Medical Vision-Language Pre-training (MedVLP) has made significant progress in enabling zero-shot tasks for medical image understanding. However, training MedVLP models typically requires large-scale datasets with paired, high-quality image-text data, which are scarce in the medical domain. Recent advancements in Large Language Models (LLMs) and diffusion models have made it possible to generate large-scale synthetic image-text pairs. This raises the question: Can MedVLP succeed using purely synthetic data? To address this, we use off-the-shelf generative models to create synthetic radiology reports and paired Chest X-ray (CXR) images, and propose an automated pipeline to build a diverse, high-quality synthetic dataset, enabling a rigorous study that isolates model and training settings, focusing entirely from the data perspective.Our results show that MedVLP models trained exclusively on synthetic data outperform those trained on real data by 3.8% in averaged AUC on zero-shot classification. Moreover, using a combination of synthetic and real data leads to a further improvement of 9.07%. Additionally, MedVLP models trained on synthetic or mixed data consistently outperform those trained on real data in zero-shot grounding, as well as in fine-tuned classification and segmentation tasks.Our analysis suggests MedVLP trained on well-designed synthetic data can outperform models trained on real datasets, which may be limited by low-quality samples and long-tailed distributions[^1].[^1]: All data and code will be released upon acceptance.

Large Language Models (LLMs) often hallucinate, producing unfaithful or factually incorrect outputs by misrepresenting the provided context or incorrectly recalling internal knowledge. Recent studies have identified specific attention heads within the Transformer architecture, known as retrieval heads, responsible for extracting relevant contextual information. We hypothesise that masking these retrieval heads can induce hallucinations and that contrasting the outputs of the base LLM and the masked LLM can reduce hallucinations. To this end, we propose Decoding by Contrasting Retrieval Heads (DeCoRe), a novel training-free decoding strategy that amplifies information found in the context and model parameters. DeCoRe mitigates potentially hallucinated responses by dynamically contrasting the outputs of the base LLM and the masked LLM, using conditional entropy as a guide. Our extensive experiments confirm that DeCoRe improves performance on tasks requiring high contextual faithfulness, such as summarisation (XSum by 18.6%), instruction following (MemoTrap by 10.9%), and open-book question answering (NQ-Open by 2.4% and NQ-Swap by 5.5%).