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byAK and the research community

Aug 19

Large Language Models Encode Clinical Knowledge

Large language models (LLMs) have demonstrated impressive capabilities in natural language understanding and generation, but the quality bar for medical and clinical applications is high. Today, attempts to assess models' clinical knowledge typically rely on automated evaluations on limited benchmarks. There is no standard to evaluate model predictions and reasoning across a breadth of tasks. To address this, we present MultiMedQA, a benchmark combining six existing open question answering datasets spanning professional medical exams, research, and consumer queries; and HealthSearchQA, a new free-response dataset of medical questions searched online. We propose a framework for human evaluation of model answers along multiple axes including factuality, precision, possible harm, and bias. In addition, we evaluate PaLM (a 540-billion parameter LLM) and its instruction-tuned variant, Flan-PaLM, on MultiMedQA. Using a combination of prompting strategies, Flan-PaLM achieves state-of-the-art accuracy on every MultiMedQA multiple-choice dataset (MedQA, MedMCQA, PubMedQA, MMLU clinical topics), including 67.6% accuracy on MedQA (US Medical License Exam questions), surpassing prior state-of-the-art by over 17%. However, human evaluation reveals key gaps in Flan-PaLM responses. To resolve this we introduce instruction prompt tuning, a parameter-efficient approach for aligning LLMs to new domains using a few exemplars. The resulting model, Med-PaLM, performs encouragingly, but remains inferior to clinicians. We show that comprehension, recall of knowledge, and medical reasoning improve with model scale and instruction prompt tuning, suggesting the potential utility of LLMs in medicine. Our human evaluations reveal important limitations of today's models, reinforcing the importance of both evaluation frameworks and method development in creating safe, helpful LLM models for clinical applications.

A Toolbox for Surfacing Health Equity Harms and Biases in Large Language Models

Large language models (LLMs) hold immense promise to serve complex health information needs but also have the potential to introduce harm and exacerbate health disparities. Reliably evaluating equity-related model failures is a critical step toward developing systems that promote health equity. In this work, we present resources and methodologies for surfacing biases with potential to precipitate equity-related harms in long-form, LLM-generated answers to medical questions and then conduct an empirical case study with Med-PaLM 2, resulting in the largest human evaluation study in this area to date. Our contributions include a multifactorial framework for human assessment of LLM-generated answers for biases, and EquityMedQA, a collection of seven newly-released datasets comprising both manually-curated and LLM-generated questions enriched for adversarial queries. Both our human assessment framework and dataset design process are grounded in an iterative participatory approach and review of possible biases in Med-PaLM 2 answers to adversarial queries. Through our empirical study, we find that the use of a collection of datasets curated through a variety of methodologies, coupled with a thorough evaluation protocol that leverages multiple assessment rubric designs and diverse rater groups, surfaces biases that may be missed via narrower evaluation approaches. Our experience underscores the importance of using diverse assessment methodologies and involving raters of varying backgrounds and expertise. We emphasize that while our framework can identify specific forms of bias, it is not sufficient to holistically assess whether the deployment of an AI system promotes equitable health outcomes. We hope the broader community leverages and builds on these tools and methods towards realizing a shared goal of LLMs that promote accessible and equitable healthcare for all.

A Forgotten Danger in DNN Supervision Testing: Generating and Detecting True Ambiguity

Deep Neural Networks (DNNs) are becoming a crucial component of modern software systems, but they are prone to fail under conditions that are different from the ones observed during training (out-of-distribution inputs) or on inputs that are truly ambiguous, i.e., inputs that admit multiple classes with nonzero probability in their ground truth labels. Recent work proposed DNN supervisors to detect high-uncertainty inputs before their possible misclassification leads to any harm. To test and compare the capabilities of DNN supervisors, researchers proposed test generation techniques, to focus the testing effort on high-uncertainty inputs that should be recognized as anomalous by supervisors. However, existing test generators can only produce out-of-distribution inputs. No existing model- and supervisor-independent technique supports the generation of truly ambiguous test inputs. In this paper, we propose a novel way to generate ambiguous inputs to test DNN supervisors and used it to empirically compare several existing supervisor techniques. In particular, we propose AmbiGuess to generate ambiguous samples for image classification problems. AmbiGuess is based on gradient-guided sampling in the latent space of a regularized adversarial autoencoder. Moreover, we conducted what is - to the best of our knowledge - the most extensive comparative study of DNN supervisors, considering their capabilities to detect 4 distinct types of high-uncertainty inputs, including truly ambiguous ones.

