When AI Gets it Wrong: Reliability and Risk in AI-Assisted Medication Decision Systems

Artificial intelligence (AI) systems are increasingly integrated into healthcare and pharmacy workflows, supporting tasks such as medication recommendations, dosage determination, and drug interaction detection. While these systems often demonstrate strong performance under standard evaluation metrics, their reliability in real-world decision-making remains insufficiently understood. In high-risk domains such as medication management, even a single incorrect recommendation can result in severe patient harm. This paper examines the reliability of AI-assisted medication systems by focusing on system failures and their potential clinical consequences. Rather than evaluating performance solely through aggregate metrics, this work shifts attention towards how errors occur and what happens when AI systems produce incorrect outputs. Through a series of controlled, simulated scenarios involving drug interactions and dosage decisions, we analyse different types of system failures, including missed interactions, incorrect risk flagging, and inappropriate dosage recommendations. The findings highlight that AI errors in medication-related contexts can lead to adverse drug reactions, ineffective treatment, or delayed care, particularly when systems are used without sufficient human oversight. Furthermore, the paper discusses the risks of over-reliance on AI recommendations and the challenges posed by limited transparency in decision-making processes. This work contributes a reliability-focused perspective on AI evaluation in healthcare, emphasising the importance of understanding failure behavior and real-world impact. It highlights the need to complement traditional performance metrics with risk-aware evaluation approaches, particularly in safety-critical domains such as pharmacy practice.

When AI Gets it Wong: Reliability and Risk in AI-Assisted Medication Decision Systems

Artificial intelligence (AI) systems are increasingly integrated into healthcare and pharmacy workflows, supporting tasks such as medication recommendations, dosage determination, and drug interaction detection. While these systems often demonstrate strong performance under standard evaluation metrics, their reliability in real-world decision-making remains insufficiently understood. In high-risk domains such as medication management, even a single incorrect recommendation can result in severe patient harm. This paper examines the reliability of AI-assisted medication systems by focusing on system failures and their potential clinical consequences. Rather than evaluating performance solely through aggregate metrics, this work shifts attention towards how errors occur and what happens when AI systems produce incorrect outputs. Through a series of controlled, simulated scenarios involving drug interactions and dosage decisions, we analyse different types of system failures, including missed interactions, incorrect risk flagging, and inappropriate dosage recommendations. The findings highlight that AI errors in medication-related contexts can lead to adverse drug reactions, ineffective treatment, or delayed care, particularly when systems are used without sufficient human oversight. Furthermore, the paper discusses the risks of over-reliance on AI recommendations and the challenges posed by limited transparency in decision-making processes. This work contributes a reliability-focused perspective on AI evaluation in healthcare, emphasising the importance of understanding failure behavior and real-world impact. It highlights the need to complement traditional performance metrics with risk-aware evaluation approaches, particularly in safety-critical domains such as pharmacy practice.

Why Aggregate Accuracy is Inadequate for Evaluating Fairness in Law Enforcement Facial Recognition Systems

Facial recognition systems are increasingly deployed in law enforcement and security contexts, where algorithmic decisions can carry significant societal consequences. Despite high reported accuracy, growing evidence demonstrates that such systems often exhibit uneven performance across demographic groups, leading to disproportionate error rates and potential harm. This paper argues that aggregate accuracy is an insufficient metric for evaluating the fairness and reliability of facial recognition systems in high-stakes environments. Through analysis of subgroup-level error distribution, including false positive rate (FPR) and false negative rate (FNR), the paper demonstrates how aggregate performance metrics can obscure critical disparities across demographic groups. Empirical observations show that systems with similar overall accuracy can exhibit substantially different fairness profiles, with subgroup error rates varying significantly despite a single aggregate metric. The paper further examines the operational risks associated with accuracy-centric evaluation practices in law enforcement applications, where misclassification may result in wrongful suspicion or missed identification. It highlights the importance of fairness-aware evaluation approaches and model-agnostic auditing strategies that enable post-deployment assessment of real-world systems. The findings emphasise the need to move beyond accuracy as a primary metric and adopt more comprehensive evaluation frameworks for responsible AI deployment.