Herbert Fussman v. Novartis Pharmaceuticals Corporation , 509 F. App'x 215 ( 2013 )


Menu:
  •                              UNPUBLISHED
    UNITED STATES COURT OF APPEALS
    FOR THE FOURTH CIRCUIT
    No. 12-1030
    HERBERT FUSSMAN, individually and as Administrator of the
    Estate of Rita Fussman,
    Plaintiff - Appellee,
    v.
    NOVARTIS PHARMACEUTICALS CORPORATION,
    Defendant - Appellant.
    Appeal from the United States District Court for the Middle
    District of North Carolina, at Greensboro. James A. Beaty, Jr.,
    Chief District Judge. (1:06-cv-00149-JAB-PTS)
    Argued:   December 7, 2012                 Decided:   February 8, 2013
    Before NIEMEYER, KING, and FLOYD, Circuit Judges.
    Affirmed by unpublished per curiam opinion.
    ARGUED: Bruce Jeffrey Berger, HOLLINGSWORTH, LLP, Washington,
    D.C., for Appellant.     John J. Vecchione, VALAD & VECCHIONE,
    PLLC, Fairfax, Virginia, for Appellee.      ON BRIEF: Peter G.
    Pappas, NEXSEN PRUET, PLLC, Greensboro, North Carolina; Joe G.
    Hollingsworth,   Katharine  R.  Latimer,  Robert  E.  Johnston,
    HOLLINGSWORTH, LLP, Washington, D.C., for Appellant.    Jodi D.
    Hildebran, ALLMAN SPRY LEGGETT & CRUMPLER, P.A., Winston-Salem,
    North Carolina, for Appellee.
    Unpublished opinions are not binding precedent in this circuit.
    PER CURIAM:
    In   June    2001,     upon   learning      that       breast     cancer      had
    metastasized        to   her     bones,     Rita    Fussman         (Fussman)      began
    receiving     monthly     infusions    of      Aredia,    a    pharmaceutical         drug
    approved by the Food Drug Administration (FDA) and marketed by
    New Jersey-based Novartis Pharmaceuticals Corporation.                           Aredia
    is a bisphosphonate, a drug designed to prevent the loss of bone
    mass.        Fussman     began    Aredia       infusions       at   the      behest    of
    oncologist Dr. Heather Shaw and continued receiving the drug
    until November 2001 when Dr. Shaw changed her monthly regimen to
    infusions     of    Zometa,      another    Novartis-marketed,            FDA-approved
    bisphosphonate.          With the exception of a one month reprieve,
    Fussman remained on Zometa until June 2005.                         Fussman died in
    2009.
    This diversity action, which Fussman initiated in February
    2006,    involves    a    side   effect     of   Aredia       and   Zometa    known    as
    “osteonecrosis of the jaw” (ONJ).                ONJ occurs when the gums fail
    to cover part of the jaw bone and the bone starves and dies from
    lack of blood.           Fussman developed ONJ in March 2003, shortly
    after having two teeth extracted.                Herbert Fussman, individually
    and as the administrator of the Estate of Rita Fussman, alleges
    that Aredia and Zometa caused Fussman’s ONJ and that Novartis
    failed to warn adequately either Fussman or Dr. Shaw of the ONJ
    risk associated with the drugs.
    2
    After coordinated Multidistrict Litigation proceedings in
    the     Middle    District        of     Tennessee,        the     Judicial      Panel     on
    Multidistrict          Litigation       remanded         this    case    to    the    Middle
    District of North Carolina for trial.                          Following a fifteen-day
    trial,    a    jury     awarded       $287,000      in    compensatory        damages     and
    $12,600,000        in        punitive     damages         to     Herbert       Fussman     as
    administrator.               Additionally,         it    awarded    $1     for     loss    of
    consortium to Herbert Fussman individually.                         Per North Carolina
    General Statute § 1D-25, the district court reduced the punitive
    damages       award     to    $861,000.            See    N.C.    Gen.     Stat.     § 1D-25
    (“Punitive damages awarded against a defendant shall not exceed
    three times the amount of compensatory damages or two hundred
    fifty    thousand        dollars       ($250,000),        whichever      is    greater.”).
