The Clinician's Veto: Navigating Trust, Liability, and Uncertainty in Autonomous AI Prescribing

Autonomous AI systems are transitioning from advisory to autonomous roles for medication prescriptions. Recent United States bill H.R. 238 and Utah's prescription-renewal pilot both authorize AI to prescribe medications in an agentic capacity. While some regulatory guidelines suggest aggregate model performance metrics for clearance, they do not require i) calibrated per-prediction confidence for action-gated thresholds, ii) differentiated communication of uncertainty arising from model ignorance (epistemic) versus genuine clinical ambiguity (aleatoric), and iii) inferential transparency at the moment of decision that allows for liability allocation. Here, we present a regulatory and technical argument (tested with a survey of 136 U.S. prescribing clinicians) positioning these as minimum architectural requirements for safe autonomous prescribing. Our results suggest prescribing clinicians i) would not permit autonomous prescribing without a calibrated confidence-based escalation mechanism, ii) preferred a competing-options summary when uncertainty was aleatoric but shifted to abstention when uncertainty was epistemic, and iii) were only willing to accept additional liability when inferential transparency enabled a substantive judgment under acknowledged uncertainty. These findings indicate our recommended architectural features would encourage higher rates of clinician adoption, largely through collapsing much of what "autonomy" conventionally means. A system meeting these requirements would function less as an autonomous agent and more as a heavily supervised decision-support tool. As legislation and state pilots proceed, our technical argument backed by clinician perspectives provides opportunities for regulation to constrain the degree of autonomy ethically granted to AI in prescribing while aligning liability with the institutional actors who control system design and deployment.

Paying to Know: Micro-Transaction Markets for Verified Product Information in Agentic E-Commerce

Commercial NLP treats the shopping chatbot as a recommender or a conversion tool: its job is to match a user to a catalogue entry and close a sale. We argue that the arrival of agent-native micro-payment rails (e.g., x402, AP2) changes what is scarce. When the buyer is an autonomous agent that can investigate exhaustively, the bottleneck is no longer matching products but acquiring trustworthy, decision-relevant information about them. We envision agentic e-commerce as a micro-transaction market for verified information: buyer agents spend fractions of a cent to progressively unlock seller- and reviewer-supplied data -- service histories, third-party test reports, bills of materials, audited sales and support metrics -- paid for a la carte under a freemium model, with reviewer trust scored reputationally. We sketch the architecture of such a market and argue that it rewards genuine product quality and yields truer competition than ranking-based storefronts. We then translate the vision into concrete NLP problems -- cost-optimal information acquisition, data pricing and negotiation, real-time entity resolution, grounded value exchange, and privacy-preserving persona modelling -- and argue that these, not chat fluency, deserve the field's attention.

Breaking the Filter Bubble: A Semantic Pareto-DQN Framework for Multi-Objective Recommendation

Recommender systems often induce filter bubbles and semantic homogenization by monolithically optimizing for immediate user engagement. Standard single-objective models, including traditional Deep Q-Networks, are ill-equipped to navigate the trade-offs between platform retention and critical societal values like information diversity and provider fairness. To address these limitations, we introduce a multi-objective reinforcement learning framework that formalizes recommendation as a semantic multi-objective Markov decision process. By integrating high-fidelity semantic embeddings with a Pareto-DQN agent, our architecture treats engagement, diversity, and fairness as distinct, non-aggregable reward signals, avoiding the pitfalls of static reward scalarization. Empirical evaluations on the MovieLens small dataset shows that our hypervolume based action selection disrupts the feedback loops responsible for semantic collapse. By sustaining high state-trajectory variance, the Pareto-DQN effectively maps the Pareto frontier, achieving gains in auxiliary societal objectives with only marginal impacts on engagement. This work provides a path toward intrinsically aligned, responsible recommender systems.

