When drug discovery fails: scientists share their frustrations with the process
In clinical trials, there are many times (and ways) a therapeutic can come up short. In clinical trials, there are many times (and ways) a therapeutic can come up short.
Academic Intelligence · Curated Daily
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In clinical trials, there are many times (and ways) a therapeutic can come up short. In clinical trials, there are many times (and ways) a therapeutic can come up short.
arXiv:2606.16723v1 Announce Type: new Abstract: Large language model (LLM) agents increasingly take actions (screening applicants, recommending credit, triaging patients), yet fairness for LLMs is still measured by grading answers. We introduce AgentFairBench, a cheap, reproducible, multi-domain benchmark for demographic disparity in the actions of LLM agents. Grounded in a companion framework, the Bias Conduction Framework (BCF, restated here), it spans three regulator-anchored domains: hiring, lending, and medical triage. Synthetic, demographic-neutral profiles are evaluated in counterfactual matched sets that vary only a name-coded race x gender signal (in the Bertrand Mullainathan tradition), under four agent scaffolds of increasing agency (direct, chain-of-thought, multi-agent deliberation, tool-augmented). A NumPy-only harness computes counterfactual flip rate, mean absolute score difference (MASD), action-rate disparity, and tool-invocation disparity, with bootstrap confidence intervals, paired tests, and false-discovery-rate control, for single-digit dollars per model. A live leaderboard with a held-out private split and a contamination canary admits external models by submission. Our pilot (864 decisions plus a test-retest replication) carries a methodological lesson: comparing a six-group score spread against a two-run noise difference overstates disparity by ~ 2.4X through statistic arity alone. Against an arity matched noise floor and an omnibus group test, claude haiku 4 5 shows no demographic effect above sampling noise (0 of 120 pairwise and 0 of 9 omnibus contrasts survive correction); a planted-bias test confirms the instrument detects disparity when present. The contribution is a sound, sensitive, adoption-ready instrument, the arity matched null methodology, and open artifacts to scale it. Code, data, and harness are released under open licenses, with an anonymized review artifact.
arXiv:2606.19510v1 Announce Type: new Abstract: The Gorini–Kossakowski–Lindblad–Sudarshan (GKLS) equation describes irreversible quantum dynamical semigroups. We show that this description cannot be exact under physically regular energy conditions. We prove that the open-system survival probability under physically regular energy conditions has sublinear decay, whereas any dissipative GKLS semigroup has a linear short-time decay. Hence exact Markovian dissipation requires singular energy resources: an unbounded-below total Hamiltonian or infinite initial energy, and a divergent interaction-energy moment. Therefore, a dissipative time-independent GKLS equation should be regarded as an effective description rather than the exact reduced dynamics of a Hamiltonian dilation satisfying physically regular energy conditions.
arXiv:2606.19569v1 Announce Type: new Abstract: Uncertainty quantification (UQ) is essential for reliable decision-making in safety-critical applications in probabilistic machine learning. For regression problems, dominant scalar UQ approaches - notably, those based on proper scoring rules - measure uncertainty via pointwise predictive risk. This can lead to counterintuitive results when the target statistic is not the conditional expectation. We propose an alternative framework, in which uncertainty is characterised by the volume of the most probable subset of a distribution's support. QUEST (Quantifying Uncertainty via highest dEnSiTy regions) is a novel approach to UQ based on the concentration of Lebesgue measure at a distribution's peak(s), evaluated at one or more values of a robustness parameter $\alpha$. We establish connections between our measures and classical statistics from information theory and economics. We show that, unlike popular alternatives based on proper scoring rules, QUEST measures of epistemic and aleatoric uncertainty satisfy a set of axioms adapted from the UQ literature, including monotonicity under distributional spread and invariance to location shifts. Selective prediction benchmarks confirm that QUEST performs favourably against standard measures such as variance and differential entropy.