    Thus,    the     total       award,    including         pre-judgment      interest,      was
    $1,258,083.19.
    Novartis filed three post-judgment motions:                          a motion for a
    new trial, a motion for judgment as a matter of law on all
    claims, and a motion for judgment as a matter of law on punitive
    damages.         The    district       court   denied       all    three      motions,    and
    Novartis now appeals the denial of its motion for judgment as a
    matter of law on punitive damages and the denial of its motion
    for a new trial.             It does not appeal the court’s denial of its
    motion for judgment as a matter of law on all claims.                                For the
    reasons that follow, we affirm.
    3
    I.
    We first address Novartis’s contention that the district
    court erred in denying its motion for a new trial.                 We review a
    district court’s denial of a motion for a new trial for abuse of
    discretion, United States v. Perry, 
    335 F.3d 316
    , 320 (4th Cir.
    2003),       recognizing      that    “[u]nder     the     applicable    legal
    principles, a trial court ‘should exercise its discretion to
    award a new trial sparingly,’ and a jury verdict is not to be
    overturned except in the rare circumstance when the evidence
    ‘weighs heavily’ against it,” United States v. Smith, 
    451 F.3d 209
    , 216–17 (4th Cir. 2006) (quoting United States v. Perry, 
    335 F.3d 316
    , 320 (4th Cir. 2003)).
    A.
    Novartis       challenges      four   of     the     district     court’s
    evidentiary rulings, which we also review under the deferential
    abuse of discretion standard, King v. McMillan, 
    594 F.3d 301
    ,
    310   (4th    Cir.   2010),    and   overturn    only    when   “arbitrary   and
    irrational,” United States v. Blake, 
    571 F.3d 331
    , 346 (4th Cir.
    2009), and violative of a “party’s substantial rights,” Fed. R.
    Civ. P. 61 (“At every stage of the proceeding, the court must
    disregard all errors and defects that do not affect any party’s
    substantial rights.”).          Thus, if we conclude that an alleged
    error would be harmless, we need not conduct additional analysis
    4
    to determine whether the district court actually erred.                    United
    States v. Banks, 
    482 F.3d 733
    , 741 (4th Cir. 2007).
    In    this     case,   our    review     of   the    evidentiary      rulings
    Novartis cites indicates that none of them, even if erroneous,
    affected     Novartis’s     “substantial      rights.”         Accordingly,    we
    affirm the district court’s denial of Novartis’s motion for a
    new trial on that basis.
    E-mails Between Novartis and Drs. Schubert and Ruggiero
    In 2004, Novartis published a “white paper” about ONJ.                    The
    paper indicated that although “[a] causal relationship between
    bisphosphonate therapy and osteonecrosis of the jaws ha[d] not
    been established,” a panel of experts had convened “to discuss
    identification of risk factors” for ONJ, to “develop clinical
    guidelines    for    prevention,      early    diagnosis,      management,    and
    multidisciplinary treatment” of ONJ in cancer patients, and to
    “develop[]    recommendations       to   reduce”    ONJ   in   cancer   patients
    receiving bisphosphonates.
    At trial, the district court admitted e-mail conversations
    that occurred between Novartis and two experts—Dr. Mark Schubert
    and Dr. Salvatore Ruggiero—during the preparation and editing of
    the paper.        In May 2004, during the final revisions of the
    paper, an e-mail exchange occurred between Dr. Schubert and Dr.
    Yong-jiang    Hei,    Global      Medical    Director     of   Novartis.      Dr.
    5
    Schubert had requested that the following language be included
    in the paper’s “Potential Risk Factors” section:
    While   osteonecrosis   of   the  jaws   following
    bisphosphonate   therapy   has  been  associated   with
    infection and/or dental surgery, cases of spontaneous
    osteonecrosis lesions without other apparent risk
    factors   have   been   observed.     Some   cases   of
    osteonecrosis of the jaws have been observed after as
    few as [two] administrations of a bisphosphonate.
