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Aug 12

RIPRAG: Hack a Black-box Retrieval-Augmented Generation Question-Answering System with Reinforcement Learning

Retrieval-Augmented Generation (RAG) systems based on Large Language Models (LLMs) have become a core technology for tasks such as question-answering (QA) and content generation. RAG poisoning is an attack method to induce LLMs to generate the attacker's expected text by injecting poisoned documents into the database of RAG systems. Existing research can be broadly divided into two classes: white-box methods and black-box methods. White-box methods utilize gradient information to optimize poisoned documents, and black-box methods use a pre-trained LLM to generate them. However, existing white-box methods require knowledge of the RAG system's internal composition and implementation details, whereas black-box methods are unable to utilize interactive information. In this work, we propose the RIPRAG attack framework, an end-to-end attack pipeline that treats the target RAG system as a black box and leverages our proposed Reinforcement Learning from Black-box Feedback (RLBF) method to optimize the generation model for poisoned documents. We designed two kinds of rewards: similarity reward and attack reward. Experimental results demonstrate that this method can effectively execute poisoning attacks against most complex RAG systems, achieving an attack success rate (ASR) improvement of up to 0.72 compared to baseline methods. This highlights prevalent deficiencies in current defensive methods and provides critical insights for LLM security research.

  • 7 authors
·
Jan 10

NeuroGenPoisoning: Neuron-Guided Attacks on Retrieval-Augmented Generation of LLM via Genetic Optimization of External Knowledge

Retrieval-Augmented Generation (RAG) empowers Large Language Models (LLMs) to dynamically integrate external knowledge during inference, improving their factual accuracy and adaptability. However, adversaries can inject poisoned external knowledge to override the model's internal memory. While existing attacks iteratively manipulate retrieval content or prompt structure of RAG, they largely ignore the model's internal representation dynamics and neuron-level sensitivities. The underlying mechanism of RAG poisoning has not been fully studied and the effect of knowledge conflict with strong parametric knowledge in RAG is not considered. In this work, we propose NeuroGenPoisoning, a novel attack framework that generates adversarial external knowledge in RAG guided by LLM internal neuron attribution and genetic optimization. Our method first identifies a set of Poison-Responsive Neurons whose activation strongly correlates with contextual poisoning knowledge. We then employ a genetic algorithm to evolve adversarial passages that maximally activate these neurons. Crucially, our framework enables massive-scale generation of effective poisoned RAG knowledge by identifying and reusing promising but initially unsuccessful external knowledge variants via observed attribution signals. At the same time, Poison-Responsive Neurons guided poisoning can effectively resolves knowledge conflict. Experimental results across models and datasets demonstrate consistently achieving high Population Overwrite Success Rate (POSR) of over 90% while preserving fluency. Empirical evidence shows that our method effectively resolves knowledge conflict.

  • 5 authors
·
Jan 10

MemoryGraft: Persistent Compromise of LLM Agents via Poisoned Experience Retrieval

Large Language Model (LLM) agents increasingly rely on long-term memory and Retrieval-Augmented Generation (RAG) to persist experiences and refine future performance. While this experience learning capability enhances agentic autonomy, it introduces a critical, unexplored attack surface, i.e., the trust boundary between an agent's reasoning core and its own past. In this paper, we introduce MemoryGraft. It is a novel indirect injection attack that compromises agent behavior not through immediate jailbreaks, but by implanting malicious successful experiences into the agent's long-term memory. Unlike traditional prompt injections that are transient, or standard RAG poisoning that targets factual knowledge, MemoryGraft exploits the agent's semantic imitation heuristic which is the tendency to replicate patterns from retrieved successful tasks. We demonstrate that an attacker who can supply benign ingestion-level artifacts that the agent reads during execution can induce it to construct a poisoned RAG store where a small set of malicious procedure templates is persisted alongside benign experiences. When the agent later encounters semantically similar tasks, union retrieval over lexical and embedding similarity reliably surfaces these grafted memories, and the agent adopts the embedded unsafe patterns, leading to persistent behavioral drift across sessions. We validate MemoryGraft on MetaGPT's DataInterpreter agent with GPT-4o and find that a small number of poisoned records can account for a large fraction of retrieved experiences on benign workloads, turning experience-based self-improvement into a vector for stealthy and durable compromise. To facilitate reproducibility and future research, our code and evaluation data are available at https://github.com/Jacobhhy/Agent-Memory-Poisoning.

