The bias is in the generator: locating medical chain-of-thought subgroup gaps upstream of the verifier

Micky C. Nnamdi, Benoit Louis Marteau, Shaun Qien Yeau Tan, J. Ben Tamo, Yining Yuan, May Dongmei Wang


Abstract
Verifier-guided best-of-N decoding has two stages: a generator samples candidate chains of thought, and a verifier selects among them. A subgroup disparity may already be present in the generator’s candidates or be amplified during selection. We separate the two stages using adversarial demographic counterfactuals of medical exam questions. On HuatuoGPT-o1-8B, a substantial race accuracy gap is already present in a single sampled response, before verifier selection. Across seven generators, only Gemma-3-27B-it under Skywork-RM shows significant verifier-induced amplification after multiple-testing correction. Even an oracle selector leaves a residual gap on every medical generator analyzed, showing that correct answers are less often available for one subgroup. Counterfactually paired low-rank adaptation (LoRA) of the generator reduces the single-sample gap on two medical models, although on HuatuoGPT-o1-8B the reduction does not persist after self-judge selection. Single-variant controls indicate that the single-sample reduction is not explained by additional training steps alone. A short fairness instruction modestly reduces the single-sample gap, and a direct preference optimization (DPO) variant of the paired training also reduces it and, on HuatuoGPT-o1-8B, keeps race mention near its baseline rate. For the medical generators studied, candidate generation rather than inference-time selection is the primary locus for mitigating this gap.
Anthology ID:
2026.aacl-long.224
Volume:
Proceedings of the 15th International Joint Conference on Natural Language Processing and the 5th Conference of the Asia-Pacific Chapter of the Association for Computational Linguistics (Volume 1: Long Papers)
Month:
November
Year:
2026
Address:
Hengqin, China
Editors:
Yue Zhang, Ruifeng Xu, Ayu Purwarianti, Tong Rong, Jun Suzuki
Venues:
AACL | IJCNLP
SIG:
Publisher:
Association for Computational Linguistics
Note:
Pages:
5027–5050
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URL:
https://aclanthology.org/2026.aacl-long.224/
DOI:
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Cite (ACL):
Micky C. Nnamdi, Benoit Louis Marteau, Shaun Qien Yeau Tan, J. Ben Tamo, Yining Yuan, and May Dongmei Wang. 2026. The bias is in the generator: locating medical chain-of-thought subgroup gaps upstream of the verifier. In Proceedings of the 15th International Joint Conference on Natural Language Processing and the 5th Conference of the Asia-Pacific Chapter of the Association for Computational Linguistics (Volume 1: Long Papers), pages 5027–5050, Hengqin, China. Association for Computational Linguistics.
Cite (Informal):
The bias is in the generator: locating medical chain-of-thought subgroup gaps upstream of the verifier (Nnamdi et al., AACL-IJCNLP 2026)
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https://aclanthology.org/2026.aacl-long.224.pdf