A Controlled Audit of Pretraining Contamination in Public Medical Vision-Language Benchmarks

Medical vision-language models (VLMs) are evaluated on public benchmarks whose images and question-answer pairs have been freely downloadable for years, yet reported accuracy assumes these examples were absent from pretraining. We audit open VLMs on SLAKE-En, PathVQA, VQA-RAD, and an auxiliary public OmniMedVQA mirror using four detector families: image-side near-neighbour overlap against PMC-OA-beta, canonical-order exchangeability, cohort-relative Min-K%++ tail enrichment, and cross-model top-K overlap. We find measurable image-side source overlap on SLAKE-En: 19.8% of images are flagged under SigLIP-B-16 and 4.2% under SigLIP-SO400M, while out-of-domain controls produce 0/2000 flags. Manual adjudication shows same-modality, same-projection matches to different patients rather than verified pixel-level duplicates, so we interpret this as source or distributional overlap rather than confirmed per-image memorization. On the text side, Qwen2.5-VL on SLAKE-En shows a canonical-order exchangeability signal that survives ordering ablation and external non-medical baselines. On the OmniMedVQA mirror, exchangeability fires for five medical and general VLMs while BLIP-2 remains clean. In contrast, cohort-relative Min-K%++ tail enrichment and cross-model top-K overlap collapse under an external pre-domain baseline: BLIP-2 reproduces the apparent positive signals despite lacking plausible medical-VQA exposure. We conclude that these cohort-relative detectors are unreliable as standalone membership-inference signals on small medical-VLM cohorts.

From Theory to Decision Rule: Calibrating the Noisy-Label Crossover for Vision-Language Model Weak Supervision Across Three Medical-Imaging Benchmarks

Classical noisy-label theory predicts that downstream performance under weak supervision is bounded above by the labeler's accuracy, implying a sharp crossover: once a gold-trained classifier matches the labeler, weak labels stop helping and start hurting. The prediction is theoretical; what is missing is a benchmark calibration that turns it into an instance-level statement for modern foundation-model labelers. We provide such a calibration for BiomedCLIP-generated weak labels on three medical-imaging benchmarks (PCAM, ISIC, NIH-CXR) and six downstream architectures spanning an 11x parameter range. The crossover predicted by theory appears at ng~100 on PCAM, 20-50 on ISIC, and 250-500 on NIH-CXR; weak labels above the crossover degrade AUC by up to -0.10. The location is architecture-invariant for four of five pretrained architectures, and a within-family DenseNet sweep (2.5x parameters, identical pretraining) supports the view that the labeler, not the student, is the dominant constraint. The calibration in turn produces a decision rule operable from 10-20 gold labels: compare gold-only AUC to VLM accuracy on the user's gold set. A structured-vs-random noise sign flip on NIH-CXR shows that the rate-only formulation of the bound is incomplete and identifies a concrete refinement (label-space projection) that future benchmarks can be designed to test.