Perspective on Bias in Biomedical AI: Preventing Downstream Healthcare Disparities

Healthcare disparities persist across socioeconomic boundaries, often attributed to unequal access to screening, diagnostics, and therapeutics. However, this perspective highlights that critical biases can emerge much earlier, during data collection and research prioritization, long before clinical implementation, particularly in studies focused on molecular and omics data. A vast number of studies focus on collecting omics data, but the demographic information associated with these datasets is often not reported, and when it is reported, it reveals substantial biases. An automated analysis of 4514 PubMed-indexed omics publications from 2015 to 2024, examining reporting across multiple demographic dimensions, reveals limited reporting overall; for example, only 2.7% of studies report ancestry or ethnicity information and geographic origin reporting is limited to 2.5%. Analysis of large-scale datasets commonly used for model training, such as CellxGene and GEO, reveals substantial population bias where European-ancestry data dominates. As biomedical foundation models become central to biomedical discovery with a paradigm in which base models are pretrained on large datasets and reusing them repeatedly for many different downstream tasks, they risk perpetuating or amplifying these early-stage biases, leading to cascading inequities that regulatory interventions cannot fully reverse. We propose a community-wide focus on three foundational principles: Provenance, Openness, and Reliability through Evaluation Transparency. Together, these principles can help make biases and limitations more visible to model developers and users, supporting more informed model development, evaluation, and deployment decisions in biomedical AI.