    Via e-mail, Dr. Hei responded that this language was excluded
    from the final draft for several reasons, one of which being
    that the language “implie[d] a degree of understanding of risk
    factors for osteonecrosis of the jaws that is not warranted in
    light of the general uncertainties regarding the causality of
    [the condition].”         In a reply e-mail, Dr. Schubert commented at
    length regarding Novartis’s decision not to include his proposed
    language, and relevant to Fussman’s claims stated, “I encourage
    you to take a bold and honest approach to realistically warn
    people[,] an[d] this will, in the long run, be the best thing.”
    In   a    different    May    2004    e-mail    exchange     with    Novartis,     Dr.
    Schubert      commented      on    Novartis’s   decision     to     include   in   the
    paper     a   long    list    of    risk   factors   that    were     “possibly     or
    possibly not related” to ONJ.              Schubert stated, “The [inclusion
    of a] laundry list of factors leading to ‘exposed bone’ does
    have the appearance of ‘blowing smoke.’”                    Similarly, in August
    2004, Dr. Ruggiero referenced the paper via e-mail, stating that
    6
    it was misrepresenting the truth and that “bisphosphonates are
    the real culprits” behind ONJ.
    Novartis contends that the district court erred in allowing
    Fussman     to     reference    these       e-mails      because          the    statements
    therein     were      inadmissible      hearsay.             But    we     conclude       that
    regardless of whether the district court erred in admitting the
    e-mails,    such       admission      was   harmless         because       the     testimony
    included in the e-mails was also offered by Dr. Robert Marx,
    another member of the expert panel who testified at trial.
    Dr. Marx testified that when he attended a meeting of the
    panel in 2004, he brought with him a “Notice of Importance” that
    he   had    developed        and      distributed        to        oral    surgeons        and
    oncologists       regarding     the    relationship          of    ONJ    to     Aredia    and
    Zometa.         Dr.   Marx   also     testified       that    his    office       faxed    the
    Notice     to    Dr.    Peter   Tarasoff,         a    Novartis          medical    affairs
    employee.        In part, the Notice stated, “The exposed bone in the
    jaws (either the maxilla or mandible) is directly related to
    Aredia/Zometa, but may be further contributed to by the primary
    disease itself, other chemotherapy agents, and steroids such as
    [D]ecadron.”          Regarding the white paper, Dr. Marx explained his
    problems with the paper, stating,
    It     was    denying    any    cause-and-effect
    relationship. . . . [I]t was actually attributing so
    many things to exposed bone, none of which really did
    that, that many of us, not just me, objected to the
    7
    written form several times that it was not addressing
    what we had inputted into the meeting.
    He further testified that he communicated his objections to the
    paper to the Novartis employee who was managing the project:
    “My   recollection        is     I    told    him     the    paper   danced    around   the
    issue;      and    that       things    such    as     smoking,      alcohol    drinking,
    periodontal disease, and a whole host of other possibilities
    don’t cause exposed bone; and to throw it into that framework
    was misleading to the readership.”
    In sum, to the extent that the jury concluded that Novartis
    knew of the ONJ risks associated with bisphosphonates and that
    it failed         to   warn    of    those    risks     or    intentionally     concealed
    those risks, the e-mails from Drs. Schubert and Ruggerio were
    not   the    sole      cause.         Dr.    Marx’s    testimony     supported    such   a
    conclusion as well.             Accordingly, the district court did not err
    in denying Novartis a new trial based on its admission of the e-
    mails.
    Dr. Lynne McGrath’s Testimony
    Since October 2005, Dr. Lynne McGrath has been the Vice
    President of Regulatory Affairs at Novartis.                         At trial, Novartis
    elicited     testimony         from    Dr.    McGrath       regarding   the    regulatory
    history of Aredia and Zometa.                  The court ruled that Dr. McGrath
    could testify only to information about which she had personal
    8
    knowledge,    effectively           limiting       her    testimony     to   post-October
    2005 history.           In contending that the district court erred in
    limiting Dr. McGrath’s testimony, Novartis maintains that her
    position     as    Vice        President      “required      her   to    have     personal
    knowledge of the full regulatory history of the drug.”
