If possible, you should write a critical response to this paper, focusing on its methodological flaws, and send it to the editors. It doesn't have to be long; critical response are usually a couple pages at most. This is likely the most effective way of removing (or at the very least, heavily qualifying) bad science from research journals.
If the authors actually wanted to do good ML research, they could always have reached out to a decent ML researcher who could have told them all of this. There's no shortage of us. The journal could have reached out to an ML reviewer. Why wouldn't they? But no one did, because the results look good and so they send it off to press and it's good for both the authors and the journal to have something that is hype-worthy. It's just the sad reality of modern science.
Any chance we could connect over email or something?
Do you mean this literally or is this a metaphor to illustrate the point? If you actually mean most papers are false it'd be nice to see a link on that!
https://www.annualreviews.org/doi/abs/10.1146/annurev-statis...
http://frog.gatech.edu/Pubs/How-to-Publish-a-Scientific-Comm...
I agree that a formal comment is best although not necessarily easy. A comment on PubPeer is easier but it will probably only be seen by those with the PubPeer extension.
I do machine learning in computational biology and cancer. The issues described in the parent comment are known among experts. It’s too bad so many others don’t know or care.
Not balancing and using ROC is a terrible combo, but the metric is the problem, not the lack of artificial balance.
The imbalance is totally artificial and objectionable though. Where's the evidence that doctors see a 80/20 split in real life? If there is going to be an imbalance they should make it reflect the actual statistics of the task that the doctors perform not some artificial number. It doesn't even reflect the statistics of the dataset they started with (which is 90/10 unblanaced).
Admittedly, the correct analysis for when the data is unbalanced is more annoying and ROC curves are easier to interpret. That's why in something like ImageNet even though the training set is imbalanced, the test set is is balanced.
Comparisons against humans are also harder when the data is imbalanced in a way that reflects the training set, not the task. Humans don't know they are supposed to say "no" 80% of the time. That rewards the machine and that isn't easy to correct (you can correct what you think about the machine results with respect to a baseline, but not what biases the humans had).
Cause they definitely don’t. Even in a select subpopulation - say, people going to a derm for screening - you’d expect one melanoma per 620 persons screened (as per the SCREEN trial). Since most people have more than one mole for evaluation, and even those with melanoma will have multiple innocent moles... a mole count >50 triggers a referral for screening, though in more cautious docs, possibly as few as 25...
If you wanna be really generous and consider our hypothetical high risk group to have an average of 10 moles per person, that’s 6209:1, not 80:20.
EDIT: I'll add that the ratio of positives to negatives in the training set is irrelevant and in no way invalidates the study. As far as testing goes, there is always a balance you must strike in a reader study involving doctors. Ideally, you would have the exact ratio a doctor would encounter in practice, but for a screening study, that is typically impractical as you would need a huge number of cases and doctor time is expensive. A ratio of 1 positive to 4 negatives is entirely reasonable, although the doctors (particularly the less experienced ones) will almost certainly have an elevated sensitivity and reduced specificity since they will know it is an enriched set, but this is reasonable for ROC comparison purposes as it mostly just selects a different point on the doctor's personal ROC curve. Note that some studies even tell the doctors beforehand what percentage of cases are positive.
My understanding is the PR curve is preferable to ROC since the ROC can make it difficult to discern differences between models on imbalanced data; but the ROC is still a valid way to compare/measure models.
The train/test data being imbalanced in the same way does give the model an advantage, but I don't think that making the test set 50% would solve the issue completely either. Doctors have been "trained" on the true distribution, while which is not 50% (I'd guess that the true distribution is actually extremely unbalanced).
The model isn't simply learning to predict no 80% of the time, it is learning the distribution of the data with respect to the input features. For example, let's say that we have a simple model with only 3 binary features. It may learn that when features X_0, X_1 and X_2 are 1, the probability of cancer is 70%. This isn't a simple multiplication of the true probability by the upscaling factor though--it depends on the percent of negative samples with this feature vector and the percent of positive samples with this feature vector.
If we are to change the test set to be 50% positive and keep the same train distribution, the model no longer has the correct information about cancer rates with respect to feature distributions, but neither does the dermatologist. The specificity and sensitivity continue to not be interpretable as predicted specificity and sensitivity in the real world.
There is no issue with reporting specificity/sensitivity if they had used the true distribution of cases. Yes, the curves/AUCs will look better than the precision/recall rates, but they do not mis-represent what the doctors are interested in (what percent of people will be missed, and what percent of healthy people will be subjected to unnecessary procedures).
Anyways, the classifier doesn't actually seem to be that good, there's actually doctors that were better than the classifiers if you check the paper.
Also, please explain the problem with using ROC here. The probabilistic interpretation of ROC's AUC is the probability of correctly ranking a random mixed pair (i.e. ranking the positive example higher than a negative one). How is that metric affected by the 80/20 split of the test data? Genuinely curios here...