Next-token prediction has produced predictable scaling in language, but the recipe presumes a sequence of tokens with a meaningful order. Single-cell RNA-seq counts have no natural gene ordering, so applying the recipe directly to raw expression fails under an ill-suited left-to-right bias. We instead ask whether a learned latent can supply the structure the recipe needs. We introduce texttt{ExpressionVAE} (eVAE), a discrete-latent perturbation model that compresses each cell into a short sequence of discrete codes through a finite-scalar-quantization (FSQ) bottleneck and trains a perturbation-conditioned discrete prior over those codes. On Replogle and Parse~1M, eVAE sets a new state of the art on every distributional metric and leads on most cell-eval perturbation metrics, with Fr'echet distance and $mathrm{MMD}^2$ roughly $3$ to $20times$ lower than the strongest continuous-latent baseline. Swapping the prior between autoregressive and masked discrete diffusion leaves performance near-identical, isolating the gain to the discrete latent itself rather than the prior family. A decoder-head ablation then exposes a single design axis, the richness of the predictive distribution at inference, that splits the standard metrics into two groups, variance-sensitive and mean-sensitive, which move in opposite directions along the axis. Finally, on a held-out CRISPRi reversion benchmark of $1{,}732$ perturbations under inflammatory cytokine stress, the frozen eVAE encoder outperforms UMAP and differential expression and matches scGPT on perturbation ranking at a fraction of the data.
Recent diffusion editors perform diverse instruction-based edits while conditioning on the source image at every denoising step. Yet persistent source-image conditioning can limit how fully an edit is executed and how natural the result appears, especially when the target scene diverges substantially from the input. We introduce DuET (Dual Expert Trajectories), a training-free inference method that temporarily relaxes source-image conditioning by transitioning through a text-to-image phase before returning to edit mode, allowing the denoising trajectory to move toward the target distribution while retaining the structural benefits of image-conditioned editing. Without modifying model weights or increasing sampling cost, DuET consistently improves instruction relevance, semantic fidelity, and perceptual quality across diverse models and benchmarks. In some cases, these gains come with a modest reduction in source-image preservation, revealing a predictable trade-off between source preservation and edit fidelity.
The shift from Convolutional Neural Networks to Transformers has reshaped computer vision, yet these two architectural families are typically viewed as fundamentally distinct. Convolutional Neural Networks are defined by spatially local convolution operations, while Transformers rely on global self-attention. We argue that convolution and self-attention, despite their apparent differences, can be unified within a single k-nearest neighbor aggregation framework. The critical insight is that both operations are special cases of neighbor selection and weighted aggregation. Convolution selects neighbors by spatial proximity while self-attention selects by feature similarity, revealing that they lie on a continuous spectrum rather than representing categorically different computations. We introduce Convolutional Nearest Neighbors (ConvNN), a unified framework that formalizes this connection. ConvNN exactly recovers standard and depthwise convolution by restricting neighbor selection to normalized spatial coordinates, and exactly recovers self-attention and its sparse variants, including KVT-attention, by replacing spatial proximity with scaled dot-product similarity. Beyond these special cases, ConvNN serves as a drop-in replacement for both convolution and attention layers, enabling systematic exploration of the intermediate spectrum between local and global aggregation through configurable similarity functions, neighbor selection strategies, positional encodings, and aggregation kernels.
Persona-grounded dialogue systems aim to produce responses consistent with a speaker's persona, yet existing methods treat personas as a flat set of sentences and fail to model the high-order relations among persona attributes-e.g., that several persona sentences share a topical category. We propose HyPE (Hypergraph Persona Encoder), a framework that (i) analyzes each persona-bearing text as a (Core, Expression, Sentiment, Category) quadruple, and (ii) organizes persona elements into a hypergraph whose hyperedges are induced by shared category labels. An HyperGCN hypergraph neural network propagates this structure into a persona summary vector and a soft-memory bank that condition the response generator. We further propose Persistent Edge Embeddings (PEE), lightweight per-category learnable priors fused into the HyperGCN message-passing step. On PersonaChat under greedy decoding, HyPE consistently outperforms sentence-level pooling baselines across GPT-2, LLaMA-3.2-3B, and Qwen2.5-3B backbones by demonstrating that structured hyperedge-level persona encoding provides a transferable advantage across model scales.
arXiv:2604.23716v2 Announce Type: replace Abstract: Information-theoretic (IT) measures are ubiquitous in artificial intelligence: entropy drives decision-tree splits and uncertainty quantification, cross-entropy is the default classification loss, mutual information underpins representation learning and feature selection, and transfer entropy reveals directed influence in dynamical systems. A second, less consolidated family of measures, integrated information (Phi), effective information (EI), and autonomy, has emerged for characterizing agent complexity. Despite wide adoption, measure selection is often decoupled from estimator assumptions, failure modes, and safe inferential claims. This paper provides a practical decision framework for all seven measures, organized around three prescriptive questions for each: (i) what question does the measure answer and in which AI context; (ii) which estimator is appropriate for the data type and dimensionality; and (iii) what is the most dangerous misuse. The framework is operationalized in two complementary artifacts: a measure-selection flowchart and a master decision table. We cover both AI/ML and decision-making agent application domains per measure, with standardized Bridge Boxes linking IT quantities to cognitive constructs. Three worked examples illustrate the framework on concrete practitioner scenarios spanning representation learning, temporal influence analysis, and evolved agent complexity.
