Clinical Question-Answering (CQA) industry systems are increasingly rely on Large Language Models (LLMs), yet their deployment is often guided by the assumption that domain-specific fine-tuning is essential. Although specialised medical LLMs such as BioBERT, BioGPT, and PubMedBERT remain popular, they face practical limitations including narrow coverage, high retraining costs, and limited adaptability. Efforts based on Supervised Fine-Tuning (SFT) have attempted to address these assumptions but continue to reinforce what we term the SPECIALISATION FALLACY—the belief that specialised medical LLMs are inherently superior for CQA. To address this assumption, we introduce MEDASSESS-X, a deployment-industry-oriented CQA framework that applies alignment at inference time rather than through SFT. MEDASSESS-X uses lightweight steering vectors to guide model activations toward medically consistent reasoning without updating model weights or requiring domain-specific retraining. This inference-time alignment layer stabilises CQA performance across both general-purpose and specialised medical LLMs, thereby resolving the SPECIALISATION FALLACY. Empirically, MEDASSESS-X delivers consistent gains across all LLM families, improving Accuracy by up to +6%, Factual Consistency by +7%, and reducing Safety Error Rate by as much as 50%.

Large Language Model (LLM) safety is inherently pluralistic, reflecting variations in moral norms, cultural expectations, and demographic contexts. Yet, existing alignment datasets such as Anthropic-HH and DICES rely on demographically narrow annotator pools, overlooking variation in safety perception across communities. Demo-SafetyBench addresses this gap by modeling demographic pluralism directly at the prompt level, decoupling value framing from responses. In Stage I, prompts from DICES are reclassified into 14 safety domains (adapted from BeaverTails) using Mistral-7B-Instruct-v0.3, retaining demographic metadata and expanding low-resource domains via Llama-3.1-8B-Instruct with SimHash-based deduplication, yielding 43,050 samples. In Stage II, pluralistic sensitivity is evaluated using LLMs-as-Raters—Gemma-7B, GPT-4o, and LLaMA-2-7B—under zero-shot inference. Balanced thresholds (delta = 0.5, tau = 10) achieve high reliability (ICC = 0.87) and low demographic sensitivity (DS = 0.12), confirming that pluralistic safety evaluation can be both scalable and demographically robust. Code and data available at: https://github.com/usmaann/Demo-SafetyBench