MIRA: A Bilingual Benchmark for Medical Information Response Audit

Large language models (LLMs) are increasingly used for medical and health-related questions, yet their safety in high-risk medical scenarios remains poorly understood. We introduce \textsc{MedHarm}\footnote{Code and data will be released upon acceptance. Due to the sensitive nature of high-risk medical queries, data access will be available to qualified researchers upon request.}, a high-risk medical safety benchmark with 1,100 medically grounded queries across 10 safety-critical categories, including toxicology, pharmacology, covert poisoning, anesthesia, and fetal harm. Unlike broad medical QA benchmarks, \textsc{MedHarm} targets realistic clinical, educational, and technical prompts that require refusal, caution, or safe redirection rather than direct helpfulness. We evaluate 15 LLMs spanning general-purpose, medical-purpose, closed-source, and downstream SFT models, together with 4 representative guardrail models. Results reveal a substantial gap between apparent alignment and medical safety: aligned models can still produce unsafe or actionable responses, medical fine-tuning can amplify harmful specificity, and external guardrails reduce some failures while introducing brittle blocking and weak safe helpfulness. These findings show that medical safety cannot be inferred from general alignment or medical capability alone, highlighting the need for domain-specific stress testing before deploying LLMs in safety-critical medical applications.

Large language models (LLMs) now reach expert-level scores on medical licensing exams, encouraging the assumption that high scores imply safe medical judgment while patients increasingly use them for health advice. We show this assumption is fragile: when misleading context is injected into questions that LLMs originally answer correctly, they abandon the correct answer. We call the ability to maintain correct judgment under adversarial context epistemic resilience, and introduce MedMisBench to measure it. MedMisBench contains 10,932 medical question items and 48,889 misleading context-option pairs spanning medical reasoning, agentic capability, and patient-journey evaluation. Across 11 model configurations, mean accuracy falls from 71.1% on original questions to 38.0% under focused misleading context, with 51.5% attack success. The most damaging injections are formal, rule-like fabrications: authority-framed falsehoods reach 69.5% attack success and exception-poisoning claims reach 64.1%. A 14-member clinical panel from 7 countries identified serious potential harm in 38.2% of reviewed cases. MedMisBench exposes a structural blind spot in LLM evaluation in medical settings: existing benchmarks measure what models know, but not whether they preserve correct medical judgment under misleading context.

Large language models (LLMs) increasingly provide conversational health information that may influence treatment decisions, yet existing benchmarks do not isolate whether medication-safety boundaries persist across follow-ups after explicit self-treatment intent. We introduce TAF-MED, a physician-reviewed benchmark of 500 fixed three-turn scenarios, and evaluate eight LLMs across 4,000 conversations. A rubric-based automated judge labelled responses as SAFE, LEAKY, or UNSAFE, and two physicians independently annotated a model-balanced random subset of 400 conversations. We assessed unsafe guidance, collapse after a strictly SAFE initial response, and model-ranking stability. Overall, 71.6% of conversations contained an UNSAFE response, and 61.4% of those beginning with a strictly SAFE response later collapsed to UNSAFE; model-level collapse rates ranged from 24.4% to 96.2%. Four of 28 model pairs reversed order between initial unsafe and collapse rates. Automated labels achieved 94.3% agreement with the adjudicated physician reference ($κ= 0.895$). These findings show that first-turn safety is an incomplete proxy for conversational safety persistence and motivate evaluation across complete dialogue trajectories. We will release TAF-MED on Hugging Face to support reproducible research on multi-turn medical safety.