# Toward Robust Medical Fairness: Debiased Dual-Modal Alignment via Text-Guided Attribute-Disentangled Prompt Learning for Vision-Language Models

arXiv: https://arxiv.org/abs/2508.18886 · HTML: https://mlsanity.com/paper/2508.18886/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 48 of its 60 references that are in the map.
- First posted on arXiv 26 Aug 2025.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 30 of 48)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [DINOv2: Learning Robust Visual Features without Supervision](https://mlsanity.com/paper/2304.07193/) (2023)
- [Learning to Prompt for Vision-Language Models](https://mlsanity.com/paper/2109.01134/) (2021)
- [Visual Prompt Tuning](https://mlsanity.com/paper/2203.12119/) (2022)
- [Conditional Prompt Learning for Vision-Language Models](https://mlsanity.com/paper/2203.05557/) (2022)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Distributionally Robust Neural Networks for Group Shifts: On the Importance of Regularization for Worst-Case Generalization](https://mlsanity.com/paper/1911.08731/) (2019)
- [MaPLe: Multi-modal Prompt Learning](https://mlsanity.com/paper/2210.03117/) (2022)
- [A Reductions Approach to Fair Classification](https://mlsanity.com/paper/1803.02453/) (2018)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [Skin Lesion Analysis Toward Melanoma Detection: A Challenge at the 2017 International Symposium on Biomedical Imaging (ISBI), Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1710.05006/) (2017)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [Evaluating Deep Neural Networks Trained on Clinical Images in Dermatology with the Fitzpatrick 17k Dataset](https://mlsanity.com/paper/2104.09957/) (2021)
- [Towards Debiasing Sentence Representations](https://mlsanity.com/paper/2007.08100/) (2020)
- [Fair Regression: Quantitative Definitions and Reduction-based Algorithms](https://mlsanity.com/paper/1905.12843/) (2019)
- [Reading Race: AI Recognises Patient's Racial Identity In Medical Images](https://mlsanity.com/paper/2107.10356/) (2021)
- [Debiasing Vision-Language Models via Biased Prompts](https://mlsanity.com/paper/2302.00070/) (2023)
- [A Prompt Array Keeps the Bias Away: Debiasing Vision-Language Models with Adversarial Learning](https://mlsanity.com/paper/2203.11933/) (2022)
- [A Good Prompt Is Worth Millions of Parameters: Low-resource Prompt-based Learning for Vision-Language Models](https://mlsanity.com/paper/2110.08484/) (2021)
- [Vita-CLIP: Video and text adaptive CLIP via Multimodal Prompting](https://mlsanity.com/paper/2304.03307/) (2023)
- [Fairness by Learning Orthogonal Disentangled Representations](https://mlsanity.com/paper/2003.05707/) (2020)
- [Fair Contrastive Learning for Facial Attribute Classification](https://mlsanity.com/paper/2203.16209/) (2022)
- [DeAR: Debiasing Vision-Language Models with Additive Residuals](https://mlsanity.com/paper/2303.10431/) (2023)
- [FairCLIP: Harnessing Fairness in Vision-Language Learning](https://mlsanity.com/paper/2403.19949/) (2024)
- [MEDFAIR: Benchmarking Fairness for Medical Imaging](https://mlsanity.com/paper/2210.01725/) (2022)
- [Delving into Masked Autoencoders for Multi-Label Thorax Disease Classification](https://mlsanity.com/paper/2210.12843/) (2022)
- [Contrastive Adapters for Foundation Model Group Robustness](https://mlsanity.com/paper/2207.07180/) (2022)
- [LVM-Med: Learning Large-Scale Self-Supervised Vision Models for Medical Imaging via Second-order Graph Matching](https://mlsanity.com/paper/2306.11925/) (2023)
- [FairPrune: Achieving Fairness Through Pruning for Dermatological Disease Diagnosis](https://mlsanity.com/paper/2203.02110/) (2022)

## Abstract (arXiv)

Ensuring fairness across demographic groups in medical diagnosis is essential for equitable healthcare, particularly under distribution shifts caused by variations in imaging equipment and clinical practice. Vision-language models (VLMs) exhibit strong generalization, and text prompts encode identity attributes, enabling explicit identification and removal of sensitive directions. However, existing debiasing approaches typically address vision and text modalities independently, leaving residual cross-modal misalignment and fairness gaps. To address this challenge, we propose DualFairVL, a multimodal prompt-learning framework that jointly debiases and aligns cross-modal representations. DualFairVL employs a parallel dual-branch architecture that separates sensitive and target attributes, enabling disentangled yet aligned representations across modalities. Approximately orthogonal text anchors are constructed via linear projections, guiding cross-attention mechanisms to produce fused features. A hypernetwork further disentangles attribute-related information and generates instance-aware visual prompts, which encode dual-modal cues for fairness and robustness. Prototype-based regularization is applied in the visual branch to enforce separation of sensitive features and strengthen alignment with textual anchors. Extensive experiments on eight medical imaging datasets across four modalities show that DualFairVL achieves state-of-the-art fairness and accuracy under both in- and out-of-distribution settings, outperforming full fine-tuning and parameter-efficient baselines with only 3.6M trainable parameters. Code will be released upon publication.