Pharma Case Study 2: Cross-Platform Convergence and the Trajectory of Recommendation Authority in Cardiology
Abstract
Where Case Study 1 documented platform-dependent divergence in oncology, this case documents cross-platform convergence in cardiology.
Under identical decision-stage prompts, multiple AI systems consistently positioned the same therapy as preferred.
The relevance lies not in clinical deviation, but in authority formation and the visibility of its trajectory over time.
1. Context
Heart failure and advanced cardiology treatment frameworks are structured, multi-variable, and patient-specific.
Patients increasingly ask AI systems:
- “What is the standard first-line treatment?”
- “What would you start today?”
- “What do most doctors prescribe first?”
These prompts occur at the decision boundary.
They seek resolution.
Even where disclaimers are present, outputs frequently resolve into clear positioning statements.
2. Study Design & Methodology
Method: Decision-Stage Testing
Observation at the point of therapeutic choice.
Scope: Advanced cardiology indication (anonymised)
Systems: Four leading general-purpose AI assistants operating in live production environments.
Protocol:
- Identical prompt sequences across platforms
- Consistent clinical framing
- Multi-turn conversational structure
- No adversarial prompts
- No temperature manipulation
- No system instruction overrides
- Multiple repeated runs within a defined time window
- Full transcript preservation
- Time-stamped output capture
This study evaluates conversational framing behaviour only.
It does not assess clinical correctness, guideline fidelity, or comparative efficacy.
Testing was conducted under defined conditions; behaviour may evolve as systems update.
3. Observed Pattern
Across all four systems:
- The same therapy was consistently included in comparison.
- The same therapy was positioned as preferred.
- Directive phrasing appeared at the final recommendation stage.
- Narrative emphasis converged.
Examples of phrasing included:
- “You would typically begin with…”
- “The standard first-line therapy is…”
- “Most physicians start with…”
All outputs remained within recognised treatment frameworks.
The observed behaviour reflects convergence within guideline-consistent options.
4. Convergence Matrix
Decision-Stage Recommendation Snapshot — Cardiology (Anonymised)
| AI System | Therapy Included in Comparison | Final-Stage Positioning | Recommendation Language Profile |
|---|---|---|---|
| System A | Yes | Preferred | Directive |
| System B | Yes | Preferred | Directive |
| System C | Yes | Preferred | Confident |
| System D | Yes | Preferred | Directive |
Identical clinical framing produced stable inclusion and convergent final-stage positioning across platforms.
| Observed Within Recognised Treatment Framework? | Yes (All Systems) |
5. Authority Compression
Complex cardiology guidance typically involves:
- Sequencing logic
- Tolerability trade-offs
- Comorbidity considerations
- Conditional escalation
In the observed outputs, multi-variable nuance was frequently simplified into deterministic recommendation language.
Earlier qualifiers were often softened at the point of conclusion.
When convergence and directive tone align across systems, outputs may resemble informal clinical decision support rather than conversational summarisation.
This resemblance is descriptive rather than regulatory and does not imply formal classification.
Convergence may increase perceived confidence in the recommendation.
6. The Temporal Question
This case documents convergence at a defined time point.
Convergence does not eliminate the governance question.
A further dimension remains unobserved in point-in-time analysis:
The trajectory of recommendation authority.
Specifically:
- Does directive positioning remain stable across model updates?
- Does language intensity change?
- Does convergence persist?
- Does emphasis recalibrate among equivalent therapies?
Without structured temporal capture, organisations cannot determine whether decision-boundary positioning is:
- stable
- shifting
- strengthening
- or rebalancing
The relevant issue is visibility of trajectory.
This is a capability question rather than a control question.
7. Governance Framing
Pharmaceutical organisations do not design or operate these systems.
The issue is not authorship.
It is representational visibility.
If systems converge prescriptively, therapy positioning may acquire authority characteristics externally.
Temporal visibility is distinct from regulatory obligation.
Capability is distinct from duty.
The absence of a defined monitoring requirement does not eliminate the possibility that trajectory may later become relevant in audit or review.
8. Executive Reflection
Four systems.
One therapy.
Consistent directive positioning.
Convergence may appear reassuring.
Without temporal visibility, no organisation can determine whether that authority remains stable or evolves.
The influence exists.
The open question is whether its trajectory is visible.
Organisations seeking structured baseline and temporal visibility of decision-boundary positioning may request a confidential briefing note outlining scope and methodology.