Document ID: ./input/supremecourt_opinions/opinions/14pdf/14-7955_aplc.pdf
Page Number: 104

8 

GLOSSIP v. GROSS 

SOTOMAYOR, J., dissenting 

anybody,”  he  noted  that  deaths  had  occurred  in  doses  as
low  as  0.04  to  0.07  milligrams  per  kilogram  (2.8  to  4.9
milligrams for a 70-kilogram adult), and contended that a 
500-milligram  dose  would  itself  cause  death  within  less
than an hour—a conclusion he characterized as “essentially 
an  extrapolation  from  a  toxic  effect.”  Id.,  at  327;  see  id., 
at 308. 

Second, in explaining how he reconciled his opinion with
the evidence of midazolam’s ceiling effect, Dr. Evans testi­
fied  that  while  “GABA  receptors  are  found  across  the 
entire  body,”  midazolam’s  ceiling  effect  is  limited  to  the 
“spinal cord” and there is “no ceiling effect” at the “higher 
level of [the] brain.”  Id., at 311–312.  Consequently, in his
view, “as you increase the dose of midazolam, it’s a linear 
effect,  so  you’re  going  to  continue  to  get  an  impact  from
higher  doses  of  the  drug,”  id.,  at  332,  until  eventually
“you’re  paralyzing  the  brain,”  id.,  at  314.    Dr.  Evans  also 
understood  the  chemical  source  of  midazolam’s  ceiling 
effect  somewhat  differently  from  petitioners’  experts. 
Although he agreed that midazolam produces its effect by
“binding to [GABA] receptors,” id., at 293, he appeared to 
believe  that  midazolam  produced  sedation  by  “inhibiting
GABA” from attaching to GABA receptors, not by promot­
ing GABA’s sedative effects, id., at 312.  Thus, when asked 
about  Dr.  Lubarsky’s  description  of  the  ceiling  effect,  Dr. 
Evans  characterized  the  phenomenon  as  stemming  from
“the  competitive  nature  of  substances  trying  to  attach  to 
GABA receptors.”  Id., at 313. 

Dr.  Evans  cited  no  scholarly  research  in  support  of  his
opinions.  Instead,  he  appeared  to  rely  primarily  on  two
sources:  the  Web  site  www.drugs.com,  and  a  “Material
Safety Data Sheet” produced by a midazolam manufacturer.
See  id.,  at  303.  Both  simply  contained  general  infor­
mation that covered the experts’ areas of agreement.