  • 2 authors
·
Dec 18, 2025

CPA-RAG:Covert Poisoning Attacks on Retrieval-Augmented Generation in Large Language Models

Retrieval-Augmented Generation (RAG) enhances large language models (LLMs) by incorporating external knowledge, but its openness introduces vulnerabilities that can be exploited by poisoning attacks. Existing poisoning methods for RAG systems have limitations, such as poor generalization and lack of fluency in adversarial texts. In this paper, we propose CPA-RAG, a black-box adversarial framework that generates query-relevant texts capable of manipulating the retrieval process to induce target answers. The proposed method integrates prompt-based text generation, cross-guided optimization through multiple LLMs, and retriever-based scoring to construct high-quality adversarial samples. We conduct extensive experiments across multiple datasets and LLMs to evaluate its effectiveness. Results show that the framework achieves over 90\% attack success when the top-k retrieval setting is 5, matching white-box performance, and maintains a consistent advantage of approximately 5 percentage points across different top-k values. It also outperforms existing black-box baselines by 14.5 percentage points under various defense strategies. Furthermore, our method successfully compromises a commercial RAG system deployed on Alibaba's BaiLian platform, demonstrating its practical threat in real-world applications. These findings underscore the need for more robust and secure RAG frameworks to defend against poisoning attacks.

  • 6 authors
·
May 26, 2025

Poison-RAG: Adversarial Data Poisoning Attacks on Retrieval-Augmented Generation in Recommender Systems

This study presents Poison-RAG, a framework for adversarial data poisoning attacks targeting retrieval-augmented generation (RAG)-based recommender systems. Poison-RAG manipulates item metadata, such as tags and descriptions, to influence recommendation outcomes. Using item metadata generated through a large language model (LLM) and embeddings derived via the OpenAI API, we explore the impact of adversarial poisoning attacks on provider-side, where attacks are designed to promote long-tail items and demote popular ones. Two attack strategies are proposed: local modifications, which personalize tags for each item using BERT embeddings, and global modifications, applying uniform tags across the dataset. Experiments conducted on the MovieLens dataset in a black-box setting reveal that local strategies improve manipulation effectiveness by up to 50\%, while global strategies risk boosting already popular items. Results indicate that popular items are more susceptible to attacks, whereas long-tail items are harder to manipulate. Approximately 70\% of items lack tags, presenting a cold-start challenge; data augmentation and synthesis are proposed as potential defense mechanisms to enhance RAG-based systems' resilience. The findings emphasize the need for robust metadata management to safeguard recommendation frameworks. Code and data are available at https://github.com/atenanaz/Poison-RAG.

  • 3 authors
·
Jan 20, 2025

MM-PoisonRAG: Disrupting Multimodal RAG with Local and Global Poisoning Attacks

Multimodal large language models with Retrieval Augmented Generation (RAG) have significantly advanced tasks such as multimodal question answering by grounding responses in external text and images. This grounding improves factuality, reduces hallucination, and extends reasoning beyond parametric knowledge. However, this reliance on external knowledge poses a critical yet underexplored safety risk: knowledge poisoning attacks, where adversaries deliberately inject adversarial multimodal content into external knowledge bases to steer model toward generating incorrect or even harmful responses. To expose such vulnerabilities, we propose MM-PoisonRAG, the first framework to systematically design knowledge poisoning in multimodal RAG. We introduce two complementary attack strategies: Localized Poisoning Attack (LPA), which implants targeted multimodal misinformation to manipulate specific queries, and Globalized Poisoning Attack (GPA), which inserts a single adversarial knowledge to broadly disrupt reasoning and induce nonsensical responses across all queries. Comprehensive experiments across tasks, models, and access settings show that LPA achieves targeted manipulation with attack success rates of up to 56%, while GPA completely disrupts model generation to 0% accuracy with just a single adversarial knowledge injection. Our results reveal the fragility of multimodal RAG and highlight the urgent need for defenses against knowledge poisoning.

