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Resolving the bias-precision paradox with stochastic causal representation learning for personalized medicine

2026-05-07 · Peisong Zhang, Manqiang Peng, Yuxuan Wu, Pawit Phadungsaksawasdi, Wesley Yeung, Ye Zhang, Trang Nguyen, Qiang Zhang, Nan Liu, Meng Wang, Kee Yuan Ngiam, Yih-Chung Tham, Ching-Yu Cheng, Tianfan Fu, Qingyu Chen, Rosemary Ke, Chang Li, Wenzhuo Yang, Zhenghao Lu, Chunyou Lai, Yu Zhang, Sheng Zhong, Hao Deng, Dianbo Liu arxiv

Estimating individualized treatment effects from longitudinal observational data is central to data-driven medicine, yet existing methods face a fundamental limitation: reducing confounding bias often suppresses clinically informative heterogeneity, degrading patient-specific predictions. Here, we identify this tension as a bias-precision paradox in causal representation learning and introduce sampling-based maximum mean discrepancy (sMMD), a stochastic alignment strategy that replaces global adversarial balancing with subset-level matching. We instantiate this approach in a framework for counterfactual outcome prediction with attribution-grounded interpretability. Across two large-scale ICU cohorts (n = 27,783), our framework improves accuracy under distribution shift, reducing error by up to 11.5% and substantially increasing recall in high-risk tasks. Mechanistic analyses show that sMMD selectively preserves clinically decisive variables. In human-AI evaluation, our method outperforms clinicians-in-training and large language models, and improves clinician accuracy by 14.7% while reducing decision time, enabling interpretable, real-time clinical decision support.

📄 PDF Abstract BibTeX arXiv:2605.05706

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