Kos Pharm Inc v. Andrx Corp ( 2004 )


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  •                                                                                                                            Opinions of the United
    2004 Decisions                                                                                                             States Court of Appeals
    for the Third Circuit
    5-24-2004
    Kos Pharm Inc v. Andrx Corp
    Precedential or Non-Precedential: Precedential
    Docket No. 03-3977
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    Recommended Citation
    "Kos Pharm Inc v. Andrx Corp" (2004). 2004 Decisions. Paper 649.
    http://digitalcommons.law.villanova.edu/thirdcircuit_2004/649
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    PRECEDENTIAL       Richard W. Young (Argued)
    Liisa M. Thomas
    UNITED STATES COURT OF               Nicole M. Murray
    APPEALS                       Gardner Carton & Douglas LLP
    FOR THE THIRD CIRCUIT               191 N. Wacker Drive, Suite 3700
    Chicago, Illinois 60606
    No. 03-3977                  Mark S. Olinsky
    James M . Hirschhorn
    Sills Cummis Radin Tischman Epstein &
    KOS PHARM ACEUTICALS, INC.,                      Gross, P.A.
    One Riverfront Plaza
    Appellant                   Newark, New Jersey 07102-5400
    v.                             Attorneys for Appellant
    ANDRX CORPORATION; ANDRX                  Allyn Z. Lite (Argued)
    LABORATORIES, INC.                     Joseph J. DePalma
    Michael E. Patunas
    Lite DePalma Greenberg & Rivas, LLC
    Two Gateway Center, 12th Floor
    On Appeal from the United States         Newark, New Jersey 07102
    District Court for the
    District of New Jersey             James V. Costigan
    (District Court No. 03-cv-03714)         Martin P. Endres
    District Court Judge: Honorable Dennis      Kathleen A. Costigan
    M. Cavanaugh                   Hedman & Costigan, P.C.
    1185 Avenue of the Americas
    New York, New York 10036
    Argued: March 9, 2004
    Attorneys for the Appellees
    Before: SLOVITER, NYGAARD,
    Circuit Judges, and OBERDORFER,*
    District Judge.                       OPINION OF THE COURT
    (Opinion Filed: May 24, 2004)
    OBERDORFER, Senior District Judge.
    This is an appeal from the denial of
    *
    The Honorable Louis F. Oberdorfer,     preliminary relief in a trademark
    Senior District Judge for the District of   infringement action. Plaintiff-appellant
    Columbia, sitting by designation.           Kos Pharmaceuticals, Inc. (“Kos”) owns
    the mark ADVICOR, which it uses in                drug, Advicor. 1
    connection with cholesterol-altering drugs
    Shortly after Kos began marketing
    available by prescription. Kos sought a
    Advicor, it learned that Andrx planned to
    preliminary injunction preventin g
    use the mark ALTOCOR for its own new
    defendants-appellees Andrx Corporation
    anticholesterol medication, which would
    and Andrx Laboratories, Inc. (collectively,
    contain only a single active ingredient, an
    “Andrx”) from using the mark ALTOCOR
    extended-release form of lovastatin, in
    in connection with sales of Andrx’s own
    varying strengths (10, 20, 40 or 60
    cholesterol-altering prescription drugs.
    milligrams). Andrx announced on January
    The district court denied the requested
    31, 2002 that it had received preliminary
    relief, and this appeal followed. Because
    marketing approval for Altocor from the
    the denial of the preliminary injunction
    United States Food and Dru g
    was premised on legal errors, we reverse.
    Administration (the “FDA”). On February
    We remand the case to the district court
    5, 2002, the PTO published for opposition
    with directions to enter a preliminary
    the ALTOCOR mark, which Andrx had
    injunction on an expedited basis.
    applied to register in December 2000.
    I. BACKGROUND
    Kos tried to dissuade or otherwise
    Unless otherwise noted, the             prevent Andrx from using the ALTOCOR
    following facts are undisputed.       On          mark several times, both before and after
    October 3, 2000, Kos filed an application         Andrx began selling its new drug. On
    with the United States Patent and                 April 1, 2002, Kos wrote to Andrx that, in
    Trademark Office (the “PTO”) to register          its view, the proposed use of the mark
    ADVICOR as the mark for a new                     ALTOCOR “would constitute trademark
    m e d i c a t ion designed to improve             infringement and unfair competition.” JA
    cholesterol levels.      This new drug            at 273. It advised Andrx to “refrain from
    combines 20 milligrams of lovastatin              using ALTOCOR or any other mark which
    (which lowers LDL, or “bad” cholesterol)          is likely to cause confusion with
    with varying strengths (500, 750, or 1000         A D V I CO R f o r p h ar m aceutic al
    milligrams) of an extended-release                preparations.” 
    Id. Kos described
    its prior
    formulation of niacin (which increases            use of ADVICOR for its own cholesterol-
    HDL, or “good” cholesterol). Kos has              altering medication and stated further that:
    been selling its proprietary extended-
    If Andrx were to use the
    release form of niacin under the trade
    name Niaspan since 1997. In July 2001
    Kos began advertising, and in December               1
    To distinguish the marks from the
    2001 began selling, its new combination
    drugs they identify, we use all capital
    letters to refer to the marks, but capitalize
    only the first letter when referring to the
    drugs.
    2
    mark ALTOCOR for                            Kos also expressed its concerns
    [the described]                     about potential confusion to the FDA
    pha r m a c e utical                division responsible for reviewing
    preparations,                       proposed new drug names from a public
    consumers and                       health perspective, the Office of Drug
    m e d i c a l                       Safety’s Division of Medication Errors and
    professionals would                 Technical Support (the “Division of
    inevitably believe                  Medication Errors”). The Division of
    that Andrx’s product                Medication Errors had preliminarily
    originates with or is               approved the name Altocor in November
    authorized by,                      2001.3 At that time, the Division stated
    sponsored by, or in                 that the “name Advicor looks and sounds
    some way connected                  similar [to] Altocor,” but concluded that
    with Kos and its                    the “difference in the written strengths” of
    A D V I C O R                       the drugs reduced the risk of “error . . .
    p h a r m a ceutical                between the two products.” 
    Id. at 269.
                  products. . . . The                 After Kos learned of the preliminary
    similarity betw een                 approval, it sent a letter to the FDA, dated
    the marks and the                   March 6, 2002, stating that it was
    goods may create                    “concerned that the similarity in the
    confusion among                     proprietary names of these two products
    health          care                may create confusion among health care
    practitioners in terms              practitioners in terms of both prescribing
    of both prescribing                 and dispensing these medications.” 
    Id. at a
    n d dispen s i n g,               250.
    resulting           in
    In April 2002, the Division of
    d a n g e r o u s
    Medication Errors reiterated its opinion
    medication errors.
    that “the difference in the strengths
    
    Id. at 272-73.
    A similar letter followed on       (combination vs. single) will help ensure
    April 15, 2002. 
    Id. at 362.
    Andrx                 that medication errors do not occur
    responded to neither letter. 2                    between the two products.” 
    Id. at 261.
    At
    the same time, however, it concluded that
    “the name, Altocor, [is] no longer
    2
    At oral argument, counsel for
    Andrx -- apparently and inexplicably
    3
    unaware of these letters -- incorrectly                  The Division of Medication
    stated that Kos did not inform Andrx              Errors was then known as the Office of
    directly of its view that Andrx’s                 Post-Marketing Drug Risk Assessment.
    proposed mark was confusingly similar             For ease of reference, we use the current
    to its own before Altocor went to market.         name.
    3
    acceptable due to the potential for                opposition is susp ende d pen din g
    confusion with” a third, unrelated drug.           disposition of this civil litigation.
    
    Id. at 258.
    When Andrx objected to
    In July 2002, Andrx began
    changing the name of its product, the
    marketing Altocor.         Thereafter, Kos
    Division of Medication Errors, while “not
    “advised Andrx of the growing number of
    recommend[ing] the use of the proposed
    instances of actual confusion” on multiple
    name, Altocor,” gave conditional approval
    occasions. 
    Id. at 75.
    For example, on
    to using the name so long as Andrx
    January 10, 2003, Kos sent Andrx’s
    “commit[ed] to submitting all potential
    counsel a chart “setting forth . . .
    and actual errors involving Altocor . . .
    occurrences of actual consumer confusion”
    [and] to changing the proprietary name,
    reported to it. 
    Id. at 368.
    On February 20,
    Altocor, if two or more reports of actual
    2003, Kos sent an updated chart, entitled
    errors occur.” 
    Id. at 256.4
                                                       “Summary of Confusion Involving
    Kos next raised its concerns with           Advicor and Altocor,” that listed 39
    the PTO. In May 2002, Kos filed an                 discrete instances of purported confusion.
    opposition to Andrx’s application to               
    Id. at 304-08
    (listing incidents between
    register the mark ALTOCOR. Some                    September 2, 2002 and February 12,
    discovery has been conducted in that               2003).
    proceeding, but no decision has been
    In the meantime, on December 5,
    issued. According to the PTO docket, the
    2002, Andrx filed with the FDA a
    “supplemental new drug application
    4
    propos[ing] three alternate proprietary
    The precise terms of the
    names” for Altocor. 
    Id. at 380.
    On April
    conditional FDA approval are in some
    11, 2003, Andrx filed an application with
    dispute, but are only tangentially relevant
    the PTO to register the mark ALTOPREV.
    to issues raised here. Andrx claims it
    And Andrx’s 2002 Annual Report, issued
    needed to change its mark only if there
    in the spring of 2003, stated:
    were four actual errors the first year
    Altocor was sold, and then only if the                    Andrx’s application for a
    errors were between Altocor and the                       registered trademark for
    unrelated drug about which the FDA                        Altocor has been opposed
    expressed concern. JA at 345 (citing a                    by Kos Pharmaceuticals,
    letter Andrx sent the FDA shortly before                  who alleges that there is a
    the April 2002 Division of Medication                     likelihood of confusion
    Errors document was issued). In that                      between Kos’ trademark,
    letter, however, Andrx agreed to “submit                  Advicor, and Altocor.
    all reports” of medication errors “related                Andrx has requested FDA
    to Altocor” that it receives, not just those              guidance on other names,
    involving Altocor and one particular                      and may seek to change the
    drug. 
    Id. at 348.
                                            name of Altocor.
    4
    
    Id. at 374.
    The FDA approved Andrx’s              issue here. Neither party requested an
    supplemental application on August 20,            opportunity to adduce oral testimony on
    2003, stating that “the proprietary name,         the application.
    Altoprev, is acceptable.” 
    Id. at 380.
    5
    The documentary evidence before
    By August 2003, Kos had spent              the district court included the following:
    more than $ 40 million on promotion and
    Evidence      Regarding      Actual
    advertising, and Advicor had been
    Confusion
    prescribed more than 350,000 times,
    grossing approximately $ 70 million in                   Kos submitted the Certification of
    sales. Andrx had spent more than $ 21             its Vice President of Marketing, Aaron
    million on promotion and advertising, and         Berg, dated August 5, 2003 (“Berg
    Altocor had been prescribed more than             Certification”), 6 which stated, inter alia,
    300,000 times, grossing more than $ 27            that Andrx’s use of the mark ALTOCOR
    million.                                          has caused confusion. Berg further stated
    that “over 60 instances of actual confusion
    On August 6, 2003, Kos filed a
    between the two drugs have been
    verified complaint, claiming that Andrx’s
    documented and reported to [him] by [his]
    use of the mark ALTOCOR on its
    staff,” including “six patients [who]
    anticholesterol drugs constituted trademark
    received the wrong medication, either
    infringement and unfair competition under
    because they had been given a sample of
    the federal Lanham Act, and under state
    one drug instead of the other, or because a
    and common law equivalents.             Kos
    pharmacist filled a prescription with the
    accompanied the complaint with the
    wrong drug.” 
    Id. at 69.
    Based on his
    application for a preliminary injunction at
    “personal knowledge or [his] review of the
    business records of Kos,” Berg described
    5
    Andrx claims that it no longer has         “representative . . . instances” of the
    FDA approval to use this name, but                incidents reported to him. 
    Id. at 68,
    71.
    submitted no evidence to support that             These included, for example, doctors
    claim.                                            complaining to Kos representatives about
    the pricing or insurance coverage of
    According to records available on          Advicor, when their complaints were in
    the PTO website, a Notice of Allowance            fact about Altocor, as well as medical
    for the ALTOPREV mark was issued on               professionals identifying Altocor samples
    February 24, 2004. We may take judicial
    notice of such public records. See, e.g.,
    6
    Hoganas AB v. Dresser Indus., Inc., 9                     Andrx challenged the
    F.3d 948, 954 n.27 (Fed. Cir. 1993);              admissibility and probative value of the
    Standard Havens Prods., Inc. v. Gencor            Berg Certification. JA at 41-44. The
    Indus., Inc., 
    897 F.2d 511
    , 514 n.3 (Fed.         district court never ruled on Andrx’s
    Cir. 1990).                                       objection.
    5
    as Adv i co r s am p le s, Altocor                        doing well on the Advicor .
    representatives as Advicor representatives,               . . no reason to change!
    A l t o c o r c o nfere nces as A dvic o r
    