  • 9 authors
·
Feb 24, 2025

One Pic is All it Takes: Poisoning Visual Document Retrieval Augmented Generation with a Single Image

Multi-modal retrieval augmented generation (M-RAG) is instrumental for inhibiting hallucinations in large multi-modal models (LMMs) through the use of a factual knowledge base (KB). However, M-RAG introduces new attack vectors for adversaries that aim to disrupt the system by injecting malicious entries into the KB. In this paper, we present the first poisoning attack against M-RAG targeting visual document retrieval applications where the KB contains images of document pages. We propose two attacks, each of which require injecting only a single adversarial image into the KB. Firstly, we propose a universal attack that, for any potential user query, influences the response to cause a denial-of-service (DoS) in the M-RAG system. Secondly, we present a targeted attack against one or a group of user queries, with the goal of spreading targeted misinformation. For both attacks, we use a multi-objective gradient-based adversarial approach to craft the injected image while optimizing for both retrieval and generation. We evaluate our attacks against several visual document retrieval datasets, a diverse set of state-of-the-art retrievers (embedding models) and generators (LMMs), demonstrating the attack effectiveness in both the universal and targeted settings. We additionally present results including commonly used defenses, various attack hyper-parameter settings, ablations, and attack transferability.

  • 6 authors
·
Apr 2, 2025

Joint-GCG: Unified Gradient-Based Poisoning Attacks on Retrieval-Augmented Generation Systems

Retrieval-Augmented Generation (RAG) systems enhance Large Language Models (LLMs) by retrieving relevant documents from external corpora before generating responses. This approach significantly expands LLM capabilities by leveraging vast, up-to-date external knowledge. However, this reliance on external knowledge makes RAG systems vulnerable to corpus poisoning attacks that manipulate generated outputs via poisoned document injection. Existing poisoning attack strategies typically treat the retrieval and generation stages as disjointed, limiting their effectiveness. We propose Joint-GCG, the first framework to unify gradient-based attacks across both retriever and generator models through three innovations: (1) Cross-Vocabulary Projection for aligning embedding spaces, (2) Gradient Tokenization Alignment for synchronizing token-level gradient signals, and (3) Adaptive Weighted Fusion for dynamically balancing attacking objectives. Evaluations demonstrate that Joint-GCG achieves at most 25% and an average of 5% higher attack success rate than previous methods across multiple retrievers and generators. While optimized under a white-box assumption, the generated poisons show unprecedented transferability to unseen models. Joint-GCG's innovative unification of gradient-based attacks across retrieval and generation stages fundamentally reshapes our understanding of vulnerabilities within RAG systems. Our code is available at https://github.com/NicerWang/Joint-GCG.

  • 7 authors
·
Jun 6, 2025

ControlNET: A Firewall for RAG-based LLM System

Retrieval-Augmented Generation (RAG) has significantly enhanced the factual accuracy and domain adaptability of Large Language Models (LLMs). This advancement has enabled their widespread deployment across sensitive domains such as healthcare, finance, and enterprise applications. RAG mitigates hallucinations by integrating external knowledge, yet introduces privacy risk and security risk, notably data breaching risk and data poisoning risk. While recent studies have explored prompt injection and poisoning attacks, there remains a significant gap in comprehensive research on controlling inbound and outbound query flows to mitigate these threats. In this paper, we propose an AI firewall, ControlNET, designed to safeguard RAG-based LLM systems from these vulnerabilities. ControlNET controls query flows by leveraging activation shift phenomena to detect adversarial queries and mitigate their impact through semantic divergence. We conduct comprehensive experiments on four different benchmark datasets including Msmarco, HotpotQA, FinQA, and MedicalSys using state-of-the-art open source LLMs (Llama3, Vicuna, and Mistral). Our results demonstrate that ControlNET achieves over 0.909 AUROC in detecting and mitigating security threats while preserving system harmlessness. Overall, ControlNET offers an effective, robust, harmless defense mechanism, marking a significant advancement toward the secure deployment of RAG-based LLM systems.

  • 8 authors
·
Apr 13, 2025

Confundo: Learning to Generate Robust Poison for Practical RAG Systems

Retrieval-augmented generation (RAG) is increasingly deployed in real-world applications, where its reference-grounded design makes outputs appear trustworthy. This trust has spurred research on poisoning attacks that craft malicious content, inject it into knowledge sources, and manipulate RAG responses. However, when evaluated in practical RAG systems, existing attacks suffer from severely degraded effectiveness. This gap stems from two overlooked realities: (i) content is often processed before use, which can fragment the poison and weaken its effect, and (ii) users often do not issue the exact queries anticipated during attack design. These factors can lead practitioners to underestimate risks and develop a false sense of security. To better characterize the threat to practical systems, we present Confundo, a learning-to-poison framework that fine-tunes a large language model as a poison generator to achieve high effectiveness, robustness, and stealthiness. Confundo provides a unified framework supporting multiple attack objectives, demonstrated by manipulating factual correctness, inducing biased opinions, and triggering hallucinations. By addressing these overlooked challenges, Confundo consistently outperforms a wide range of purpose-built attacks across datasets and RAG configurations by large margins, even in the presence of defenses. Beyond exposing vulnerabilities, we also present a defensive use case that protects web content from unauthorized incorporation into RAG systems via scraping, with no impact on user experience.

