What Does It Mean for a Medical AI System to Be Right?

Abstract

This paper examines what it means for a medical AI system to be right by grounding the question in a specific clinical context: the automatic classification of plasma cells in digitized bone marrow smears for the diagnosis of multiple myeloma. Drawing on philosophy of science and research ethics, the paper argues that correctness in medical AI is not a singular property reducible to benchmark performance, but a multi-dimensional concept involving the availability of expertly labeled medical datasets, the explainability and interpretability of model outputs, the clinical meaningfulness of evaluation metrics, and the distribution of accountability in human-AI workflows. As such, the paper develops this argument through four interrelated themes: the instability of ground truth labels, the opacity of overconfident AI, the inadequacy of standard clinical metrics, and the risk of automation bias in time-pressured clinical settings.