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North American Medical Corp. v. Axiom Worldwide, Inc.

Court: Court of Appeals for the Eleventh Circuit
Date filed: 2008-04-07
Citations: 522 F.3d 1211
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                                                                  [PUBLISH]



             IN THE UNITED STATES COURT OF APPEALS

                     FOR THE ELEVENTH CIRCUIT           FILED
                      ________________________ U.S. COURT OF APPEALS
                                                         ELEVENTH CIRCUIT
                                                            APRIL 7, 2008
                             No. 07-11574
                                                          THOMAS K. KAHN
                       ________________________
                                                              CLERK

                  D. C. Docket No. 06-01678 CV-JTC-1

NORTH AMERICAN MEDICAL CORPORATION,
ADAGEN MEDICAL INTERNATIONAL, INC.,
Georgia corporations,

                                                   Plaintiffs-Appellees,

                                  versus

AXIOM WORLDWIDE, INC.,
a Florida corporation,
JAMES GIBSON, JR.,
NICHOLAS EXARHOS,
residents of Florida,
                                              Defendants-Appellants.
                       ________________________

                Appeal from the United States District Court
                   for the Northern District of Georgia
                     _________________________

                              (April 7, 2008)

Before ANDERSON, BLACK and HILL, Circuit Judges.

ANDERSON, Circuit Judge:
       Defendants-Appellants Axiom Worldwide, Inc. (“Axiom”), James Gibson,

Jr., and Nicholas Exarhos appeal the district court’s grant of a preliminary

injunction in favor of the Plaintiffs-Appellees, North American Medical

Corporation (“NAM”) and Adagen Medical International, Inc. (“Adagen”).1 The

district court enjoined the Defendants-Appellants from engaging in certain alleged

acts of trademark infringement and false advertising. We now affirm the district

court’s order in part and vacate and remand it in part.



                              I. STANDARD OF REVIEW

       We will reverse a grant of a preliminary injunction only if the district court

abused its discretion. Johnson & Johnson Vision Care, Inc. v. 1-800 Contacts,

Inc., 299 F.3d 1242, 1246 (11th Cir. 2002). We review the district court’s

findings of fact under a clearly erroneous standard, noting that a finding of fact is

clearly erroneous only when “although there is evidence to support it, the

reviewing court on the entire evidence is left with the definite and firm conviction

that a mistake has been committed.” Id. (quoting Univ. of Ga. Athletic Ass’n v.



       1
         Defendant-Appellant Ren Scott originally participated in this appeal as well, but we
previously granted a joint motion to voluntarily dismiss him from the case after he reached a
settlement agreement with the Plaintiffs-Appellees. Accordingly, we need not address Scott’s
argument that the district court lacked personal jurisdiction over him.

                                               2
Laite, 756 F.2d 1535, 1543 (11th Cir.1985)). We review the district court’s

conclusions of law de novo, “understanding that ‘[a]pplication of an improper

legal standard . . . is never within a district court’s discretion.’ ” Id. (quoting Am.

Bd. of Psychiatry & Neurology, Inc. v. Johnson-Powell, 129 F.3d 1, 2-3 (1st Cir.

1997)).



                                II. BACKGROUND

      NAM designs and manufacturers physiotherapeutic spinal devices,

commonly known as traction devices, which are used, for example, to treat lower

back pain. Adagen is an authorized distributor of NAM’s devices. Axiom, a

competitor of NAM’s, manufacturers a physiotherapeutic device known generally

as the DRX 9000. Gibson and Exharhos are, respectively, the president and vice

president of Axiom. In the present lawsuit, NAM and Adagen allege that Axiom

engaged in unfair competition by infringing NAM’s trademarks and by issuing

false advertising regarding the DRX 9000.

      The trademark infringement claims stem from Axiom’s use of two of

NAM’s registered trademarks: the terms “Accu-Spina” and “IDD Therapy.”




                                           3
Axiom included these terms on its website within meta tags.2 Although Axiom’s

website never displayed NAM’s trademarked terms to visitors and never

mentioned NAM or NAM’s products, Axiom nonetheless included the terms

within its meta tags to influence Internet search engines. For instance, evidence in

this case indicated that, before Axiom removed these meta tags from its website, if

a computer user entered the trademarked terms into Google’s Internet search

engine, Google listed Axiom’s website as the second most relevant search result.

