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.

A Bayesian Spatial Model to Correct Under-Reporting in Urban Crowdsourcing

Decision-makers often observe the occurrence of events through a reporting process. City governments, for example, rely on resident reports to find and then resolve urban infrastructural problems such as fallen street trees, flooded basements, or rat infestations. Without additional assumptions, there is no way to distinguish events that occur but are not reported from events that truly did not occur--a fundamental problem in settings with positive-unlabeled data. Because disparities in reporting rates correlate with resident demographics, addressing incidents only on the basis of reports leads to systematic neglect in neighborhoods that are less likely to report events. We show how to overcome this challenge by leveraging the fact that events are spatially correlated. Our framework uses a Bayesian spatial latent variable model to infer event occurrence probabilities and applies it to storm-induced flooding reports in New York City, further pooling results across multiple storms. We show that a model accounting for under-reporting and spatial correlation predicts future reports more accurately than other models, and further induces a more equitable set of inspections: its allocations better reflect the population and provide equitable service to non-white, less traditionally educated, and lower-income residents. This finding reflects heterogeneous reporting behavior learned by the model: reporting rates are higher in Census tracts with higher populations, proportions of white residents, and proportions of owner-occupied households. Our work lays the groundwork for more equitable proactive government services, even with disparate reporting behavior.

Domain constraints improve risk prediction when outcome data is missing

Machine learning models are often trained to predict the outcome resulting from a human decision. For example, if a doctor decides to test a patient for disease, will the patient test positive? A challenge is that the human decision censors the outcome data: we only observe test outcomes for patients doctors historically tested. Untested patients, for whom outcomes are unobserved, may differ from tested patients along observed and unobserved dimensions. We propose a Bayesian model class which captures this setting. The purpose of the model is to accurately estimate risk for both tested and untested patients. Estimating this model is challenging due to the wide range of possibilities for untested patients. To address this, we propose two domain constraints which are plausible in health settings: a prevalence constraint, where the overall disease prevalence is known, and an expertise constraint, where the human decision-maker deviates from purely risk-based decision-making only along a constrained feature set. We show theoretically and on synthetic data that domain constraints improve parameter inference. We apply our model to a case study of cancer risk prediction, showing that the model's inferred risk predicts cancer diagnoses, its inferred testing policy captures known public health policies, and it can identify suboptimalities in test allocation. Though our case study is in healthcare, our analysis reveals a general class of domain constraints which can improve model estimation in many settings.

Reconciling the accuracy-diversity trade-off in recommendations

In recommendation settings, there is an apparent trade-off between the goals of accuracy (to recommend items a user is most likely to want) and diversity (to recommend items representing a range of categories). As such, real-world recommender systems often explicitly incorporate diversity separately from accuracy. This approach, however, leaves a basic question unanswered: Why is there a trade-off in the first place? We show how the trade-off can be explained via a user's consumption constraints -- users typically only consume a few of the items they are recommended. In a stylized model we introduce, objectives that account for this constraint induce diverse recommendations, while objectives that do not account for this constraint induce homogeneous recommendations. This suggests that accuracy and diversity appear misaligned because standard accuracy metrics do not consider consumption constraints. Our model yields precise and interpretable characterizations of diversity in different settings, giving practical insights into the design of diverse recommendations.

Large language models shape and are shaped by society: A survey of arXiv publication patterns

There has been a steep recent increase in the number of large language model (LLM) papers, producing a dramatic shift in the scientific landscape which remains largely undocumented through bibliometric analysis. Here, we analyze 388K papers posted on the CS and Stat arXivs, focusing on changes in publication patterns in 2023 vs. 2018-2022. We analyze how the proportion of LLM papers is increasing; the LLM-related topics receiving the most attention; the authors writing LLM papers; how authors' research topics correlate with their backgrounds; the factors distinguishing highly cited LLM papers; and the patterns of international collaboration. We show that LLM research increasingly focuses on societal impacts: there has been an 18x increase in the proportion of LLM-related papers on the Computers and Society sub-arXiv, and authors newly publishing on LLMs are more likely to focus on applications and societal impacts than more experienced authors. LLM research is also shaped by social dynamics: we document gender and academic/industry disparities in the topics LLM authors focus on, and a US/China schism in the collaboration network. Overall, our analysis documents the profound ways in which LLM research both shapes and is shaped by society, attesting to the necessity of sociotechnical lenses.

