Generative Simulation Benchmarking for precision oncology clinical workflows with ethical auditability baked in The Unexpected Epiphany It was 2 AM, and I was staring at a screen filled with genomic mutation data from a patient with triple-negative breast cancer. My team had spent six months building an agentic AI system designed to recommend personalized treatment pathways—combining molecular profiling, drug interaction databases, and clinical trial matching. The system was technically brilliant: it could parse 10,000+ research papers per hour, simulate drug responses using quantum-inspired tensor networks, and generate treatment plans in under 90 seconds. But as I watched the AI recommend a promising PARP inhibitor combination, a cold realization hit me: we had no way to ethically audit this recommendation . The system had learned from historical clinical data that disproportionately underrepresented minority populations.…