    Id. at 340.
    Andrx also countered the Berg
    conferences, and vice versa.
    Certification with the declaration of its
    Andrx submitted excerpts from              Vice President for Regulatory Affairs,
    Berg’s deposition testimony, taken on June         Nicholas Farina, whose job requires him to
    12, 2003 in the PTO opposition                     report to the FDA “every incidence of
    proceeding. There, Berg said he had not            actual confusion” involving Andrx in
    had “direct contact” with the medical              which “a product other than the one
    professionals involved in any of the               prescribed by a physician is dispensed by
    reported incidents of confusion, but had           a pharmacist and the patient leaves the
    learned of those incidents primarily               pharmacy.” 
    Id. at 345.
    Farina said no
    through voice-mail or e-mail. 
    Id. at 291.
             such incidents relating to Altocor had been
    Andrx contrasted Berg’s characterization           reported to Andrx as of the date of his
    of one incident -- where, Berg said, a             declaration, August 26, 2003. 
    Id. at 346.
    patient whose “condition was improving .
    Medical Evidence
    . . asked his cardiologist for more of the”
    Advicor his doctor had prescribed, but the                The parties submitted competing
    “cardiologist refilled the prescription with       medical affidavits to support their
    Altocor,” 
    id. at 71
    -- with the following          respective views as to the nature and
    more detailed description of the same              severity of potential consequences of mis-
    incident, sent to Berg by e-mail:                  filled prescriptions.7 Per Kos, niacin --
    and thus Advicor, but not Altocor -- may
    [A doctor] said that he had a
    cause serious injury, or even death, to
    patient that he had put on
    patients with various conditions or
    Advicor and when he went
    sensitivities to the drug. Other, less
    to his cardiologist, . . . he
    serious, side effects of niacin may worry
    was due for a refill on
    patients who have not been warned of
    Advicor.         The patient
    those effects, and who may thus
    returned . . . and [the doctor]
    discontinue needed treatment. Patients
    notice[d] that the medicine
    who mistakenly receive Altocor rather
    listed was not Advicor, but
    Altocor! . . . [T]he patient
    told him that [th e                            7
    Kos initially relied on the Berg
    cardiologist] renewed his
    Certification for these medical issues, but
    Rx. [The doctor] did not
    supplemented this -- at the hearing --
    question [the cardiologist]
    with a physician’s certification. The
    directly . . . ‘not my place to
    district court’s order, issued the day after
    ? a cardiologist’. Up to that
    the hearing, mentions only the initial
    point, the patient had been
    certification.
    6
    than Advicor are also at risk, says Kos,            ALTOCOR was one of many . . .
    since the conditions the niacin is meant to         generated by” an outside firm. 
    Id. at 342.
    address will remain untreated. Andrx, on
    the other hand, claims that the “safety
    profile of both products is similar” and that
    there need not be “any unusual concern”
    about “harm to the public if the Andrx
    product is substituted for the KOS
    product.” 
    Id. at 226.
           Evidence Regarding Adoption of
    Marks
    The Berg Certification also
    addressed selection of the ADVICOR and
    ALTOCOR marks. Berg stated that Kos
    chose ADVICOR as “a fanciful, made-up
    name” that would be “an unusual,
    distinctive name to make the drug stand
    out to doctors as unique.” 
    Id. at 73.
    He
    asserted that a former Kos product
    manager, Charles Schneider, “who was
    actively participating in [Kos’s] naming
    initiative” left Kos for Andrx during the
    “naming process.” 
    Id. at 73-74.
    Kos
    submitted an e-mail, sent to Schneider
    before his departure, that listed 42 possible
    names that it was considering, of which 12
    -- including ADVICOR and AVICOR --
    were “already picked” by it as possible
    names, and asked Schneider and one other
    Kos employee to select ten “back up
    names.” 
    Id. at 356-57.
    Berg said Andrx
    then applied to register “two closely
    similar trademarks:          AVICOR and
    ALTOCOR” “[a]lmost immediately after”
    Schneider arrived there. 
    Id. at 74.
    Andrx
    submitted a declaration from Schneider
    stating that he “was never involved with
    nor aware of the selection of the name
    AD VICO R,” and that the “name
    7
    Evidence    R egarding          Other          court held that Kos had not shown that it
    Proceedings                                    was likely to succeed on the merits, and
    found, based in large part on its negative
    Andrx submitted letters Kos sent
    assessment of Kos’s likelihood of success,
    the European Community Trademark
    that Kos did not satisfy the other
    Office in support of its application to
    prerequisites for extraordinary relief. Kos
    register ADVICOR over the mark
    filed this interlocutory appeal, and we
    ACTIVOR, which was being used, not on
    granted Kos’s request for an expedited
    prescription anticholesterol drugs, but
    appeal schedule.
    rather on over-the-counter “stimulants and
    preparations used to build up vitality.” 
    Id. II. LEGAL
    STANDARDS AND
    at 329, 333. Kos argued there, inter alia,                     JURISDICTION
    that (1) the “opening syllable[s]” of the
    The test for preliminary relief is a
    marks (AD v. AC) are “not identical,”
    familiar one.       A party seeking a
    which is important “since attention to a
    preliminary injunction must show: (1) a
    polysyllabic word is normally focused on
    likelihood of success on the merits; (2) that
    the beginning,” 
    id. at 328;
    (2) neither the
    it will suffer irreparable harm if the
    middle (VI v. TI) nor final (COR v. VOR)
    injunction is denied; (3) that granting
    syllables are identical; (3) the “suffix COR
    preliminary relief will not result in even
    . . . is very common in the pharmaceutical
    greater harm to the nonmoving party; and
    Class 5 category,” 
    id. at 329;
    (4) the
    (4) that the public interest favors such
    “functions [of the products] do not
    relief. Allegheny Energy, Inc. v. DQE,
    overlap,” id.; (5) “there is little chance that
    Inc., 
    171 F.3d 153
    , 158 (3d Cir. 1999).
    any doctor would confuse a prescription
    Preliminary injunctive relief is “an
    cholesterol altering medication with an
    extraordinary remedy” and “should be
    over the counter product,” or that a
    granted only in limited circumstances.”
    “qualified pharmacist” would do so, 
    id. at American
    Tel. & Tel. Co. v. Winback &
    333; and (6) “the channels of distribution,
    Conserve Program, Inc., 
    42 F.3d 1421
    ,
    method of purchase and the targeted
    1427 (3d Cir. 1994) (quotation omitted).
    customer is different in relation to the two
    “[O]ne of the goals of the preliminary
    products,” 
    id. injunction analysis
    is to maintain the status
    On September 17, 2003, after                   quo, defined as the last, peaceable,
    hearing argument, the district court denied           noncontested status of the parties.”
    Kos’s application for a preliminary                   Opticians Ass’n of Am. v. Indep.
    injunction from the bench. The court                  Opticians of Am., 
    920 F.2d 187
    , 197 (3d
    issued a supplemental memorandum the                  Cir. 1990) (citation and quotation
    following day that incorporated the                   omitted); see also 5 J. Thomas McCarthy,
    “reasons . . . stated on the record during            McCarthy on Trademarks and Unfair
    oral argument” and provided additional                Competition § 30:50 (4th ed. 2003) (“The
    reasons for its decision. 
    Id. at 13.
    The              status quo to be preserved is not the
    8
    situation of contested rights . . . . In a            appeal pursuant to 15 U.S.C. § 1121(a)
    trademark case, [it] is the situation prior to        and 28 U.S.C. § 1292(a).
    the time the junior user began use of its
    III. LIKELIHOOD OF SUCCESS ON
    contested mark: the last peaceable, non-
    THE MERITS
    contested status.”).
    To prevail on a claim for trademark
    We review the denial of a
    infringement or unfair competition under
    preliminary injunction for “an abuse of
    the Lanham Act, the owner of a valid and
    discretion, an error of law, or a clear
    legally protectable mark, such as Kos,
    mistake in the consideration of proof.”
    must show that a defendant’s use of a
    
    Winback, 42 F.3d at 1427
    (quotation
    similar mark for its goods “causes a
    omitted). “[A]ny determination that is a
    likelihood of confusion.”          A & H
    prerequisite to the issuance of an
    Sportswear, Inc. v. Victoria’s Secret
    injunction . . . is reviewed according to the
    Stores, Inc., 
    237 F.3d 198
    , 210 (3d Cir.
    standard applicable to that particular
    2000). 8 This Court has adopted a non-
    determination.” 
    Id. (second alteration
    in
    exhaustive list of factors to consider in
    original, quotation omitted). “Thus, we
    evaluating likelihood of confusion,
    exercise plenary review over the district
    commonly referred to as the “Lapp
    court’s conclusions of law and its
    factors.” See Interpace Corp. v. Lapp,
    application of law to the facts, but review
    Inc., 
    721 F.2d 460
    , 463 (3d Cir. 1983).
    its findings of fact for clear error, which
    These factors were developed for cases
    occurs when we are left with a definite and
    involving non-competing products. 
    Id. at firm
    conviction that a mistake has been
    committed.” Duraco Prods., Inc. v. Joy
    8
    Plastic Enters., Ltd., 
    40 F.3d 1431
    , 1438                     See 15 U.S.C. § 1114(1)(a)
    (3d Cir. 1994) (citations and quotation               (defining infringement as the
    omitted). “Despite oft repeated statements            unauthorized use of a “colorable
    that the issuance of a preliminary                    imitation of a registered mark in
    injunction rests in the discretion of the trial       connection with the sale, offering for
    judge[,] whose decisions will be reversed             sale, distribution or advertising of any
    only for ‘abuse,’ a court of appeals must             goods or services on or in connection
    reverse if the district court has proceeded           with which such use is likely to cause
    on the basis of an erroneous view of the              confusion, or to cause mistake, or to
    applicable law.” Apple Computer, Inc. v.              deceive”); 15 U.S.C. § 1125(a)(1)
    Franklin Computer Corp., 
    714 F.2d 1240
    ,               (creating cause of action for use “in
    1242 (3d Cir. 1983) (quotation omitted).              connection with any goods . . . [of] any
    word, term [or] name . . . likely to cause
    The district court had original
    confusion, or to cause mistake, or to
    jurisdiction pursuant to 15 U.S.C. §
    deceive as to . . . the origin, sponsorship,
    1121(a) and 28 U.S.C. § 1338, and we
    or approval of [those] goods . . . by
    have jurisdiction over this interlocutory
    another person”).
    9
    462. Although we have held that courts                       same channels of trade and
    “‘need rarely look beyond the mark itself’”                  advertised through the same
    in cases involving competing goods, we                       media;
    recently recognized that “consideration of
    (8) the extent to which the
    the Lapp factors . . . can be quite useful for
    targets of the parties’ sales
    determining likelihood of confusion even
    efforts are the same;
    when the goods compete directly.” A &
    
    H, 237 F.3d at 212
    (quoting Lapp, 721                        (9) the relationship of the
    F.2d at 462). Because some of the initial                    goods in the minds of
    Lapp factors were “not apposite for                          consumers, whether because
    directly competing goods,” we “adapted                       of the near-identity of the
    [them] to make them applicable whether                       products, the similarity of
    the products directly compete or not.” 
    Id. function, or
    other factors;
    at 212-13. As adapted, the factors are:
    (10) other facts suggesting
    (1) the degree of similarity                          that the consuming public
    between the owner’s mark                              might expect the prior
    and the alleged infringing                            owner to manufacture both
    mark;                                                 products, or expect the prior
    owner to manufacture a
    (2) the strength of the
    product in the defendant’s
    owner’s mark;
    market, or expect that the
    (3) the price of the goods                            prior owner is likely to
    and other factors indicative                          expand into the defendant’s
    of the care and attention                             market.
    expected of consumers
    
