WHBench: Evaluating Frontier LLMs with Expert-in-the-Loop Validation on Women's Health Topics

Background: Clinical trials rely on transparent inclusion criteria to ensure generalizability. In contrast, benchmarks validating health-related large language models (LLMs) rarely characterize the "patient" or "query" populations they contain. Without defined composition, aggregate performance metrics may misrepresent model readiness for clinical use. Methods: We analyzed 18,707 consumer health queries across six public benchmarks using LLMs as automated coding instruments to apply a standardized 16-field taxonomy profiling context, topic, and intent. Results: We identified a structural "validity gap." While benchmarks have evolved from static retrieval to interactive dialogue, clinical composition remains misaligned with real-world needs. Although 42% of the corpus referenced objective data, this was polarized toward wellness-focused wearable signals (17.7%); complex diagnostic inputs remained rare, including laboratory values (5.2%), imaging (3.8%), and raw medical records (0.6%). Safety-critical scenarios were effectively absent: suicide/self-harm queries comprised <0.7% of the corpus and chronic disease management only 5.5%. Benchmarks also neglected vulnerable populations (pediatrics/older adults <11%) and global health needs. Conclusions: Evaluation benchmarks remain misaligned with real-world clinical needs, lacking raw clinical artifacts, adequate representation of vulnerable populations, and longitudinal chronic care scenarios. The field must adopt standardized query profiling--analogous to clinical trial reporting--to align evaluation with the full complexity of clinical practice.

Safety alignment in Large Language Models is critical for healthcare; however, reliance on binary refusal boundaries often results in over-refusal of benign queries or unsafe compliance with harmful ones. While existing benchmarks measure these extremes, they fail to evaluate Safe Completion: the model's ability to maximise helpfulness on dual-use or borderline queries by providing safe, high-level guidance without crossing into actionable harm. We introduce Health-ORSC-Bench, the first large-scale benchmark designed to systematically measure Over-Refusal and Safe Completion quality in healthcare. Comprising 31,920 benign boundary prompts across seven health categories (e.g., self-harm, medical misinformation), our framework uses an automated pipeline with human validation to test models at varying levels of intent ambiguity. We evaluate 30 state-of-the-art LLMs, including GPT-5 and Claude-4, revealing a significant tension: safety-optimised models frequently refuse up to 80% of "Hard" benign prompts, while domain-specific models often sacrifice safety for utility. Our findings demonstrate that model family and size significantly influence calibration: larger frontier models (e.g., GPT-5, Llama-4) exhibit "safety-pessimism" and higher over-refusal than smaller or MoE-based counterparts (e.g., Qwen-3-Next), highlighting that current LLMs struggle to balance refusal and compliance. Health-ORSC-Bench provides a rigorous standard for calibrating the next generation of medical AI assistants toward nuanced, safe, and helpful completions. Furthermore, our benchmark facilitates reproducible evaluation, encourages safety calibration, and supports development of clinically reliable, context-aware, human-aligned medical AI systems. Our code and data are available at: https://github.com/ZhihaoZhang97/Health-ORSC-Bench. Warning: Some contents may include toxic or undesired contents.

General-purpose health benchmarks increasingly anchor claims about LLM medical performance, but they are not always resolved by clinical specialty, making domain-specific performance hard to isolate. Mental health is of acute public-health concern as millions of people turn to LLMs for psychological support, and most existing evaluations are bespoke academic benchmarks that are difficult to integrate into developer workflows. We introduce HealthBench-Psych and HealthBench-Psych-Hard. We screened HealthBench's 5,000 physician-rubric conversations for mental-health relevance with a transparent LLM-applied rubric, then validated the subset through two rounds of blinded clinician review with concealed known-exclude controls, yielding 610 conversations (12.2% of the corpus). Evaluating 20 frontier and open models under a cross-vendor panel of three LLM judges, we find a statistically tied frontier cluster, measurable refusal behavior in two models, and near-identical rankings across judges ($τ\ge 0.92$). We release the subset, pipeline, model responses, grades, and analysis code as a reusable resource.