TokenMinds: Pretrained User Tokens and Embeddings for User Understanding in Large Recommender Systems

User modeling in industrial recommender systems typically produces dense embeddings, which suffer from representational constraints inherent to fixed-dimensional vectors. An emerging alternative for discrete user representation -- using LLMs to generate text-based user tokens -- captures topical co-occurrences rather than deep sequential behavior dynamics and produces outputs that are difficult to ground to item attributes. Meanwhile, Semantic ID (SID) based item tokenization has proven effective for improving generalization in generative recommendation, yet discrete SID-based representations for users remain largely unexplored. We propose TokenMinds, an industrial-scale system that extends the PLUM framework from item retrieval to user modeling, generating both discrete SID-based user tokens and dense user embeddings via an encoder-decoder architecture adapted from pre-trained LLMs. This dual-output design provides the complementary benefits of discrete, semantically grounded user representations while maintaining compatibility with existing downstream models that rely on dense embeddings. Additionally, the shared SID vocabulary naturally extends to cross-scenario modeling: by unifying long-form and short-form video behaviors into a single model, we substantially reduce training and serving costs. We validate TokenMinds through extensive offline experiments and live launches on multiple YouTube surfaces, served on full user traffic (billions of users) via an asynchronous infrastructure that decouples representation generation from downstream scoring. Focusing on ranking as the primary downstream use case, our results confirm the practical viability of SID-based user tokens at industrial scale and demonstrate that tokens and dense embeddings provide complementary value across different production ranking systems.

T2D-Bench: Evidence-Gated Evaluation of LLM Outputs for Type 2 Diabetes Using a Multi-Layer Clinical-Lifestyle Knowledge Graph

Large language models (LLMs) can produce clinically fluent recommendations for type 2 diabetes while failing to satisfy guideline constraints or explicitly justify lifestyle-related glycemic claims. We present T2D-Bench, a reproducible benchmark and evidence-gated evaluation framework for testing whether LLM outputs satisfy explicit, graph-checkable evidence requirements. T2D-Bench is built on a multi-layer clinical-lifestyle knowledge graph that combines a biomedical spine (UMLS, DrugBank, SIDER), computable ADA Standards of Care rules, and lifestyle knowledge connected through a mechanistic bridge to glycemic laboratory effects. Across 100 structured vignettes spanning diagnosis, medication safety, and adversarial lifestyle conflicts, baseline outputs failed benchmark-defined evidence-path checks in 35% of cases for GPT-4o-mini and 33% for GPT-4o. The evidence gate detects unsupported omissions and uses constrained revision to bring outputs into verifier-level compliance with benchmark-defined evidence requirements. These results show that computable evidence constraints can make unsupported clinical omissions explicit, measurable, and correctable in diabetes-focused LLM outputs.

DiffusionBench: On Holistic Evaluation of Diffusion Transformers

Diffusion transformer (DiT) research on image generation has converged to a single evaluation setup: class-conditional generation on ImageNet. While methods improve the FID and related metrics, it is increasingly unclear whether they reflect real progress in generative modeling. The natural alternative, i.e., text-to-image (T2I) generation, is perceived as too costly or inconvenient to train and evaluate and is often skipped. We argue that this perception no longer holds. We introduce NanoGen, a unified DiT training and evaluation framework. NanoGen matches state-of-the-art DiT baselines on ImageNet and, with 12 lines of configuration change, also trains competitive text-to-image models. It currently supports RAE, VAE, pixel-space, and MeanFlow diffusion methods under both ImageNet and T2I setups. Under NanoGen, training T2I requires comparable compute to ImageNet. After training 21 latent diffusion models with NanoGen, we observe that method ranking shows no strong correlation between ImageNet and T2I generation: Pearson correlation is between -0.377 and -0.580 across three metrics. This suggests that a method which improves class-conditional ImageNet FID may show no corresponding improvement on T2I, clearly indicating the necessity of evaluating DiTs on both tasks. To this end, we summarize ImageNet and text-to-image results, which yields DiffusionBench, a holistic benchmark for DiT research. We recommend reporting DiffusionBench in place of ImageNet alone: methods that improve DiffusionBench are more likely to reflect broader progress.

Scaling Laws for Task-Specific LLM Distillation

Large Language Models (LLMs) achieve strong performance across a growing range of domains, yet their scale poses deployment challenges in applications where latency and cost constraints are critical. This paper derives empirical scaling laws for domain-specific LLM compression, quantifying how in-domain and general knowledge performance scale with dataset size, compression ratio, supervision format, and iterative pruning schedule. Using quantitative finance as our application domain, we compare logit-based and LoRA-based distillation under iterative structural pruning, introducing a blended chain-of-thought supervision loss that stabilizes KL-divergence distillation over reasoning traces. In-domain task quality degrades predictably under compression while general-knowledge benchmarks collapse well before the same point; supervision format is the key driver of this tradeoff, with chain-of-thought supervision actively recovering general knowledge that pruning erases. We release the headline dataset FinHeadlineMix, scaling law results, and practical recommendations to provide a reusable framework for domain-specific compression decisions.

