base models in only 26.7% of cases, reach a (statistical) tie in 16.7% of cases, and perform significantly worse in the remaining 56.7% of cases. Our conclusions are based on (i) comparing each medical model directly against its base model; (ii) optimizing the prompts for each model separately in zero-/few-shot prompting; and (iii) accounting for statistical uncertainty in comparisons. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

cs.CL↗

arXiv2024

Medical Adaptation of Large Language and Vision-Language Models: Are We Making Progress?

Several recent works seek to develop foundation models specifically for medical applications, adapting general-purpose large language models (LLMs) and vision-language models (VLMs) via continued pretraining on publicly available biomedical corpora. These works typically claim that such domain-adaptive pretraining (DAPT) improves performance on downstream medical tasks, such as answering medical licensing exam questions. In this paper, we compare seven public "medical" LLMs and two VLMs against their corresponding base models, arriving at a different conclusion: all medical VLMs and nearly all medical LLMs fail to consistently improve over their base models in the zero-/few-shot prompting regime for medical question-answering (QA) tasks. For instance, across the tasks and model pairs we consider in the 3-shot setting, medical LLMs only outperform their base models in 12.1% of cases, reach a (statistical) tie in 49.8% of cases, and are significantly worse than their base models in the remaining 38.2% of cases. Our conclusions are based on (i) comparing each medical model head-to-head, directly against the corresponding base model; (ii) optimizing the prompts for each model separately; and (iii) accounting for statistical uncertainty in comparisons. While these basic practices are not consistently adopted in the literature, our ablations show that they substantially impact conclusions. Our findings suggest that state-of-the-art general-domain models may already exhibit strong medical knowledge and reasoning capabilities, and offer recommendations to strengthen the conclusions of future studies.

cs.CL↗

arXiv2024

Auditing Fairness under Unobserved Confounding

Many definitions of fairness or inequity involve unobservable causal quantities that cannot be directly estimated without strong assumptions. For instance, it is particularly difficult to estimate notions of fairness that rely on hard-to-measure concepts such as risk (e.g., quantifying whether patients at the same risk level have equal probability of treatment, regardless of group membership). Such measurements of risk can be accurately obtained when no unobserved confounders have jointly influenced past decisions and outcomes. However, in the real world, this assumption rarely holds. In this paper, we show that, surprisingly, one can still compute meaningful bounds on treatment rates for high-risk individuals (i.e., conditional on their true, \textit{unobserved} negative outcome), even when entirely eliminating or relaxing the assumption that we observe all relevant risk factors used by decision makers. We use the fact that in many real-world settings (e.g., the release of a new treatment) we have data from prior to any allocation to derive unbiased estimates of risk. This result enables us to audit unfair outcomes of existing decision-making systems in a principled manner. We demonstrate the effectiveness of our framework with a real-world study of Paxlovid allocation, provably identifying that observed racial inequity cannot be explained by unobserved confounders of the same strength as important observed covariates.

cs.LG↗

arXiv2024

Recent Advances, Applications, and Open Challenges in Machine Learning for Health: Reflections from Research Roundtables at ML4H 2023 Symposium

The third ML4H symposium was held in person on December 10, 2023, in New Orleans, Louisiana, USA. The symposium included research roundtable sessions to foster discussions between participants and senior researchers on timely and relevant topics for the \ac{ML4H} community. Encouraged by the successful virtual roundtables in the previous year, we organized eleven in-person roundtables and four virtual roundtables at ML4H 2022. The organization of the research roundtables at the conference involved 17 Senior Chairs and 19 Junior Chairs across 11 tables. Each roundtable session included invited senior chairs (with substantial experience in the field), junior chairs (responsible for facilitating the discussion), and attendees from diverse backgrounds with interest in the session's topic. Herein we detail the organization process and compile takeaways from these roundtable discussions, including recent advances, applications, and open challenges for each topic. We conclude with a summary and lessons learned across all roundtables. This document serves as a comprehensive review paper, summarizing the recent advancements in machine learning for healthcare as contributed by foremost researchers in the field.

