Rethinking Retrieval-Augmented Generation for Medicine: A Large-Scale, Systematic Expert Evaluation and Practical Insights

Large language models (LLMs) are transforming the landscape of medicine, yet two fundamental challenges persist: keeping up with rapidly evolving medical knowledge and providing verifiable, evidence-grounded reasoning. Retrieval-augmented generation (RAG) has been widely adopted to address these limitations by supplementing model outputs with retrieved evidence. However, whether RAG reliably achieves these goals remains unclear. Here, we present the most comprehensive expert evaluation of RAG in medicine to date. Eighteen medical experts contributed a total of 80,502 annotations, assessing 800 model outputs generated by GPT-4o and Llama-3.1-8B across 200 real-world patient and USMLE-style queries. We systematically decomposed the RAG pipeline into three components: (i) evidence retrieval (relevance of retrieved passages), (ii) evidence selection (accuracy of evidence usage), and (iii) response generation (factuality and completeness of outputs). Contrary to expectation, standard RAG often degraded performance: only 22% of top-16 passages were relevant, evidence selection remained weak (precision 41-43%, recall 27-49%), and factuality and completeness dropped by up to 6% and 5%, respectively, compared with non-RAG variants. Retrieval and evidence selection remain key failure points for the model, contributing to the overall performance drop. We further show that simple yet effective strategies, including evidence filtering and query reformulation, substantially mitigate these issues, improving performance on MedMCQA and MedXpertQA by up to 12% and 8.2%, respectively. These findings call for re-examining RAG's role in medicine and highlight the importance of stage-aware evaluation and deliberate system design for reliable medical LLM applications.

ChatGPT Based Data Augmentation for Improved Parameter-Efficient Debiasing of LLMs

Large Language models (LLMs), while powerful, exhibit harmful social biases. Debiasing is often challenging due to computational costs, data constraints, and potential degradation of multi-task language capabilities. This work introduces a novel approach utilizing ChatGPT to generate synthetic training data, aiming to enhance the debiasing of LLMs. We propose two strategies: Targeted Prompting, which provides effective debiasing for known biases but necessitates prior specification of bias in question; and General Prompting, which, while slightly less effective, offers debiasing across various categories. We leverage resource-efficient LLM debiasing using adapter tuning and compare the effectiveness of our synthetic data to existing debiasing datasets. Our results reveal that: (1) ChatGPT can efficiently produce high-quality training data for debiasing other LLMs; (2) data produced via our approach surpasses existing datasets in debiasing performance while also preserving internal knowledge of a pre-trained LLM; and (3) synthetic data exhibits generalizability across categories, effectively mitigating various biases, including intersectional ones. These findings underscore the potential of synthetic data in advancing the fairness of LLMs with minimal retraining cost.

Exploring Social Bias in Downstream Applications of Text-to-Image Foundation Models

Text-to-image diffusion models have been adopted into key commercial workflows, such as art generation and image editing. Characterising the implicit social biases they exhibit, such as gender and racial stereotypes, is a necessary first step in avoiding discriminatory outcomes. While existing studies on social bias focus on image generation, the biases exhibited in alternate applications of diffusion-based foundation models remain under-explored. We propose methods that use synthetic images to probe two applications of diffusion models, image editing and classification, for social bias. Using our methodology, we uncover meaningful and significant inter-sectional social biases in \textit{Stable Diffusion}, a state-of-the-art open-source text-to-image model. Our findings caution against the uninformed adoption of text-to-image foundation models for downstream tasks and services.