Generative pretraining established reusable task representations; later work on language-based task conditioning and in-context learning showed that a fixed model could adapt its behavior from instructions and demonstrations. Policy Iteration with Human Feedback (PIHF) builds on this development and the recurrent evaluate-and-improve structure of generalized policy iteration. PIHF uses a pretrained language model as its execution substrate and moves persistent revision to a versioned natural-language policy and tool set. A language-model critic and clinical expert review complete-panel reasoning and tool-use trajectories to localize recurrent failures and form candidate revisions; the expert may reinterpret the evidence and retains authority over admission and rollback, while Recall@1 and Recall@5 validate outcomes after candidate execution. Across cumulative ablations and ultra-rare-disease benchmarks, a PIHF-derived policy improved Recall@1 in one proprietary executor and three open-weight executors spanning 3 to 49 billion active parameters. Gains were 32.7 percentage points for GPT-5.4 and 31.1 points for Qwen3.6-35B, a difference of 1.7 points. These results support the feasibility of using pretrained language models as fixed-weight execution substrates for expert-guided policy development in rare-disease diagnosis.

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