Model Tampering Attacks Enable More Rigorous Evaluations of LLM Capabilities

Evaluations of large language model (LLM) risks and capabilities are increasingly being incorporated into AI risk management and governance frameworks. Currently, most risk evaluations are conducted by designing inputs that elicit harmful behaviors from the system. However, a fundamental limitation of this approach is that the harmfulness of the behaviors identified during any particular evaluation can only lower bound the model's worst-possible-case behavior. As a complementary method for eliciting harmful behaviors, we propose evaluating LLMs with model tampering attacks which allow for modifications to latent activations or weights. We pit state-of-the-art techniques for removing harmful LLM capabilities against a suite of 5 input-space and 6 model tampering attacks. In addition to benchmarking these methods against each other, we show that (1) model resilience to capability elicitation attacks lies on a low-dimensional robustness subspace; (2) the attack success rate of model tampering attacks can empirically predict and offer conservative estimates for the success of held-out input-space attacks; and (3) state-of-the-art unlearning methods can easily be undone within 16 steps of fine-tuning. Together these results highlight the difficulty of removing harmful LLM capabilities and show that model tampering attacks enable substantially more rigorous evaluations than input-space attacks alone. We release models at https://huggingface.co/LLM-GAT

Assessing Language Model Deployment with Risk Cards

This paper introduces RiskCards, a framework for structured assessment and documentation of risks associated with an application of language models. As with all language, text generated by language models can be harmful, or used to bring about harm. Automating language generation adds both an element of scale and also more subtle or emergent undesirable tendencies to the generated text. Prior work establishes a wide variety of language model harms to many different actors: existing taxonomies identify categories of harms posed by language models; benchmarks establish automated tests of these harms; and documentation standards for models, tasks and datasets encourage transparent reporting. However, there is no risk-centric framework for documenting the complexity of a landscape in which some risks are shared across models and contexts, while others are specific, and where certain conditions may be required for risks to manifest as harms. RiskCards address this methodological gap by providing a generic framework for assessing the use of a given language model in a given scenario. Each RiskCard makes clear the routes for the risk to manifest harm, their placement in harm taxonomies, and example prompt-output pairs. While RiskCards are designed to be open-source, dynamic and participatory, we present a "starter set" of RiskCards taken from a broad literature survey, each of which details a concrete risk presentation. Language model RiskCards initiate a community knowledge base which permits the mapping of risks and harms to a specific model or its application scenario, ultimately contributing to a better, safer and shared understanding of the risk landscape.

Ethical and social risks of harm from Language Models

This paper aims to help structure the risk landscape associated with large-scale Language Models (LMs). In order to foster advances in responsible innovation, an in-depth understanding of the potential risks posed by these models is needed. A wide range of established and anticipated risks are analysed in detail, drawing on multidisciplinary expertise and literature from computer science, linguistics, and social sciences. We outline six specific risk areas: I. Discrimination, Exclusion and Toxicity, II. Information Hazards, III. Misinformation Harms, V. Malicious Uses, V. Human-Computer Interaction Harms, VI. Automation, Access, and Environmental Harms. The first area concerns the perpetuation of stereotypes, unfair discrimination, exclusionary norms, toxic language, and lower performance by social group for LMs. The second focuses on risks from private data leaks or LMs correctly inferring sensitive information. The third addresses risks arising from poor, false or misleading information including in sensitive domains, and knock-on risks such as the erosion of trust in shared information. The fourth considers risks from actors who try to use LMs to cause harm. The fifth focuses on risks specific to LLMs used to underpin conversational agents that interact with human users, including unsafe use, manipulation or deception. The sixth discusses the risk of environmental harm, job automation, and other challenges that may have a disparate effect on different social groups or communities. In total, we review 21 risks in-depth. We discuss the points of origin of different risks and point to potential mitigation approaches. Lastly, we discuss organisational responsibilities in implementing mitigations, and the role of collaboration and participation. We highlight directions for further research, particularly on expanding the toolkit for assessing and evaluating the outlined risks in LMs.

Truthful AI: Developing and governing AI that does not lie

In many contexts, lying -- the use of verbal falsehoods to deceive -- is harmful. While lying has traditionally been a human affair, AI systems that make sophisticated verbal statements are becoming increasingly prevalent. This raises the question of how we should limit the harm caused by AI "lies" (i.e. falsehoods that are actively selected for). Human truthfulness is governed by social norms and by laws (against defamation, perjury, and fraud). Differences between AI and humans present an opportunity to have more precise standards of truthfulness for AI, and to have these standards rise over time. This could provide significant benefits to public epistemics and the economy, and mitigate risks of worst-case AI futures. Establishing norms or laws of AI truthfulness will require significant work to: (1) identify clear truthfulness standards; (2) create institutions that can judge adherence to those standards; and (3) develop AI systems that are robustly truthful. Our initial proposals for these areas include: (1) a standard of avoiding "negligent falsehoods" (a generalisation of lies that is easier to assess); (2) institutions to evaluate AI systems before and after real-world deployment; and (3) explicitly training AI systems to be truthful via curated datasets and human interaction. A concerning possibility is that evaluation mechanisms for eventual truthfulness standards could be captured by political interests, leading to harmful censorship and propaganda. Avoiding this might take careful attention. And since the scale of AI speech acts might grow dramatically over the coming decades, early truthfulness standards might be particularly important because of the precedents they set.

