# A Principle-based Framework for the Development and Evaluation of Large Language Models for Health and Wellness

arXiv: https://arxiv.org/abs/2512.08936 · HTML: https://mlsanity.com/paper/2512.08936/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 51 of its 73 references that are in the map.
- First posted on arXiv 23 Oct 2025.

## Builds on (most cited first, 30 of 51)

- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [Jailbroken: How Does LLM Safety Training Fail?](https://mlsanity.com/paper/2307.02483/) (2023)
- [A Survey on Evaluation of Large Language Models](https://mlsanity.com/paper/2307.03109/) (2023)
- [A Diversity-Promoting Objective Function for Neural Conversation Models](https://mlsanity.com/paper/1510.03055/) (2015)
- [Length-Controlled AlpacaEval: A Simple Way to Debias Automatic Evaluators](https://mlsanity.com/paper/2404.04475/) (2024)
- [Can Large Language Models Be an Alternative to Human Evaluations?](https://mlsanity.com/paper/2305.01937/) (2023)
- [Texygen: A Benchmarking Platform for Text Generation Models](https://mlsanity.com/paper/1802.01886/) (2018)
- [All That's 'Human' Is Not Gold: Evaluating Human Evaluation of Generated Text](https://mlsanity.com/paper/2107.00061/) (2021)
- [Judging the Judges: Evaluating Alignment and Vulnerabilities in LLMs-as-Judges](https://mlsanity.com/paper/2406.12624/) (2024)
- [Evaluating Large Language Models: A Comprehensive Survey](https://mlsanity.com/paper/2310.19736/) (2023)
- [Foundational Challenges in Assuring Alignment and Safety of Large Language Models](https://mlsanity.com/paper/2404.09932/) (2024)
- [Large Language Model Routing with Benchmark Datasets](https://mlsanity.com/paper/2309.15789/) (2023)
- [MART: Improving LLM Safety with Multi-round Automatic Red-Teaming](https://mlsanity.com/paper/2311.07689/) (2023)
- [Sociotechnical Safety Evaluation of Generative AI Systems](https://mlsanity.com/paper/2310.11986/) (2023)
- [Repairing the Cracked Foundation: A Survey of Obstacles in Evaluation Practices for Generated Text](https://mlsanity.com/paper/2202.06935/) (2022)
- [Who Validates the Validators? Aligning LLM-Assisted Evaluation of LLM Outputs with Human Preferences](https://mlsanity.com/paper/2404.12272/) (2024)
- [Is LLM-as-a-Judge Robust? Investigating Universal Adversarial Attacks on Zero-shot LLM Assessment](https://mlsanity.com/paper/2402.14016/) (2024)
- [Dissecting Adversarial Robustness of Multimodal LM Agents](https://mlsanity.com/paper/2406.12814/) (2024)
- [Evaluating Open-Domain Question Answering in the Era of Large Language Models](https://mlsanity.com/paper/2305.06984/) (2023)
- [How Memory Management Impacts LLM Agents: An Empirical Study of Experience-Following Behavior](https://mlsanity.com/paper/2505.16067/) (2025)
- [LongEval: Guidelines for Human Evaluation of Faithfulness in Long-form Summarization](https://mlsanity.com/paper/2301.13298/) (2023)
- [CheckEval: A reliable LLM-as-a-Judge framework for evaluating text generation using checklists](https://mlsanity.com/paper/2403.18771/) (2024)
- [LLM-Rubric: A Multidimensional, Calibrated Approach to Automated Evaluation of Natural Language Texts](https://mlsanity.com/paper/2501.00274/) (2024)
- [Foundational Autoraters: Taming Large Language Models for Better Automatic Evaluation](https://mlsanity.com/paper/2407.10817/) (2024)
- [A Framework for Human Evaluation of Large Language Models in Healthcare Derived from Literature Review](https://mlsanity.com/paper/2405.02559/) (2024)
- [Operationalizing a Threat Model for Red-Teaming Large Language Models (LLMs)](https://mlsanity.com/paper/2407.14937/) (2024)
- [A Toolbox for Surfacing Health Equity Harms and Biases in Large Language Models](https://mlsanity.com/paper/2403.12025/) (2024)
- [The Ethics of ChatGPT in Medicine and Healthcare: A Systematic Review on Large Language Models (LLMs)](https://mlsanity.com/paper/2403.14473/) (2024)
- [AI-Driven Review Systems: Evaluating LLMs in Scalable and Bias-Aware Academic Reviews](https://mlsanity.com/paper/2408.10365/) (2024)

## Built on by (most cited first, 3 of 3)

- [AI Chatbot Suicide Risk Detection and Response: Human Validation Study of the Open-Source VERA-MH Safety Evaluation](https://mlsanity.com/paper/2602.05088/) (2026)
- [RubricsTree: Scalable and Evolving Open-Ended Evaluation of Personal Health Agents across Health Memory and Medical Skills](https://mlsanity.com/paper/2606.18203/) (2026)
- [A primer on evaluation methods for large language models in healthcare](https://mlsanity.com/paper/2609.14819/) (2026)

## Abstract (arXiv)

The incorporation of generative artificial intelligence into personal health applications presents a transformative opportunity for personalized, data-driven health and fitness guidance, yet also poses challenges related to user safety, model accuracy, and personal privacy. To address these challenges, a novel, principle-based framework was developed and validated for the systematic evaluation of LLMs applied to personal health and wellness. First, the development of the Fitbit Insights explorer, a large language model (LLM)-powered system designed to help users interpret their personal health data, is described. Subsequently, the safety, helpfulness, accuracy, relevance, and personalization (SHARP) principle-based framework is introduced as an end-to-end operational methodology that integrates comprehensive evaluation techniques including human evaluation by generalists and clinical specialists, autorater assessments, and adversarial testing, into an iterative development lifecycle. Through the application of this framework to the Fitbit Insights explorer in a staged deployment involving over 13,000 consented users, challenges not apparent during initial testing were systematically identified. This process guided targeted improvements to the system and demonstrated the necessity of combining isolated technical evaluations with real-world user feedback. Finally, a comprehensive, actionable approach is established for the responsible development and deployment of LLM-powered health applications, providing a standardized methodology to foster innovation while ensuring emerging technologies are safe, effective, and trustworthy for users.