Jotterand and Wangmo’s (2014) reconsideration of the principle of equivalence in prison medicine concludes with a refreshing call for realism. A realistic assessment of the circumstances of prisoners, particularly in the United States, which is the focus of this commentary, clearly indicates why equivalence in health care is an unachievable goal. Their analysis, particularly the review of the underlying values of national and international guidelines on the treatment of prisoners, stands in stark contrast to the everyday life experience of the incarcerated. Indeed, it verges on the ludicrous to suggest that any aspect of incarceration, including such health care as may be provided to prisoners, might be informed by such core values as respect for autonomy, privacy, dignity, and beneficence. […]