HealMed: Multilingual Evaluation of Large Language Models in Medicine

We present HealMed, an expert-reviewed benchmark for multilingual evaluation of large language models in medicine. HealMed contains 1,000 examples in each of nine languages, drawn from nine datasets and covering three task formats: MCQA, NLI and open-ended QA. The benchmark was developed over two years by 23 physicians and medical experts based across nine countries and regions. Each translation was evaluated and revised by two experts fluent in English and the corresponding target language. On HealMed, performance declined most in low-resource languages, although the size of the gap varied markedly across languages and models. The strongest proprietary models were the most stable across languages, whereas many open-source and medically specialized models showed larger and less consistent gaps. Medical specialization alone did not ensure multilingual robustness. Furthermore, expert revision could either raise or lower measured performance, indicating that translation quality materially affects cross-language evaluation results.

MedPMC: A Systematic Framework for Scaling High-Fidelity Medical Multimodal Data for Foundation Models

Medicine is inherently multimodal, requiring clinicians to synthesize information across diverse data streams. Yet the development of multimodal foundation models is constrained by limited access to large-scale, high-quality clinical data. Although PubMed Central (PMC) offers a complementary source of expert-authored image-text data, existing PMC-derived resources remain limited in fidelity, reproducibility, and clinical validation. We introduce MedPMC, an automated, continuously updatable framework that transforms permissively licensed literature into high-fidelity infrastructure for medical multimodal models. Applied to 6.1 million PMC articles, MedPMC curated 11 million medical image-text pairs. Component evaluations showed strong performance for initial screening (F1 = 93.2), multi-panel figure detection (F1 = 96.5), figure separation (mAP = 89.8), caption separation and alignment (F1 = 81.4; ROUGE-L = 85.3), and medical figure classification (F1 = 96.5). Manual review by five annotators, three with medical training, found 95.3% of MedPMC images medically relevant, versus 19.7% in a prior PMC-derived dataset. Across 26 benchmarks spanning 11 specialties, a MedPMC-trained CLIP-style model improved average zero-shot AUC by 7.1 percentage points over the strongest architecture-matched biomedical CLIP baseline despite using fewer than half as many image-text pairs. As the vision encoder in a multimodal large language model, it improved medical visual question-answering by 1.9 and 16.9 percentage points across two benchmarks. In 10,524 Yale New Haven Health System dermatology photographs, it improved morphology-to-image retrieval Recall@5 by 11.7 percentage points. These findings show that high-fidelity literature curation strengthens medical multimodal foundation models across benchmark and clinical settings. We publicly release the framework, corpus, benchmarks, and pretrained models.

From Voting to Agent Collaboration: Answer-Type-Aware LLM Pipelines for BioASQ 14b

Biomedical question answering requires not only accurate extraction of information from scientific literature but also reliable integration of evidence across multiple documents. This study presents a question-type-specific large language model (LLM) framework for BioASQ 14b Task B, designed to improve answer robustness and evidence grounding in biomedical question answering. Rather than applying a single prompting strategy to all questions, the framework selects different inference procedures for yes/no, factoid, and list questions according to their distinct reasoning and evaluation requirements. For yes/no questions, snippet shuffling and self-reflection are used to reduce sensitivity to evidence ordering and improve decision stability. For factoid questions, full-snippet input is combined with chain-of-thought-based in-context learning to support accurate biomedical entity identification. For list questions, a multi-agent architecture is employed, in which evidence extraction, candidate generation, answer verification, and final aggregation are handled collaboratively. Preliminary experiments on BioASQ 13b were used to identify effective inference strategies for each question type, and the resulting framework was subsequently evaluated in the official BioASQ 14b Task B challenge. In the official evaluation, our framework showed competitive performance across multiple batches and achieved first place in the factoid subtask of Batch 4. These results demonstrate the effectiveness of combining question-type-specific inference, ensemble prediction, and agent-based verification for reliable biomedical question answering.

