Medical language models (LMs) can memorize and reproduce protected health information, but privacy evaluations often focus on recovery of training text rather than disclosure under realistic threat models. We introduce a clinically grounded framework that evaluates leakage along a graded axis of adversarial access, ranging from publicly inferable demographics to leaked note fragments. At each tier, we measure verbatim memorization of patient-specific text and semantic leakage of sensitive diagnoses. Applying the framework to an LM pretrained on 378k clinical notes, we find that routine encounter metadata (i.e. name, date of birth, provider, practice, visit date) elicits high rates of verbatim memorization across a patient's timeline and sensitive-diagnosis recovery (AUROC 0.91 for abortion, 0.81 for HIV). At the same time, exact-match memorization can overstate disclosure: 36% of memorized tokens reflect templated documentation. Our work highlights the risks of training on longitudinal clinical data, providing a practical framework for contextual privacy evaluation of medical LMs.
Medical knowledge is continuously evolving. This creates a need to update or selectively forget information encoded in already-trained medical LLMs. Machine unlearning aims to remove the influence of specific training data from a model without full retraining. Yet, existing unlearning benchmarks rely on synthetic or small-scale general data, leaving clinical unlearning understudied. We introduce AMNESIA, the first large-scale, open source benchmark for medical unlearning, with 70,560 question-answer pairs from 8,820 patient notes across 11 disease categories. AMNESIA includes both factual questions testing direct recall and reasoning questions testing clinical inference. We use it to evaluate four widely used unlearning methods at both random patient and disease-level, and introduce a new metric for detecting leakage of medical terminology. We show that unlearning individual patients erodes knowledge of others with the same condition, calling for methods that can better separate patients from shared clinical knowledge.
While large language models (LLMs) are increasingly used for clinical applications, many existing pipelines require sending raw sensitive health information to remote servers for processing, which heightens the risk of privacy leakage. A natural approach to mitigate this risk is to encrypt the data before transmission. However, straightforward solutions such as encrypting the entire dataset introduce prohibitive computational, alignment, and communication overheads, rendering large-scale practical deployment infeasible. To preserve privacy while maintaining usability, we present Healthcare Encryption & Redaction via Adaptive Linguistic Decomposition (HERALD), a token-level cryptographic redaction framework designed to achieve this balance by encrypting only sensitive tokens while preserving the surrounding context for downstream model utility. HERALD combines medical named-entity recognizer (NER) with part-of-speech (POS) driven policies to select candidate tokens, performs targeted lemmatization to stabilize surface forms, and substitutes each protected token with a deterministic ciphertext wrapped in explicit delimiters. Notably, HERALD is model-agnostic and operates entirely on the client side, ensuring that sensitive content remains encrypted throughout storage, transmission, and processing without requiring changes to downstream models. We evaluated HERALD on both classification and medical question answering (MQA) tasks on public datasets. Across different tasks, experiments illustrate that fully secured baselines suffer significant utility loss, whereas HERALD consistently recovers performance close to plaintext. Overall, HERALD provides a novel utilization pipeline.
Large language models can reproduce training data, but existing memorization evaluations mostly measure whether models can be forced to do so, rather than whether they do so under ordinary use. We introduce PropMe, a propensity-aware framework for memorization evaluation that contrasts prefix-based capability attacks with non-adversarial evaluations. We propose a metric transformation that, applied to existing functions, allows to create propensity metrics. We further introduce SimpleTrace, a lightweight tracing pipeline built on infini-gram that deterministically attributes model generations to large-scale training corpora and computes verbatim, near-verbatim, and propensity-transformed memorization metrics. Evaluating two fully-open models: Comma and DFM Decoder on two datasets: Common Pile and Dynaword in two languages, we find a consistent gap between capability and propensity: prefix attacks elicit substantially stronger memorization signals than generic or dataset-specific prompts, while propensity scores remain low overall. Thus, the models can reveal training data when directly elicited, but rarely do so in more common non-adversarial settings. We also find that DFM Decoder, which is continually pre-trained from Comma, exhibits reduced memorization and memorization propensity for Common Pile, confirming that memorization capability can decrease when later training emphasizes partially different data. Our results suggest, and we encourage, that memorization audits should report both worst-case extractability and ordinary leakage propensity in order to have a more comprehensive view of this phenomenon.
Gianluca Barmina, Peter Schneider-Kamp, Lukas Galke Poech