LLM agents in interactive environments are highly sensitive to their prompts, yet prompt engineering remains a manual, task-specific process. We introduce an automated prompt optimization framework for LLM agents that decomposes the observation-to-action pipeline into a goal-conditioned descriptor agent and an action selection agent, and iteratively refines each module's prompt through an LLM-driven evolutionary loop guided by environment returns. We propose a behavior analyzer to attribute episode outcomes to specific prompt components, and a mutator to propose targeted revisions to the prompt, before validating them through environment rollouts. We evaluate on all five BabyAI tasks in the BALROG benchmark, comparing our pipeline against BALROG's RobustCoTAgent under both plain and guided prompt initializations. Optimization improves performance consistently across tasks and conditions, without requiring updates to the model weights. On PutNext, a multi-step coordination task where the RobustCoTAgent achieves 0% success, our framework reaches up to 72.5% success rate using the same underlying LLM with optimized prompts. These results suggest that a multi-agent framework, combined with automatic prompt optimization, enhances LLMs without the need for fine-tuning or extensive human supervision.
arXiv:2606.13978v1 Announce Type: cross Abstract: This paper evaluates a signal-processing and supervised-learning pipeline for classifying SDSS DR17 astronomical spectra into stars, galaxies, and quasars. Each spectrum is represented by its measured flux and inverse-variance information, combining spectral shape with a wavelength-dependent reliability profile. After resampling onto a common logarithmic wavelength grid, the flux and inverse-variance vectors are standardized and separately compressed using principal component analysis. The resulting components are concatenated and used to train several classifiers. The best performance was obtained with the LightGBM gradient-boosting classifier, reaching $94.6\%$ accuracy and $92.1\%$ balanced accuracy on the test set.
Accurate identification of Pinus sylvestris var. mongolica plantations is important for monitoring afforestation quality and ecological restoration in northern Shaanxi. This paper proposes ROSA-TFormer, a radar-optical sensor-aware temporal Transformer for P. sylvestris classification using Sentinel-1/2 time-series data generated on Google Earth Engine. The model integrates separate SAR and optical embedding branches, a sensor-aware gate, and temporal attention pooling to capture multi-source seasonal features. Experiments on monthly and half-month point-level datasets show that ROSA-TFormer achieves strong classification performance, with 99.67% overall accuracy, 99.56% macro F1, and 98.91% P. sylvestris F1 on the HalfMonth-dataBig dataset. Spatial block validation and ablation results further indicate the effectiveness of radar-optical temporal fusion and sensor-aware modeling. The results demonstrate the potential of ROSA-TFormer for point-level P. sylvestris plantation classification, while broader wall-to-wall validation remains necessary.
arXiv:2602.03045v2 Announce Type: replace Abstract: Large language models have recently enabled text-to-CAD systems that synthesize parametric CAD programs (e.g., CadQuery) from natural-language prompts. In practice, however, geometric descriptions can be under-specified or internally inconsistent: critical dimensions may be missing and constraints may conflict. However, existing fine-tuned models tend to reactively follow the user instructions and hallucinate dimensions when the text is ambiguous. To address this, we propose a proactive agentic framework for text-to-CadQuery generation, named as ProCAD, that resolves specification issues before code synthesis. Our framework pairs a proactive clarifying agent, which audits the prompt and asks targeted clarification questions only when necessary to produce a self-consistent specification, with a CAD coding agent that translates the specification into an executable CadQuery program. We fine-tune the coding agent based on a curated high-quality text-to-CadQuery dataset and train the clarifying agent via agentic SFT on clarification trajectories. Experiments show that proactive clarification significantly improves robustness to ambiguous prompts while keeping interaction overhead low. ProCAD outperforms frontier closed-source models, including Claude Sonnet 4.5, reducing the mean Chamfer distance by 79.9% and lowering the invalidity ratio from 4.8% to 0.9%. Our code and datasets are made publicly available on https://github.com/BoYuanVisionary/Pro-CAD.