    Novartis avers that the district court’s ruling inhibited
    the jury from learning “information critical to [its] defense.”
    Specifically, it notes that Dr. McGrath would have testified
    that (1) Novartis “worked closely with [the] FDA on all of the
    various label changes and that attention was paid to every word
    in   the   label,”           (2)   Novartis      “worked    aggressively        to    obtain
    information       from       Dr.   Marx    and     even    hired   a    medical      records
    company to assist in the process of collecting medical records,”
    (3) Novartis’s Emergency Management team “worked diligently to
    understand the new side effect, and, within a month of convening
    [in July 2003], decided to revise the label to reflect the cases
    of ONJ and began the process of revising the label,” (4) “the
    risk factors listed in the September 2003 label were considered
    by   [Novartis]         to    be   well   documented        in   the    general      medical
    literature        for    osteonecrosis           generally,      the    only    available
    literature at that time,” (5) the “FDA simultaneously, looking
    at   the   same     information,          also      recognized     the       propriety    of
    listing the same risk factors,” and (6) Novartis “considered
    label changes very serious matters and worked hard to ensure
    9
    that there was a strong basis for what it included in each label
    change.”         Additionally,          Novartis     contends       that   without      the
    court-imposed       limitation          Dr.     McGrath      could    have       countered
    Fussman’s presentation of the chronology of events, Fussman’s
    implication that Novartis “simply ‘chose’ not to put necessary
    safety information into its label,” and Fussman’s disparagement
    of the Novartis Emergency Management team.
    Once       again,    we    need     not    determine     whether      the    district
    court erred in limiting Dr. McGrath’s testimony because any such
    error was harmless.              Novartis’s regulatory expert, Dr. Janet
    Arrowsmith, provided the testimony that Novartis maintains Dr.
    McGrath could have provided.                   Dr. Arrowsmith indicated that she
    reviewed “new drug applications for Aredia and Zometa,” “notes
    of meetings between FDA and Novartis,” and “notes of advisory
    boards    [and]    internal          communications        within    Novartis.”        She
    testified,       among        other     things,     concerning       the     details    of
    Novartis’s interaction with the FDA; the timing and extent of
    Novartis’s       knowledge       that    bisphosphonates          cause    ONJ;    whether
    Novartis would have modified the initial label on the drugs had
    potential    cases       of    ONJ    revealed      during    clinical      trials     been
    notated    as    such;    the     organization        of    the   Novartis       Emergency
    Management team; the team’s decision to modify the drugs’ labels
    in August 2003; and the actual modification of the labels in
    September 2003.          Given the extent of Dr. Arrowsmith’s testimony,
    10
    we cannot conclude that the district court’s limitation of Dr.
    McGrath’s testimony harmed Novartis in a manner that affected
    its “substantial rights.”
    Dr. Ruggiero’s Testimony
    At     trial,        Fussman     repeatedly        referenced          Dr.    Salvatore
    Ruggiero’s     research       regarding          occurrences     of    ONJ    in     patients
    that receive bisphosphonates.                    It presented an e-mail showing
    that in April 2002, Dr. Ruggiero queried Dr. Tarrassoff about
    whether bisphosphonates cause osteonecrosis.                          It also presented
    an   e-mail    indicating          that     in    May    2003,    when       Dr.     Ruggiero
    attempted      to        publish     a      case       series     regarding          ONJ     in
    bisphosphonate           patients,        Novartis      sought        to    prevent        such
    publication.        Using this evidence, Fussman averred that Novartis
    knew bisphosphonates present ONJ risks and chose not to act on
    what it knew.
    To rebut the implications of Fussman’s evidence, Novartis
    attempted to admit deposition testimony that Dr. Ruggiero had
    provided      in     another        Aredia       and    Zometa        case.          Novartis
    represented to the district court that in the prior case Dr.
