Technological progress has led to concrete advancements in tasks that were regarded as challenging, such as automatic fact-checking. Interest in adopting these systems for public health and medicine has grown due to the high-stakes nature of medical decisions and challenges in critically appraising a vast and diverse medical literature. Evidence-based medicine connects to every individual, and yet the nature of it is highly technical, rendering the medical literacy of majority users inadequate to sufficiently navigate the domain. Such problems with medical communication ripen the ground for end-to-end fact-checking agents: check a claim against current medical literature and return with an evidence-backed verdict. And yet, such systems remain largely unused.In this position paper, developed with expert input, we present the first study examining how clinical experts verify real claims from social media by synthesizing medical evidence. In searching for this upper-bound, we reveal fundamental challenges in end-to-end fact-checking when applied to medicine: Difficulties connecting claims in the wild to scientific evidence in the form of clinical trials; ambiguities in underspecified claims mixed with mismatched intentions; and inherently subjective veracity labels. We argue that fact-checking should be approached as an interactive communication problem, rather than an end-to-end process.

In high-stakes domains like medicine, it may be generally desirable for models to faithfully adhere to the context provided. But what happens if the context does not align with model priors or safety protocols? In this paper, we investigate how LLMs behave and reason when presented with counterfactual (or even adversarial) medical evidence. We first construct MedCounterFact, a counterfactual medical QA dataset that requires the models to answer clinical comparison questions (i.e., judge the efficacy of certain treatments, with evidence consisting of randomized controlled trials provided as context). In MedCounterFact, real-world medical interventions within the questions and evidence are systematically replaced with four types of counterfactual stimuli, ranging from unknown words to toxic substances. Our evaluation across multiple frontier LLMs on MedCounterFact reveals that in the presence of counterfactual evidence, existing models overwhelmingly accept such “evidence” at face value even when it is dangerous or implausible, and provide confident and uncaveated answers. While it may be prudent to draw a boundary between faithfulness and safety, our findings suggest that models arguably overemphasize the former.

The morphological form of a word can often give cues to its meaning, but purely relying on these mappings can lead to overgeneralization in high-stakes domains. In the medical domain, for instance, LLMs can confidently reason about fictitious drugs from their affixes alone (e.g., wugcillin) and generate plausible-looking clinical content. We present a behavioral and mechanistic study of LLM ”affix heuristics” in pharmacology. Using fictitious drug names built from real affixes, we show that affix signals alone elicit class-level pharmacological responses. We introduce a framework for identifying whether a model’s drug semantics are driven mainly by the affix, the stem, or the drug name as a whole. Applied across 653 drugs, our framework reveals that models often induce drug meaning primarily through affix cues, yet rarely explicitly indicate this reliance, and sometimes incorrectly conflate properties among affix-sharing drugs. Activation patching across models further localizes this behavior to early-mid layers. These findings show that morphological shortcuts pose a subtle but measurable risk to safety.