    Id. at 215.
    “None of these factors is
    when making a purchase;
    determinative in the likelihood of
    (4) the length of time the                     confusion analysis and each factor must be
    defendant has used the mark                    weighed and balanced one against the
    without evidence of actual                     other.” Checkpoint Sys., Inc. v. Check
    confusion arising;                             Point Software Techs., Inc., 
    269 F.3d 270
    ,
    280 (3d Cir. 2001). Each factor is
    (5) the intent of the
    “weighed . . . separately,” which “is not to
    defendant in adopting the
    say that all factors must be given equal
    mark;
    weight.” Fisons Horticulture, Inc. v.
    (6) the evidence of actual                     Vigoro Indus., Inc., 
    30 F.3d 466
    , 476 &
    confusion;                                     n.11 (3d Cir. 1994). “[T]he different
    factors may properly be accorded different
    (7) whether the goods,
    weights depending on the particular factual
    competing or not competing,
    setting. A district court should utilize the
    are marketed through the
    10
    factors that seem appropriate to a given
    situation.” A & 
    H, 237 F.3d at 215
    . The
    Lapp factors are best understood as “tools
    to guide a qualitative decision.” 
    Id. at 216.
            Here, the district court held that two
    of the factors -- strength of the owner’s
    mark, and the extent to which the parties’
    sales efforts are the same -- favored Kos,
    but that “the remaining Lapp factors do
    not.” JA at 10-11. The court found
    “[s]uccess on these two Lapp factors . . .
    insufficient to persuade [it] that confusion
    is likely to occur.” 
    Id. at 9.
    It further
    found that Kos “failed to convince [it] that
    the selective consumers in this case,
    physicians and pharmacists, will suffer
    from a likelihood of confusion.” 
    Id. at 9.
    The opinion analyzed only the two factors
    the court found weighed in Kos’s favor.
    As to the remaining factors, the court said
    only that, “[a]fter carefully evaluating the
    Lapp test in its entirety, [it] concludes that
    there is no likelihood of confusion.” 
    Id. at 11.
            We recognize that district courts
    must exercise their discretion on an
    expedited basis in deciding whether to
    grant preliminary relief. Although we
    ordinarily defer to that discretion, we
    cannot do so if it was exercised under a
    mistaken view of the law. Here, two
    fundamental errors of law taint the district
    court opinion: (1) the court used an overly
    narrow definition of confusion, in effect
    evaluating the likelihood of misdispensing
    rather than confusion; (2) the court did not
    properly analyze or weigh the Lapp
    factors.
    11
    First, the hearing transcript betrays               pharmacist cannot fill the
    a focus on whether prescriptions are likely                  wrong prescription.      It’s
    to be mis-filled, to the apparent exclusion                  impossible to fill the wrong
    of all other types of confusion with which                   prescription.
    the Lanham Act is concerned.               For
    THE COURT: That’s my
    example:
    point: . . . that because of
    MR. YOUNG [Counsel for                                the types of dosages, if they
    Kos]: . . . The Lanham Act                            have the wrong name, if
    doesn’t           require                             they have a name with the
    misdispensing. What we                                wrong dos age , they
    have seen is, a lot of doctors                        wouldn’t . . . be able to fill
    are saying --                                         that prescription.
    THE COURT:        Yes, but                            MR. LITE: T h a t ’ s
    misdispensing is the basis                            absolutely correct, Your
    for confusion.                                        Honor.
    MR. YOUNG:           That’s                           THE COURT: So there
    p o w erf ul evidence of                              can’t be confusion, you’re
    confusion. But what’s also                            saying.
    happening        in    the
    MR. LITE: Well, I don’t
    marketplace is, doctors are
    t h i n k t h e r e ca n b e
    saying, Look, I’m not going
    confusion.        There can’t,
    to prescribe either drug
    certainly, be confusion in
    because I can’t keep them
    the prescribing or
    straight. . . .
    dispensing of these drugs. .
    ...                                                   ..
    THE COURT: Well, if that                       
    Id. at 39-40.
    Much of the balance of the
    were the case, then I guess                    colloquy focused on the possibility, and
    there’s no concern about                       potential danger, of misdispensing.9 As
    adverse health effects to the
    patient, because they’re not
    9
    getting the wrong drug;                               The court’s extensive focus on
    they’re getting another drug                   misdispensing may reflect consideration
    that the doctor wants them                     of Kos’s “public interest” argument (that
    to have.                                       the chance of serious injury made
    preliminary relief essential) as well as a
    JA at 52 (emphasis added). Similarly:
    narrow view of the element of confusion.
    MR. LITE [Counsel for                          See, e.g., JA at 20:20; 
    id. at 21:3-22;
    id.
    Andrx]: . 
    . . A prudent                        at 25:4-14, 
    id. at 31:4-33:20;
    id. at 34:5-
    
    12
    noted above, the district court opinion                          The Act is now broad enough to
    incorporates the reasons articulated by the            cover “the use of trademarks which are
    court at oral argument. These statements               likely to cause confusion, mistake, or
    are thus a powerful indicator that the                 deception of any kind, not merely of
    court’s “likelihood of confusion” analysis             purchasers nor simply as to source of
    rested substantially, if not entirely, on              origin.” Syntex Labs., Inc. v. Norwich
    misdispensing as the confusion at issue.               Pharmacal Co., 
    437 F.2d 566
    , 568 (2d Cir.
    This is not the law. It is clear error to treat        1971) (emphasis added); see, e.g.,
    misdispensing as the only relevant Lanham              
    Checkpoint, 269 F.3d at 295
    (overly
    Act confusion.                                         narrow view of confusion “would
    undervalue the importance of a company’s
    The Lanham Act defines trademark
    g o o d w i l l w i th it s c u st om e r s ” );
    infringement as use of a mark so similar to
    Morningside Group Ltd. v. Morningside
    that of a prior user as to be “likely to cause
    Capital Group, L.L.C., 
    182 F.3d 133
    , 141
    confusion, or to cause mistake, or to
    (2d Cir. 1999) (reversing due to lower
    deceive.”         15 U.S.C. § 1114(1).
    court’s use of “inordinately narrow
    Likelihood of confusion under the Lanham
    definition of actual confusion” that
    Act is not limited to confusion of products,
    ignored “actual confusion regarding
    as in misdispensing. Confusion as to
    affiliation or sponsorship”); Meridian
    source is also actionable. See, e.g., Fisons,
    Mutual Ins. Co. v. Meridian 
    Insurance 30 F.3d at 472
    (“[L]ikelihood of confusion
    Group, Inc., 
    128 F.3d 1111
    , 1118 (7th Cir.
    . . . exists when the consumers viewing the
    1997) (context of confusion “immaterial”
    mark would probably assume that the
    because any injury to goodwill or loss of
    product . . . it represents is associated with
    control over reputation is actionable);
    the source of a different product . . .
    Champions Golf Club, Inc. v. Champions
    identified by a similar mark.”) (quotation
    Golf Club, Inc., 
    78 F.3d 1111
    , 1119-20
    omitted). We recently described how the
    (6th Cir. 1996) (relevant evidence of
    1962 amendments to the Lanham Act
    confusion goes beyond purchaser
    broadened the scope of trademark
    confusion and includes “confusion among
    protection beyond the traditional source-
    nonpurchasers” in order to “protect the
    of-origin confusion. Checkpoint, 269 F.3d
    manufacturer’s reputation”); Fuji Photo
    at 295 (citing deletion of the phrase
    Film Co. v. Shinohara Shoji Kabushiki
    “purchasers as to the source of origin of
    Kaisha, 
    754 F.2d 591
    , 596 (5th Cir. 1985)
    such goods or services” from the end of
    (actionable confusion includes any use
    the former definition, which now reads
    “likely to confuse purchasers with respect
    “likely to cause confusion, or to cause
    to . . . [a product’s] endorsement by . . ., or
    mistake, or to deceive”).
    its connection with[,] the plaintiff”).
    Second, the district court failed to
    13; 
    id. at 35:4-36:20;
    id. at 37:19-40:15; 
                “employ all the relevant Lapp factors and
    
    id. at 42:10-18;
    id. at 48:16-52:25. 
                      weigh each factor to determine whether in
    13
    the totality of the circumstances                            When reviewing an order that does
    marketplace confu sio n is like ly.”                 not adequately support the resolution of a
    
    Checkpoint, 269 F.3d at 296
    (emphasis                motion for preliminary injunction, we may
    added). Despite recognizing that “‘each              vacate and remand for additional findings
    factor must be weighed and balanced,’”               or may “first look[] to see whether the
    the court did not perform the requisite              record provides a sufficient basis to
    weighing and balancing on the record. JA             ascertain the legal and factual grounds for
    at 8 (quoting Checkpoint, 269 F.3d at                the grant or denial of the injunction.”
    280). The Lapp test is not a mechanistic             Bradley v. Pittsburgh Bd. of Educ., 910
    one. It need not be “followed precisely so           F.2d 1172, 1178 (3d Cir. 1990). Although
    long as the relevant comparisons suggested           a district court’s application of an incorrect
    by the test are made.” A & H, 237 F.3d at            legal standard “would normally result in a
    207. But if a district court finds “certain          remand, we need not remand” if
    of the Lapp factors are inapplicable or              application of the correct standard could
    unhelpful in a particular case,” that court
    should “explain its choice not to employ
    runs afoul of Rule 52(a), which requires
    those factors.” 
    Id. at 214
    n.8. Here, the
    courts to “set forth the findings of fact
    court analyzed only two of the ten Lapp
    and conclusions of law which constitute
    factors -- both of which it found favored
    the grounds” for “granting or refusing
    Kos. The court’s conclusory statement
    interlocutory injunctions.” Fed. R. Civ.
    that “the remaining Lapp factors do not
    P. 52(a). “[F]air compliance with Rule
    [weigh in Petitioner’s favor],” JA at 10-11,
    52(a)” is “of the highest importance to a
    does not explain the basis for its holding as
    proper review of the action of a court in
    to each factor, whether it viewed each as
    granting or refusing a preliminary
    neutral, irrelevant, or favorable to Andrx,
    injunction.” Mayo v. Lakeland
    or how it weighed and balanced the
    Highlands Canning Co., 
    309 U.S. 310
    ,
    combined factors. The opinion thus does
    316 (1940). A district court’s factual
    not make the “relevant comparisons”
    findings and legal conclusions must
    which the Lapp test identifies. Compare
    “explain the basis for” and “permit
    
    Fisons, 30 F.3d at 481
    (reversing because
    meaningful review of its ruling.” Elliott
    “district court misapplied some [Lapp
    v. Kiesewetter, 
    98 F.3d 47
    , 55 (3d Cir.
    factors] and did not consider others”) with
    1996) (quotation omitted). “[T]he
    A& 
    H, 237 F.3d at 215
    -16 (affirming since
    conclusions of law must carefully
    “ostensibly missing Lapp factors appear to
    enunciate and explain the trial court’s
    be incorporated into the District Court’s
    resolution of questions of law, so that the
    test,” which was “functionally similar to
    appellate court is able to conduct a just
    the Lapp test”).10
    and orderly review of the rights of the
    parties.” 9 James Wm. M oore et al.,
    10
    The court’s failure to explain its             Moore’s Federal Practice § 52.15[3] (3d
    conclusions as to each Lapp factor also              ed. 2000).
    14
    support only one conclusion. Duraco                   mark similarity.” A & 
    H, 237 F.3d at 216
    ;
    Prods., Inc. v. Joy Plastic Enters., Ltd., 40         see also 
    id. at 214
    (“[W]hen goods are
    F.3d 1431, 1451 (3d Cir. 1994) (affirming             directly competing, both precedent and
    denial of preliminary injunction where                common sense counsel that the similarity
    plaintiff could not demonstrate likelihood            of the marks takes on great prominence.”).
    of success even “with the evidence viewed             Marks “are confusingly similar if ordinary
    in the light most favorable to it”); see also         consumers would likely conclude that [the
    
