State Chapters
Letter to NEJM regarding the IOM Report and Prisoner Health Care

May 3, 2007

To the Editor:

The piece by Dr Lerner is an excellent review of the history of human experimentation on prisoners and clearly delineates the concerns about the Institute of Medicine (IOM) report that recommends the inclusion of prisoners in research studies.¹

One notable problem that was not mentioned is the significant lack of access to basic and competent medical care in the prison system. In New York and across the nation, the medical care of prisoners has been documented to be sub-standard with preventable deaths resulting from the neglect of prisoner’s complaints and medical conditions.²  Disturbingly, medical care of prisoners in many locales is under the control of for-profit corporations creating the situation where a physician must reconcile the conflict between the patient’s best interest and that of the corporation.² These competing interests are the foundation of prohibitions on the corporate practice of medicine that exist, but are generally not enforced, in most states.³

Before considering whether there is a safe and ethical method for conducting research on the prison population, the states and the federal government should first ensure the basic medical needs of prisoners. Until these needs are met, the consideration of prisoner research should be tabled. 

Lemeneh Tefera, MD
New York Chapter,
American Academy of Emergency Medicine
New York, NY

Robert McNamara, MD
Temple University
Philadelphia, PA

1. Lerner BH. Subjects or object? Prisoners and human experimentation. N Engl J Med 2007: 356: 1806-7.

2. von ZIELBAUER Paul. “Private Health Care in Jails Can Be a Death Sentence.” New York Times 27 Feb 2006.

3. Serbaroli FJ. The corporate practice of medicine prohibition in the modern era of health care. BNA’s Health Law & Business Series no. 2800, Washington, DC, 1999.