The authors present a "penal harm medicine" hypothesis in their research on correctional health care and they distinguish between penal harm and penal managerialism concepts. These concepts are related, however, in that they produce similar effects on inmate conditions of confinement. The penal harm concept recognizes that the incarceration experience is intended to harm. Moreover, penal harm advocates strive to make incarceration as harsh as possible. The penal managerialism concept is more concerned with efficiently managing burgeoning aggregate inmate populations according to principles of actuarial justice and risk management. The authors respond to specific criticisms of their research findings. 32 references and 7 footnotes