In addition, Google provided the searcher with a brief description of Axiom’s

website, and the description included these terms and highlighted them.3

       The false advertising claims stem from certain statements that Axiom made

about its product, the DRX 9000. In particular, two representations by Axiom are




       2
           Meta tags consist of words and phrases that are intended to describe the contents of a
website. These descriptions are embedded within the website’s computer code. Although
websites do not display their meta tags to visitors, Internet search engines utilize meta tags in
various ways. First, when a computer user enters particular terms into an Internet search engine,
the engine may rank a webpage that contains the search terms within its meta tags higher in the
list of relevant results. Second, when a particular webpage is listed as a relevant search result,
the search engine may use the meta tags to provide the searcher a brief description of the
webpage. See Brookfield Commc’ns, Inc. v. W. Coast Entm’t Corp., 174 F.3d 1036, 1045 (9th
Cir. 1999).
       3
           Incidentally, Axiom makes a brief, conclusory argument that no evidence exists to
establish that the meta tags affected the search results. We disagree. The evidence indicates that
nowhere in Axiom’s website do NAM’s two trademarked terms appear (e.g., in comparative
adverstising). Rather, the terms appear only in Axiom’s meta tags. We cannot conclude that the
district court’s implied finding of a causal relationship is clearly erroneous.

                                                4
relevant to this appeal.4 First, Axiom represented in various ways that an

affiliation exists between NASA and Axiom or between NASA and the DRX

9000. Second, Axiom asserted in advertisements that the DRX 9000 is FDA

“approved.”

       The district court issued a preliminary injunction in favor of NAM and

Adagen, prohibiting Axiom from using NAM’s trademarks within meta tags and

prohibiting Axiom from making the challenged statements about the DRX 9000.

Among other things, the district court specifically found that Axiom’s use of

NAM’s trademarks created a likelihood of confusion, and the court also found that

Axiom’s advertising statements are literally false and material to consumers’

purchasing decisions.



                                      III. DISCUSSION

       At the outset, we note that a district court may grant a preliminary

injunction only if the movant establishes the following: “(1) a substantial

likelihood of success on the merits of the underlying case, (2) the movant will


       4
          A third representation by Axiom, that Axiom patented the DRX 9000 or any portion or
feature thereof, was also deemed literally false by the district court. Because Axiom’s brief on
appeal fails to challenge this aspect of the district court’s ruling, however, Axiom has waived the
issue. This circuit has consistently held that issues not raised on appeal are abandoned. See, e.g.,
Greenbriar, Ltd. v. City of Alabaster, 881 F.2d 1570, 1573 n.6 (11th Cir. 1989).

                                                 5
suffer irreparable harm in the absence of an injunction, (3) the harm suffered by

the movant in the absence of an injunction would exceed the harm suffered by the

opposing party if the injunction issued, and (4) an injunction would not disserve

the public interest.” Johnson & Johnson, 299 F.3d at 1246-47. Axiom challenges

the district court’s order on multiple grounds. First, Axiom argues that NAM and

Adagen failed to establish a substantial likelihood of success on the merits of their

trademark infringement claims. Specifically, Axiom urges that its use of NAM’s

trademarks in invisible meta tags is not a “use in commerce” and does not create a

likelihood of confusion. Second, Axiom argues that NAM and Adagen also failed

to establish a substantial likelihood of success on the merits of their false

advertising claims. Specifically, Axiom asserts that its advertising statements are

not literally false and are not material to consumers’ purchasing decisions. Third

and finally, Axiom argues that, even assuming NAM and Adagen are likely to

succeed on the merits of these unfair competition claims, the district court erred by

categorically presuming that any plaintiff with a viable unfair competition claim

will always suffer irreparable harm in the absence of a preliminary injunction. We

address each point in turn.

      A. Likelihood of Success on the Merits of the Trademark Infringement
      Claims



                                           6
      Because Axiom’s use of NAM’s trademarks constitutes a “use in

commerce” in connection with the advertisement of goods, and because the district

court did not clearly err in its factual finding that a likelihood of confusion exists,

NAM and Adagen demonstrated a likelihood of success on the merits of their

trademark infringement claims. Regarding trademark infringement, the Lanham

Act provides, in relevant part, as follows:

      (1) Any person who shall, without the consent of the registrant –

             (a) use in commerce any reproduction, counterfeit, copy, or
             colorable imitation of a registered mark in connection with the
             sale, offering for sale, distribution, or advertising of any goods or
             services on or in connection with which such use is likely to
             cause confusion, or to cause mistake, or to deceive . . .

      shall be liable in a civil action by the registrant for the remedies
      hereinafter provided.