The Ethics of ChatGPT in Medicine and Healthcare: A Systematic Review on Large Language Models (LLMs)

With the introduction of ChatGPT, Large Language Models (LLMs) have received enormous attention in healthcare. Despite their potential benefits, researchers have underscored various ethical implications. While individual instances have drawn much attention, the debate lacks a systematic overview of practical applications currently researched and ethical issues connected to them. Against this background, this work aims to map the ethical landscape surrounding the current stage of deployment of LLMs in medicine and healthcare. Electronic databases and preprint servers were queried using a comprehensive search strategy. Studies were screened and extracted following a modified rapid review approach. Methodological quality was assessed using a hybrid approach. For 53 records, a meta-aggregative synthesis was performed. Four fields of applications emerged and testify to a vivid exploration phase. Advantages of using LLMs are attributed to their capacity in data analysis, personalized information provisioning, support in decision-making, mitigating information loss and enhancing information accessibility. However, we also identifies recurrent ethical concerns connected to fairness, bias, non-maleficence, transparency, and privacy. A distinctive concern is the tendency to produce harmful misinformation or convincingly but inaccurate content. A recurrent plea for ethical guidance and human oversight is evident. Given the variety of use cases, it is suggested that the ethical guidance debate be reframed to focus on defining what constitutes acceptable human oversight across the spectrum of applications. This involves considering diverse settings, varying potentials for harm, and different acceptable thresholds for performance and certainty in healthcare. In addition, a critical inquiry is necessary to determine the extent to which the current experimental use of LLMs is necessary and justified.

Toxicity in ChatGPT: Analyzing Persona-assigned Language Models

Large language models (LLMs) have shown incredible capabilities and transcended the natural language processing (NLP) community, with adoption throughout many services like healthcare, therapy, education, and customer service. Since users include people with critical information needs like students or patients engaging with chatbots, the safety of these systems is of prime importance. Therefore, a clear understanding of the capabilities and limitations of LLMs is necessary. To this end, we systematically evaluate toxicity in over half a million generations of ChatGPT, a popular dialogue-based LLM. We find that setting the system parameter of ChatGPT by assigning it a persona, say that of the boxer Muhammad Ali, significantly increases the toxicity of generations. Depending on the persona assigned to ChatGPT, its toxicity can increase up to 6x, with outputs engaging in incorrect stereotypes, harmful dialogue, and hurtful opinions. This may be potentially defamatory to the persona and harmful to an unsuspecting user. Furthermore, we find concerning patterns where specific entities (e.g., certain races) are targeted more than others (3x more) irrespective of the assigned persona, that reflect inherent discriminatory biases in the model. We hope that our findings inspire the broader AI community to rethink the efficacy of current safety guardrails and develop better techniques that lead to robust, safe, and trustworthy AI systems.

Large Language Model for Mental Health: A Systematic Review

Large language models (LLMs) have received much attention and shown their potential in digital health, while their application in mental health is subject to ongoing debate. This systematic review aims to summarize and characterize the use of LLMs in mental health by investigating the strengths and limitations of the latest work in LLMs and discusses the challenges and opportunities for early screening, digital interventions, and other clinical applications in mental health. Following PRISMA guidelines, we examined English articles from PubMed, DBLP Computer Science Bibliography, and IEEE Xplore, published between 1 January 2017, and 1 September 2023, focusing on mental health and LLMs. The review analyzed 32 articles, including mental health analysis using social media datasets (n=13), mental health chatbots (n=10), and other mental health applications (n=9). Findings reveal LLMs' effectiveness in mental health issue detection and the enhancement of telepsychological services through personalised healthcare. Nonetheless, risks like text inconsistencies, hallucinatory content, and the lack of an ethical framework raise concerns about their clinical use. Despite these challenges, the advancement of LLMs underscores their potential as innovative clinical tools, necessitating further research and development. The review emphasizes that LLMs should complement, not replace, professional mental health services.