Do All Visual Tokens Matter Equally? Object-Evidence Preserving Token Merging for Vision-Language Retrieval

Multi-vector vision-language retrieval preserves fine-grained visual evidence through maximum-similarity late interaction, but dense image-side tokens make storage and scoring expensive. Existing token compression methods reduce this cost, yet they can remove or collapse object- and region-level evidence that future query tokens may need to select. We propose SaMer, an object-aware token merging framework that compresses image-side post-projector tokens into $K$ representative centroids while preserving the original late-interaction interface. SaMer uses object annotations only during training as a merge prior to discourage cross-instance mixing, requires no ground-truth bounding boxes or detectors at inference time, and adapts only the shared projection layer with frozen vision and language backbones. With $K=64$, SaMer removes more than 93% of image-side tokens and reduces ColPali storage by $16.09\times$, while improving R@1 on Flickr30K and MSCOCO. These gains arise because object-aware merging preserves query-selectable object evidence that pruning or feature-only pooling can remove or collapse. SaMer also outperforms compression baselines and shows stronger phrase-level grounding, suggesting that efficient multi-vector retrieval depends not only on reducing token count, but on preserving the evidence future query tokens need to select.

Breaking Failure Cascades: Step-Aware Reinforcement Learning for Medical Multimodal Reasoning

Recent multimodal large language models have shown great promise in clinical image reasoning, but existing post-training pipelines remain predominantly outcome-centric, relying on final answer correctness or sequence-level preferences. This suffers from sparse credit assignment, making it difficult to optimize the reasoning process essential for clinical applications. Our analysis reveals that cascading errors from early-stage reasoning failures are a leading cause of incorrect predictions in medical visual question answering (VQA) benchmarks. Motivated by this, we propose Medical Reasoning-aware Policy Optimization (MRPO), an RL algorithm that incorporates step-wise process rewards. When the final answer is incorrect, MRPO assigns exponentially larger penalties to tokens in earlier invalid reasoning steps, breaking failure cascades without compromising successful paths. Across three multimodal LLM backbones, MRPO consistently outperforms standard GRPO and a recent RL baseline, and on Qwen3-VL-8B-Instruct even surpasses substantially larger medical MLLMs such as HuatuoGPT-Vision-34B by 2.79 points. Moreover, MRPO reduces early-stage reasoning failures from 64.0% to 13.0%, showing that targeted mitigation of cascading failures improves both reasoning quality and final answer accuracy. Our code is available at https://github.com/dmis-lab/MRPO

MolDeTox: Evaluating Language Model's Stepwise Fragment Editing for Molecular Detoxification

Large Language Models (LLMs) and Vision Language Models (VLMs) have recently shown promising capabilities in various scientific domain. In particular, these advances have opened new opportunities in drug discovery, where the ability to understand and modify molecular structures is critical for optimizing drug properties such as efficacy and toxicity. However, existing models and benchmarks often overlook toxicity-related challenges, focusing primarily on general property optimization without adequately addressing safety concerns. In addition, even existing toxicity repair benchmarks suffer from limited data diversity, low structural validity of generated molecules, and heavy reliance on proxy models for toxicity assessment. To address these limitations, we propose MolDeTox, a novel benchmark for molecular detoxification, designed to enable fine-grained and reliable evaluation of toxicity-aware molecular optimization across stepwise tasks. We evaluate a wide range of general-purpose LLMs and VLMs under diverse settings, and demonstrate that understanding and generating molecules at the fragment-level improves structural validity and enhances the quality of generated molecules. Moreover, through detailed task-level performance analysis, MolDeTox provides an interpretable benchmark that enables a deeper understanding of the detoxification process. Our dataset is available at : https://huggingface.co/datasets/MolDeTox/MolDeTox

ToxReason: A Benchmark for Mechanistic Chemical Toxicity Reasoning via Adverse Outcome Pathway

Recent advances in large language models (LLMs) have enabled molecular reasoning for property prediction. However, toxicity arises from complex biological mechanisms beyond chemical structure, necessitating mechanistic reasoning for reliable prediction. Despite its importance, current benchmarks fail to systematically evaluate this capability. LLMs can generate fluent but biologically unfaithful explanations, making it difficult to assess whether predicted toxicities are grounded invalid mechanisms. To bridge this gap, we introduce ToxReason, a benchmark grounded in the Adverse Outcome Pathway (AOP) that evaluates organ-level toxicity reasoning across multiple organs. ToxReason integrates experimental drug-target interaction evidence with toxicity labels, requiring models to infer both toxic outcomes and their underlying mechanisms from Molecular Initiating Event (MIE) to Adverse Outcome (AO). Using ToxReason, we evaluate toxicity prediction performance and reasoning quality across diverse LLMs. We find that strong predictive performance does not necessarily imply reliable reasoning. Furthermore, we show that reasoning-aware training improves mechanistic reasoning and, consequently, toxicity prediction performance. Together, these results underscore the necessity of integrating reasoning into both evaluation and training for trustworthy toxicity modeling.