cs.LG↗

arXiv2024

Benchmarking Observational Studies with Experimental Data under Right-Censoring

Drawing causal inferences from observational studies (OS) requires unverifiable validity assumptions; however, one can falsify those assumptions by benchmarking the OS with experimental data from a randomized controlled trial (RCT). A major limitation of existing procedures is not accounting for censoring, despite the abundance of RCTs and OSes that report right-censored time-to-event outcomes. We consider two cases where censoring time (1) is independent of time-to-event and (2) depends on time-to-event the same way in OS and RCT. For the former, we adopt a censoring-doubly-robust signal for the conditional average treatment effect (CATE) to facilitate an equivalence test of CATEs in OS and RCT, which serves as a proxy for testing if the validity assumptions hold. For the latter, we show that the same test can still be used even though unbiased CATE estimation may not be possible. We verify the effectiveness of our censoring-aware tests via semi-synthetic experiments and analyze RCT and OS data from the Women's Health Initiative study.

stat.ME↗

arXiv2023

Understanding the Risks and Rewards of Combining Unbiased and Possibly Biased Estimators, with Applications to Causal Inference

Several problems in statistics involve the combination of high-variance unbiased estimators with low-variance estimators that are only unbiased under strong assumptions. A notable example is the estimation of causal effects while combining small experimental datasets with larger observational datasets. There exist a series of recent proposals on how to perform such a combination, even when the bias of the low-variance estimator is unknown. To build intuition for the differing trade-offs of competing approaches, we argue for examining the finite-sample estimation error of each approach as a function of the unknown bias. This includes understanding the bias threshold -- the largest bias for which a given approach improves over using the unbiased estimator alone. Though this lens, we review several recent proposals, and observe in simulation that different approaches exhibits qualitatively different behavior. We also introduce a simple alternative approach, which compares favorably in simulation to recent alternatives, having a higher bias threshold and generally making a more conservative trade-off between best-case performance (when the bias is zero) and worst-case performance (when the bias is adversarially chosen). More broadly, we prove that for any amount of (unknown) bias, the MSE of this estimator can be bounded in a transparent way that depends on the variance / covariance of the underlying estimators that are being combined.

stat.ME↗

arXiv2023

Falsification before Extrapolation in Causal Effect Estimation

Randomized Controlled Trials (RCTs) represent a gold standard when developing policy guidelines. However, RCTs are often narrow, and lack data on broader populations of interest. Causal effects in these populations are often estimated using observational datasets, which may suffer from unobserved confounding and selection bias. Given a set of observational estimates (e.g. from multiple studies), we propose a meta-algorithm that attempts to reject observational estimates that are biased. We do so using validation effects, causal effects that can be inferred from both RCT and observational data. After rejecting estimators that do not pass this test, we generate conservative confidence intervals on the extrapolated causal effects for subgroups not observed in the RCT. Under the assumption that at least one observational estimator is asymptotically normal and consistent for both the validation and extrapolated effects, we provide guarantees on the coverage probability of the intervals output by our algorithm. To facilitate hypothesis testing in settings where causal effect transportation across datasets is necessary, we give conditions under which a doubly-robust estimator of group average treatment effects is asymptotically normal, even when flexible machine learning methods are used for estimation of nuisance parameters. We illustrate the properties of our approach on semi-synthetic and real world datasets, and show that it compares favorably to standard meta-analysis techniques.

cs.LG↗

arXiv2023

Falsification of Internal and External Validity in Observational Studies via Conditional Moment Restrictions

Randomized Controlled Trials (RCT)s are relied upon to assess new treatments, but suffer from limited power to guide personalized treatment decisions. On the other hand, observational (i.e., non-experimental) studies have large and diverse populations, but are prone to various biases (e.g. residual confounding). To safely leverage the strengths of observational studies, we focus on the problem of falsification, whereby RCTs are used to validate causal effect estimates learned from observational data. In particular, we show that, given data from both an RCT and an observational study, assumptions on internal and external validity have an observable, testable implication in the form of a set of Conditional Moment Restrictions (CMRs). Further, we show that expressing these CMRs with respect to the causal effect, or "causal contrast", as opposed to individual counterfactual means, provides a more reliable falsification test. In addition to giving guarantees on the asymptotic properties of our test, we demonstrate superior power and type I error of our approach on semi-synthetic and real world datasets. Our approach is interpretable, allowing a practitioner to visualize which subgroups in the population lead to falsification of an observational study.

