Opinion ID: 2828807
Heading Depth: 1
Heading Rank: 4

Heading: How Reliable is Our Research?

Text: Thus far I have avoided debating the details of the majority’s research, but they deserve closer attention. The specific details highlight the more general criticisms I have directed at such factual research by judges. First, on the websites the majority relies upon, we find important disclaimers that emphasize the need for filtering their information through qualified medical advice, which no member of this court is qualified to provide. The Physician’s Desk Reference site says it is to be used “only as a reference aid. It is not intended to be a substitute for the exercise of professional judgment. You should confirm the information on the PDR.net site through independent sources and seek other professional guidance in all treatment and diagnosis decisions.” www.pdr.net (last visited August 19, 2015, as were all websites cited here). The Mayo Clinic and Zantac websites have similar disclaimers advising readers to talk to a physician or other health care provider before acting on the information on the websites. See www.mayoclinic.org/about-this-site/terms-conditions-usepolicy; www.zantacotc.com/zantac-maximum- strength.html#faqs. Second, after we get past the disclaimers, the content of the majority’s websites simply does not give clear support to the majority’s views (a) that Dr. Wolfe was wrong in saying that the 150 mg pills Rowe was receiving twice a day could No. 14-3316 45 be equally effective even if not given shortly before meals, let alone (b) that Dr. Wolfe was so thoroughly and obviously wrong that a jury could infer that prison staff were deliberately indifferent to Rowe’s health needs. The majority’s websites instead show that some degree of medical judgment is needed to decide when best to administer which size pills for patients with different needs, especially patients like Rowe with chronic conditions. The Mayo Clinic site says that patients taking prescription strength Zantac twice a day should take one in the morning and one at bedtime. The majority discounts that advice because Rowe was taking an over-the-counter dosage of 150 mg pills rather than the prescription dosage of 300 mg pills. Ante at 8. Yet that explanation overlooks the advice from both the manufacturer and the Mayo Clinic that a patient should not take the over-the-counter pills for more than two weeks unless directed by a doctor. For patients like Rowe, taking Zantac long-term to treat GERD, the Mayo Clinic offers more specific guidance. It advises that adult patients with GERD take the 150 mg pill two times a day without specifying that the pills should be taken shortly before meals. www.mayoclinic.org/drugs-supplements/histamineh2-antagonist-oral-route-injection-route-intravenousroute/proper-use/drg-20068584. That advice from the Mayo Clinic seems identical to Dr. Wolfe’s view. Similarly, the PDR advises that for treatment of GERD, “Symptomatic relief commonly occurs within 24 hours after starting therapy with ZANTAC 150 mg twice daily,” again without indicating any need to take the pills before meals. www.pdr.net/full-prescribing-information/zantac-150-and300-tablets?druglabelid=241#section-standard-1. 46 No. 14-3316 The “full prescribing information” on the Physician’s Desk Reference website says that for treatment of GERD with the 150 mg and 300 mg pills, “Symptomatic relief commonly occurs within 24 hours after starting therapy with ZANTAC 150 mg twice daily,” again without saying anything about taking pills before meals. www.pdr.net/fullprescribing-information/zantac-150-and-300tablets?druglabelid=241. And again, that was Rowe’s diagnosis and those were his pills in 2011. The majority draws on the PDR website and “common sense” regarding how long the pills remain effective. Ante at 17. The PDR website, however, simply does not provide sufficient data on absorption and clearance rates for the medicine to allow us to exercise our own (non-expert) judgment about whether the timing of Rowe’s pills was appropriate. It certainly does not allow us to conclude that the timing could have amounted to deliberate indifference to his serious health needs or to find that Dr. Wolfe’s uncontradicted affidavit did not support the district court’s entry of summary judgment on this claim. Of course, the point of this discussion of the websites is not to debate the majority on the medical fine points. The websites the majority relies upon tell us themselves that their information needs to be interpreted by a qualified physician. None of this information is in the record. None was before the district court, nor is it properly before us. The majority’s interpretation of its internet research is not a reliable substitute for proper evidence subjected to adversarial scrutiny. And while Dr. Wolfe’s affidavit is far less detailed than the information the majority has explored on the internet, I also see no basis for the majority’s harsh criticism No. 14-3316 47 of him, especially when Dr. Wolfe has not been given any opportunity to respond or explain.4