arXiv:2603.07431v2 Announce Type: replace-cross
Abstract: Transformer architectures excel at sequential modeling yet remain fundamentally limited by correlational learning – they capture spurious associations induced by latent confounders rather than invariant causal mechanisms. We identify this as an epistemological challenge: standard Transformers conflate static background factors (intrinsic identity, style, context) with dynamic causal flows (state evolution, mechanism), leading to catastrophic out-of-distribution failure. We propose OrthoFormer, a causally grounded architecture that embeds instrumental variable estimation directly into Transformer blocks via neural control functions. Our framework rests on four theoretical pillars: Structural Directionality (time-arrow enforcement), Representation Orthogonality (latent-noise separation), Causal Sparsity (Markov Blanket approximation), and End-to-End Consistency (gradient- detached stage separation). We prove that OrthoFormer achieves bias strictly less than OLS for any valid instrument lag, with residual bias decaying geometrically as O(rhok ). We characterize the bias-variance-exogeneity trilemma inherent in self-instrumenting and identify the neural forbidden regression – where removing gradient detachment improves prediction loss while destroying causal validity. Experiments confirm all theoretical predictions. OrthoFormer represents a paradigm shift from correlational to causal sequence modeling, with implications for robustness, interpretability, and reliable decision-making under distribution shift.
Unlocking electronic health records: a hybrid graph RAG approach to safe clinical AI for patient QA
IntroductionElectronic health record (EHR) systems present clinicians with vast repositories of clinical information, creating a significant cognitive burden where critical details are easily overlooked. While