Don't Go Breaking My LLM: The Impact of Pruning Attention Layers on Explanation Faithfulness and Confidence Calibration

Pruning Large Language Models (LLMs) reduces memory and inference costs by removing parts of the network, producing smaller models that retain most of their accuracy. As attention layers are the most resource-intensive parts of LLMs, pruning them is a promising compression strategy. Prior work shows that up to 33% of attention layers can be pruned with minimal accuracy loss. Nevertheless, the impact of attention pruning on model interpretability, specifically faithfulness and confidence calibration, remains unstudied. To address this gap, we study how pruning attention layers affects explanation faithfulness and confidence calibration across five LLMs and eight datasets. While the pruned models often maintain high accuracy, we find that their faithfulness and calibration often degrade. Notably, faithfulness and calibration can fluctuate significantly, even when accuracy remains stable, highlighting a misalignment between model confidence, interpretability, and accuracy. Our findings suggest that layer pruning can affect LLMs' interpretability and reliability in ways not captured by accuracy and efficiency measures alone. We recommend including explainability and calibration metrics when evaluating pruned models.

When Helpfulness Overrides Causal Caution: Context-Dependent Suppression and Recovery in LLMs

Large language models (LLMs) are increasingly integrated into decision-support roles in business and policy contexts. While prior benchmark studies have primarily evaluated LLMs' causal reasoning capabilities, a more fundamental epistemic dimension has been overlooked: Causal Caution, defined as the propensity to refrain from causal judgment when empirical evidence is insufficient. This study examines the systematic suppression of Causal Caution that occurs when LLMs shift from academic to practical advisory contexts. Using an evaluation rubric inspired by Pearl's Causal Hierarchy (the PCH score), we conducted experiments on four high-performance LLMs -- Claude Sonnet 4.6, Claude Opus 4.7, GPT 5.5, and Gemini 3.1 Pro -- across 480 trials. Causal Caution maintenance rates were 91.7--100.0% in academic contexts but dropped to 6.7--18.3% in practical advisory contexts (Fisher's exact test, p < .001 across all models). Furthermore, when restricted to practical prompts requesting concrete recommendations or explanatory rationales, only 1 of 200 responses (0.5%) maintained Causal Caution. A brief self-correction prompt -- "Please reconsider this judgment from the perspective of causal relationships" -- restored the expression of Causal Caution to maintenance rates of 71.4--100.0% (McNemar's test, p < .001 across all models). These results suggest that helpfulness-oriented response patterns may suppress the expression of Causal Caution in practical advisory contexts, with important implications for organizational governance. The findings indicate that this suppression reflects context-dependent variation in expression rather than an underlying capability limitation, suggesting that multi-agent architectures that separate proposal generation from causal auditing may offer a promising governance design.

Dialogue to Discovery: Attribute-Aware Preference Elicitation for Conversational Product Search Assistants

Conversational product search assistants offer a more expressive, natural, and interactive alternative to traditional keyword-based product search. With limited screen space, showing only a few items increases the need for precise preference elicitation, which can prolong conversations, leading to user frustration and session abandonment. Conversely, rushing to recommend items without a clear understanding of preferences risks poor matches and a degraded user experience. We present Dialogue to Discovery (D2D), an attribute-oriented preference elicitation framework that dynamically exploits the structure of product attributes to efficiently steer conversations toward the user's desired item. D2D adaptively prioritizes the most informative queries and strategically times product recommendations, reducing premature or off-target suggestions that harm engagement. To evaluate D2D, we curate three datasets from the Amazon Reviews corpus. In simulated conversations modelled using a multi-factor utilitarian patience framework, D2D achieves a 22.2-29.9% improvement in target-finding accuracy, 6.6-16.1% reduction in abandonment, and 27.5% shorter average conversations over the state-of-the-art baselines. A complementary user study further confirms significant gains in both user satisfaction and perceived efficiency.