Drug companies looking for subjects to enroll in clinical trials just love prisons—they hold plenty of people who are not only hungry for potential treatments but good bets to keep appointments. And though the nation’s correctional system has a documented history of abuse of trial participants, some prisoners and their advocates now want in.

Last fall, Brown University’s HIV Education/ Prison Project (HEPP) Clinical Trials in Corrections conference brought together health, prison and legal experts to hash out the issue. “This is only the beginning of a long process,” said HEPP’s Betsy Stubblefeld, one of the confab organizers. “This is the first time since the ’70s that the prospect is even
being discussed.”

With few rights and little recourse against mistreatment, prisoners are in a tricky situation. Their regular health care may be so poor—particularly in prison systems without a history of good patient care—that a trial is their only hope for adequate treatment, let alone new, costly drugs. But incentive may not be balanced by information, according to Judy Greenspan, chair of California Prison Focus’ HIV in Prison committee. Under ideal circumstances, participation in drug trials demands considerable treatment knowledge. But prison libraries don’t have comprehensive materials, and, according to Greenspan, for prisoners with rare access to any other information about new meds, it’s hard to make an informed decision.

“Prisoners are the guinea pigs of choice,” said Allen Hornblum, who wrote Acres of Skin, an exposé about medical abuse in Philadelphia’s Holmesburg Prison. “With so many liberties taken by doctors and pharmaceutical companies, you have to be extremely suspicious of their motivations.”

The issue isn’t going anywhere fast—conference participants have been slow to produce guidelines for safe trials. Because some states prohibit trials outright, said Greenspan, often the most effective method is for a prison doctor to work with community organizations, pushing for an OK to approve trials in a particular prison “on an emergency basis.” Four states—Florida, Texas, North Carolina and Maryland—are already allowing prisoners to enroll in trials. Whether or not all the hassle will drive drug companies away for good remains to be seen.