    Opticians, 920 F.2d at 198
    ; Lapp, 721 F.2d            two products] share a common source,
    at 460 (reversing and directing entry of              affiliation, connection or sponsorship.”
    judgment). Our holding in Opticians is                
    Fisons, 30 F.3d at 477
    . The proper test is
    instructive. There, we reversed due to                “not side-by-side comparison” but
    legal error and went on to assess the                 “whether the labels create the same overall
    likelihood of confusion, which the district           impression when viewed separately.” 
    Id. court had
    not addressed. 
    Id. at 194-95
                   (quotation and citation omitted). Courts
    (“Likelihood of confusion is a fact                   should “compare the appearance, sound
    normally reviewable under the clearly                 and meaning of the marks” in assessing
    erroneous standard. Our review, however,              their similarity. Checkpoint, 269 F.3d at
    is plenary since there is no dispute as to            281 (quotation omitted). There is no
    the facts relevant to this issue.”). Rather           simple rule as to when marks are too
    than remanding for the district court to              similar. “The degree of similarity . . .
    exercise its discretion in the first instance,        needed to prove likely confusion will vary
    we determined that plaintiff had made all             with the difference in the goods . . . of the
    necessary showings on the undisputed                  parties. Where the goods . . . are directly
    facts of record and directed entry of a               competitive, the degree of similarity
    preliminary injunction. 
    Id. at 196-98.
                   required to prove a likelihood of confusion
    is less than in the case of dissimilar
    Here, we will review the findings
    products.” 3 McCarthy, supra, § 23:20.1.
    and conclusions of the district court and
    the factual assertions and contentions of                    The district court made no findings
    the parties in light of the controlling legal         as to the degree of similarity of the
    principles to see whether the facts and law           ADVICOR and ALTOCOR marks; it
    compel a particular result. If so, it would           merely concluded that this factor does not
    be a waste of judicial resources to remand            favor Kos.
    for reweighing.
    The facts predicate to this analysis
    A.     The Individual Lapp Factors                    are manifest and undisputed. The facial
    similarity of the marks is apparent “on
    1.      Degree of Similarity of the
    their face.” Both are seven-letter, three-
    Marks
    syllable words that begin and end with the
    “The single most important factor              same letters and the same sounds. The
    in determining likelihood of confusion is             marks are also similar in that both are
    15
    “coined word[s], not found even in                    the marks; the overarching question is
    approximation in the English or any other             whether the marks, “viewed in their
    familiar language.” Telechron, Inc. v.                entirety,” are confusingly similar. A & H,
    Telicon Corp., 
    198 F.2d 903
    , 905 (3d 
    Cir. 237 F.3d at 216
    (emphasis added). Cf.
    1952). “Fanciful marks are . . . given an             
    Fisons, 30 F.3d at 478
    (“[T]he district
    expansive scope of judicial protection . . .          court misapprehended the legal standard
    as to more variations of format.” 2                   when it undertook a detailed analysis of
    McCarthy, supra, § 11:6. Two names that               the differences in the marks rather than
    look and sound similar will naturally seem            focusing on the overall impression created
    even more similar where there are no                  by them.”).
    differences in meaning to distinguish
    Andrx attempts to, but cannot,
    them. Nor can the similarity of coined
    justify its approach by characterizing
    marks be explained by, or ameliorated by
    statements Kos made in European
    virtue of, any relationship between the
    trademark proceedings as “admissions that
    marks and the products identified. See,
    directly contradict its position before this
    e.g., 
    Telechron, 198 F.2d at 909
                                                          Court and the district court.” Appellees’
    (Defendant “cannot claim that he is
    Br. at 10. The European proceeding
    exercising the normal privilege of using
    involved different marks (ADVICOR v.
    ordinary language . . . [in] a case of a first
    ACTIVOR), different goods, and different
    coined word and a second coined word
    legal standards than those at issue here.
    resembling it.”); Lambert Pharmacal Co. v.
    Kos’s statements in those proceedings
    Bolton Chem. Corp., 
    219 F. 325
    , 326
    show that the material facts are not
    (S.D.N.Y. 1915) (Hand, J.) (One who has
    equiv alent.        For e x a m p l e , K os
    “adopt[ed a] . . . trade name, arbitrary in
    distinguished Advicor from the over-the-
    character, . . . has the right to insist that
    counter “stimulants and preparations to
    others in making up their arbitrary names
    build up vitality” at issue there by arguing,
    should so certainly keep away from his
    inter alia, that “their functions do not
    customers as to raise no question.”).
    overlap,” and that they have different
    Andrx would differentiate the                 “channels of distribution, method[s] of
    marks by distinguishing what it deems                 purchase and . . . targeted customer[s].”
    unimportant features (namely, “the first              JA at 329, 333. More importantly, Kos’s
    letter ‘A’ and the suffix ‘COR’”) from                claims in those proceedings are all
    those that are “salient” (the “first                  premised on European Community law.
    syllables”).     Appellees’ Br. at 19-20.             Trademark standards do not traverse
    Andrx argues that the “first syllables (AD            international borders. “The concept of
    compared to AL) . . . create a completely             territoriality is basic to trademark law;
    different sight, sound and impression.” 
    Id. trademark rights
    exist in each country
    at 20 (emphasis added). But the proper                solely according to that country’s statutory
    legal test is not whether there is some               scheme.” Fuji 
    Photo, 754 F.2d at 599
    confusing similarity between sub-parts of             (finding it “error to admit evidence of the
    16
    parties’ foreign trademark practices”); see                Second, the PTO has not allowed
    also E. Remy Martin & Co. v. Shaw-Ross             Andrx to register the ALTOCOR mark.
    Int’l Imports, Inc., 
    756 F.2d 1525
    , 1531           As stated above, Kos’s opposition remains
    (11th Cir. 1985) (district court erred in          pending. Andrx’s claim about a favorable
    considering status of parties’ marks in            PTO determination presumably rests on
    France; “Our concern must be the business          the examining attorney’s decision
    and goodwill attached to United States             approving publication of the ALTOCOR
    trademarks, not French trademark rights            mark for opposition.11 The record contains
    under French law.”) (quotation omitted);           no information about the basis for the
    Vanity Fair Mills v. T. Eaton Co., 234             publication decision or about what
    F.2d 633, 639 (2d Cir. 1956) (“[W]hen              information was before the examining
    trade-mark rights within the United States         attorney at that time. Thus, the record
    are being litigated in an American court,          does not show that the PTO actually
    the decisions of foreign courts concerning         considered the registrability of ALTOCOR
    the respective trade-mark rights of the            over ADVICOR, much less that it found
    parties are irrelevant and inadmissible.”).        the marks not to be confusingly similar.
    Cf. Marketing Displays, Inc. v. TrafFix
    Andrx also claims that “[t]he FDA
    Devices, Inc., 
    200 F.3d 929
    , 934 (6th Cir.
    and the USPTO have determined that the
    1999) (rejecting claim that registration of
    marks are not confusingly similar.”
    allegedly infringing mark creates inference
    Appellees’ Br. at 19. But neither of those
    that “the trademark examining attorney at
    proceedings can supplant the required
    the PTO actually examined the [earlier]
    Lanham Act analysis. First, the FDA
    mark and found that the [registered] mark
    applies a standard different from the
    Lanham Act “likelihood of confusion” test
    11
    at issue here. The FDA reviews proposed                    We caution that Andrx’s apparent
    drug names “to predict potential confusion         shorthand characterization of this low-
    that may arise in the actual prescription          level decision as a PTO determination
    process.” 3 McCarthy, supra, § 19:149              seems somewhat misleading, as do such
    (emphasis added); see also 
    id. at §
    19:150         statements as, for example, “the USPTO
    (FDA “likelihood of confusion test [is]            approved the mark.” Appellees’ Br. at
    wholly distinct from the test employed by          35. Publication of a mark is not
    the PTO”).        As discussed above,              equivalent to its allowance or
    misdispensing is not the only type of              registration; the PTO issues a Certificate
    confusion actionable under the Lanham              of Registration only if “all oppositions
    Act. Indeed, to the extent that the FDA’s          filed” after publication are dismissed. 37
    proprietary name review is relevant here,          C.F.R. § 2.81. Reference to PTO action
    the reviewing division’s statement that the        is more naturally understood as
    “name Advicor looks and sounds similar             allowance (or denial) of an application
    [to] Altocor” actually supports Kos’s              rather than publication of a mark,
    claim. See JA at 269.                              especially where an opposition is filed.
    17
    did not infringe it”), rev’d on other               receive less protection from strong
    grounds, 
    532 U.S. 23
    (2001). Indeed, even           infringing marks than weak ones. Indeed,
    where the record shows that an examining            it might be argued that a stronger junior
    attorney has explicitly considered a prior          mark is more likely to cause confusion, at
    mark, we have held that an “initial PTO             least where, as here, both marks are being
    determination . . . may be considered [but]         used in the same market.
    need not be given weight when the PTO
    3.      Factors Indicative of the
    attorney did not review all the evidence
    Care and A ttentio n
    available to the District Court.” A & H,
    Expected of 
    Consumers 237 F.3d at 221
    (affirming decision that
    gave “no weight” to “low-level                              The third Lapp factor weighs
    preliminary decision” even though                   against finding a likelihood of confusion
    examiner assessed likelihood of confusion           “[w]hen consumers exercise heightened
    with prior mark).                                   care in evaluating the relevant products
    before making purchasing decisions.”
    We hold that the district court
    
    Checkpoint, 269 F.3d at 284
    . The district
    clearly erred in failing to recognize that
    court held that Kos did not “convince [it]
    this factor weighs in Kos’s favor. It does.
    that the selective consumers in this case,
    2.     Strength of the Owner’s               physicians and pharmacists, will suffer
    Mark                                  from a likelihood of confusion.” JA at 9.
    The opinion provided no basis for this
    The record supports the district
    conclusion, but did incorporate the
    court’s finding that this factor weighs in
    “reasons . . . stated on the record during
    favor of Kos. The court properly analyzed
    oral argument.” 
    Id. at 13.
    There, the
    both the conceptual and commercial
    judge stated that he thought the differences
    strength of the ADVICOR mark. Andrx
    in the dosage of each drug made errors in
    argues that this factor does not favor Kos
    filling prescriptions unlikely. E.g., 
    id. at because
    ALTOCOR and ADVICOR are
    49 (“[I]t seems to me because of the
    similarly distinctive and have similar
    dosage that has to be made part of the
    strength in the marketplace. But the
    prescription that the pharmacist would
    relative strength of the Andrx’s mark is not
    have to ignore some aspect of such a
    relevant here. The second Lapp factor
    prescription to make a mistake.”). The
    looks to “the strength of the owner’s
    court did not analyze the likelihood of any
    mark.” 
    Lapp, 721 F.2d at 463
    (emphasis
    t yp e o f c o n f u s i o n o t h e r t h a n
    added). “Under the Lanham Act, stronger
    misdispensing.
    marks receive greater protection” because
    they “carry greater recognition, [so that] a               The district court and the parties
    similar mark is more likely to cause                treated medical professionals, such as
    confusion.” A & 
    H, 237 F.3d at 222
    . It              doctors, nurses and pharmacists, as the
    would not serve the purposes of the
    Lanham Act for trademark owners to
    18
    relevant consumers. 12       These trained          Morgenstern Chem. Co. v. G.D. Searle &
    professionals may be expected to be                 Co., 
    253 F.2d 390
    , 393 (3d Cir. 1958)
    knowledgeable about, and to exercise care           (quotation omitted). “[P]hysicians are not
    in distinguishing between, medicines. We            immune from confusion or mistake.” 
    Id. have emphasized
    a countervailing concern            (quotation omitted); see also Syntex Labs.,
    that weighs against allowing the expertise          Inc. v. Norwich Pharmacal Co., 437 F.2d
    of physicians and pharmacists to trump              566, 569 (2d Cir. 1971) (since confusion
    other factors in assessing the likelihood of        of prescription drugs “could result in
    confusion in drug cases. “Prevention of             physical harm to the consuming public,” a
    confusion and mistakes in medicines is too          “stricter standard in order to prevent
    vital to be trifled with” since “[c]onfusion        likelihood of confusion seems desirable”).
    in such products can have serious                   Other jurisdictions and a uthorities
    consequences for the pa tient.”                     similarly recognize that “greater care
    should be taken to avoid confusion in
    12
    connection with medications which affect
    We note that neither the parties
    the health of the patient.” 3A Louis
    nor the court below addressed the
    Altman, Callman on Unfair Competition,
    possible confusion of ultimate
    Trademarks & Monopolies § 21:10 & nn.
    consumers. While doctors and
    121-132 (4th ed. 2003) (collecting cases
    pharmacists play a gate-keeping role
    and authorities).
    between patients and prescription drugs,
    they are not the ultimate consumers.                       In assessing how customer
    Patients are. Courts have noted that                sophistication should be weighed “[w]ith
    drugs are increasingly marketed directly            respect to pharmaceuticals,” the “expertise
    to potential patients through, for                  of the physicians and pharmacists may be
    example, “ask-your-doctor-about-Brand-              outweighed by” this need for heightened
    X” style advertising. See, e.g., Puritan-           care. 
    Id. at §
    21:12 & n.24 (emphasis
    Bennett Corp. v. Penox Techs. Inc., No.             added). Where both professionals and the
    IP 02-0762-C, 
    2004 WL 866618
    , at * 4                general public are relevant consumers,
    (S.D. Ind. Mar. 2, 2004) (admitting                 “the standard of care to be exercised . . .
    evidence of patient confusion as to                 will be equal to that of the least
    medical devices available only by                   sophisticated consumer in the class.”
    prescription but advertised directly to             
    Checkpoint, 269 F.3d at 285
    .             In
    patients because patients “are a part of,           Morgenstern, we criticized the district
    although not the entire, relevant                   court for weighing the “high standards of
    market”); Upjohn Co. v. American Home               care” expected of “physicians and
    Prods. Corp., No. 1:95CV237, 1996 WL                pharmacists” more heavily than the
    33322175, at *4 (W.D. Mich. Apr. 5,                 “obvious similarity in derivation,
    1996) (patients are among relevant                  suggestiveness, spelling, and sound in
    consumers for prescription drugs whose              careless pronunciation between [the
    marketing targets them).                            marks] as applied to pills to be taken by
    19
    mouth for therapeutic purposes.” 253 F.2d           supra, § 23:32 (“[I]t is proper to require a
    at 392. Recognizing that doctors and                lesser quantum of proof of confusing
    pharmacists “are carefully trained to detect        similarity for drugs and m edicinal
    differences in the characteristics of               preparations. . . . [For] prescription drugs,
    pharmaceutical products,” we held that              [this] rule . . . should control over the
    this “does not open the door to the                 supposed ‘sophistication’ of physicians
    adoption by manufacturers of medicines of           and pharmacists.”) (emphasis added).
    trade-marks or names which would be
    Andrx argues that confusion is even
    confusingly similar to anyone not
    less likely here than in other cases
    exercising such great care.” 
    Id. at 393
                                                        involving medical professionals since
    (emphasis added).13 See also 3 McCarthy,
    prescriptions must reflect the different
    chemical composition of the drugs, with
    13
    At oral argument, the question              Advicor prescriptions specifying strengths
    was raised whether Morgenstern creates              of two active ingredients, and Altocor only
    a different standard for drug cases --              one.    Of course, this difference in
    “possibility of confusion” rather than              prescribing is not relevant to the common
    “likelihood of confusion” -- and, if so,            practice of providing samples or to any
    whether it is good law. Compare                     typ e of confusion other than
    
    Morgenstern, 253 F.2d at 394
    (“If there             misdispensing. There is no reason to
    is any possibility of . . . confusion in the        believe that medical expertise as to
    case of medicines public policy requires            products will obviate confusion as to
    that the use of the confusingly similar             source or affiliation or other factors
    name be enjoined.”) with A & H                      affecting goodwill. “It is well settled that
    Sportswear, Inc. v. Victoria’s Secret               expertise in the field of trademarks cannot
    Stores, Inc., 
    166 F.3d 197
    , 205 (3d Cir.
    1999) (en banc) (“[T]he appropriate
    standard for determining trademark                  relying on Morgenstern for the
    infringement under the Lanham Act is                proposition that “the potential harm from
    the likelihood of confusion.”). But cf.             a mistake warrants closer scrutiny” in
    