    Ruggiero had testified that (1) in April 2002, he did not report
    a case of ONJ to Novartis, and (2) he had “no knowledge of
    anyone    trying     to    stop     him    from    publishing”        his     case   series.
    Ultimately,        the    district       court     denied   the       admission       of    the
    11
    deposition,       and   Novartis    now        argues      that   such    denial   was
    prejudicial because the “excluded testimony tended to negate key
    allegations of wrongdoing that Fussman used to support liability
    and punitive damages.”          But such is not the case.                The excluded
    deposition    testimony     would    not       have     helped    Novartis    to   any
    notable degree.
    First, Novartis avows that Fussman repeatedly claimed that
    Dr. Ruggiero reported cases of ONJ to Novartis in April 2002.
    But our review of the record reveals that Fussman in fact did
    not make such a claim.        Rather, Fussman merely repeated what the
    evidence demonstrated—that in April 2002, Dr. Ruggiero asked Dr.
    Tarasoff if bisphosphonates cause osteoneocrosis.                        Fussman did
    not present evidence that Dr. Ruggierio reported specific ONJ
    cases.      Thus, although Novartis contends that Dr. Ruggerio’s
    testimony from the prior case would have undermined Fussman’s
    claims,     his    deposition      would       have     simply    contradicted     an
    argument that Fussman never pressed—namely, that Dr. Ruggiero
    reported cases of ONJ to Novartis in April 2002.
    Similarly, Dr. Ruggiero’s testimony—that he did not know
    Novartis attempted to prevent publication of his case series—
    would have failed to contradict effectively Fussman’s evidence
    that Novartis had indeed engaged in such conduct.                        Simply put,
    one would not expect that Novartis would notify Dr. Ruggiero of
    its   own   suppression     attempts.           It    is   unsurprising     that   Dr.
    12
    Ruggerio     was     unaware   of    Novartis’s      actions,   and   evidence
    supporting this fact would not have advanced Novartis’s defense.
    Hence, given the harmlessness of any district court error, we
    again affirm the district court’s denial of Novartis’s motion
    for a new trial.
    Evidence of 2007 Zometa Label Revision
    In   pertinent     part,     Zometa’s     2003   label   included   the
    following paragraph:
    Cases of osteonecrosis (primarily of the jaws) have
    been     reported     since    market    introduction.
    Osteonecrosis of the jaws has other well documented
    multiple risk factors.       It is not possible to
    determine if these events are related to Zometa or
    other bisphosphonates, to concomitant drugs or other
    therapies . . . , to patient’s underlying disease, or
    to other comorbid risk factors . . . .
    In 2007, Novartis revised this portion of the label so that it
    stated the following:
    Cases of osteonecrosis (primarily involving the
    jaws) have been reported predominantly in cancer
    patients   treated  with   intravenous  bisphosphonates
    including Zometa.    Many of these patients were also
    receiving chemotherapy and corticosteroids which may
    be a risk factor for ONJ.      Data suggests a greater
    frequency of reports of ONJ in certain cancers, such
    as advanced breast cancer and multiple myeloma.     The
    majority of the reported cases are in cancer patients
    following invasive dental procedures, such as tooth
    extraction. It is therefore prudent to avoid invasive
    dental procedures as recovery may be prolonged . . . .
    Prior to trial, Novartis moved to exclude evidence of the
    2007    revision,     maintaining     that     the   revision   constituted   a
    13
    subsequent      remedial       measure.           See     Fed.    R.     Evid.    407       (“When
    measures are taken that would have made an earlier injury or
    harm less likely to occur, evidence of the subsequent measures
    is not admissible to prove: negligence[,] culpable conduct[,] a
    defect in a product or its design[,] or a need for a warning or
    instruction.”).          Although the district court granted Novartis’s
    pre-trial       motion,       it    reversed       course        at    trial     and    allowed
    Fussman    to     cross-examine        Dr.        Arrowsmith          regarding       the    label
    changes.        Additionally,         it    allowed       Fussman        to    reference       the
    revision during closing argument.