Why should it be balanced? It should be the expected natural clinical class distribution, no? The humans have priors about this too. If anything, it should be more imbalanced, as I would guess (I would hope!) that less than 20% of scans are malignant.
I wish they added this context in the limitations section. The paper only says:
"There are some limitations to this system. It remains an open question whether the design of the questionnaire had any influence on the performance of the dermatologists compared with clinical settings. Furthermore, clinical encounters with actual patients provide more information than that can be provided by images alone. Hänßle et al. showed that additional clinical data improve the sensitivity and specificity of dermatologists slightly [5]. Machine learning techniques can also include this information in their decisions. However, even with this slight improvement, the CNN would still outperform the dermatologists."
Your points hit on validity issues. Where would it fit on the errors of omission/commission scale?
Your first two suggestions combined together are very wrong. If you made the test dataset balanced and then measured PR curve the precision would be way too optimistic as it is directly affected by the class imbalance. ROC curve on the other hand is invariant to the test set imbalance.
You can find interesting this short article I have written about this problem: https://arxiv.org/abs/1812.01388
A̶F̶A̶I̶K̶,̶ ̶a̶ ̶R̶O̶C̶ ̶c̶u̶r̶v̶e̶ ̶c̶a̶n̶ ̶b̶e̶ ̶m̶i̶s̶l̶e̶a̶d̶i̶n̶g̶ ̶f̶o̶r̶ ̶a̶n̶ ̶i̶m̶b̶a̶l̶a̶n̶c̶e̶d̶ ̶d̶a̶t̶a̶s̶e̶t̶,̶ ̶b̶u̶t̶ ̶t̶h̶e̶ ̶A̶U̶C̶ ̶i̶s̶ ̶s̶t̶i̶l̶l̶ ̶o̶k̶a̶y̶ ̶f̶o̶r̶ ̶s̶e̶l̶e̶c̶t̶i̶n̶g̶ ̶m̶o̶d̶e̶l̶s̶.̶ Edit: This is incorrect, a PR curve + PR AUC should be used for model selection if imbalanced. I agree it would be really misleading if they (say) just reported accuracy (since the null classifier of always guess negative would give 80% overall accuracy). I̶ ̶t̶h̶o̶u̶g̶h̶t̶ ̶t̶h̶a̶t̶ ̶t̶h̶e̶ ̶A̶U̶C̶ ̶f̶o̶r̶ ̶R̶O̶C̶ ̶c̶u̶r̶v̶e̶ ̶s̶h̶o̶u̶l̶d̶ ̶s̶t̶i̶l̶l̶ ̶b̶e̶ ̶a̶ ̶v̶a̶l̶i̶d̶ ̶m̶e̶a̶s̶u̶r̶e̶ ̶s̶i̶n̶c̶e̶ ̶i̶t̶'̶s̶ ̶s̶h̶o̶w̶i̶n̶g̶ ̶h̶o̶w̶ ̶m̶u̶c̶h̶ ̶b̶e̶t̶t̶e̶r̶ ̶t̶h̶e̶ ̶m̶o̶d̶e̶l̶ ̶p̶e̶r̶f̶o̶r̶m̶s̶ ̶t̶h̶a̶n̶ ̶r̶a̶n̶d̶o̶m̶ ̶g̶u̶e̶s̶s̶i̶n̶g̶.̶
How do you usually handle imbalanced data? I've had some success with SMOTE or weighted loss for imbalanced datasets, but I'm embarrassed to say I've been using AUC with ROC curves as the default - if this gives inferior model selection than AUC with PR curve I'll have to start doing that instead.
But sensitivity and recall are the same thing...
* They give the network is huge advantage: they teach it that it should say "no" 80% of the time. The training data is unbalanced (80% no vs 20% yes) as is the test data. Of course it does well! I don't care what they do at training time, but the test data should be balanced or they should correct for this in the analysis.
* They measure the wrong things that reward the network. Because the dataset is imbalanced you can't use an ROC curve, sensitivity, or specificity. You need to use precision and recall and make a PR curve. This is machine learning and stats 101.
* They measure the wrong thing about humans. What a doctor does is they decide how confident they are and then they refer you to a biopsy. They don't eyeball it and go "looks fine" or "it's bad". They should measure how often this leads to a referral, and they'll see totally different results. There's a long history in papers like this of defining a bad task and then saying that humans can't do it.
* They have a biased sample of doctors that is highly skewed toward people with no experience. Look at figure 1. A lot of those doctors have about as much experience to detect melanoma as you do. They just don't do this task.
* "Electronic questionnaire"s are a junk way of gathering data for this task. Doctors are busy. What tells the authors that they're going to be as careful for this task as with a real patient? Real patients also have histories, etc.
I could go on. The number of problems with this paper is just interminable (54% of their images were non-cancer because a bunch of people looked at them. If people are so wrong, why are they trusting these images? I would only trust biopsies).
This isn't coming to a doctor's office anywhere near you. It's just a publicity stunt by clueless people. Please collaborate with some ML folks before publishing work like this! There are so many of us!