Pedram Fard

Cameron Cagan, Pedram Fard, Jiazi Tian et al.

Autonomous agentic workflows that iteratively refine their own behavior hold considerable promise, yet their failure modes remain poorly characterized. We investigate optimization instability, a phenomenon in which continued autonomous improvement paradoxically degrades classifier performance, using Pythia, an open-source framework for automated prompt optimization. Evaluating three clinical symptoms with varying prevalence (shortness of breath at 23%, chest pain at 12%, and Long COVID brain fog at 3%), we observed that validation sensitivity oscillated between 1.0 and 0.0 across iterations, with severity inversely proportional to class prevalence. At 3% prevalence, the system achieved 95% accuracy while detecting zero positive cases, a failure mode obscured by standard evaluation metrics. We evaluated two interventions: a guiding agent that actively redirected optimization, amplifying overfitting rather than correcting it, and a selector agent that retrospectively identified the best-performing iteration successfully prevented catastrophic failure. With selector agent oversight, the system outperformed expert-curated lexicons on brain fog detection by 331% (F1) and chest pain by 7%, despite requiring only a single natural language term as input. These findings characterize a critical failure mode of autonomous AI systems and demonstrate that retrospective selection outperforms active intervention for stabilization in low-prevalence classification tasks.

Jiazi Tian, Liqin Wang, Pedram Fard et al.

Early identification of cognitive concerns is critical but often hindered by subtle symptom presentation. This study developed and validated a fully automated, multi-agent AI workflow using LLaMA 3 8B to identify cognitive concerns in 3,338 clinical notes from Mass General Brigham. The agentic workflow, leveraging task-specific agents that dynamically collaborate to extract meaningful insights from clinical notes, was compared to an expert-driven benchmark. Both workflows achieved high classification performance, with F1-scores of 0.90 and 0.91, respectively. The agentic workflow demonstrated improved specificity (1.00) and achieved prompt refinement in fewer iterations. Although both workflows showed reduced performance on validation data, the agentic workflow maintained perfect specificity. These findings highlight the potential of fully automated multi-agent AI workflows to achieve expert-level accuracy with greater efficiency, offering a scalable and cost-effective solution for detecting cognitive concerns in clinical settings.

Pedram Fard, Alaleh Azhir, Neguine Rezaii et al.

Artificial intelligence in medicine is built to serve the average patient. By minimizing error across large datasets, most systems deliver strong aggregate accuracy yet falter at the margins: patients with rare variants, multimorbidity, or underrepresented demographics. This average patient fallacy erodes both equity and trust. We propose a different design: a multi-agent ecosystem for N-of-1 decision support. In this environment, agents clustered by organ systems, patient populations, and analytic modalities draw on a shared library of models and evidence synthesis tools. Their results converge in a coordination layer that weighs reliability, uncertainty, and data density before presenting the clinician with a decision-support packet: risk estimates bounded by confidence ranges, outlier flags, and linked evidence. Validation shifts from population averages to individual reliability, measured by error in low-density regions, calibration in the small, and risk--coverage trade-offs. Anticipated challenges include computational demands, automation bias, and regulatory fit, addressed through caching strategies, consensus checks, and adaptive trial frameworks. By moving from monolithic models to orchestrated intelligence, this approach seeks to align medical AI with the first principle of medicine: care that is transparent, equitable, and centered on the individual.