  • 6 authors
·
Feb 5

AgentPoison: Red-teaming LLM Agents via Poisoning Memory or Knowledge Bases

LLM agents have demonstrated remarkable performance across various applications, primarily due to their advanced capabilities in reasoning, utilizing external knowledge and tools, calling APIs, and executing actions to interact with environments. Current agents typically utilize a memory module or a retrieval-augmented generation (RAG) mechanism, retrieving past knowledge and instances with similar embeddings from knowledge bases to inform task planning and execution. However, the reliance on unverified knowledge bases raises significant concerns about their safety and trustworthiness. To uncover such vulnerabilities, we propose a novel red teaming approach AgentPoison, the first backdoor attack targeting generic and RAG-based LLM agents by poisoning their long-term memory or RAG knowledge base. In particular, we form the trigger generation process as a constrained optimization to optimize backdoor triggers by mapping the triggered instances to a unique embedding space, so as to ensure that whenever a user instruction contains the optimized backdoor trigger, the malicious demonstrations are retrieved from the poisoned memory or knowledge base with high probability. In the meantime, benign instructions without the trigger will still maintain normal performance. Unlike conventional backdoor attacks, AgentPoison requires no additional model training or fine-tuning, and the optimized backdoor trigger exhibits superior transferability, in-context coherence, and stealthiness. Extensive experiments demonstrate AgentPoison's effectiveness in attacking three types of real-world LLM agents: RAG-based autonomous driving agent, knowledge-intensive QA agent, and healthcare EHRAgent. On each agent, AgentPoison achieves an average attack success rate higher than 80% with minimal impact on benign performance (less than 1%) with a poison rate less than 0.1%.

  • 5 authors
·
Jul 17, 2024 3

Ranking Free RAG: Replacing Re-ranking with Selection in RAG for Sensitive Domains

Traditional Retrieval-Augmented Generation (RAG) pipelines rely on similarity-based retrieval and re-ranking, which depend on heuristics such as top-k, and lack explainability, interpretability, and robustness against adversarial content. To address this gap, we propose a novel method METEORA that replaces re-ranking in RAG with a rationale-driven selection approach. METEORA operates in two stages. First, a general-purpose LLM is preference-tuned to generate rationales conditioned on the input query using direct preference optimization. These rationales guide the evidence chunk selection engine, which selects relevant chunks in three stages: pairing individual rationales with corresponding retrieved chunks for local relevance, global selection with elbow detection for adaptive cutoff, and context expansion via neighboring chunks. This process eliminates the need for top-k heuristics. The rationales are also used for consistency check using a Verifier LLM to detect and filter poisoned or misleading content for safe generation. The framework provides explainable and interpretable evidence flow by using rationales consistently across both selection and verification. Our evaluation across six datasets spanning legal, financial, and academic research domains shows that METEORA improves generation accuracy by 33.34% while using approximately 50% fewer chunks than state-of-the-art re-ranking methods. In adversarial settings, METEORA significantly improves the F1 score from 0.10 to 0.44 over the state-of-the-art perplexity-based defense baseline, demonstrating strong resilience to poisoning attacks. Code available at: https://anonymous.4open.science/r/METEORA-DC46/README.md

  • 6 authors
·
May 21, 2025

SoK: Agentic Retrieval-Augmented Generation (RAG): Taxonomy, Architectures, Evaluation, and Research Directions

