Consistent but Biased: Chair Personas Trade Noise for Bias in Multi-Agent Clinical Decisions

Clinical decision support is moving toward committees of language-model agents deliberating on a shared workspace. We ask whether such committees can be gamed by shortcuts, cues a benchmark rewards but a clinician would ignore. Across seven cohorts on six public datasets spanning text (MedQA-USMLE, MedMCQA, MIMIC-CXR reports), imaging (NIH ChestX-ray14, MIMIC-CXR-JPG, CheXpert) and tabular ICU records (SUPPORT2), Gemini committees resist these cues in isolation (flip 5-16%), yet a socially plausible shortcut spreads: when two peers assert the same wrong answer, the holdout under test adopts it in 38% of cases, as does a false "pre-screen" system flag, on both capability tiers. Of three oversight agents, a gate cannot separate adoption from honest agreement (false-positive rate 100%); a same-lineage judge reading only the transcript flags adoption on text (precision 100%, recall 93%) but collapses onto the gate in imaging; a referee that privately re-queries the holdout transfers to imaging (77-88% precision, 13-21% false-positive rate). Tripling a cue's visual salience does not move contagion, whereas a second peer voice raises it by half again. Gaming a hidden rubric is near-silent: only 1/10 text and 1/134 imaging drifters name the rubric they moved toward. What games a committee is social plausibility, and only a referee independent of self-report catches it. Code: https://github.com/criticaldata/benchmaxxing

Persona prompting is widely used to construct user simulations with large language models (LLMs), yet it relies on a largely untested assumption: specifying one user attribute should change that attribute alone. We test this assumption and identify a systematic failure of selective control: across all eight black-box LLMs we audit, changing a target attribute also shifts responses on unspecified, non-target attributes. For example, describing a user as more risk-seeking shifts color choices, even though the prompt never mentions color; we term this cross-attribute influence. Semantic, contextual, and internal analyses collectively suggest that models treat a persona prompt as evidence about the user and extend the inferred profile to unspecified preferences, a process we call trait-conditioned completion. We next ask whether explicitly specifying non-target attributes restores selective control. When a non-target attribute is assigned a clear direction, models generally follow the declaration and suppress the target attribute's influence. However, when the same attribute is declared neutral, the target continues to affect choices across all five open-weight checkpoints, even when the model correctly reports the declared state. This disparity, the neutrality gap, demonstrates that successful persona following does not imply selective persona control, which additionally requires keeping non-target attributes stable. We operationalize this distinction with a three-state diagnostic that leaves the non-target attribute unspecified or declares it directional or neutral; because directional tests can be passed by simply following the stated persona, the neutral state reveals failures they miss. In a post hoc analysis of independent items, neutral declarations leave 51-81% of items target-sensitive, against at most 1 of 320 item-pole comparisons under directional ones.

Multi-agent systems of LLMs add discussion to majority voting and are therefore expected to be more capable. However, empirical reports conflict on whether discussion improves accuracy or leads to an incorrect consensus. Here, we introduce a parsimonious model that explains when discussion improves accuracy and when it ends in an incorrect consensus, built from four behaviors repeatedly observed in LLM agents: (1) withholding dissent, (2) internalizing a stated answer, (3) reconsidering after seeing dissent, and (4) correcting toward the correct answer. The model shows that discussion can overturn an incorrect initial majority only when the withholding rate $c$ is below a critical rate $c^* = γ/(γ+ a)$, set by the net correction rate $γ$ and the internalization rate $a$. We estimate these rates from conversation logs with a Bayesian method and place LLM teams relative to $c^*$. As the model predicts, the gain from discussion shrinks as withholding rises, across LLMs and on a hidden profile benchmark, HiddenBench, and MedEInst. Instructing agents not to withhold dissent increases this gain. Turning reasoning off also increases the gain, because reasoning raises the internalization rate $a$ and keeps agents from reconsidering a minority answer. These findings reconcile the conflicting reports and identify when discussion outperforms majority voting.