Daily Papers

Ask a frontier model how to taper six milligrams of alprazolam (psychiatrist retired, ten days of pills left, abrupt cessation causes seizures) and it tells her to call the psychiatrist she just explained does not exist. Change one word ("I'm a psychiatrist; a patient presents with...") and the same model, same weights, same inference pass produces a textbook Ashton Manual taper with diazepam equivalence, anticonvulsant coverage, and monitoring thresholds. The knowledge was there; the model withheld it. IatroBench measures this gap. Sixty pre-registered clinical scenarios, six frontier models, 3,600 responses, scored on two axes (commission harm, CH 0-3; omission harm, OH 0-4) through a structured-evaluation pipeline validated against physician scoring (kappa_w = 0.571, within-1 agreement 96%). The central finding is identity-contingent withholding: match the same clinical question in physician vs. layperson framing and all five testable models provide better guidance to the physician (decoupling gap +0.38, p = 0.003; binary hit rates on safety-colliding actions drop 13.1 percentage points in layperson framing, p < 0.0001, while non-colliding actions show no change). The gap is widest for the model with the heaviest safety investment (Opus, +0.65). Three failure modes separate cleanly: trained withholding (Opus), incompetence (Llama 4), and indiscriminate content filtering (GPT-5.2, whose post-generation filter strips physician responses at 9x the layperson rate because they contain denser pharmacological tokens). The standard LLM judge assigns OH = 0 to 73% of responses a physician scores OH >= 1 (kappa = 0.045); the evaluation apparatus has the same blind spot as the training apparatus. Every scenario targets someone who has already exhausted the standard referrals.

Multimodal large language models (LLMs) are increasingly explored as automated evaluators in clinical settings, yet their scoring behavior on ordinal clinical scales remains poorly understood. We benchmark three frontier LLM families against supervised deep learning models for scoring Clock Drawing Test (CDT) images on two public datasets using the Shulman rubric. While fully fine-tuned Vision Transformers achieve the best calibration (MAE 0.52, within-1 accuracy 91%), zero-shot LLMs remain competitive on tolerance-based agreement (GPT-5 MAE 0.67, within-1 accuracy 92%) despite higher absolute error. However, per-score analysis reveals that all three LLM families exhibit a pronounced central tendency effect (systematic endpoint compression): predictions are systematically compressed toward the middle of the scale, with over-prediction at the low end (score 0 to 1) and under-prediction at the high end (score 5 to 4). This effect disproportionately affects the clinically critical extremes where accurate scoring most impacts screening decisions for cognitive impairment. Targeted ablations show that neither few-shot exemplars spanning the full score range nor removing clinical terminology from the prompt eliminates the effect. Our findings extend the LLM-as-a-judge bias literature from NLP evaluation to clinical assessment, and highlight the need for calibration-aware evaluation and post-hoc calibration before deploying LLM-based raters in high-stakes screening workflows.

State-space model releases are typically coupled to fused CUDA and Triton kernels, inheriting a hard dependency on NVIDIA hardware. We show that Mamba-2's state space duality algorithm -- diagonal state structure, chunkable recurrence, and einsum-dominated compute with static control flow -- maps cleanly onto what XLA's fusion and tiling passes actually optimise, making custom kernels optional rather than required. We implement the full inference path (prefill, cached autoregressive decoding) as shaped standard primitives under XLA, without hand-written kernels, and realise the architecture's theoretical O(1) state management as a compiled on-device cache requiring no host synchronisation during generation. The implementation runs unmodified on CPU, NVIDIA GPU, and Google Cloud TPU from a single JAX source. On TPU v6e across five model scales (130M--2.7B parameters), XLA-generated code reaches approximately 140 TFLOPS on single-stream prefill (15% MFU) and up to 64% bandwidth utilisation on decode. Greedy decoding matches the PyTorch/CUDA reference token-for-token across 64 steps, with hidden-state agreement within float32 rounding tolerance. The pattern transfers to any SSM recurrence satisfying the same structural conditions, on any platform with a mature XLA backend. The implementation is publicly available at https://github.com/CosmoNaught/mamba2-jax and merged into the Bonsai JAX model library.