    To the extent that the district court erred in admitting
    evidence     of    the     2007      label        revision,       such        error    did     not
    prejudice Novartis.                Evidence of the revision was relevant to
    Novartis’s awareness of the dangers of Zometa and to whether
    Zometa    caused       Fussman’s       ONJ.        Given       that     Fussman        presented
    extensive       evidence       apart       from     the    2007        label     change      that
    supported       both     of    these       claims,        we     cannot        conclude       that
    admission of the label change “substantially swayed” the jury’s
    verdict.     Thus, once again, we conclude that the district court
    did not err in denying Novartis a new trial on such a basis.
    B.
    Novartis also contends that the district court’s denial of
    two of its requested punitive damages jury instructions merited
    14
    a   new   trial.        We   review   jury       instructions     “holistically        and
    through the prism of the abuse of discretion standard.”                         Noel v.
    Artson, 
    641 F.3d 580
    , 586 (4th Cir. 2011).                            We must “simply
    determine ‘whether the instructions construed as a whole, and in
    light of the whole record, adequately informed the jury of the
    controlling legal principles without misleading or confusing the
    jury to the prejudice of the objecting party.’”                          
    Id.
     (quoting
    Bailey    v.    Cnty.    of    Georgetown,        
    94 F.3d 152
    ,    156    (4th    Cir.
    1996)).     A party challenging a jury instruction “faces a heavy
    burden, for ‘we accord the district court much discretion to
    fashion the charge.’”            
    Id.
     (quoting Teague v. Bakker, 
    35 F.3d 978
    , 985 (4th Cir. 1994)).              Indeed, we will reverse a district
    court for declining to give a requested instruction “only when
    the   requested     instruction         ‘(1)       was    correct;      (2)    was     not
    substantially covered by the court’s charge to the jury; and (3)
    dealt with some point in the trial so important, that failure to
    give the requested instruction seriously impaired’ that party’s
    ability    to    make    its   case.”        
    Id.
           (quoting   United      States    v.
    Lighty, 
    616 F.3d 321
    , 366 (4th Cir. 2010)).
    Novartis      challenges        the        district      court’s       denial     of
    Requested Jury Charge No. 37, which states:
    In making your determination of punitive damages
    in this case, you cannot consider any conduct
    occurring outside the state of North Carolina.
    15
    In   making   your  determinations   of   punitive
    damages, you may not consider any harm that may have
    been done to any other individual not in this case.
    Thus, in making your determinations of punitive
    damages in this case, you can only consider profits
    derived by [Novartis] from the state of North Carolina
    during the years of Mrs. Fussman’s use.
    It also challenges the denial of Requested Jury Charge No. 43,
    which states, “The law prohibits imposing punitive damages based
    on any corporate misconduct that did not specifically harm Mrs.
    Fussman.”
    Novartis avers that it requested these charges to guard
    against the risk that the jury would award damages to Fussman
    for     harm    that    other        individuals     suffered.       And     Novartis
    maintains       that    such     a     risk    was   concrete    because      Fussman
    presented evidence that other individuals developed ONJ after
    they    had    been    treated       with   Aredia   and   Zometa;   questioned       a
    Novartis expert about his diagnosis of a Tennessee woman who
    allegedly developed ONJ after using Aredia; and discussed total
    Zometa sales across the United States in 2005 and 2009.                           Citing
    Philip Morris USA v. Williams, 
    549 U.S. 346
     (2007), Novartis
    urges    that    the    “Due     Process       Clause   precludes    a     jury    from
    punishing for ‘the harm caused to others,’” and that therefore,
    “when asked, the district court is required to provide a jury
    instruction that protects against the risk that punishment will
    be meted out for harm done to others.”                     We conclude, however,
    16
    that    the    district     court     did        not   abuse      its    discretion   in
    declining to give the charges Novartis requested.
