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.

When many people highlight the same document, is the crowd a single consensus, or is it internally structured into reader sub-groups that mark different things -- and is that structure a stable property of a reader or of the document? Building on prior work showing an individual's within-document highlighting signal is a whisper while individuality lives in selection, we ask the group-level question on a co-readership platform using a margin-preserving curveball null. Experiment 1: within a document, readers form strong sub-groups -- pairs agree far beyond what shared salience, mark density, and sentence popularity predict (nearest-neighbour agreement z=+6.3, significant in 88% of documents). Under an eight-block region-preserving null, shared engagement with the same coarse regions of the document accounts for about 40% of this excess; the majority survives as finer reader-specific agreement (z=+3.6, 77% significant). So the within-document crowd is, in a descriptive sense, factional. Experiment 2: is that grouping a stable reader trait? Here we are honest about power. The cross-document split-half reproducibility of a pair's agreement is near zero pooled (+0.078 and 0.000 in two separately drawn samples), and a power calibration shows the test is informative only for pairs that co-read many documents. In the only informative high-overlap subset (k>=4), point estimates are positive but small-sample, imprecise across the separately drawn samples, never significant, and attenuate under the region-preserving null. We therefore leave cross-document stability unresolved: the data is consistent with anything from situational grouping to a weak-to-moderate stable reader trait. The crowd is factional within a document; whether its factions follow the reader across documents is, honestly, beyond our reach.

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.

Claims that language models homogenise are usually measured against human judgements collected for the study, which makes the human side an artifact of the design: a crowdworker given the model's instruction is running the model's prompt. We measure convergence against a human reference nobody built for the purpose -- 2,523 reader mark sets across 120 web documents, produced by people highlighting for their own reasons on a platform where the overlay of others' marks is off by default. Agreement is the overlap between two size-matched sentence sets minus the overlap expected when each is resampled within its own depth-and-length bands. The null's calibration is demonstrated, not asserted: every pair involving a random baseline lands within 0.006 of zero. On the median document each party names 14 sentences of 70; two readers share 4.1 and two models 8.7. Across 18 model arms spanning 11 vendors, 3 countries and both weight regimes, the median of 153 model pairs is +0.093 against a human yardstick of +0.040, and 99 sit entirely above the human interval. Two frontier models from rival labs reach +0.203, twice what GPT-4o agrees with itself on a second call. The effect is not determinism, prompt wording, procedure, vendor or routing, and it is graded: the smallest models agree at the human level. No model agrees with readers detectably more than a reader does, and at equal depth and length no surface feature separates their choices. The multiples are procedure-dependent and the ordering is not: models are cut to their sharpest set while a reader's is a random draw from what they marked, and blunting the models alike halves the gap without closing it. Tested out of sample on four models released after this analysis, against predictions fixed beforehand, none clears the human interval. A population simulated from several models is not several populations.