Detecting Spin in Clinical Trials with Large Language Models

As large language models (LLMs) are increasingly used in clinical settings, it is critical to evaluate their reliability under realistic variation in clinical text. We study this question in clinical triage, comparing LLMs to practicing physicians under text perturbations that preserve the underlying clinical setting. We introduce a benchmark of over 6,000 clinical scenarios, 7,000 physician annotations, and 225,000 model responses. Using this benchmark, we make two key observations. First, LLMs are more likely than physicians to recommend unnecessary care at baseline, and this tendency increases under perturbed inputs. Further, we find that LLM recommendations are more sensitive to gender and tone perturbations than human recommendations. Together, these results demonstrate that LLMs can vary under clinically irrelevant textual changes, highlighting the need for deployment-oriented evaluations grounded in expert physician behavior.

Large language models (LLMs) hallucinate with confidence: their outputs can be fluent, authoritative, and simply wrong. In medical, legal, and scientific applications this failure causes direct harm, and detecting it from internal model states offers a path to safer deployment. A growing body of work reports that this problem is increasingly tractable, with recent methods achieving high detection performance on widely used benchmarks. We show, however, that much of this apparent progress does not survive scrutiny. Four of the six corpora embed the ground-truth answer directly in the input prompt. A naïve text-similarity baseline we call \textsc{TxTemb} exploits this to achieve near-perfect detection scores without any access to model internals. To measure what genuine detection capability remains once these artifacts are controlled, we conduct a large-scale evaluation spanning twenty-two detection methods, twelve open-source models spanning six architectural families, and six corpora. We further introduce \textbf{DRIFT}, a supervised probe over inter-layer hidden-state transitions, as a point of comparison for live-generation detection. Our findings suggest that the field's reported progress on hallucination detection is substantially explained by benchmark construction artifacts in widely used corpora, and that the majority of established baselines perform near chance under controlled conditions; the consistent exceptions are SAPLMA and DRIFT, both supervised probes on upper-layer hidden states.

Large language models are increasingly used to summarize clinical trial results for healthcare providers, patients, and payers, but their tendency to hallucinate poses significant risks in this high-stakes context. This study introduces a benchmark evaluation framework for measuring the faithfulness of LLM-generated clinical trial summaries across three stakeholder audiences. The framework consists of 200 stratified trials drawn from the Aggregate Analysis of ClinicalTrials.gov database, evaluated using audience-specific prompt templates and a six-dimension faithfulness annotation schema. Baseline measurements were established for GPT-4o, Claude Sonnet 4.6, and Gemini 2.5 Flash across 1,800 generated summaries scored using a cross-encoder natural language inference (NLI) model. Unsupported Claims was identified as the dominant failure mode across all three models, with a mean annotation score of 1.55 out of three. A knowledge-graph-augmented retrieval system was developed and evaluated against the baseline, producing statistically significant improvements in NLI-based faithfulness scores (entailment +0.0125, faithfulness +0.0130, p < 0.0001). Improvement pathways were model-dependent, with GPT-4o improving primarily through contradiction reduction while Claude Sonnet 4.6 and Gemini 2.5 Flash improved through increased entailment.