    Morgenstern, 253 F.2d at 392
    (test for              such cases. Audio Tape of Oral
    infringement is whether marks are so                Argument before Court of Appeals for
    similar “that ordinary purchasers, buying           the Third Circuit (Mar. 9, 2004) (on file
    with ordinary caution, are likely to be             with Court). Morgenstern’s holding --
    misled”) (quotation omitted, emphasis               that drug manufacturers cannot use
    added).                                             marks that would be confusingly similar
    We need not consider the                    to non-experts -- may be best understood
    applicability of the discredited                    as a warning that medical expertise is not
    “possibility of confusion” standard. Kos            enough, in and of itself, to lessen the
    conceded at oral argument that the proper           likelihood of confusion in prescription
    standard is “likelihood of confusion,”              drug cases.
    20
    be inferred from expertise in another area.”        confused either.” 
    Fisons, 30 F.3d at 476
    .
    Fuji 
    Photo, 754 F.2d at 595
    (collecting             The sixth Lapp factor looks at evidence of
    cases); see also Altman, supra, § 21:10 &           actual confusion.
    n.139 (“[I]t has been held that the care
    The district court recited Kos’s
    with which consumers select a product
    claim that, in the thirteen months since
    does not impact the association they may
    ALTOCOR was first sold,14 “at least six
    make regarding sponsorship of another
    patients have received the wrong
    product or service; therefore even a high
    medication due to confusion between the
    degree of care would have little effect on
    drugs’ names” and “over sixty instances of
    confusion of sponsorship.”); cf. Sterling
    actual confusion [have been] reported to
    Drug Inc. v. Lincoln Labs., Inc., 322 F.2d
    [Kos].”    JA at 6.        Yet the court
    968, 971 (7th Cir. 1963) (that defendant’s
    conspicuously failed to analyze either
    product requires prescription does not
    Lapp factor concerned with actual
    “eliminat[e] the likelihood of confusion as
    confusion or to explain why these factors
    to source of origin” for medical products
    did not favor Kos in light of the incidents
    “designed to remedy the same condition in
    Kos identified.
    . . . [and] purchased and used by the same
    classes of persons”); Champions, 78 F.3d                    a.    Admissibility     of    Berg
    at 1121 (6th Cir. 1996) (sophistication of                        Certification
    consumers, who exercise great care in
    Before we reach the substantive
    joining golf club, does not preclude
    issue of actual confusion, we must
    confusion “about affiliation between the
    consider the evidentiary status of the Berg
    two clubs”).
    Certification on which Kos’s claims about
    The district court did not err in            such confusion rest. Andrx challenges the
    holding that this factor does not favor Kos.        admissibility and reliability of the Berg
    We conclude, however, that no reasonable            Certification, which it deems “self-serving,
    factfinder could weigh it heavily for               unreliable and uncorroborated hearsay”
    Andrx.                                              that “is an insufficient basis for the
    issuance of preliminary relief in a
    4/6.   Length of Time Defendant’s
    Mark Has Been Used
    Without Confusion /
    Evidence of Actual
    Confusion
    14
    Per the fourth Lapp factor, two                     Compare Scott Paper Co. v.
    parties’ concurrent use of “similar marks           Scott’s Liquid Gold, Inc., 
    589 F.2d 1225
    ,
    for a sufficient period of time without             1230 (3d Cir. 1978) (citing “over forty
    evidence of consumer confusion about the            years” of concurrent use “without any
    source of the products” allows “an                  evidence of actual confusion” in finding
    inference that future consumers will not be         no likelihood of confusion).
    21
    trademark matter.” Appellees’ Br. at 25.15          trial on the merits.” University of Texas v.
    Camenisch, 
    451 U.S. 390
    , 395 (1981). In
    We have considered the possibility
    keeping with this principle, many of our
    that the district court’s conclusory finding
    sister Circuits have recognized that
    as to these Lapp factors was based on its
    “[a]ffidavits and other hearsay materials
    acceptance of the objections Andrx raised
    are often received in preliminary
    below to the Berg Certification. While it
    injunction proceedings.” Asseo v. Pan
    is implicit in the district court’s holding
    Am. Grain Co., 
    805 F.2d 23
    , 26 (1st Cir.
    that it found the Berg Certification
    1986); see also Ty, Inc. v. GMA
    insufficient to show actual confusion,
    Accessories, Inc., 
    132 F.3d 1167
    , 1171
    nothing in the record suggests that it
    (7th Cir. 1997) (citing Asseo); Levi
    sustained Andrx’s objections to the
    Strauss & Co. v. Sunrise Int’l Trading,
    admissibility or credibility of the document
    Inc., 
    51 F.3d 982
    , 985 (11th Cir. 1995)
    itself. See, e.g., JA at 41. Indeed, in its
    (“At the preliminary injunction stage, a
    opinion, the court twice took cognizance
    district court may rely on affidavits and
    of the Certification with no indication that
    hearsay materials which would not be
    it viewed the document as inadmissible,
    admissible evidence for a permanent
    inherently unreliable, or otherwise
    injunction . . . .”); Sierra Club, Lone Star
    unworthy of consideration. 
    Id. at 6,
    12.
    Chapter v. FDIC, 
    992 F.2d 545
    , 551 (5th
    Nor do we agree with Andrx that              Cir. 1993) (courts at preliminary injunction
    the Berg Certification is an inadequate             stage “may rely on otherwise inadmissible
    basis for preliminary relief because it             evidence, including hearsay”); Flynt
    contains multiple levels of hearsay and is          Distrib. Co. v. Harvey, 
    734 F.2d 1389
    ,
    not based solely on personal knowledge.             1394 (9th Cir. 1984) (“The urgency of
    It is well established that “a preliminary          obtaining a preliminary injunction . . .
    injunction is customarily granted on the            makes it difficult to obtain affidavits from
    basis of procedures that are less formal and        persons who would be competent to testify
    evidence that is less complete than in a            at trial. The trial court may even give
    inadmissible evidence some weight . . . .”);
    15
    cf. Heideman v. South Salt Lake City, 348
    Our holding in Versa Products.
    F.3d 1182, 1188 (10th Cir. 2003) (“The
    Co. v. Biford Co., 
    50 F.3d 189
    (3d Cir.
    Federal Rules of Evidence do not apply to
    1995) does not support Andrx’s
    preliminary injunction hearings.”).
    argument that “[such] double hearsay is
    an insufficient basis for . . . preliminary                These cases are consistent with the
    relief in a trademark matter.” See                  lack of any rule in the preliminary
    Appellees’ Br. at 25 (citing Versa Prods.,          injunction context akin to the strict 
    rules 50 F.3d at 212
    ). Versa Products was an              governing the form of affidavits that may
    appeal from a final judgment after a                be considered in summary judgment
    bench trial; its holding is not relevant in         proceedings. Compare Fed. R. Civ. P.
    the preliminary injunction context.                 56(e) (affidavits on summary judgment
    22
    “shall be made on personal knowledge,               Under the circumstances here, we find that
    shall set forth such facts as would be              the district court’s implicit admission of
    admissible in evidence, and shall show              the Berg Certification for use at this
    affirmatively that the affiant is competent         preliminary stage was not clearly
    to testify to the matters stated therein”)          erroneous.
    with Fed. R. Civ. P. 65 (no similar
    Moreover, we note that some of the
    provision in rule governing preliminary
    evidence of actual confusion in the Berg
    injunctions). See also 11A Charles Alan
    Certification would be admissible even if
    Wright et al., Federal Practice &
    compliance with the Federal Rules of
    Procedure § 2949 (2d ed. 1995) (“[A]
    Evidence or the strictures governing Rule
    consideration of the different policies that
    56(e) affidavits were required. The first
    underlie Rules 56 and 65 indicates [that
    level of hearsay analysis concerns the
    the Rule 56(e) standard] should not be
    underlying statements said to show
    imposed on applications under the latter
    confusion. Such statements fall into two
    rule.”).
    categories -- those exhibiting confusion
    District courts must exercise their          and those proclaiming it. Statements of
    discretion in “weighing all the attendant           the first type (Dr. A 17 says “We have
    factors, including the need for expedition,”        plenty of Advicor” but points to Altocor
    to assess whether, and to what extent,              samples) are not hearsay because they are
    affidavits or other hearsay materials are
    “appropriate given the character and
    objectives of the injunctive proceeding.”           hearing; indeed, neither party asked for a
    
    Asseo, 805 F.2d at 26
    . The weight to                hearing.
    which such materials are entitled may of
    17
    course vary greatly depending on the facts                  We note that one of Andrx’s
    and circumstances of a given case.16                complaints is that the Berg Certification
    does not identify the doctors involved in
    each incident. This does not affect its
    16
    We note that such assessments               admissibility. See Callahan v. A.E.V.,
    must be made in light of the rule that it           Inc., 
    182 F.3d 237
    , 252 n.11 (3d Cir.
    may be improper to resolve a preliminary            1999) (“In a practical sense, the[]
    injunction motion on a paper record                 identities [of the customers who made
    alone; where the motion turns on a                  the statements at issue] are not important.
    disputed factual issue, an evidentiary              The relevance of their statements
    hearing is ordinarily required. See, e.g.,          depends only on the fact that they were
    Sims v. Greene, 
    161 F.2d 87
    , 88 (3d Cir.            the plaintiffs’ customers . . . .
    1947) (evidentiary hearing needed in                Furthermore, we do not think that the
    light of conflicting claims in pleadings            admissibility of their statements under
    and affidavits). Neither party claims the           the Rule 803(3) hearsay exception
    district court erred here by not holding a          depends on their being identified.”).
    23
    not submitted for their truth; indeed, it is               marketplace.” JA at 68-69. He certified
    their falsity that shows the speaker’s                     that his staff has reported more than 60
    confusion. Statements of the second type                   incidents of actual confusion to him. He
    (Dr. B says “I find these names                            describes a range of “representative . . .
    c o n f u s i n g . ” ) a r e a d m i s si b l e as        i n s ta n c es,” i n c l u d i n g : m e d i c al
    “statement[s] of the declarant’s then                      professionals providing patients the wrong
    existing state of mind.” Fed. R. Civ. P.                   drug samples and, on one occasion,
    803(3). To the extent such statements                      improperly filling a prescription; doctors
    address the speaker’s plans (Dr. C says                    complaining to Kos representatives about
    “Because these names are confusing, I will                 “Advicor,” when their complaints really
    not prescribe either drug.”), they create an               c on c e r ne d Altoc or ; a nd me dic al
    inference “that the declarant acted in                     professionals confusing Altocor samples
    accord with that plan.” See, e.g., United                  w i t h A d v i c o r s a m p l e s, A l t o co r
    States v. Donley, 
    878 F.2d 735
    , 738 (3d                    r e p r e se n t a tives with Ad vico r
    Cir. 1989). The second level is the report                 representatives, or Altocor-sponsored
    of the marketing representative to Berg                    events with Advicor-sponsored events. 
    Id. (Employee D:
    “Dr. A told me . . . .”).                     at 69-71.
    There is a factual dispute as to whether
    It may be that the Berg Certification
    some, all, or none of these reports satisfy
    is not competent proof or reliable evidence
    the “business records” exception to the
    of any particular incident that it describes.
    hearsay rule. Even if the reports are not
    However, as noted above, Berg is
    garden variety business records, however,
    competent to attest that he received over
    Berg could attest to having received more
    60 reports of alleged confusion, and his
    than 60 reports of confusion in his official
    credibility as to this assertion has been
    capacity. Berg’s direct testimony that he
    tested by deposition in the PTO opposition
    received numerous and varied reports of
    proceedings. Moreover, the very number
    alleged confusion is not hearsay but a
    of reports Berg says he received, and the
    factual claim that, as discussed below, has
    variety of sources and types of confusion
    independent evidentiary significance
    reported, bolster the reliability of the
    tending to show actual confusion.
    reports as a whole. Courts are entitled to
    b.       Probative Value of Berg                   view such diverse reports of confusion as
    Certification as to Actual                mutually reinforcing, particularly where,
    Confusion                                 as here, the names and products are so
    similar as to make the reported confusion
    As Vice President of Marketing,
    plausible. Indeed, the reverse may be true
    Berg is responsible for Kos’s “overall
    as well: here, for example, the 60 reported
    marketing strategy” and receives reports
    instances of confusion tend to confirm our
    from “district managers who oversee the
    determination that the names are
    distribution of [Kos’s] drugs . . . about
    confusingly similar.
    significant issues occurring in the
    24
    Andrx argues that Kos cannot show             confusion”) (emphasis added); cf. Sara
    trademark confusion because the 60                   Lee Corp. v. Kayser-Roth Corp., 81 F.3d
    alleged incidents of confusion comprise              455, 466 (4th Cir. 1996) (“[W]e can but
    too small a perc entag e of th e                     wonder how often the experiences related
    appr oxim ately 350,000 Adv icor                     by the trial witnesses have been repeated --
    prescriptions, or the approximately                  but not reported -- in stores across the
    650,000 combined prescriptions.18 We                 country.”).
    have recognized, however, that evidence
    The Berg Certification provides
    of actual confusion “is difficult to find . .
    more than enough evidence of actual
    . because many instances are unreported.”
    confusion to support weighing the fourth
    
