Addressing benchmarking gaps in large language models for health and medicine with dynamic red-teaming

Abstract

Large language models (LLMs) are increasingly used to answer health-related questions and support healthcare workflows, yet evidence for their safety still relies heavily on static benchmarks that can rapidly become obsolete or be optimized against. Here we introduce a Dynamic, Automatic and Systematic (DAS) red-teaming audit framework that continuously stress-tests LLMs for health across four safety-critical axes: robustness, privacy, bias and hallucination. Validated against board-certified clinicians, a suite of adversarial agents autonomously mutates health-related test cases to uncover vulnerabilities in real time. Applying DAS to 15 state-of-the-art LLMs revealed a profound gap between high static benchmark performance and low dynamic reliability—the ‘benchmarking gap’. Despite median MedQA accuracy exceeding 80%, 94% of previously correct answers failed under dynamic robustness testing. This brittleness generalized to the realistic, open-ended HealthBench dataset, where top-tier models exhibited failure rates exceeding 70%, suggesting that high scores on established static benchmarks may reflect superficial memorization. We observed similarly high failure rates across other domains: privacy leaks were elicited in 86% of scenarios, cognitive bias priming altered recommendations in 81% of fairness tests and hallucination rates exceeded 74% in widely used models. By converting LLM safety evaluation for health from a static checklist into a living adversarial audit, DAS provides a scalable framework for surfacing latent risks before such systems are deployed in consumer-facing health assistants and broader clinical workflows.