With the Prison-Guard Strike, the NEJM Erodes its Scientific Authority

On "Carceral Health Care"

At least nine inmates in New York prisons have died since February 17th, when thousands of corrections workers went on strike across the state. Citing violent work conditions and severe staff shortages, the striking prison officers blamed many of their problems on the enforcement of New York’s HALT Act, which was signed into law in 2021. As we will see, the law’s full name—the Humane Alternatives to Long-Term Solitary Confinement Act—does not meaningfully capture the substantive changes it introduced in the penal system.

The strike hasn’t been sanctioned by the officers’ union, and it led to the National Guard being called in to subdue the prison chaos. It ended in an uneasy truce this week, after Governor Kathy Hochul threatened to bar striking workers from future law-enforcement and other civil-service jobs. On Monday, approximately 5,000 striking officers returned to work. On Tuesday, Hochul signed an executive order making good on her warning: over 2,000 workers who remained on strike have been fired and cannot be re-employed in the civil service.

Mike Groll/Office of Governor Kathy Hochul

Interestingly, the strike also coincided with the publication of “Carceral Health Care” in a February “review” section of the New England Journal of Medicine. Unlike the NEJM’s “perspective” section, which publishes narrative or opinion essays, a review article is meant to provide an authoritative examination of medical research in a given field. Recent review articles have titles like “Primary Central Nervous System Vasculitis” or “Genetics of Chronic Kidney Disease.” By contrast, recent perspective pieces include “What I Wish I Had Done for a Grieving Father” and “Facing Political Attacks on Medical Education—The Future of Diversity, Equity, and Inclusion in Medicine.” In other words, NEJM review articles are ostensibly there to provide up-to-date clinical guidance to physicians—not personal reflections or policy arguments.

Its opening lines, however, indicate that “Carceral Health Care” is not a scientific paper:

Decades of strict sentencing laws, the racially motivated “War on Drugs,” and simultaneous erosion of community mental health and social services have contributed to the American public health crisis of mass incarceration. . . Overlapping medical, behavioral, and social forces produce distinctive health needs among incarcerated people. Many people arrive at carceral facilities with sociocultural health risks, including poor health care access, substance use disorder, mental illness, exposure to violence, housing instability, poverty, and physical or psychological trauma. These intersecting health risks become magnified in many carceral facilities, where exposure to violence and drugs, as well as loneliness, is the norm. Mass incarceration is also both a manifestation and a driver of structural racism.

Readers may agree with virtually every premise here: that “mass incarceration” is a product and generator of “structural racism,” and that it constitutes a “public-health crisis”; that the “War on Drugs” was racially motivated; and that a combination of strict sentencing laws and weak mental-health services have resulted in sorry conditions in the nation’s prisons. There are serious, long-debated questions concerning incarceration—how to understand the proper role of prisons, how to protect prisoners from each other and themselves, how to keep prison workers safe. These questions entail serious cost-benefit analyses regarding the risks posed by drugs or violent offenders to the public, the morality of cell confinement or other forms of discipline, and the effectiveness of rehabilitation programs. And they have no place in the review section of a clinical medical journal.