15 U.S.C. § 1114(1)(a) (2006). To prevail on a claim of trademark infringement in

this case, plaintiffs must establish: (1) that they possess a valid mark, (2) that the

defendants used the mark, (3) that the defendants’ use of the mark occurred “in

commerce,” (4) that the defendants used the mark “in connection with the sale . . .

or advertising of any goods,” and (5) that the defendants used the mark in a

manner likely to confuse consumers. See 1-800 Contacts, Inc. v. WhenU.com,

Inc., 414 F.3d 400, 406-07 (2d Cir. 2005); People for Ethical Treatment of



                                           7
Animals v. Doughney, 263 F.3d 359, 364 (4th Cir. 2001).

       Axiom does not challenge the validity of NAM’s marks, nor does Axiom

dispute that its use of NAM’s trademarks affects interstate commerce.5 Thus,

although Axiom purports to challenge whether its placing of NAM’s trademarks in

its meta tags is a “use in commerce” and whether such use is likely to confuse

consumers, Axiom’s arguments actually focus only on the second, fourth, and fifth

elements. Moreover, because Axiom separates its “use” challenge from its

“likelihood of confusion” challenge, we first address the second and fourth

elements together (i.e., whether there was a “use . . . in connection with the sale . .

. or advertising of any goods”), and we then address the fifth element (i.e., whether

such use was in a manner “likely to confuse consumers”).

       1. Use in Commerce in Connection with the Sale or Advertising of Any
       Goods

       Axiom briefly argues that placing a competitor’s trademarks within meta

tags, which consumers never view, does not constitute a “use” as required to find

trademark infringement under the Lanham Act. However, we readily conclude

that the facts of the instant case do involve a “use” as contemplated in the Lanham

       5
        The Lanham Act defines “commerce” broadly for jurisdictional purposes as “all
commerce which may lawfully be regulated by Congress.” 15 U.S.C. § 1127 (2006); see also
Bosely Med. Inst., Inc. v. Kremer, 403 F.3d 672, 677 (9th Cir. 2005)(describing “use in
commerce” as a “jurisdictional predicate”); Planetary Motion, Inc. v. Techsplosion, Inc., 261
F.3d 1188, 1194-95 (11th Cir. 2001) (same).

                                               8
Act – that is, a use in connection with the sale or advertisement of goods. In

deciding whether Axiom has made an infringing “use,” we focus on the plain

language of § 1114(1)(a), which, as noted above, requires a “use in commerce . . .

of a registered mark in connection with the sale . . . or advertising of any goods.”

15 U.S.C. § 1114(1)(a). The facts of the instant case are absolutely clear that

Axiom used NAM’s two trademarks as meta tags as part of its effort to promote

and advertise its products on the Internet. Under the plain meaning of the

language of the statute, such use constitutes a use in commerce in connection with

the advertising of any goods. Accordingly, we readily conclude that plaintiffs in

this case have satisfied that (1) they possessed a valid mark, (2) that the defendant

used the mark, (3) that the defendant’s use of the mark occurred “in commerce,”

and (4) that the defendant used the mark “in connection with the sale . . . or

advertising of any goods.”

      In an effort to avoid the foregoing plain meaning of the statutory language,

Axiom places its sole reliance on the Second Circuit’s 1-800 Contacts case. In

that case, whenever a consumer who had installed the defendant’s computer

program clicked on or searched for the plaintiff’s website address, the program

generated on the consumer’s screen not only the website sought (e.g., plaintiff’s),

but also a second window displaying pop-up ads for the defendant’s alternative,

                                          9
competing products. 414 F.3d at 404-05. The Second Circuit ultimately held, as a

matter of law, that such use of the web address is not a “use in commerce.” Id. at

403.

