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Jun 11

Trustworthy and Fair SkinGPT-R1 for Democratizing Dermatological Reasoning across Diverse Ethnicities

The clinical translation of dermatological AI is hindered by opaque reasoning and systematic performance disparities across skin tones. Here we present SkinGPT-R1, a multimodal large language model that integrates chain-of-thought diagnostic reasoning with a fairness-aware mixture-of-experts architecture for interpretable and equitable skin disease diagnosis. Through parameter-efficient adaptation of a frozen reasoning backbone, SkinGPT-R1 generates structured diagnostic reports comprising visual findings, differential reasoning, and final diagnosis. Across seven external datasets spanning diverse pathologies and imaging conditions, SkinGPT-R1 achieves state-of-the-art accuracy on six benchmarks, including 82.50\% on a challenging 40-class long-tail classification task (+19.30\% over leading baselines). Blinded evaluation by five board-certified dermatologists on 1,000 phenotypically balanced cases yields a mean score of 3.6 out of 5, with the highest ratings in safety (3.8) and reasoning coherence (3.6), indicating that the generated rationales are clinically safe, logically grounded, and suitable for supporting diagnostic decision-making. Critically, SkinGPT-R1 mitigates algorithmic bias across the full Fitzpatrick spectrum, achieving a robust worst-group performance of 41.40\% on the Fitz17k benchmark and a five-fold relative improvement in lower-bound accuracy on the DDI dataset compared to standard multimodal baselines. These results establish a framework for trustworthy, fair, and explainable AI-assisted dermatological diagnosis.

  • 17 authors
·
Nov 19, 2025

Spread Spurious Attribute: Improving Worst-group Accuracy with Spurious Attribute Estimation

The paradigm of worst-group loss minimization has shown its promise in avoiding to learn spurious correlations, but requires costly additional supervision on spurious attributes. To resolve this, recent works focus on developing weaker forms of supervision -- e.g., hyperparameters discovered with a small number of validation samples with spurious attribute annotation -- but none of the methods retain comparable performance to methods using full supervision on the spurious attribute. In this paper, instead of searching for weaker supervisions, we ask: Given access to a fixed number of samples with spurious attribute annotations, what is the best achievable worst-group loss if we "fully exploit" them? To this end, we propose a pseudo-attribute-based algorithm, coined Spread Spurious Attribute (SSA), for improving the worst-group accuracy. In particular, we leverage samples both with and without spurious attribute annotations to train a model to predict the spurious attribute, then use the pseudo-attribute predicted by the trained model as supervision on the spurious attribute to train a new robust model having minimal worst-group loss. Our experiments on various benchmark datasets show that our algorithm consistently outperforms the baseline methods using the same number of validation samples with spurious attribute annotations. We also demonstrate that the proposed SSA can achieve comparable performances to methods using full (100%) spurious attribute supervision, by using a much smaller number of annotated samples -- from 0.6% and up to 1.5%, depending on the dataset.

  • 4 authors
·
Apr 5, 2022

Assessing Algorithmic Bias in Language-Based Depression Detection: A Comparison of DNN and LLM Approaches

This paper investigates algorithmic bias in language-based models for automated depression detection, focusing on socio-demographic disparities related to gender and race/ethnicity. Models trained using deep neural networks (DNN) based embeddings are compared to few-shot learning approaches with large language models (LLMs), evaluating both performance and fairness on clinical interview transcripts from the Distress Analysis Interview Corpus/Wizard-of-Oz (DAIC-WOZ). To mitigate bias, fairness-aware loss functions are applied to DNN-based models, while in-context learning with varied prompt framing and shot counts is explored for LLMs. Results indicate that LLMs outperform DNN-based models in depression classification, particularly for underrepresented groups such as Hispanic participants. LLMs also exhibit reduced gender bias compared to DNN-based embeddings, though racial disparities persist. Among fairness-aware techniques for mitigating bias in DNN-based embeddings, the worst-group loss, which is designed to minimize loss for the worst-performing demographic group, achieves a better balance between performance and fairness. In contrast, the fairness-regularized loss minimizes loss across all groups but performs less effectively. In LLMs, guided prompting with ethical framing helps mitigate gender bias in the 1-shot setting. However, increasing the number of shots does not lead to further reductions in disparities. For race/ethnicity, neither prompting strategy nor increasing N in N-shot learning effectively reduces disparities.

  • 3 authors
·
Sep 30, 2025

Taming the Fragility of KV Cache Eviction in LLM Inference

Large language models have revolutionized natural language processing, yet their deployment remains hampered by the substantial memory and runtime overhead of the transformer's Key-Value cache. To mitigate this, recent methods employ a scoring-aggregation framework to evict unimportant cache entries, based on the stability assumption-that a fixed subset of entries remains consistently important during generation. However, prior work has largely focused on refining importance indicators for scoring, while defaulting to mean aggregation due to a faithful trust in the stability assumption. In this work, we argue that this underlying assumption is inherently fragile, making mean aggregation highly vulnerable in extreme cases. To counter this, we propose a simple yet elegant defensive aggregation strategy: a two-step, linear-time approach that controls worst-case risk, thereby defending against extreme cases with negligible computational overhead. Embodying this strategy, we propose a novel cache eviction method, DefensiveKV and its extension, Layer-DefensiveKV, which incorporates layer-wise budget allocation. Across seven task domains (18 datasets), our methods reduce generation quality loss by 2.3x and 4.3x respectively, versus the strongest baseline under a 20% cache size. These results set new performance benchmarks and pioneer a promising direction for optimizing cache eviction against underlying fragility through worst-case risk management. Our code is available at https://github.com/FFY0/DefensiveKV.

  • 5 authors
·
Oct 15, 2025