A Toolbox for Surfacing Health Equity Harms and Biases in Large Language Models

Large language models (LLMs) hold immense 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. In this work, 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 then conduct an empirical case study with Med-PaLM 2, resulting in the largest human evaluation study in this area to date. Our contributions include a multifactorial framework for human assessment of LLM-generated answers for biases, and EquityMedQA, a collection of seven newly-released datasets comprising both manually-curated and LLM-generated questions enriched for adversarial queries. Both our human assessment framework and dataset design process are grounded in an iterative participatory approach and review of possible biases in Med-PaLM 2 answers to adversarial queries. Through our empirical study, we find that the use of a collection of datasets curated through a variety of methodologies, coupled with a thorough evaluation protocol that leverages multiple assessment rubric designs and diverse rater groups, surfaces biases that may be missed via narrower evaluation approaches. Our experience underscores the importance of using diverse assessment methodologies and involving raters of varying backgrounds and expertise. We emphasize that while our framework can identify specific forms of bias, it is not sufficient to holistically assess whether the deployment of an AI system promotes equitable health outcomes. We hope the broader community leverages and builds on these tools and methods towards realizing a shared goal of LLMs that promote accessible and equitable healthcare for all.

Dialog Inpainting: Turning Documents into Dialogs

Many important questions (e.g. "How to eat healthier?") require conversation to establish context and explore in depth. However, conversational question answering (ConvQA) systems have long been stymied by scarce training data that is expensive to collect. To address this problem, we propose a new technique for synthetically generating diverse and high-quality dialog data: dialog inpainting. Our approach takes the text of any document and transforms it into a two-person dialog between the writer and an imagined reader: we treat sentences from the article as utterances spoken by the writer, and then use a dialog inpainter to predict what the imagined reader asked or said in between each of the writer's utterances. By applying this approach to passages from Wikipedia and the web, we produce WikiDialog and WebDialog, two datasets totalling 19 million diverse information-seeking dialogs -- 1,000x larger than the largest existing ConvQA dataset. Furthermore, human raters judge the answer adequacy and conversationality of WikiDialog to be as good or better than existing manually-collected datasets. Using our inpainted data to pre-train ConvQA retrieval systems, we significantly advance state-of-the-art across three benchmarks (QReCC, OR-QuAC, TREC CAsT) yielding up to 40% relative gains on standard evaluation metrics.