stat.ME↗

arXiv2023

Evaluating Robustness to Dataset Shift via Parametric Robustness Sets

We give a method for proactively identifying small, plausible shifts in distribution which lead to large differences in model performance. These shifts are defined via parametric changes in the causal mechanisms of observed variables, where constraints on parameters yield a "robustness set" of plausible distributions and a corresponding worst-case loss over the set. While the loss under an individual parametric shift can be estimated via reweighting techniques such as importance sampling, the resulting worst-case optimization problem is non-convex, and the estimate may suffer from large variance. For small shifts, however, we can construct a local second-order approximation to the loss under shift and cast the problem of finding a worst-case shift as a particular non-convex quadratic optimization problem, for which efficient algorithms are available. We demonstrate that this second-order approximation can be estimated directly for shifts in conditional exponential family models, and we bound the approximation error. We apply our approach to a computer vision task (classifying gender from images), revealing sensitivity to shifts in non-causal attributes.

cs.LG↗

arXiv2021

Finding Regions of Heterogeneity in Decision-Making via Expected Conditional Covariance

Individuals often make different decisions when faced with the same context, due to personal preferences and background. For instance, judges may vary in their leniency towards certain drug-related offenses, and doctors may vary in their preference for how to start treatment for certain types of patients. With these examples in mind, we present an algorithm for identifying types of contexts (e.g., types of cases or patients) with high inter-decision-maker disagreement. We formalize this as a causal inference problem, seeking a region where the assignment of decision-maker has a large causal effect on the decision. Our algorithm finds such a region by maximizing an empirical objective, and we give a generalization bound for its performance. In a semi-synthetic experiment, we show that our algorithm recovers the correct region of heterogeneity accurately compared to baselines. Finally, we apply our algorithm to real-world healthcare datasets, recovering variation that aligns with existing clinical knowledge.

cs.LG↗

arXiv2021

Regularizing towards Causal Invariance: Linear Models with Proxies

We propose a method for learning linear models whose predictive performance is robust to causal interventions on unobserved variables, when noisy proxies of those variables are available. Our approach takes the form of a regularization term that trades off between in-distribution performance and robustness to interventions. Under the assumption of a linear structural causal model, we show that a single proxy can be used to create estimators that are prediction optimal under interventions of bounded strength. This strength depends on the magnitude of the measurement noise in the proxy, which is, in general, not identifiable. In the case of two proxy variables, we propose a modified estimator that is prediction optimal under interventions up to a known strength. We further show how to extend these estimators to scenarios where additional information about the "test time" intervention is available during training. We evaluate our theoretical findings in synthetic experiments and using real data of hourly pollution levels across several cities in China.

cs.LG↗

arXiv2020

Trajectory Inspection: A Method for Iterative Clinician-Driven Design of Reinforcement Learning Studies

Reinforcement learning (RL) has the potential to significantly improve clinical decision making. However, treatment policies learned via RL from observational data are sensitive to subtle choices in study design. We highlight a simple approach, trajectory inspection, to bring clinicians into an iterative design process for model-based RL studies. We identify where the model recommends unexpectedly aggressive treatments or expects surprisingly positive outcomes from its recommendations. Then, we examine clinical trajectories simulated with the learned model and policy alongside the actual hospital course. Applying this approach to recent work on RL for sepsis management, we uncover a model bias towards discharge, a preference for high vasopressor doses that may be linked to small sample sizes, and clinically implausible expectations of discharge without weaning off vasopressors. We hope that iterations of detecting and addressing the issues unearthed by our method will result in RL policies that inspire more confidence in deployment.

cs.LG↗