    Checkpoint, 269 F.3d at 291
    . W ithout
    and sixth Lapp factors in Kos’s favor.
    knowing how many, or what percent of,
    Nonetheless, because there is room for
    incidents go unreported, anecdotal
    differing views as to the weight to which
    evidence of confusion cannot usefully be
    the document is entitled, and because some
    compared to the universe of potential
    of the underlying facts are disputed,19 we
    incidents of confusion. The rarity of such
    decline to hold that the record evidence
    evidence makes even a few incidents
    compels weighing these factors in Kos’s
    “highly probative of the likelihood of
    favor as a matter of law. On the other
    confusion.”      
    Id. (Because “reliable
                                                         hand, it would be clear error to weigh
    evidence of actual confusion is difficult to
    either factor against Kos on the present
    obtain in trademark and unfair competition
    record.
    cases, any such evidence is substantial
    evidence of likelihood of confusion.”)                       5.    Defendant’s Intent         in
    (quotation omitted, emphasis added); see                           Adopting the Mark
    also Country Floors, Inc. v. Partnership of
    “[E]vidence of intentional, willful
    Gepner & Ford, 
    930 F.2d 1056
    , 1064 (3d
    and admitted adoption of a mark closely
    Cir. 1991) (quoting cases holding that
    similar to the existing mark[] weighs
    “very little proof of actual confusion
    strongly in favor of finding [a] likelihood
    would be necessary to prove likelihood of
    of confusion.” 
    Checkpoint, 269 F.3d at 286
    (quotation omitted). This inquiry
    18
    The district judge commented on
    19
    these figures, but did not analyze them or                  For example, Andrx claims that
    otherwise indicate whether he saw them               Berg’s characterization of one incident as
    as legally or factually significant. See,            evincing confusion is belied by the e-
    e.g., JA at 19 (“So we’re talking about              mail describing that incident, which,
    something in the vicinity for both                   Andrx claims, shows only that a
    prescriptions of 650,000 drugs, of which             cardiologist overrode the prescription
    you’re aware of approximately 60                     choice made by a patient’s non-specialist
    instances of confusion.”).                           physician. See supra p. 6.
    25
    extends beyond asking whether a                     allegedly infringing mark “was specifically
    defendant purposely chose its mark to               considered by the USPTO, the FDA and a
    “promot[e] confusion and appropriat[e] the          district court and found not to be
    prior user’s good will.” Fisons, 30 F.3d at         confusingly similar.” Appellees’ Br. at 24.
    479 (quotation omitted). The adequacy
    As stated previously, Andrx is not
    and care with which a defendant
    entitled to rely on the PTO or FDA actions
    investigates and evaluates its proposed
    to justify its own. See supra pp. 16-17.
    mark, and its knowledge of similar marks
    Andrx’s attempt to justify its conduct by
    or allegations of potential confusion, are
    reference to the district court decision is
    highly relevant. See, e.g., 
    id. at 480
                                                        puzzling; that decision was obviously not
    (directing district court to consider
    issued when Andrx adopted th e
    defend ant’s trademark search and
    ALTOCOR mark. Andrx chose to use this
    investigation of similar marks to determine
    mark with clear notice of Kos’s objections
    if it was “careless in its evaluation of the
    and its successful prior use of the
    likelihood of confusion”); Lapp, 721 F.2d
    ADVICOR mark for similar goods. There
    at 463 (relying on district court’s finding
    was, in the words of Judge Learned Hand,
    that while defendant “may have acted
    “no reason whatever why [defendant]
    innocently, [it] was careless in not
    should have selected [an arbitrary, made-
    conducting a thorough name search for
    up trade-name] which bore so much
    A m e r i c a n us e s o f th e n a m e ” );
    resemblance to the plaintiff’s.”       See
    
    Morgenstern, 253 F.2d at 394
    (citing
    Lambert Pharmacal Co. v. Bolton Chem.
    finding that defendant “trod a very narrow
    Corp., 
    219 F. 325
    , 326 (S.D.N.Y. 1915).
    course when it adopted the name Mictine
    Andrx’s use of ALTOCOR for its anti-
    with full knowledge of the prior use of the
    cholesterol drug was at least reckless, at
    name Micturin by the plaintiff”). A
    worst a deliberate appropriation of the
    defendant that “persisted in its plan” to
    goodwill Kos had generated for its anti-
    adopt a mark “after being warned of too
    cholesterol product, Advicor.
    close resemblance between” its proposed
    mark and plaintiff’s mark is not                            We therefore conclude that the
    “blameless[].” Telechron, Inc. v. Telicon           district court clearly erred in failing to
    Corp., 
    198 F.2d 903
    , 908 (3d Cir. 1952).            weigh this factor for Kos.20
    The district court did not analyze
    20
    this factor on the record or make relevant                 In view of this conclusion, it is
    factual findings. Kos argues that Andrx’s           unnecessary to address the factual
    intent to trade on Kos’s goodwill may be            dispute between the parties as to whether
    inferred from Andrx’s insistence on using           Andrx deliberately chose the ALTOCOR
    this particular made-up (and meaningless)           mark knowing Kos would be using
    mark despite being warned of the                    ADVICOR for its own similar product in
    likelihood of confusion before beginning            order to trade on the goodwill it expected
    to sell Altocor. Andrx responds that its            Kos’s new product to generate.
    26
    7.      Whether   Goods     A re              the same channels and advertised through
    Marketed Through the Same                     the same media.” 
    Lapp, 721 F.2d at 463
    .
    Channels of Trade and Advertised              There are other Lapp factors that take
    in the Same Media                             those issues into account. “[W]e [do] not
    discount the strength of plaintiff’s case in
    “[T]he greater the similarity in
    one area because of weakness in another;
    advertising and marketing campaigns, the
    we weigh[] each factor separately.”
    greater the likelihood of confusion.”
    
    Fisons, 30 F.3d at 476
    (holding district
    
    Checkpoint, 269 F.3d at 288-89
    (quotation
    court erred in “fail[ing] to count the
    omitted). This is a “fact intensive inquiry”
    similarities in channels of trade and target
    that requires a court to examine the “media
    audience” for plaintiff due to district
    the parties use in marketing their products
    court’s view that other Lapp factors
    as well as the manner in which the parties
    weighed against plaintiff).
    use their sales forces to sell their products
    to consumers.” 
    Id. at 289.
    The district                      We find that the district court
    court did not address this factor directly,          clearly erred in failing to recognize that
    but implicitly found that it did not favor           this factor favors Kos. It does.
    Kos. Nonetheless, the court’s statement,
    8.     Extent to Which Targets of
    when analyzing the eighth Lapp factor,
    the Parties’ Sales Efforts Are
    that both parties’ “sales representatives
    the Same
    visit physicians with drug samples and
    related information” is relevant here, and                   The record supports the district
    supports weighing this factor in Kos’s               court’s finding that this factor supports
    favor. JA at 10.                                     Kos because the “‘parties target their sales
    efforts to the same consumers,’” namely,
    Andrx concedes that the “goods are
    “physicians and pharmacists.” JA at 10
    marketed through the same channels,” but
    (quoting 
    Checkpoint, 269 F.3d at 289
    ).
    argues that confusion is not likely since the
    Andrx again argues that “any potential
    “channels of trade and marketing efforts
    confusion” is “obviate[d]” because the
    are directed to a very educated and highly
    target audience is “a highly educated and
    sophisticated group.” Appellees’ Br. at 30.
    sophisticated group.” Appellees’ Br. at 30.
    Andrx also claims that this factor favors it
    The district court properly rejected this
    “because the products are not in direct
    argu men t, recogn izing th at it
    competition” since each should be
    impermissibly conflated different Lapp
    prescribed under somewhat different
    factors. Cf. 
    Fisons, 30 F.3d at 476
    .
    circumstances. 
    Id. 9. Relationship
    of the Goods
    The problem with Andrx’s
    approach is that neither customer                           “The closer the relationship
    sophistication nor the relationship between          between the products, . . . the greater the
    the goods is relevant to determining                 likelihood of confusion.” Lapp, 721 F.2d
    whether the goods are “marketed through              at 462. The question is how similar, or
    27
    closely related, the products are. Fisons,         factor to support finding a likelihood 
    of 30 F.3d at 481
    (describing cases where             confusion. See, e.g., A & H, 237 F.3d at
    “the relationship of the products was close        224 (affirming holding that “product
    enough to lead to the likelihood of                similarity factor favored [plaintiff]” where
    confusion” and “the goods were similar             p r o d u c t s w e r e o n l y “ s o m e w ha t
    enough that a consumer could assume they           interchangeable” due to “slightly different
    were offered by the same source”). This            functions”). The question is not whether it
    factor focuses on the nature of the                is possible to distinguish between the
    products themselves, asking whether it             products but whether, and to what extent,
    would be reasonable for consumers to               the products seem related, “whether
    associate them or see them as related. We          because of [their] near-identity, . . . or
    have recognized that “the near-identity of         similarity of function, or other factors.”
    the products” or their “similarity of              
    Id. at 215;
    see also 
    Fisons, 30 F.3d at 481
    function” are key to assessing whether             (equating factor with Sixth Circuit test for
    consumers may see them as related. A &             “Relatedness of the Goods”). Courts may
    
    H, 237 F.3d at 215
    .                                consider here “whether buyers and users of
    each parties’ goods are likely to encounter
    The district court did not analyze
    the goods of the other, creating an
    this factor.     It did, however, make
    assumption of com mon sourc e[,]
    potentially relevant findings about
    affiliation or sponsorship.” Checkpoint,
    similarities and differences in the 
    usage 269 F.3d at 286
    .
    and composition of the drugs. JA at 6
    (“While both drugs are used to treat                       Advicor and Altocor are both
    elevated cholesterol levels, their chemical        prescription drugs used to improve
    compositions differ in such a way that             cholesterol levels. The products are of the
    there are different active ingredients,            same type and serve the same function in
    dosages, and side effects.”).        Andrx         slightly different (but overlapping) ways
    maintains that doctors will necessarily            that may be appropriate for slightly
    “distinguish the two products in their             different (but overlapping) sets of patients.
    minds” because they will need to decide            That doctors will need to decide which
    which to prescribe since Advicor, but not          drug to prescribe does not mean they
    Altocor, contains niacin. Appellees’ Br. at        won’t see the drugs as related or otherwise
    30-31. Kos argues that the “differences in         associate them. Indeed, it could be argued
    active ingredients,” which make the drugs          that the opposite is true, that is, that they
    appropriate “for treatment of different            will associate the products because they
    types of patients with the same ailment[,]         must consider both to decide which to
    . . . do not negate a likelihood of                prescribe. See, e.g., Syntex Labs., Inc. v.
    confusion.” Appellant’s Br. at 25-26.              Norwich Pharmacal Co., 
    437 F.2d 566
    ,
    568-69 & n.1 (2d Cir. 1971) (affirming
    finding that drugs for “treatment of closely
    Goods need not be identical for this
    parallel and medically related conditions”
    28
    -- which had different compositions such            expertise” to enter defendant’s field due to
    that each was contraindicated for some              “highly specialized and technical nature”
    patients who could take the other drug --           of defendant’s products); Fisons, 30 F.3d
    “are likely to be closely associated in the         at 480 (evidence that products “are closely
    minds of those who prescribe and dispense           related and are used together” and that
    them”); Sterling Drug Inc. v. Lincoln               “other companies market both products”
    Labs., Inc., 
    322 F.2d 968
    , 971 (7th Cir.            supports finding that public might expect
    1963) (confusion likely as to medicines             senior user to offer products of junior
    “designed to remedy the same condition in           user); 
    Lapp, 721 F.2d at 464
    (close
    [and] purchased and used by the same                relationship between products that may be
    class of persons,” even though products             used together supports finding that “even
    had different active ingredients, and were          sophisticated customers . . . would find it
    used and sold in different ways) (reversing         natural or likely” that plaintiff might offer
    and directing entry of permanent                    product similar to defendant’s); McNeil
    injunction); Ortho Pharm. Corp. v.                  Labs., Inc. v. American Home Prods.
    American Cyanamid Co., 361 F. Supp.                 Corp., 
    416 F. Supp. 804
    , 806-07 (D.N.J.
    1032, 1040 (D.N.J. 1973) (medical                   1976) (consumer might reasonably think
    personnel likely to “mentally . . .                 TYLENOL manufacturer used
    associate” products even though unlikely            EXTRANOL mark for extra-strength
    to dispense one thinking it is the other).          version of its drug); Ortho Pharm., 361 F.
    Supp. at 1040 (while purchasing agents are
    Accordingly, we hold that the
    “likely to know that [drugs] are the
    district court clearly erred in holding that
    products of two separate companies” since
    this factor does not weigh in Kos’s favor.
    they typically order “face-to-face” with a
    It does.
    sales representative, medical professionals
    10.    Other Facts Suggesting the            will likely “associate with [defendant] the
    Public Might Expect the               goodwill and the high reputation which
    Prior Owner To Manufacture            [plaintiff] has acquired”).
    Both Products
    The district court did not discuss
    In assessing this factor, courts may         this factor, but held that it did not favor
    look at the nature of the products or the           Kos.
    relevant market, the practices of other
    In light of the close relationship
    companies in the relevant fields, or any
    between the drugs, customers could easily
    other circumstances that bear on whether
    expect the maker of one to make the other.
    consumers might reasonably expect both
    Cf. 
    Checkpoint, 269 F.3d at 290
    products to have the same source. This
    (“Evaluating this factor, courts look to
    issue is highly context-dependent. See,
    evidence that . . . the products at issue are
    e.g., 
    Checkpoint, 269 F.3d at 291
                                                        so closely related that the consuming
    (affirming finding that consumers were
    public might find it natural for one
    unlikely to expect plaintiff to “have the
    29
    company to” sell both.). In addition, Kos            appearance, and neither has any meaning
    argues that medical professionals might              that could distinguish between them or
    expect it to make a drug akin to Altocor in          lead customers to associate them with
    light of how well such a drug would fit              distinct products. The ADVICOR mark is
    into Kos’s product line. Kos sells “two              entitled to broad protection because it is a
    prescription drugs for the treatment of              coined term and because it is a strong
    chronic . . . cholesterol disorders” --              mark, both conceptually and commercially.
    Niaspan, which contains only niacin, and             The products in question are closely
    Advicor, which contains both lovastatin              related and are marketed and sold to
    and niacin. JA at 69. A lovastatin-only              practically identical audiences in
    anticholesterol drug could easily be a seen          practically identical ways. These are
    as a natural brand extension.                        products customers could easily expect to
    be manufactured by a single source. Also
    Andrx responds that doctors choose
    in Kos’s favor is Andrx’s deliberate
    which drug to prescribe “based upon a
    decision to use a name dangerously close
    patient’s particular needs, not based upon
    to that of a competing drug, with no
    who manufactures the drug.” Appellees’
    apparent reason for choosing an arbitrary
    Br. at 31. This response is wholly
    mark so similar to its competitor’s and
    irrelevant to the question whether
    despite being warned of the confusing
    customers might expect Kos to offer a
    similarity. Accordingly, the first, second,
    product like Altocor. Andrx’s argument
    fifth, seventh, eighth, ninth, and tenth
    seems premised on the idea that goodwill
    Lapp factors unquestionably weigh in
    is virtually irrelevant for prescription
    favor of Kos as a matter of law.
    drugs. Andrx does not point to any
    evidence in support of such a novel                         There is a factual dispute as to how
    position, which is counter to the purposes           Kos’s evidence of actual confusion affects
    and assumptions of the Lanham Act.                   the analysis of the fourth and sixth Lapp
    factors. We conclude that while the
    Because Andrx has done nothing to
    evidence Kos submitted is undoubtedly
    rebut Kos’s showing that customers could
    sufficient to support weighing these
    easily and naturally assume that Kos
    factors in its favor, it is not so great as to
    manufactures both products, we find that
    compel that result. But the best Andrx
    this factor favors Kos as a matter of law on
    could hope for on the present record is that
    the present record. The district court
    these factors be found in equipoise; no
    clearly erred in not weighing this factor for
    reasonable factfinder could find that they
    Kos.
    weigh against finding a likelihood of
    B.     Weighing the Lapp Factors                     confusion here. Only the third Lapp factor
    arguably weighs against finding a
    The most important factor -- mark
    likelihood of confusion.           It would,
    similarity -- favors Kos. ADVICOR and
    however, be clear error to allow this one
    ALTOCOR are similar in sound and
    factor to outweigh Kos’s strong showing
    30
    on the key factor of mark similarity and on               IV. IRREPARABLE HARM
    the remaining factors, particularly in light
    The district court held that Kos had
    of our earlier discussion of the dangers of
    not shown it would suffer irreparable harm
    relying too heavily on m edical
    absent an injunction because Kos’s
    sophistication in prescription drug cases.
    product had been on the market “less than
    We have carefully considered                two years.”     JA at 11.        The court
    whether to direct the district court on             apparently deemed this an insufficient time
    remand to weigh the Lapp factors anew in            in which to establish the goodwill needed
    light of the proper legal standards. On             to show such harm, as compared with the
    reflection, however, we conclude that               “over sixteen years” during which the
    doing so would serve no useful purpose.             goods were marketed in the case on which
    The undisputed facts weigh heavily in               Kos relied.     
    Id. (comparing Merrell-
    favor of Kos as a matter of law.                    National Labs., Inc. v. Zenith Labs., Inc.,
    Regardless of how the factual disputes              194 U.S.P.Q. 157, 161 (D.N.J. 1977)).
    might be resolved, any reasonable
    “Grounds for irreparable injury
    factfinder weighing the Lapp factors in
    include loss of control of reputation, loss
    accordance with the correct legal standards
    of trade, and loss of good will.” Pappan
    would hold that Kos is likely to succeed on
    Enters., Inc. v. Hardee’s Food Sys., Inc.,
    the merits. Because the record could not
    