When Choices Become Priors: Contrastive Decoding for Scientific Figure Multiple-Choice QA

Scientific figure multiple-choice question answering (MCQA) requires models to reason over diverse visual evidence, ranging from charts and multipanel figures to microscopy and biomedical images. However, this setting suffers from a distinctive bias: answer choices themselves can act as priors, steering multimodal models toward scientifically plausible options even when the figure supports a different answer. We investigate this failure mode through a simple question: what if decoding explicitly discounts what the model would prefer from text alone, so as to favor figure-grounded evidence? To this end, we propose SCICON, a training-free decoding method that scores each candidate by subtracting a text-only option score from its image-conditioned counterpart. Unlike prior contrastive decoding approaches that mitigate hallucinations by contrasting original inputs with distorted images or perturbed instructions, SCICON directly targets the choice-induced prior encoded in candidate text. Across three scientific figure QA benchmarks and three model backbones, SCICON consistently improves accuracy over standard decoding baselines. These results show that decoding against choice-induced priors is an effective and simple way to improve figure-grounded reasoning in scientific MCQA.

CLAG: Adaptive Memory Organization via Agent-Driven Clustering for Small Language Model Agents

Large language model agents heavily rely on external memory to support knowledge reuse and complex reasoning tasks. Yet most memory systems store experiences in a single global retrieval pool which can gradually dilute or corrupt stored knowledge. This problem is especially pronounced for small language models (SLMs), which are highly vulnerable to irrelevant context. We introduce CLAG, a CLustering-based AGentic memory framework where an SLM agent actively organizes memory by clustering. CLAG employs an SLM-driven router to assign incoming memories to semantically coherent clusters and autonomously generates cluster-specific profiles, including topic summaries and descriptive tags, to establish each cluster as a self-contained functional unit. By performing localized evolution within these structured neighborhoods, CLAG effectively reduces cross-topic interference and enhances internal memory density. During retrieval, the framework utilizes a two-stage process that first filters relevant clusters via their profiles, thereby excluding distractors and reducing the search space. Experiments on multiple QA datasets with three SLM backbones show that CLAG consistently improves answer quality and robustness over prior memory systems for agents, remaining lightweight and efficient.

ATTNSOM: Learning Cross-Isoform Attention for Cytochrome P450 Site-of-Metabolism

Identifying metabolic sites where cytochrome P450 enzymes metabolize small-molecule drugs is essential for drug discovery. Although existing computational approaches have been proposed for site-of-metabolism prediction, they typically ignore cytochrome P450 isoform identity or model isoforms independently, thereby failing to fully capture inherent cross-isoform metabolic patterns. In addition, prior evaluations often rely on top-k metrics, where false positive atoms may be included among the top predictions, underscoring the need for complementary metrics that more directly assess binary atom-level discrimination under severe class imbalance. We propose ATTNSOM, an atom-level site-of-metabolism prediction framework that integrates intrinsic molecular reactivity with cross-isoform relationships. The model combines a shared graph encoder, molecule-conditioned atom representations, and a cross-attention mechanism to capture correlated metabolic patterns across cytochrome P450 isoforms. The model is evaluated on two benchmark datasets annotated with site-of-metabolism labels at atom resolution. Across these benchmarks, the model achieves consistently strong top-k performance across multiple cytochrome P450 isoforms. Relative to ablated variants, the model yields higher Matthews correlation coefficient, indicating improved discrimination of true metabolic sites. These results support the importance of explicitly modeling cross-isoform relationships for site-of-metabolism prediction. The code and datasets are available at https://github.com/dmis-lab/ATTNSOM.