Choosing the Right Weights: Balancing Value, Strategy, and Noise in Recommender Systems

Many recommender systems are based on optimizing a linear weighting of different user behaviors, such as clicks, likes, shares, etc. Though the choice of weights can have a significant impact, there is little formal study or guidance on how to choose them. We analyze the optimal choice of weights from the perspectives of both users and content producers who strategically respond to the weights. We consider three aspects of user behavior: value-faithfulness (how well a behavior indicates whether the user values the content), strategy-robustness (how hard it is for producers to manipulate the behavior), and noisiness (how much estimation error there is in predicting the behavior). Our theoretical results show that for users, upweighting more value-faithful and less noisy behaviors leads to higher utility, while for producers, upweighting more value-faithful and strategy-robust behaviors leads to higher welfare (and the impact of noise is non-monotonic). Finally, we discuss how our results can help system designers select weights in practice.

Coarse race data conceals disparities in clinical risk score performance

Healthcare data in the United States often records only a patient's coarse race group: for example, both Indian and Chinese patients are typically coded as ``Asian.'' It is unknown, however, whether this coarse coding conceals meaningful disparities in the performance of clinical risk scores across granular race groups. Here we show that it does. Using data from 418K emergency department visits, we assess clinical risk score performance disparities across granular race groups for three outcomes, five risk scores, and four performance metrics. Across outcomes and metrics, we show that there are significant granular disparities in performance within coarse race categories. In fact, variation in performance metrics within coarse groups often exceeds the variation between coarse groups. We explore why these disparities arise, finding that outcome rates, feature distributions, and the relationships between features and outcomes all vary significantly across granular race categories. Our results suggest that healthcare providers, hospital systems, and machine learning researchers should strive to collect, release, and use granular race data in place of coarse race data, and that existing analyses may significantly underestimate racial disparities in performance.

How do Authors' Perceptions of their Papers Compare with Co-authors' Perceptions and Peer-review Decisions?

How do author perceptions match up to the outcomes of the peer-review process and perceptions of others? In a top-tier computer science conference (NeurIPS 2021) with more than 23,000 submitting authors and 9,000 submitted papers, we survey the authors on three questions: (i) their predicted probability of acceptance for each of their papers, (ii) their perceived ranking of their own papers based on scientific contribution, and (iii) the change in their perception about their own papers after seeing the reviews. The salient results are: (1) Authors have roughly a three-fold overestimate of the acceptance probability of their papers: The median prediction is 70% for an approximately 25% acceptance rate. (2) Female authors exhibit a marginally higher (statistically significant) miscalibration than male authors; predictions of authors invited to serve as meta-reviewers or reviewers are similarly calibrated, but better than authors who were not invited to review. (3) Authors' relative ranking of scientific contribution of two submissions they made generally agree (93%) with their predicted acceptance probabilities, but there is a notable 7% responses where authors think their better paper will face a worse outcome. (4) The author-provided rankings disagreed with the peer-review decisions about a third of the time; when co-authors ranked their jointly authored papers, co-authors disagreed at a similar rate -- about a third of the time. (5) At least 30% of respondents of both accepted and rejected papers said that their perception of their own paper improved after the review process. The stakeholders in peer review should take these findings into account in setting their expectations from peer review.

Trucks Don't Mean Trump: Diagnosing Human Error in Image Analysis

Algorithms provide powerful tools for detecting and dissecting human bias and error. Here, we develop machine learning methods to to analyze how humans err in a particular high-stakes task: image interpretation. We leverage a unique dataset of 16,135,392 human predictions of whether a neighborhood voted for Donald Trump or Joe Biden in the 2020 US election, based on a Google Street View image. We show that by training a machine learning estimator of the Bayes optimal decision for each image, we can provide an actionable decomposition of human error into bias, variance, and noise terms, and further identify specific features (like pickup trucks) which lead humans astray. Our methods can be applied to ensure that human-in-the-loop decision-making is accurate and fair and are also applicable to black-box algorithmic systems.

Quantifying Inequality in Underreported Medical Conditions

Estimating the prevalence of a medical condition, or the proportion of the population in which it occurs, is a fundamental problem in healthcare and public health. Accurate estimates of the relative prevalence across groups -- capturing, for example, that a condition affects women more frequently than men -- facilitate effective and equitable health policy which prioritizes groups who are disproportionately affected by a condition. However, it is difficult to estimate relative prevalence when a medical condition is underreported. In this work, we provide a method for accurately estimating the relative prevalence of underreported medical conditions, building upon the positive unlabeled learning framework. We show that under the commonly made covariate shift assumption -- i.e., that the probability of having a disease conditional on symptoms remains constant across groups -- we can recover the relative prevalence, even without restrictive assumptions commonly made in positive unlabeled learning and even if it is impossible to recover the absolute prevalence. We provide a suite of experiments on synthetic and real health data that demonstrate our method's ability to recover the relative prevalence more accurately than do baselines, and the method's robustness to plausible violations of the covariate shift assumption.