Vector quantization is central to modern generative modeling pipelines, but large-codebook VQ models often suffer from codebook collapse. We identify encoder drift as a key driver of this failure: as the encoder moves the latent distribution, sparsely updated code vectors can lag behind, lose assignments, and increase quantization error, creating a feedback loop through the straight-through estimator. We propose NSVQ, a non-stationary-aware VQ training strategy that combines a dense non-stationary embedding loss, codebook replacement, and stage-wise encoder freezing. NSVQ first helps the codebook track encoder drift during early training, then freezes the encoder to consolidate the codebook under a fixed latent geometry, and finally reintroduces adversarial refinement. Experiments on ImageNet-1k show that NSVQ improves reconstruction quality while maintaining full codebook utilization. On ImageNet-1k at 128$\times$128 with 65,536 codes, NSVQ reduces rFID from 2.39 to 2.10 compared with SimVQ, while both methods maintain 100\% utilization. Additional latent diffusion experiments show that NSVQ also improves downstream ImageNet generation FID.
arXiv:2606.17359v1 Announce Type: new Abstract: The stationary hydrogen atom has Coulomb degeneracy across orbital levels, whereas the Aufbau/Madelung ordering is an empirical, many-electron rule established in atomic physics. We examine the hydrogen atom through a regularized de Broglie–Bohm representation, in which stationary amplitude current constraints generate separable Sturm–Liouville branches. In this formulation, the radial, orbital, and magnetic sectors acquire canonical Langer-like inverse square corrections. The modified boundary value problems allow analytical solutions and produce a hydrogen-like spectrum with regularized radial and angular indices. Consequently, radial Coulomb quantization acquires an orbital dependent shift, lifting the Coulomb degeneracy and producing a spectral ordering that follows the Aufbau/Madelung sequence. On this basis, we construct the ordering of the regularized de Broglie–Bohm states and show that the spectral structure retains the standard degenerate Rydberg sequence in the l=0 sector. The separated amplitudes are represented by generalized special function branches, including the associated Laguerre, Legendre, and Bessel functions with non-integral parameters arising from regularized separation. Therefore, the treatment is intended as an analytical examination of spectral ordering in a regularized one center Coulomb problem rather than as a replacement for the many electron atomic structure theory. Keywords: de Broglie–Bohm representation; Coulomb spectrum; canonical regularization; Langer correction; Sturm–Liouville equations; Aufbau principle; Madelung ordering; associated Legendre functions; associated Laguerre functions; Bessel functions.
arXiv:2606.17099v1 Announce Type: cross Abstract: AI coding agents increasingly accept assigned software tasks, modify repositories under bounded authority, and return work packages for review. Prior work proposed the software delegation contract, covering the task, authority, returned work package, and acceptance context, as the unit of analysis for delegated coding work, but did not measure its effects. This paper reports a controlled pilot study of explicit delegation contracts for coding agents. We built a dependency-free TypeScript API task environment with seeded defects and documentation gaps, authored ten tasks across five families, and ran 64 agent executions across two model tiers under three conditions: a realistic issue-style prompt, an explicit delegation contract, and a contract with a required evidence bundle. Each run was scored with hidden acceptance tests, mutation checks, and scope analysis, then reviewed by three independent condition-blinded model-based reviewers using a fixed rubric, for 192 reviews. Explicit contracts did not improve objective task outcomes: all 64 runs passed hidden acceptance checks, with zero scope violations. They did improve reviewability. Evidence sufficiency improved in 22 of 30 paired comparisons and worsened in none (+0.83 on a 5-point scale, p < 0.0001, Cliff's delta = 0.66); reviewer ambiguity decreased (p = 0.035); changed-file lists, known-limitations sections, residual-risk sections, and reviewer checklists appeared mostly or only when demanded by the contract. Contracts cost +13% agent tokens and +38% wall-clock time, with larger effects for the weaker model tier. On these small tasks, delegation contracts bought reviewability rather than correctness.
Language models often solve complex tasks by generating long reasoning chains, consisting of many steps with varying importance. While some steps are crucial for generating the final answer, others are removable. Determining which steps matter most, and why, remains an open question central to understanding how models process reasoning. We investigate if this question is best approached through model internals or through tokens of the reasoning chain itself. We find that model activations contain more information than tokens for identifying important reasoning steps. Crucially, by training probes on model activations to predict importance, we show that models encode an internal representation of step importance, even prior to the generation of subsequent steps. The internal representations of importance in different models yield high agreement on which steps are important. The representation is distributed across layers, and does not correlate with surface-level features, such as a step's relative position or its length. Our findings suggest that analyzing activations can reveal aspects of reasoning that surface-level approaches fundamentally miss, indicating that reasoning analyses should look into model internals.