Retrieval-Augmented Generation (RAG) systems are increasingly evolving into agentic architectures where large language models autonomously coordinate multi-step reasoning, dynamic memory management, and iterative retrieval strategies. Despite rapid industrial adoption, current research lacks a systematic understanding of Agentic RAG as a sequential decision-making system, leading to highly fragmented architectures, inconsistent evaluation methodologies, and unresolved reliability risks. This Systematization of Knowledge (SoK) paper provides the first unified framework for understanding these autonomous systems. We formalize agentic retrieval-generation loops as finite-horizon partially observable Markov decision processes, explicitly modeling their control policies and state transitions. Building upon this formalization, we develop a comprehensive taxonomy and modular architectural decomposition that categorizes systems by their planning mechanisms, retrieval orchestration, memory paradigms, and tool-invocation behaviors. We further analyze the critical limitations of traditional static evaluation practices and identify severe systemic risks inherent to autonomous loops, including compounding hallucination propagation, memory poisoning, retrieval misalignment, and cascading tool-execution vulnerabilities. Finally, we outline key doctoral-scale research directions spanning stable adaptive retrieval, cost-aware orchestration, formal trajectory evaluation, and oversight mechanisms, providing a definitive roadmap for building reliable, controllable, and scalable agentic retrieval systems.

  • 6 authors
·
Mar 6

Rescuing the Unpoisoned: Efficient Defense against Knowledge Corruption Attacks on RAG Systems

Large language models (LLMs) are reshaping numerous facets of our daily lives, leading widespread adoption as web-based services. Despite their versatility, LLMs face notable challenges, such as generating hallucinated content and lacking access to up-to-date information. Lately, to address such limitations, Retrieval-Augmented Generation (RAG) has emerged as a promising direction by generating responses grounded in external knowledge sources. A typical RAG system consists of i) a retriever that probes a group of relevant passages from a knowledge base and ii) a generator that formulates a response based on the retrieved content. However, as with other AI systems, recent studies demonstrate the vulnerability of RAG, such as knowledge corruption attacks by injecting misleading information. In response, several defense strategies have been proposed, including having LLMs inspect the retrieved passages individually or fine-tuning robust retrievers. While effective, such approaches often come with substantial computational costs. In this work, we introduce RAGDefender, a resource-efficient defense mechanism against knowledge corruption (i.e., by data poisoning) attacks in practical RAG deployments. RAGDefender operates during the post-retrieval phase, leveraging lightweight machine learning techniques to detect and filter out adversarial content without requiring additional model training or inference. Our empirical evaluations show that RAGDefender consistently outperforms existing state-of-the-art defenses across multiple models and adversarial scenarios: e.g., RAGDefender reduces the attack success rate (ASR) against the Gemini model from 0.89 to as low as 0.02, compared to 0.69 for RobustRAG and 0.24 for Discern-and-Answer when adversarial passages outnumber legitimate ones by a factor of four (4x).

  • 3 authors
·
Nov 3, 2025

LogicPoison: Logical Attacks on Graph Retrieval-Augmented Generation

Graph-based Retrieval-Augmented Generation (GraphRAG) enhances the reasoning capabilities of Large Language Models (LLMs) by grounding their responses in structured knowledge graphs. Leveraging community detection and relation filtering techniques, GraphRAG systems demonstrate inherent resistance to traditional RAG attacks, such as text poisoning and prompt injection. However, in this paper, we find that the security of GraphRAG systems fundamentally relies on the topological integrity of the underlying graph, which can be undermined by implicitly corrupting the logical connections, without altering surface-level text semantics. To exploit this vulnerability, we propose LogicPoison, a novel attack framework that targets logical reasoning rather than injecting false contents. Specifically, LogicPoison employs a type-preserving entity swapping mechanism to perturb both global logic hubs for disrupting overall graph connectivity and query-specific reasoning bridges for severing essential multi-hop inference paths. This approach effectively reroutes valid reasoning into dead ends while maintaining surface-level textual plausibility. Comprehensive experiments across multiple benchmarks demonstrate that LogicPoison successfully bypasses GraphRAG's defenses, significantly degrading performance and outperforming state-of-the-art baselines in both effectiveness and stealth. Our code is available at bluehttps://github.com/Jord8061/logicPoison.