    First, Requested Jury Charge No. 37 is incorrect.                       Although
    Novartis accurately states that “the Constitution’s Due Process
    Clause forbids a State to use a punitive damages award to punish
    a defendant for injury that it inflicts upon nonparties or those
    whom they directly represent, i.e., injury that it inflicts upon
    those who are, essentially, strangers to the litigation,” 
    id. at 353
    , Novartis fails to recognize that due process does allow
    reference to and consideration of nonparty injuries as evidence
    of reprehensibility, 
    id. at 355
     (“Evidence of actual harm to
    nonparties can help to show that the conduct that harmed the
    plaintiff also posed a substantial risk of harm to the general
    public, and so was particularly reprehensible . . . .”).                           Thus,
    Requested Jury Charge No. 37’s counsel not to consider any harm
    inflicted on any nonparty or any conduct that occurred outside
    of     North     Carolina    is     improper,          and     the      district   court
    appropriately declined to instruct the jury in this manner.
    Second,    Requested    Jury    Charge          No.   43   was    “substantially
    covered” by the district court’s actual charge.                          Instead of the
    language that Novartis requested, the court gave the following
    punitive damages instruction:
    In making [a] determination [as to punitive
    damages], you may consider only that evidence which
    relates to the following: the reprehensibility of the
    17
    Defendant’s motive and conduct, if you have so found;
    the likelihood at the relevant time of serious harm to
    Ms. Fussman; the degree of the Defendant’s awareness
    of the probable consequences of its conduct; the
    duration of the Defendant’s conduct; the actual
    damages suffered by Ms. Fussman; any concealment by
    the Defendant of the facts or consequence[s] of its
    conduct; the existence and frequency of any similar
    past conduct by the Defendant, if you so find; whether
    the Defendant profited by the conduct.
    We believe that when the court admonished the jury to “consider
    only”    evidence     connected   to   reprehensibility        and        evidence    of
    “actual damages suffered by Ms. Fussman,” it sufficiently dealt
    with    the    risk   that   Requested    Jury   Charge      No.     43    presumably
    sought    to    guard   against—namely,       that     the    jury    would     award
    damages for harm suffered by “strangers to the litigation.”                          
    Id. at 353
    .       Thus, we also affirm the district court’s decision not
    to give Novartis’s Requested Jury Charge No. 43.
    In sum, as to the evidentiary rulings Novartis contests, we
    hold that any errors by the district court were harmless.                            And
    as to Requested Jury Charges Nos. 37 and 43, we hold that the
    district court did not abuse its discretion in declining to give
    these    charges.       Accordingly,     we   affirm    the    district       court’s
    denial of Novartis’s motion for a new trial.
    II.
    We next address the district court’s denial of Novartis’s
    post-trial motion for judgment as a matter of law on punitive
    18
    damages.      “We review de novo a district court’s denial of a Rule
    50 motion for judgment as a matter of law.”                       Lack v. Wal-Mart
    Stores, Inc., 
    240 F.3d 255
    , 259 (4th Cir. 2001).                        “If, viewing
    the facts in the light most favorable to the non-moving party,
    there is sufficient evidence for a reasonable jury to have found
    in   [Fussman’s]     favor,    we    are   constrained      to    affirm         the    jury
    verdict.”     
    Id.
    A.
    In its motion, Novartis argued (1) that the evidence of its
    misconduct suggests negligence, not willful or wanton conduct as
    required under North Carolina law to support a punitive damages
    award   and    (2)   that     evidence     of    its    suppression         of    medical
    information     regarding      ONJ    cannot     support    a     punitive        damages
    award   because      Fussman    failed     to    demonstrate       a    causal         nexus
    between Novartis’s acts and her harm.              We disagree.
    First, Fussman presented evidence showing that Novartis’s
    high-ranking officials knew about the drugs’ side effects and
    subverted medical inquiries into such effects.                         This evidence
    provided a sufficient foundation for the jury to determine that
    Novartis’s     actions   were       willful,     not    simply    negligent.             And
    second,    Fussman     presented      evidence      sufficient         to   support        a
    determination that Novartis’s acts proximately caused her ONJ.