       In so holding, the Second Circuit emphasized that the defendant did not use

plaintiff’s trademark, but rather used its website address, which differed slightly

from the mark. Id. at 408-09. Indeed, the court explicitly declined to express an

opinion on the appropriate result if defendant had in fact used plaintiff’s

trademark. Id. at 409 n.11. Even more crucial to the Second Circuit’s holding, the

court emphasized repeatedly the fact that the defendant never caused plaintiff’s

trademarks to be displayed to a consumer. Id. at 408-410. The court explained

that the defendant used plaintiff’s web address merely in the internal directory of

its proprietary software, which was “inaccessible to both the C-user and the

general public.” Id. at 409. Explaining the significance of the fact that the

defendant never caused plaintiff’s trademark to be displayed to the consumer, the

court stated that defendant’s use of plaintiff’s “website address in the directory

does not create a possibility of visual confusion with 1-800’s mark.” Id.

       In rejecting Axiom’s invitation to rely on 1-800 Contacts, we initially note

that the above two key facts are not present in the case before us. First, unlike the

defendant in 1-800 Contacts, Axiom in the instant case did use NAM’s two

                                          10
trademarks in its meta tags; it did not merely use NAM’s unprotected website

address. Second, and again unlike in 1-800 Contacts, the defendant-Axiom in this

case did cause plaintiff’s trademark to be displayed to the consumer in the search

results’ description of defendant’s site.6 Thus, the facts of the instant case stand in

stark contrast to those in 1-800 Contacts, and Axiom’s reliance on the Second

Circuit’s opinion is therefore misplaced.

           Furthermore, to the extent the 1-800 Contacts court based its “use” analysis

on the fact that the defendant did not display the plaintiff’s trademark, we think

the Second Circuit’s analysis is questionable. Although we believe that the

absence of such a display is relevant in deciding whether there is a likelihood of

confusion, we believe that, when the analysis separates the element of likelihood

of confusion from the other elements, this fact is not relevant in deciding whether

there is a use in commerce in connection with the sale or advertising of any goods.

Because the Second Circuit did separate its analysis in this manner, and did

purport not to address the likelihood of confusion issue, see id. at 406, its reliance

on the fact that there was no display of the plaintiff’s trademark (and thus no



       6
          As described more fully below, when a consumer in this case entered NAM’s
trademarks into a search engine, the search results displayed Axiom’s website along with a
description thereof, which description included NAM’s trademarks in a manner likely to confuse
consumers and suggest some relationship between Axiom and NAM.

                                              11
possibility of confusion) undermines the persuasiveness of its analysis of the

separate elements of use in commerce in connection with the sale or advertising of

any goods.

       In sum, we conclude that Axiom’s reliance on the Second Circuit decision

in 1-800 Contacts is misplaced.7 We conclude that the plain meaning of the

statutory language clearly indicates that Axiom’s use of NAM’s trademarks as

meta tags constitutes a “use in commerce . . . in connection with the sale . . . or

advertising of any goods” under the facts of this case. Thus, we turn to the fifth,

and final, element that plaintiffs’ must establish – that such use was “likely to

cause confusion.”

               2. Likelihood of Confusion


       7
           We also note that several cases, including 1-800 Contacts, refer to 15 U.S.C. § 1127
with respect to the definition of “use in commerce” in the infringement context. See, e.g., 1-800
Contacts, 414 F.3d at 407, 409. However, a leading treatise on trademarks notes that § 1127
“defines the kind of ‘use’ needed to acquire registerable trademark rights – not to infringe them.”
J. Thomas McCarthy, McCarthy on Trademarks and Unfair Competition § 23:11.50 (4th ed.
2003). McCarthy explains that § 1127 harked back to the common law “affixation” requirement,
a formalistic prerequisite to achieving technical trademark status. Id. By contrast, McCarthy
observes that § 1114(1) merely requires that a plaintiff’s proof of infringement establish a use in
commerce “in connection with the sale . . . or advertising of any goods.” Id. In any event,
McCarthy notes that the cases that inappropriately cite § 1127 in the context of an infringing
“use” analysis do not apply that section’s affixation limitations. Id. Finally, McCarthy cites
Ninth Circuit opinions as correctly construing § 1127. Id. (citing, for example, Bosely Med.
Inst., Inc. v. Kremer, 403 F.3d 672 (9th Cir. 2005)). In Kremer, the Ninth Circuit noted that §
1127 is expressly prefaced with the caveat: “unless the contrary is plainly apparent from the
context.” 403 F.3d at 677. Thus, the Kremer court held that the appropriate issue was whether
the use was “in connection with the sale of goods or services.” Id.; see also Playboy Enters., Inc.
v. Netscape Commc’ns Corp., 354 F.3d 1020, 1024 n.11 (9th Cir. 2004).