arXiv:2510.22397v2 Announce Type: replace-cross Abstract: Network operators monitor their infrastructure by collecting telemetry data such as packet counts, byte rates, or flow volumes, yet answering the questions that effective operations demand – forecasting future load, diagnosing and characterizing anomalies, and searching for and retrieving historical precedents – requires more than raw measurements. Bridging this gap calls for learned representations: compact per-entity summaries that capture temporal dynamics from each entity's univariate time series. Time-series foundation models are the natural starting point, but they are designed for dense, periodic benchmark datasets – the mild statistical regime. However, network telemetry data inhabits the wild regime: operationally relevant events are rare, separated by variable-length stretches of low or no activity (``ebbs''), with intermittent bursts of heavy-tailed extremes (``tides''). We present NetBurst, an event-centric pipeline that collapses ebbs, separates each time series into a stream of burst timings and a stream of burst magnitudes, and learns a single representation serving all three operational tasks. Compared to the strongest competitors among eight baselines – including Amazon's Chronos-2 and Datadog's Toto – and across nine production telemetry configurations, NetBurst reduces median forecasting error by $1.3$–$116\times$ on wild-regime data with a $1.0$–$7.5\times$ better match to the true burst distribution, and matches baselines on mild-regime benchmarks. For characterizing anomalies, NetBurst produces balanced, well-spread clusters that are $16\times$ more describable in operator-familiar terms under a novel interpretability score, and cluster-filtered search delivers $7.5\times$ faster end-to-end retrieval.
While recent advances in co-speech gesture generation have achieved impressive rhythmic synchronization, synthesizing gestures that are both semantically meaningful and faithful to a speaker's unique non-verbal style remains an open challenge. Semantic gestures, such as iconic shapes or deictic pointing, are statistically sparse, making them difficult to learn effectively within standard generative models. We present SiGnature, a framework for Stylized and Semantic Gesture generation that reconciles precise semantic control with high-fidelity style preservation. Unlike prevalent methods that rely on entangled latent representations, SiGnature operates in an explicit joint-rotation space. This design enables our core contribution, Joint Motion Integration (JMI), a training-free inference mechanism capable of injecting any external motion sequence, particularly in-the-wild semantic gestures, directly into the diffusion process. JMI automatically identifies the specific ``active joints'' conveying a semantic action and injects them into the generation, while relying on the diffusion backbone to synthesize the remaining body dynamics, including posture and flow, in accordance with the pre-learned style of the target speaker. This allows for the plug-and-play integration of arbitrary motions, including complex semantic gestures, without retraining or introducing the ``Frankenstein'' artifacts typical of cut-and-paste methods. Extensive experiments and perceptual studies demonstrate that SiGnature offers superior semantic motion control while maintaining smooth and natural co-speech gesture generation and preserving the distinct characteristics of the speaker, thereby outperforming state-of-the-art baselines.
arXiv:2606.11865v1 Announce Type: cross Abstract: Conformal Bayes combines Bayesian posterior predictives with conformal calibration to produce prediction sets that are both statistically valid and geometrically efficient. We study conformal Bayes under label shift from a unified perspective, identifying two complementary approaches that restore nominal target-domain coverage through importance-weighted conformal calibration but operate through independent mechanisms. Post-hoc calibration tilts the posterior predictive toward the target domain and corrects the conformal threshold via an importance-weighted quantile, leaving the parameter posterior unchanged. In-training adaptation tilts the parameter posterior itself to the target domain, producing a corrected predictive whose highest predictive density region serves as the highest predictive density (HPD) based prediction set under the fitted target predictive; efficiency is model-dependent and does not imply finite-sample conditional optimality. Two controlled experiments show that in an unbiased training regime both strategies achieve valid coverage equally, while in a lead-optimization regime in-training adaptation acts as a debiasing operator, reducing interval width at unchanged coverage.
arXiv:2606.11527v1 Announce Type: cross Abstract: Non-invertible symmetries in quantum many-body systems generally give rise to sequential unitary circuits that move symmetry defects. In this paper, we investigate invariants defined by sequences of such circuits, which move non-invertible defects and generate a Berry phase evaluated on quantum states with defects. We show that this Berry phase generally defines an invariant under local deformations, provided that the sequential circuits preserve the locality of those deformations. This invariant also rules out a short-range-entangled state that preserves the non-invertible symmetry, thereby signaling the 't Hooft anomaly of a non-invertible symmetry purely in terms of unitary operators acting on a state. We then apply this framework to loop excitations in three spatial dimensions and identify a new loop excitation in the (3+1)D $\mathbb{D}_4$ topological order, which we dub a non-Abelian fermionic loop. Using the invariant of sequential circuits, we characterize the statistics of non-Abelian fermionic loops. In addition, we find a new (3+1)D mixed topological order with a single non-Abelian fermionic loop, whose long-range entanglement is protected by an invariant of sequential circuits.