    143 F.3d 800
    , 805 (3d Cir. 1998). Lack of
    support a contrary holding, a remand for
    control over one’s mark “creates the
    reweighing would waste judicial resources
    potential for damage to . . . reputation[,
    and unnecessarily delay the proceedings
    which] constitutes irreparable injury for
    further. Cf. 
    Fisons, 30 F.3d at 482
    (Garth,
    the purpose of granting a preliminary
    J., concurring in part and dissenting in
    injunction in a trademark case.” Opticians
    part) (“I can see no purpose in remanding
    Ass’n of Am. v. Indep. Opticians of Am.,
    for retrial of Fisons’ Lanham Act claims
    
    920 F.2d 187
    , 196 (3d Cir. 1990). Thus,
    when it is so evident that the marks at
    “trademark infringement amounts to
    issue here are confusingly similar.”).
    irreparable injury as a matter of law.” S &
    Compare A & 
    H, 237 F.3d at 238
                                                        R Corp. v. Jiffy Lube Int’l, Inc., 968 F.2d
    (remanding where court could “not say as
    371, 378 (3d Cir. 1992); see also Times
    a matter of law that a different weighing of
    Mirror Magazines, Inc. v. Las Vegas
    the factors could not have influenced the
    Sports News, L.L.C., 
    212 F.3d 157
    , 169
    District Court to make a different finding
    (3d Cir. 2000) (“potential damage to . . .
    of ultimate fact”) with Tanimura & Antle,
    reputation or goodwill or likely confusion
    Inc. v. Packed Fresh Produce, Inc., 222
    between parties’ marks” is irreparable
    F.3d 132, 140 (3d Cir. 2000) (reversing
    injury).         “[O]nce the likelihood of
    and directing entry of preliminary
    c o n f u s i o n c a u s e d b y tr a d e m a rk
    injunction after finding “the four factors
    infringement has been established, the
    required to grant a preliminary injunction
    inescapable conclusion is that there was
    are apparent on the record before us”).
    31
    also irreparable injury.” Pappan, 143 F.3d            not depend on the length of time it has
    at 805.                                               been using that mark.
    The district court’s erroneous                        Nor can we accept Andrx’s
    holding that Kos had not proven that it was           argument that Kos’s delay -- filing suit
    likely to succeed on its trademark claims             after Altocor had been on the market for
    deprived Kos of the benefit of this rule.             13 months -- shows that Kos is not being
    As we have already found that Kos has                 irreparably harmed.21 The claim that this
    shown a likelihood of success, we hold it             delay bars preliminary relief is not
    is entitled to a presumption that it will             consistent with the law of this Circuit or
    suffer irreparable harm absent an                     the facts of this case. The Third Circuit
    injunction.                                           case Andrx cites for the proposition that
    “delay alone defeats Kos’ assertions of
    We see nothing in the record that
    irreparable harm” -- indeed, the only Third
    could overcome this presumption.
    Circuit case Andrx relies on for this
    Although we need not defer to the district
    argument -- does not support its claim.
    court’s holding since it was premised on
    Appellees’ Br. at 32 (citing Times Mirror,
    an error of law, we have 
    considered 212 F.3d at 161
    ). In that case, we
    whether the length of time Advicor was
    considered -- and rejected -- the argument
    marketed weakens Kos’s showing of
    that a 15-month filing delay showed
    irreparable harm. We conclude that it does
    plaintiff’s injury was “not immediate and
    not. First, the district court’s view that the
    irreparable,” finding the argument
    relatively short time Advicor was on the
    unpersuasive since the “delay was
    market shows that Kos had not generated
    sufficient goodwill to suffer irreparable
    harm seems inconsistent with its holding                 21
    Andrx’s other argument -- that
    that -- over the same time period -- Kos
    Kos will suffer no irreparable harm
    developed a “high level of commercial
    because prescriptions will not be mis-
    strength” based on sales grossing more
    filled, and, even if they are, there will be
    than $ 70 million on more than 350,000
    no “dire” medical consequences -- is
    prescriptions. JA at 9. Second, we do not
    clearly disposed of by our earlier holding
    agree that a company’s goodwill is less
    that the Lanham Act covers likelihood of
    likely to be irreparably harmed if it has
    confusion of all types, and not just the
    used its mark for only a short time.
    likelihood that one product will be
    Indeed, it could be argued that irreparable
    mistakenly substituted for another.
    harm is more likely where a “young” mark,
    Kos’s loss of control over its mark is
    rather than an old and well-established
    irreparable harm regardless of whether
    mark, is infringed.       Most importantly,
    resulting confusion might lead to further
    however, a company’s right to control its
    injuries. Cf. Jiffy 
    Lube, 968 F.2d at 378
    own mark so it can avoid potential damage
    (irrelevant whether “infringer is putting
    to its goodwill or possible confusion does
    the mark to better use”).
    32
    attributable to negotiations between the           be understood as a suggestion by Andrx
    parties.” Times 
    Mirror, 212 F.3d at 169
    .           that the matter might be resolved absent a
    lawsuit. Under these circumstances, no
    While Times Mirror may imply that
    reasonable factfinder could find that Kos
    inexcusable delay could defeat the
    had waived its rights or conceded that it
    presumption of irreparable harm in an
    was not irreparably harmed by filing when
    appropriate case, it makes clear that the
    it did.
    present case is not an appropriate one.
    Kos sought relief directly and through                    Accordingly, we find that, given the
    administrative proceedings from the time           undisputed facts of record, this factor
    it learned of the proposed use of the              weighs in favor of injunctive relief as a
    ALTOCOR mark through the time it filed             matter of law.
    this suit. Andrx’s conduct -- submitting
    V. BALANCE OF HARDSHIPS
    alternate names to the FDA and the PTO,
    and stating in its 2002 Annual Report that                 The district court held that
    Kos had opposed its application to register        “granting relief will result in greater harm
    ALTOCOR and, in the next sentence, that            to” Andrx than Kos would suffer absent an
    it might “seek to change the name of               injunction. JA at 12. The court found that
    Altocor,” JA at 37422 -- could reasonably          an injunction would “significantly affect”
    the “considerable time and expense”
    Andrx had spent “developing the market
    22
    At argument, Andrx’s counsel               for [its] drug.” 
    Id. The court
    rejected
    represented that Andrx applied for                 Kos’s argument that the harm to Andrx
    alternate names “to be used only if” at            would be minimal since Andrx could
    least four incidents of actual confusion           continue to market its successful product,
    between Altocor and a third, unrelated             albeit under a different, non-infringing
    drug were reported the first year Altocor          name. This claim failed, according to the
    was sold. Audio Tape of Oral Argument              district court, because “there is no
    before Court of Appeals for the Third              trademark infringement.” 
    Id. We cannot
    Circuit (Mar. 9, 2004) (on file with               base our analysis on, or defer to, the
    Court) (emphasis added). Andrx points              district court’s balancing of the equities
    to no record evidence that shows that              because that analysis is premised on
    possible confusion with a drug other than          holdings we have already found clearly
    Advicor was its only concern in                    erroneous, namely, that Kos has shown
    considering a name change, and this                neither trademark infringement nor
    representation seems inconsistent with             irreparable harm.
    the juxtaposition of the Kos Opposition
    The question is whether, and to
    and the possible name change in the
    what “extent[,] . . . the defendants will
    same paragraph of the 2002 Annual
    suffer irreparable harm if the preliminary
    Report, with no mention of any other
    injunction is issued.” Opticians, 920 F.2d
    basis for the name change.
    33
    at 192.      If temporary relief would               Jobbers Ass’n v. FPC, 
    259 F.2d 921
    , 925
    irreparably harm an alleged infringer                (D.C. Cir. 1958)). The costs in time and
    pending final disposition of the case, the           money associated with adopting a new
    court should “balanc[e] the hardships” to            mark are not “injuries . . . that could not be
    “ensure that the issuance of an injunction           remedied by money damages.” Pappan,
    would not harm the infringer more than 
    a 143 F.3d at 805-6
    (“significant financial
    denial would harm the mark’s owner.” 
    Id. injuries,” including
    costs of replacing
    at 197. “Irreparable harm must be of a               “several months worth of logoed product,”
    peculiar nature, so that compensation in             do not constitute irreparable harm).
    money alone cannot atone for it.” Pappan,
    Andrx also argues that an 
    injunction 143 F.3d at 805
    (quotation omitted).
    would “destroy the market” it has
    District courts should consider financial
    developed and would cause it to lose the
    damages when establishing and setting the
    goodwill associated with the ALTOCOR
    bond for an injunction, not when deciding
    mark. Appellees’ Br. at 34. Kos responds
    whether to grant it. See Fed. R. Civ. P.
    that this harm would be minimal since
    65(c) (“No . . . preliminary injunction shall
    Andrx already has an alternate mark
    issue except upon the giving of security by
    already in place. Appellant’s Br. at 34.
    the applicant, in such sum as the court
    Although Andrx denies that it has an
    deems proper, for the payment of such
    approved alternate name available,23 its
    costs and damages as may be incurred . . .
    vague, unsubstantiated representation that
    by any party who is found to have been
    the FDA approval is no longer valid
    wrongfully enjoined.”).
    cannot create a factual dispute in the face
    Andrx states that “if required to         of record evidence that the FDA approved
    rename the product, [it will] incur                  its use of the ALTOPREV mark and the
    significant time and expense in obtaining            judicially noticeable fact that the PTO has
    trademark clearance services, changing the
    labeling and product inserts, product re-
    23
    l a u n c h a d v e rtising and the r e -                   Nor is it clear that the alleged
    establishment of goodwill,” and perhaps in           expiration of FDA approval would weigh
    “destroying inventory or recalling the               in Andrx’s favor. Even on Andrx’s
    products already distributed.” Appellees’            account, the lapse of approval is the
    Br. at 35. Such costs, however, are                  consequence of Andrx’s own actions in
    compensable by money damages and thus                that approval supposedly expired “when
    do not constitute irreparable harm as a              we didn’t use the name.” See Audio
    matter of law. “Mere injuries, however               Tape of Oral Argument before Court of
    substantial, in terms of money, time and             Appeals for the Third Circuit (Mar. 9,
    energy necessarily expended in the                   2004) (on file with Court). Moreover,
    absence of a stay, are not enough.”                  Andrx has never alleged that there would
    Sampson v. Murray, 
    415 U.S. 61
    , 90                   be any barrier to its seeking reapproval
    (1974) (quoting Virginia Petroleum                   of the mark if it has indeed elapsed.
    34
    issued a Notice of Allowance for this              Andrx took a deliberate risk by proceeding
    mark.24                                            despite being warned that its mark was
    dangerously close to that of a competing
    Injury to goodwill does constitute
    product, and is thus “not in position to
    irreparable harm. See, e.g., Opticians, 920
    urge its original blamelessness as a
    F.2d at 195. But, when the potential harm
    consideration which should be persuasive
    to each party is weighed, a party “can
    to a court of equity.” Telechron, 198 F.2d
    hardly claim to be harmed [where] it
    at 908; see also 
    Novartis, 290 F.3d at 596
    .
    brought any and all difficulties occasioned
    by the issuance of an injunction upon                      One other factor we have held
    itself.” 
    Id. at 197
    (directing entry of            weighs in the balance of hardships analysis
    preliminary injunction). We have often             is the “goal[] of the preliminary injunction
    recognized that “the injury a defendant            analysis [of] maintain[ing] the status quo,
    might suffer if an injunction were imposed         defined as the last peaceable, noncontested
    may be discounted by the fact that the             status of the parties.” Opticians, 920 F.2d
    defendant brought that injury upon itself.”        at 197 (directing entry of injunction where
    Novartis Consumer Health, Inc. v. Johnson          such relief would restore status quo since
    & Johnson-Merck Consumer Pharm. Co.,               defendant could not use mark “[b]efore
    