                                                12
      The district court’s finding that a likelihood of confusion exists is not

clearly erroneous. Seven factors are relevant when determining whether a

likelihood of confusion exists:

      (1) the strength of the plaintiff’s mark; (2) the similarity between the
      plaintiff’s mark and the allegedly infringing mark; (3) the similarity
      between the products and services offered by the plaintiff and defendant;
      (4) the similarity of the sales methods; (5) the similarity of advertising
      methods; (6) the defendant’s intent, e.g., does the defendant hope to gain
      competitive advantage by associating his product with the plaintiff’s
      established mark; and (7) actual confusion.

Alliance Metals, Inc., of Atlanta v. Hinely Indus., Inc., 222 F.3d 895, 907 (11th

Cir. 2000). “The findings as to each factor, and as to the ultimate conclusion

regarding whether or not a likelihood of confusion existed, are subject to the

clearly erroneous standard of review.” Frehling Enters., Inc. v. Int’l Select Group,

Inc., 192 F.3d 1330, 1335 (11th Cir. 1999).

      The district court expressly acknowledged the foregoing factors, but it made

an explicit finding only with respect to the ultimate conclusion that there was a

likelihood of confusion. Regarding that issue, Axiom’s brief on appeal did not

challenge the district court’s implied findings with respect to any of the subsidiary

factors (i.e., the foregoing seven factors). Rather, Axiom challenged only: (1) the

district court’s implied finding that Axiom’s use of NAM’s two trademarks as




                                         13
meta tags caused the Internet search results at issue,8 and (2) the district court’s

reliance on Brookfield Communications, Inc. v. West Coast Entertainment Corp.,

174 F.3d 1036 (9th Cir. 1999), and Promatek Industries, Ltd. v. Equitrac Corp.,

300 F.3d 808 (7th Cir. 2002), with respect to the nature of meta tags and search

engines. Axiom argues that those opinions erroneously misled the district court to

find a likelihood of confusion; Axiom contends that its use of the meta tags was

instead analogous to a store placing its own generic brand next to a brand name

product on the store’s shelf. Because Axiom has not challenged the district

court’s implied findings with respect to the subsidiary factors, any such challenge

is deemed abandoned. Indeed, it is apparent that the marks are not only similar,

but identical; Axiom’s meta tags precisely mimic NAM’s “IDD Therapy” and

“Accu-Spina” trademarks. Axiom concedes that it is a direct competitor of NAM.

It is also apparent that Axiom intended to gain a competitive advantage by

associating its product with NAM’s trademark. Finally, the litigation on appeal

has proceeded on the assumption that there would be a likelihood of confusion,

unless Axiom’s arguments about the nature of meta tags and search engines (i.e.,


       8
          As noted above, we summarily reject this argument. See supra note 3. NAM’s
trademarks appeared in the Google search result as part of the description of Axiom’s website.
Because on this record the only possible cause for this is Axiom’s use of the trademarks as meta
tags, we readily conclude that the district court was not clearly erroneous in its implicit finding
that the meta tags caused the search result and thus the likelihood of confusion.

                                                 14
Axiom’s challenge to Brookfield and Promatek) prevailed.

      Therefore, we address Axiom’s challenge to Brookfield and Promatek. In

the leading case on this issue, the Ninth Circuit concluded that the Lanham Act

bars a defendant from including in its meta tags a competitor’s trademark or

confusingly similar terms. Brookfield, 174 F.3d at 1065. Accordingly, the

Brookfield court enjoined one online video store, West Coast, from using in its

meta tags the trademark (and similarly confusing terms) of a competing online

video store, Movie Buff. Id. at 1066-67. Despite its ultimate conclusion, the

Brookfield court conceded that even when a consumer who enters a company’s

trademark into a search engine sees a list displaying a competitor’s website in

addition to the trademark holder’s website, the consumer will often be able to find

the particular website he is seeking by simply scanning the list of results. Id. at

1062. The court also acknowledged that even if the web user chooses the

competitor’s website from the list, assuming the allegedly infringed trademark is

not actually displayed by the competitor, “it is difficult to say that a consumer is

likely to be confused about whose site he has reached or to think that [the plaintiff]

somehow sponsors [the competitor’s] web site.” Id. Nevertheless, the Brookfield

court concluded that the competitor’s use of the trademark “in metatags will still

result in what is known as initial interest confusion.” Id. That is, “[a]lthough

                                          15
there is no source confusion in the sense that consumers know they are patronizing

[the competitor] rather than [the plaintiff], there is nevertheless initial interest

confusion in the sense that, by using [the trademark] to divert people looking for

[the plaintiff’s] web site, [the competitor] improperly benefits from the good will

that [the plaintiff] has developed in its mark.” Id.