    Fussman’s     deposition       testimony,       taken    before    her      death        and
    19
    presented     at    trial,    indicated      that    she    would    not     have   taken
    Aredia and Zometa if she had known the drugs’ risks.                               Indeed,
    evidence      presented      at    trial    indicated       that    Fussman        stopped
    taking      the    drugs    once     she    knew    their    hazards.         Moreover,
    although      Dr.    Shaw    testified      that     she    would    have     continued
    Fussman’s     treatments      even     if    she    had    known    that     ONJ    was    a
    possibility, the jury could have determined from other evidence
    that Dr. Shaw would have modified various aspects of Fussman’s
    treatment had she been adequately warned of the drugs’ perils.
    We have simply sampled the record here.                         But the trial
    proceedings and the whole of the evidence that Fussman supplied
    to   this    Court    bely    a    conclusion       that    insufficient       evidence
    supported the jury’s punitive damages award.                        Thus, we affirm
    the district court’s denial of Novartis’s motion for judgment as
    a matter of law on this basis.
    B.
    We also affirm the district court’s denial of Novartis’s
    motion for judgment as a matter of law on a preemption theory.
    Novartis contends that the Federal Food, Drug, and Cosmetic Act
    (FDCA),      
    21 U.S.C. §§ 301-399
    ,      preempts      the     jury’s    award       of
    punitive damages because the Aredia and Zometa labels complied
    with   FDA    regulations      and    the    FDA    has    exclusive    authority         to
    20
    enforce the labeling requirements of the FDCA.                     Once again, we
    disagree.
    In no uncertain terms, the Supreme Court has dictated that
    the    FDCA   does    not   preempt      state   law   claims   against       a    drug
    company whose drug label complies with FDA regulations.                           Wyeth
    v. Levine, 
    555 U.S. 555
    , 581 (2009).                   In Wyeth v. Levine, the
    Court examined the history of the FDCA and Congress’s intent in
    enacting      the    statute.      The    Court    noted    that    in    spite     of
    Congress’s “certain awareness of the prevalence of state tort
    litigation,” it declined to expressly preempt state law failure-
    to-warn claims for prescription drugs.                  
    Id. at 575
     (“The case
    for federal pre-emption is particularly weak where Congress has
    indicated its awareness of the operation of state law in a field
    of federal interest, and has nonetheless decided to stand by
    both    concepts     and    to   tolerate      whatever    tension    there       [is]
    between them.”) (alteration in original) (quoting Bonito Boats,
    Inc. v. Thunder Craft Boats, Inc., 
    489 U.S. 141
    , 166–67 (1989)
    (internal quotation marks omitted)).               Congress’s silence on the
    matter    was   notable,     the   Court       reasoned,   because       in   another
    context—i.e., medical devices—it had amended the FDCA to include
    an express preemption provision.               See Pub. L. No. 94-295, § 521,
    
    90 Stat. 574
     (1976) (codified at 21 U.S.C. § 360k); Wyeth, 
    555 U.S. at 567
    .
    21
    Here,    Novartis      seeks   to    carve    out    a   niche     in    existing
    precedent by arguing that Wyeth is inapplicable because it does
    not expressly reference punitive damages.                  But Novartis fails to
    put   forth    any   logical    reason     why     the    basis   for    the   Court’s
    decision in Wyeth should not equally apply to claims involving
    punitive damages.         Novartis argues that the FDCA preempts the
    recovery of punitive damages because (1) the purpose of punitive
    damages is to punish and deter, something the FDA has “ample
    power”    to     accomplish          through       enforcement          of     labeling
    requirements     and   (2)     allowing     the    punishment     of     FDA-approved
    conduct is improper.         Neither of these arguments is efficacious.
    Had Congress intended to preempt punitive damages recovery, it
    could have clearly indicated as much—just as it did when it
    addressed medical devices.           Thus, we affirm the district court’s
    denial of Novartis’s motion for judgment as a matter of law on
    this basis as well.
    III.
    For the foregoing reasons, we affirm the judgment of the
    district court.
    AFFIRMED
    22