  • 9 authors
·
Apr 2

Topic-FlipRAG: Topic-Orientated Adversarial Opinion Manipulation Attacks to Retrieval-Augmented Generation Models

Retrieval-Augmented Generation (RAG) systems based on Large Language Models (LLMs) have become essential for tasks such as question answering and content generation. However, their increasing impact on public opinion and information dissemination has made them a critical focus for security research due to inherent vulnerabilities. Previous studies have predominantly addressed attacks targeting factual or single-query manipulations. In this paper, we address a more practical scenario: topic-oriented adversarial opinion manipulation attacks on RAG models, where LLMs are required to reason and synthesize multiple perspectives, rendering them particularly susceptible to systematic knowledge poisoning. Specifically, we propose Topic-FlipRAG, a two-stage manipulation attack pipeline that strategically crafts adversarial perturbations to influence opinions across related queries. This approach combines traditional adversarial ranking attack techniques and leverages the extensive internal relevant knowledge and reasoning capabilities of LLMs to execute semantic-level perturbations. Experiments show that the proposed attacks effectively shift the opinion of the model's outputs on specific topics, significantly impacting user information perception. Current mitigation methods cannot effectively defend against such attacks, highlighting the necessity for enhanced safeguards for RAG systems, and offering crucial insights for LLM security research.

  • 8 authors
·
Feb 3, 2025

TriShieldRAG: A Three-Ring Defense-in-Depth Framework Against Knowledge Corruption in Retrieval-Augmented Generation

Retrieval-Augmented Generation (RAG) lets a large language model answer questions using documents retrieved from an external knowledge base at query time. This makes RAG useful for private data, fast-changing information, and reducing hallucination, but it also means the model's answer is only as trustworthy as whatever the retriever hands it. If the knowledge base accepts writes from more than one party, an attacker needs only a handful of adversarial documents to steer the model toward a chosen wrong answer. PoisonedRAG demonstrated this: as few as five crafted documents flip an undefended system's answer roughly 90% of the time, and three natural single-stage defenses (perplexity filtering, query paraphrasing, knowledge-base expansion) leave attack success at 30% or higher. We built TriShieldRAG to close that gap. Rather than relying on one checkpoint, we place three independent, formally specified rings across the pipeline: an Ingest Guard that screens documents for lexical and statistical poisoning signatures; a Retrieval Scorer that re-ranks the retrieved set by a provenance and consistency-weighted trust score; and a Cross-LLM Consensus stage that polls three architecturally diverse language models (Claude, Mistral Small, Llama 3.2) and allows one bounded re-retrieval on disagreement. We derive the conditions under which Rings 2 and 3 are expected to work: a minority-poison assumption and an explicit provenance-tag assumption. Our reported configuration is consistent with this analysis, though we have not yet run the controlled poison-fraction sweep needed to confirm it independently. Evaluated against the non-adaptive attacker from the original PoisonedRAG, over a 5,000-document Wikipedia knowledge base with 10 target questions, the full pipeline reduces attack success rate from roughly 91% to roughly 13% while preserving accuracy on benign queries.

  • 5 authors
·
Jul 25

Safety and accuracy follow different scaling laws in clinical large language models

Clinical LLMs are often scaled by increasing model size, context length, retrieval complexity, or inference-time compute, with the implicit expectation that higher accuracy implies safer behavior. This assumption is incomplete in medicine, where a few confident, high-risk, or evidence-contradicting errors can matter more than average benchmark performance. We introduce SaFE-Scale, a framework for measuring how clinical LLM safety changes across model scale, evidence quality, retrieval strategy, context exposure, and inference-time compute. To instantiate this framework, we introduce RadSaFE-200, a Radiology Safety-Focused Evaluation benchmark of 200 multiple-choice questions with clinician-defined clean evidence, conflict evidence, and option-level labels for high-risk error, unsafe answer, and evidence contradiction. We evaluated 34 locally deployed LLMs across six deployment conditions: closed-book prompting (zero-shot), clean evidence, conflict evidence, standard RAG, agentic RAG, and max-context prompting. Clean evidence produced the strongest improvement, increasing mean accuracy from 73.5% to 94.1%, while reducing high-risk error from 12.0% to 2.6%, contradiction from 12.7% to 2.3%, and dangerous overconfidence from 8.0% to 1.6%. Standard RAG and agentic RAG did not reproduce this safety profile: agentic RAG improved accuracy over standard RAG and reduced contradiction, but high-risk error and dangerous overconfidence remained elevated. Max-context prompting increased latency without closing the safety gap, and additional inference-time compute produced only limited gains. Worst-case analysis showed that clinically consequential errors concentrated in a small subset of questions. Clinical LLM safety is therefore not a passive consequence of scaling, but a deployment property shaped by evidence quality, retrieval design, context construction, and collective failure behavior.

  • 12 authors
·
May 4