by Sahar Javaheri Tehrani, Toni Ingolf Gossmann Trainees in computational biology frequently inherit research plans whose aims, datasets, analytical strategies, and technical constraints were defined before their arrival. These plans often emerge from grants, collaborations, legacy codebases, shared high-performance computing environments, or partially completed analyses. While such plans provide a useful scaffold, they rarely specify all implementation details, prior assumptions, evaluation criteria, or dependencies needed for reliable execution. The transition from inheriting a partially articulated plan to producing reproducible results therefore creates an execution gap: a phase in which trainees must reconstruct what the project is, which elements are fixed, which remain negotiable, and which technical or organizational assumptions need to be tested before full-scale analysis begins. In this Ten Simple Rules article, we provide a practice-oriented framework for stabilizing inherited computational biology projects before workflows, benchmarks, and decision paths become entrenched. We do not claim that the individual practices described here are novel in isolation. Rather, our contribution is to organize familiar practices into a sequenced framework for a recurrent but under-articulated phase of computational research: inherited-plan execution. Computational biology makes this phase especially important because projects often combine heterogeneous datasets, fragile software environments, undocumented preprocessing choices, benchmarking assumptions, distributed collaborators, and asymmetrical access to contextual knowledge. By making this transition visible and operational, the rules aim to help trainees, supervisors, and collaborators reduce ambiguity, test feasibility, document decisions, and support reproducible and equitable project execution under real-world constraints.
We propose SpectralDiT, a lightweight modification to flow-matching Diffusion Transformers that adds timestep-conditioned spectral correction to the MLP residual branch. The module decomposes each residual update into low- and high-frequency components on the patch-token grid, then learns a zero-initialized additive gate so the model initially matches the baseline DiT. On CIFAR-10 pixel-space generation, SpectralDiT improves FID from 20.78 to 19.71 at patch size 1 and reduces the radial Fourier spectrum gap. Furthermore, we scale our method to latent diffusion on ImageNet-100. With 0.6% additional theoretical FLOPs and 1.36% additional parameters, SpectralDiT improves latent flow-matching, achieving an 8.7% relative FID reduction under classifier-free guidance (CFG 2.0). All reported results are averaged over five seeds. Ablations and gate visualizations on CIFAR-10 reveal stable block-specific spectral correction patterns.
Long-term mortality rates after endovascular aneurysm repair (EVAR) remain elevated due to post-EVAR rupture caused by loss of seal in stent graft sealing zones. Structured CT review using centerline measurements improves detection, but current workflows require manual centerline editing and expert operators. We propose a transformer framework for automated, protocol-driven sealing zone assessment that combines 3D centerline tracking with embedding-based geometric prediction. Two state-of-the-art image-to-graph models are evaluated for aorto-iliac centerline extraction from follow-up CT and for measurement of stent position, vessel diameters, and seal lengths according to EVAR4C protocol. Across the full test set and a challenging no-contrast subset, the proposed fully automatic method outperforms the commercial semi-automatic workflow.
Automated International Classification of Diseases (ICD) coding is a core medical-coding task for billing, epidemiology, and clinical decision support. Generative large language models (LLMs) are often reported as weak medical coders, but this finding mainly comes from inference-time settings such as prompting, retrieval, reranking, or tool use, leaving the role of task-specific post-training underexplored. We present a controlled empirical study of post-training for generative ICD coding, comparing discriminative baselines with LLM coders across prompting, supervised fine-tuning, and reinforcement learning under a common protocol and metric set. To our knowledge, this is the first study to evaluate RL-based post-training for generative LLM coders in ICD coding. We further introduce PHI, a diagnostic curriculum that extends GRPO to refine missed-code cases. Our results show that prompting-only evaluation substantially underestimates the potential of LLMs for ICD coding. SFT provides the main capability jump, GRPO further improves code-set prediction beyond SFT, and PHI provides targeted gains on macro-level performance. These findings suggest that the main bottleneck is not the generative formulation alone, but how the model is adapted and optimized for full-taxonomy recall. We release our code, data splits, and checkpoints at https://github.com/AlexandreWANG915/LLM4ICD.