An Overview of Catastrophic AI Risks

Rapid advancements in artificial intelligence (AI) have sparked growing concerns among experts, policymakers, and world leaders regarding the potential for increasingly advanced AI systems to pose catastrophic risks. Although numerous risks have been detailed separately, there is a pressing need for a systematic discussion and illustration of the potential dangers to better inform efforts to mitigate them. This paper provides an overview of the main sources of catastrophic AI risks, which we organize into four categories: malicious use, in which individuals or groups intentionally use AIs to cause harm; AI race, in which competitive environments compel actors to deploy unsafe AIs or cede control to AIs; organizational risks, highlighting how human factors and complex systems can increase the chances of catastrophic accidents; and rogue AIs, describing the inherent difficulty in controlling agents far more intelligent than humans. For each category of risk, we describe specific hazards, present illustrative stories, envision ideal scenarios, and propose practical suggestions for mitigating these dangers. Our goal is to foster a comprehensive understanding of these risks and inspire collective and proactive efforts to ensure that AIs are developed and deployed in a safe manner. Ultimately, we hope this will allow us to realize the benefits of this powerful technology while minimizing the potential for catastrophic outcomes.

Evaluation of GPT-3.5 and GPT-4 for supporting real-world information needs in healthcare delivery

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

LLM Can be a Dangerous Persuader: Empirical Study of Persuasion Safety in Large Language Models

Recent advancements in Large Language Models (LLMs) have enabled them to approach human-level persuasion capabilities. However, such potential also raises concerns about the safety risks of LLM-driven persuasion, particularly their potential for unethical influence through manipulation, deception, exploitation of vulnerabilities, and many other harmful tactics. In this work, we present a systematic investigation of LLM persuasion safety through two critical aspects: (1) whether LLMs appropriately reject unethical persuasion tasks and avoid unethical strategies during execution, including cases where the initial persuasion goal appears ethically neutral, and (2) how influencing factors like personality traits and external pressures affect their behavior. To this end, we introduce PersuSafety, the first comprehensive framework for the assessment of persuasion safety which consists of three stages, i.e., persuasion scene creation, persuasive conversation simulation, and persuasion safety assessment. PersuSafety covers 6 diverse unethical persuasion topics and 15 common unethical strategies. Through extensive experiments across 8 widely used LLMs, we observe significant safety concerns in most LLMs, including failing to identify harmful persuasion tasks and leveraging various unethical persuasion strategies. Our study calls for more attention to improve safety alignment in progressive and goal-driven conversations such as persuasion.

OS-Harm: A Benchmark for Measuring Safety of Computer Use Agents

Computer use agents are LLM-based agents that can directly interact with a graphical user interface, by processing screenshots or accessibility trees. While these systems are gaining popularity, their safety has been largely overlooked, despite the fact that evaluating and understanding their potential for harmful behavior is essential for widespread adoption. To address this gap, we introduce OS-Harm, a new benchmark for measuring safety of computer use agents. OS-Harm is built on top of the OSWorld environment and aims to test models across three categories of harm: deliberate user misuse, prompt injection attacks, and model misbehavior. To cover these cases, we create 150 tasks that span several types of safety violations (harassment, copyright infringement, disinformation, data exfiltration, etc.) and require the agent to interact with a variety of OS applications (email client, code editor, browser, etc.). Moreover, we propose an automated judge to evaluate both accuracy and safety of agents that achieves high agreement with human annotations (0.76 and 0.79 F1 score). We evaluate computer use agents based on a range of frontier models - such as o4-mini, Claude 3.7 Sonnet, Gemini 2.5 Pro - and provide insights into their safety. In particular, all models tend to directly comply with many deliberate misuse queries, are relatively vulnerable to static prompt injections, and occasionally perform unsafe actions. The OS-Harm benchmark is available at https://github.com/tml-epfl/os-harm.

Can large language models democratize access to dual-use biotechnology?

Large language models (LLMs) such as those embedded in 'chatbots' are accelerating and democratizing research by providing comprehensible information and expertise from many different fields. However, these models may also confer easy access to dual-use technologies capable of inflicting great harm. To evaluate this risk, the 'Safeguarding the Future' course at MIT tasked non-scientist students with investigating whether LLM chatbots could be prompted to assist non-experts in causing a pandemic. In one hour, the chatbots suggested four potential pandemic pathogens, explained how they can be generated from synthetic DNA using reverse genetics, supplied the names of DNA synthesis companies unlikely to screen orders, identified detailed protocols and how to troubleshoot them, and recommended that anyone lacking the skills to perform reverse genetics engage a core facility or contract research organization. Collectively, these results suggest that LLMs will make pandemic-class agents widely accessible as soon as they are credibly identified, even to people with little or no laboratory training. Promising nonproliferation measures include pre-release evaluations of LLMs by third parties, curating training datasets to remove harmful concepts, and verifiably screening all DNA generated by synthesis providers or used by contract research organizations and robotic cloud laboratories to engineer organisms or viruses.