    290 F.3d 578
    , 596 (3d Cir. 2002). Indeed,          this controversy began”) (citation and
    a different rule would allow “a knowing            quotation omitted). This factor favors Kos
    infringer [that] construct[s] its business         since it objected to Andrx’s adoption of
    around its infringement” to avoid an               the ALTOCOR mark before Andrx had
    injunction by claiming it would have a             begun to use it in commerce.
    “devastating effect” on that business, “a
    We recently rejected an argument --
    result we cannot condone.”           Apple
    similar to one Andrx makes here -- that the
    Computer, Inc. v. Franklin Computer
    harm a defendant would suffer if enjoined
    Corp., 
    714 F.2d 1240
    , 1255 (3d Cir. 1983).
    from selling its product under its current
    Andrx knew before its drug was first sold
    name “outweigh[ed] the potential harm to
    that Kos viewed ALTOCO R and
    [its competitor] from losing market share
    ADVICOR as confusingly similar when
    if the injunction were not issued.”
    used to identify competing prescription
    
    Novartis, 290 F.3d at 596
    (affirming
    drugs for patients with high cholesterol.
    preliminary injunction in false advertising
    case). We emphasized that the injunction
    24
    did “not require [defendant] to abandon its
    Our review of the record and the
    product name forever[, but] only [to] cease
    parties’ arguments convinces us that the
    shipping the [] product under that name
    facts relevant to balancing the hardships
    until the end of the litigation on the
    are undisputed. Cf. Opticians, 920 F.2d
    merits.” 
    Id. at 597.
    The same is true here.
    at 197 (conducting own assessment of
    We also stated that the defendant could
    the balance of hardships where facts
    still “ship[] the product currently in
    were not in dispute).
    35
    inventory under a different name [and]                Kos would continue to suffer absent an
    label” or ship that product without any               injunction. Cf. Tenafly Eruv Ass’n, Inc.
    such change if it were to prevail on the              v. Borough of Tenafly, 
    309 F.3d 144
    , 178
    merits. 
    Id. Again, the
    same is true here.25           (3d Cir. 2002) (assessing balance of
    We note that Kos may be in an even                    hardships based on own “review of the
    stronger position than was the plaintiff in           record”) (reversing and directing entry of
    Novartis. The false advertising claim in              injunction); Meridian Mutual Ins. Co. v.
    Novartis was not based on any confusing               Meridian Insurance Group, Inc., 128 F.3d
    similarity between the plaintiff’s and                1111, 1121 (7th Cir. 1997) (“Our
    defendant’s marks; thus, the plaintiff there          examination of the record shows that . . .
    -- unlike Kos -- was not threatened with a            the harm to the plaintiff if no injunction is
    likelihood of confusion or with loss of               issued therefore outweighs any harm to the
    control over its own mark, which can lead             defendants if one is entered.”) (reversing
    to loss of reputation, loss of trade, and loss        and directing entry of injunction); Jiffy
    of goodwill. See Opticians, 920 F.2d at               
    Lube, 968 F.2d at 379
    (balancing harms in
    195.                                                  first instance and holding that “self-
    inflicted harm” to alleged infringer “is far
    We have recognized that “[t]he
    outweighed by the immeasurable damage
    more likely the plaintiff is to win, the less
    done [plaintiff] by the infringement of its
    heavily need the balance of harms weigh
    trademark,” despite “sympathetic position”
    in his favor.” 
    Novartis, 290 F.3d at 597
    .
    of defendant who would have to change
    In light of Kos’s strong showing of its
    name under which it was operating its
    likelihood of success, and the fact that
    business) (reversing and directing entry of
    Andrx accepted the risk of injury to its
    injunction); 
    Opticians, 920 F.2d at 197
    goodwill when it ignored Kos’s claim of
    (finding on undisputed facts that “grant of
    infringement, we hold that no reasonable
    an injunction would impose no greater
    factfinder could conclude that the
    harm on [defendant] than would be
    irreparable harm Andrx might suffer
    imposed upon the [plaintiff] by the denial
    pending resolution of this matter on the
    of an injunction”) (reversing and directing
    merits outweighs the irreparable harm that
    entry of injunction).
    Accordingly, we find that this
    25
    We note that the graphic Andrx                 factor weighs in favor of injunctive relief
    submitted of its product does not show                as a matter of law.
    the ALTOCOR mark on the pills
    VI. PUBLIC INTEREST
    themselves. See Appellees’ Br. at 28.
    Cf. 
    Opticians, 920 F.2d at 197
    (noting                        The district court held that the
    that defendant could continue to sell its             “public interest does not favor” injunctive
    product since the challenged mark was                 relief because Kos “failed to persuade [it]
    not placed on the “primary trade                      . . . that the public is at a serious health
    product” but on “promotional material”).              risk if this Court does not grant a
    36
    permanent [sic] injunction.” JA at 12.                 C on ve rse ly, a p r o h i b it i o n u p o n
    [defendant’s] use of [its] mark[] would
    Kos claims that the public interest
    eliminate that confusion.” Opticians, 920
    “demands entry of a preliminary
    F.2d at 198. Ordinarily, this might be the
    injunction” here because “[n]o public
    extent of the relevant analysis. Weighing
    interest is greater than the public interest to
    the public interest in preliminary relief is
    preserve lives.” Appellant’s Br. at 35.
    often fairly routine. See American Tel. &
    Andrx responds that Kos’s “self-serving,
    Tel. Co. v. Winback & Conserve Program,
    inflammatory rhetoric” is belied by the
    Inc., 
    42 F.3d 1421
    , 1427 n.8 (3d Cir. 1994)
    “neutral” conclusion of the FDA that it is
    (“As a practical matter, if a plaintiff
    unlikely that a patient will receive the
    demonstrates both a likelihood of success
    wrong prescription. Appellees’ Br. at 37.
    on the merits and irreparable injury, it
    Andrx also argues that the public would be
    almost always will be the case that the
    harmed by an injunction because those
    public interest will favor the plaintiff.”).
    patients who depend on Altocor would be
    “deprive[d] . . . of a drug product that has                  Here, however, we must confront
    been incorporated into their daily routine,”           the question whether the parties’ claims as
    and would suffer “unnecessary worry and                to specific harms to the public change the
    anxiety when their prescriptions cannot be             usual calculus.
    refilled and their doctors need to start them
    We first consider Kos’s claim that
    on a new drug regimen.” 
    Id. at 38.
                                                           the interest in “preserv[ing] lives” requires
    These are not your usual Lanham                 injunctive relief. There is a factual dispute
    Act public interest arguments. Indeed,                 as to this issue. The parties submitted
    neither the district court nor the parties             competing medical affidavits to support
    even mentions the most basic public                    their respective views as to the nature and
    interest at stake in all Lanham Act cases:             severity of the potential consequences of a
    the interest in prevention of confusion,               mis-filled prescription.26      Andrx also
    particularly as it affects the public interest
    in truth and accuracy. We have often                      26
    We note that the affidavit Andrx
    recognized that “[p]ublic interest . . . in a
    submitted focused on the potential harm
    trademark case . . . is most often a
    of substituting Altocor for Advicor,
    synonym for the right of the public not to
    while the more serious harms Kos
    be deceived or confused.” Pappan, 143
    identified are those that may occur in the
    F.3d at 807 (quoting Opticians, 920 F.2d at
    reverse case, that is, when Advicor is
    197).
    substituted for Altocor. See supra p. 6.
    In light of our holding that “there is         Although the Andrx affidavit cannot
    a likelihood of consumer confusion created             create a factual dispute as to the type of
    by” the use of confusingly similar marks,              substitution it does not address, we
    “it follows that if such use continues, the            hesitate to draw conclusions from the
    public interest would be damaged.                      “undisputed” fact that serious harm may
    37
    disputed Kos’s allegations as to the risks          clearly erroneous.27
    of misdispensing by arguing it is extremely
    We must, however, distinguish
    unlikely that a pharmacist would
    between the court’s finding that Kos did
    improperly fill a prescription. The district
    not establish a “serious health risk” and its
    court resolved this dispute in Andrx’s
    conclusion that “[t]herefore, the public
    favor, holding that Kos had not proven that
    interest does not favor” injunctive relief.
    the public would face a serious health risk
    JA at 12 (emphasis added). While we
    absent an injunction. The colloquy at the
    defer to the former, the court’s ultimate
    hearing shows that the court was
    assessment of the public interest is clearly
    impressed by the FDA’s statement that the
    erroneous because it does not take into
    “possibility of confusion was minimal,”
    account the “right of the public not to be
    and was persuaded that “it would be
    deceived or confused.” Opticians, 920
    difficult to imagine a situation” where the
    F.2d at 197. As stated above, that right is
    drugs would be confused “when a
    implicated here.
    pharmacist is filling a prescription.” JA at
    25, 51. We note that, although the FDA’s                    The remaining question is whether
    inquiry is not equivalent to the Lanham             this public interest is outweighed by the
    Act “likelihood of confusion” test, its             potential public harm of “depriv[ing]”
    review of proprietary drug names is                 patients of Altocor. Appellees’ Br. at 38.
    relevant in assessing the health risks of           Andrx claims that an injunction would
    mis-filled prescriptions.      Indeed, the          mean that Altocor “prescriptions [could]
    purpose of FDA review is “to predict                not be refilled and . . . doctors [would]
    potential confusion that may arise in the           need to start [patients] on a new drug
    actual prescription process.” 3 M cCarthy,          regimen.” 
    Id. The factual
    predicate for
    supra, § 19:149 (4th ed. 2003). We defer            this claim seems to be the Declaration of
    to the district court’s resolution of this          Charles Schneider, which states that “[i]f
    factual dispute because its finding is              Andrx is forced to suspend sales of
    supported by the record and is thus not             ALTOCOR, [it] will suffer great economic
    harm by losing sales of an existing product
    and by a loss of good will with its
    27
    result from substituting Advicor for                        We do not suggest that the district
    Altocor. The most serious risks Kos                 court or the FDA (or, for that matter, this
    identifies were mentioned for the first             Court) is careless or insensitive to the
    time in the affidavit Kos submitted at the          potentially serious health risks of mis-
    hearing. See JA at 28-29. Since the                 filled prescriptions. Nonetheless, the
    district court ruled from the bench,                recognition that the stakes are high does
    Andrx had no chance to respond to these             not mean that disputed claims about the
    new claims and cannot be said to have               possibility for such harm must be
    conceded them.                                      credited.
    38
    customers due to an interruption in the               lovastatin medication.28
    supply of an existing product.” JA at 343.
    Andrx’s broad claims that it would
    have to “suspend” sales and “deprive”
    patients of Altocor ignore the fact that it is
    only the ALTOCOR mark and not the drug
    itself that an injunction should address.
    Andrx has provided no evidence to show
    that temporarily ceasing use of the
    ALTOCOR mark would cause “an
    interruption in the supply” of its extended-
    release lovastatin product. The record is
    bare of information as to how long it
    would take Andrx to provide new labels or
    label information for pharmacies to use
    when dispensing the drugs, to replace
    branded samples in physician’s offices, to
    re-package its existing product as needed
    for pharmacies, or to take other necessary
    steps to suspend use of the mark
    ALTOCOR. Andrx has thus introduced no
    evidence from which a reasonable
    factfinder could find that the public would
    28
    be harmed by the proposed injunction.                         We note that the district court will
    be setting such bond as it determines to
    Accordingly, we find that this
    be appropriate to secure payment to
    factor weighs in favor of injunctive relief
    Andrx of any compensable money
    as a matter of law.
    damages that it may incur prior to final
    VII.                              disposition of this matter should it be
    determined that Andrx was erroneously
    In light of the foregoing analysis,
    enjoined. In determining the amount of
    we conclude that the district court clearly
    such bond, the district court should, of
    erred in denying Kos’s motion for a
    course, take into account Andrx’s ability
    preliminary injunction. We therefore
    to minimize the potential for such
    reverse and remand with instructions that
    damages. See supra p. 61. To that end,
    the district court fashion and enter, on an
    the court may wish to shape the
    expedited basis, an order preliminarily
    preliminary injunction, or set its effective
    enjoin ing Andrx from using the
    date, to allow Andrx to take reasonable,
    ALTOCOR mark in connection with the
    expeditious steps to begin marketing its
    marketing and sale of its extended-release
    product under another name.
    39