Organizations: School of Nursing, Columbia University, New York, NY, USA · Data Science Institute, Columbia University, New York, NY, USA · VNS Health, New York, NY, USA · Tel Aviv Sourasky Medical Center, Tel Aviv, Israel · Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland · Wellbeing Services County of North Savo, Kuopio, Finland · Wellbeing Services County of Southwest Finland, Turku, Finland
Abstract
Background. Large language models are increasingly used to help write biomedical text but may fabricate references to nonexistent work. How often large language models do so is not well characterized. Methods. We prompted 26 language models from eight developers (2023 to 2026) to supply a missing reference for each of 69 biomedical passages across ten domains. References were classified as verifiable (real paper with a resolving identifier), partial matches (real paper without a resolving identifier), fabricated (no matching indexed paper), or declined (the model refused to supply a reference). A reference was considered correct in every evaluated bibliographic field only when it was verifiable and its journal, year, and listed authors matched those of the cited paper. Results. Fabrication ranged from 10.2% (Claude Opus 4.8, which declined 52.1% of prompts) to 98.4% (Ministral 3B, which produced no verifiable reference). Claude Opus 4.6 and Claude Sonnet 4.5 produced similar proportions of verifiable references (77.6% and 76.6%) but named authors correctly in 78.7% and 28.7% of author-evaluable verifiable references, respectively, and were correct in every evaluated field in 54.6% and 19.9% of responses. GPT-5.5 was correct in every field in 48.1%. Across all models, 55.4% of responses were fabricated and 14.9% were correct in every field. Among the five tested models first released in 2026, the corresponding proportions were 35.3% and 31.8%, respectively. Conclusions. Fabrication remained common, and no model was correct in every evaluated bibliographic field in more than 54.6% of responses. Models that identify real papers may still misstate their metadata, so references produced with model assistance require verification before use.
Large language models (LLMs) now routinely draft literature reviews and assist with academic writing, which means a higher risk of fabricated references: GPTZero found 53 papers with hallucinated citations among NeurIPS 2025's accepted set. Rule- and LLM-based verifiers are emerging, but no shared benchmark compares them and gives detailed failure diagnostics. We close that gap with HALLMARK (Hallucination benchmark): 2,526 BibTeX entries spanning 14 hallucination types, three difficulty tiers, six diagnostic sub-tests per entry, and a contamination-resistant held-out split. On it we evaluate a DOI-lookup baseline, frontier LLMs zero-shot, tool-augmented agents, and our own rule-based, co-designed verifier bibtex-updater. Across the benchmark one result is consistent: the false-positive rate, not recall, decides whether a verifier is deployable. HALLMARK makes it concrete through three failure modes: agentic lookups buy recall but inflate false positives; at a venue-realistic base rate, the order-of-magnitude spread in false-positive rates (FPRs) -- not recall -- governs whether a verifier's flags are mostly true catches or mostly noise; and most LLMs over-flag papers published past their training cutoff, where only the two latest-cutoff models hold their false-positive rate near in-distribution levels (a signal we report as descriptive, since it is confounded with possible recall of those entries). Thus FPR is the deployment bottleneck, but an undetected fabrication remains the costlier error for the scientific record.
We investigate how well large language models (LLMs) can assist with literature reviews for scientific research. We perform a controlled study of eight expert-conceived research projects across the areas of physics, astrophysics, and cosmology. Each project has a defined background and goal, and human experts and AI prompters are asked to perform identical literature review tasks in parallel. We compare the relevant literature selected by humans with that selected by mid-2025 LLMs (ChatGPT-4o, ChatGPT Deep Research, and Gemini). We find the overlap between human- and AI-selected references to be small (<6%), indicating that AI models do not yet reproduce a competent expert search on their own, though they have the potential to complement literature searches by humans. We then assess the reliability and completeness of AI-generated candidate references, distinguishing two types of hallucination: fabrications (references to nonexistent papers) and metadata mismatches (real papers with one or more incorrect fields). We find that while fabricated references make up 3% of the AI-generated references, 64% are real papers with at least one incorrect field (title, author, year, journal, DOI, or link), indicating that the mid-2025 models require systematic verification. However, the performance is significantly improved for the 2026 model ChatGPT Pro 5.5, with a single-project test showing zero fabrication or metadata mismatches.
Frontier language models are increasingly evaluated on biomedical benchmarks, but two problems undermine most published evaluations: legacy benchmarks are near-saturated, and open-ended responses are graded by other language models. We evaluate Claude Fable 5, Anthropic's most capable publicly available model, across eight biomedical benchmarks, four text and four multimodal, using deterministic scoring against fixed answer keys throughout. We include two Claude predecessors and GPT-5 as baselines. Refusal is tracked as a distinct outcome in every result table. That decision produces the paper's central finding. Fable 5 refuses between 8.0% and 99.4% of questions depending on the benchmark, a pattern absent in both predecessors and in GPT-5. Once refused items are excluded from the denominator, Fable 5's accuracy exceeds or meets every other model on every benchmark in this study. We identify two distinguishable refusal patterns: one concentrating in basic-science and mechanism content across MedQA and MedXpertQA MM, confirmed independently on two benchmarks using each benchmark's own category labels; and a separate disease-domain pattern on RareBench, where inborn metabolic disease presentations are refused near-universally while adult-onset autoimmune presentations are not. The primary constraint on Fable 5's biomedical usefulness is willingness to engage, not capability once it does.
Dominic Okonkwo, Magnus Hodgson, Temitope I. David +1