      In the other case relied upon by the district court, the Seventh Circuit faced

facts similar to those in Brookfield and agreed with the Brookfield court’s

analysis. Promatek, 300 F.3d at 810-13. Other courts, however, have criticized

various aspects of the Brookfield opinion. See, e.g., 1-800 Contacts, 414 F.3d at

410-11; Playboy Enters., Inc. v. Netscape Commc’ns Corp., 354 F.3d 1020, 1034-

36 (9th Cir. 2004) (Berzon, J., concurring); J.G. Wentworth, S.S.C. Ltd. P’ship v.

Settlement Funding LLC, No. 06-0597, 2007 WL 30115, at *6-*7 (E.D. Pa. Jan. 4,

2007); see also J. Thomas McCarthy, McCarthy on Trademarks and Unfair

Competition § 25:69 (4th ed. 2003) (discussing meta tags, initial interest

confusion, and criticisms of the Brookfield court’s approach).

      Like the Brookfield and Promatek courts, we ultimately conclude that a

company’s use in meta tags of its competitor’s trademarks may result in a

likelihood of confusion. However, because NAM and Adagen have demonstrated




                                           16
a likelihood of actual source confusion,9 we need not decide, as those courts did,

whether initial interest confusion alone may provide a viable method of

establishing a likelihood of confusion. Unlike those courts, we are not faced with

a situation where the trademarks are used without being displayed to consumers.

       In Brookfield and Promatek, consumers who entered the plaintiff’s

trademarks into a search engine saw a list displaying the competitor’s website in

addition to the trademark holder’s website without any other indication from the

search results that the competitor’s website is sponsored by the plaintiff or related

to the plaintiff’s trademarks. In contrast, in the instant case, when consumers

entered NAM’s trademarks into a search engine, the search results not only

displayed Axiom’s competing website, but they also included a brief description

of Axiom’s website, which description included and highlighted NAM’s

trademarked terms. That is, the evidence in the instant case specifically shows that

if consumers searched with Google for the terms “IDD Therapy” and “Accu-

Spina,” the first listed result was a legitimate website sponsored by NAM, the


       9
           “Source confusion” exists because consumers are likely to be confused as to whether
Axiom’s products have the same source or sponsor as NAM’s or whether there is some other
affiliation or relationship between the two. As has been noted by the Eighth Circuit, “[i]f the
products are closely related, and it is reasonable for consumers to believe the products come from
the same source, confusion is more likely. Davis v. Walt Disney Co., 430 F.3d 901, 904 (8th Cir.
2005).


                                               17
owner of these trademarks, and the second entry in the search results was Axiom’s

competing website. Furthermore, and in contrast to Brookfield and Promatek, as

noted above, the search results not only listed the competitor’s (i.e., Axiom’s) web

address, but they also included a brief description of the Axiom’s site, and this

description included and highlighted both of NAM’s trademarked terms, “IDD

Therapy” and “Accu-Spina,” in addition to Axiom’s competing products.

Consumers viewing these search results would be led to believe that Axiom’s

products have the same source as the products of the owner of the “IDD Therapy”

and “Accu-Spina” trademarks, or at least that Axiom distributed or sold all of the

products to which the brief description referred, or that Axiom was otherwise

related to NAM. This, of course, is misleading to the consumer because Axiom is

not related in any way to NAM, nor does Axiom distribute or sell the products of

NAM. Moreover, there was nothing in Axiom’s website itself to disabuse

consumers of the notion (suggested by the Google search) that there is some

relationship between Axiom and NAM. In other words, if consumers accessed

Axiom’s website after viewing the Google search results, they would be told all

about Axiom’s products but would be met with utter silence with respect to

NAM’s products. For example, there was no comparative advertising in Axiom’s

website which would have made clear to consumers that NAM’s and Axiom’s

                                         18
products are competing items. Thus, the factual situation in the instant case is

that Axiom’s use of the meta tags caused a likelihood of actual consumer

confusion as to source.

      The instant case is more like Playboy Enterprises, Inc. v. Netscape

Communications Corp., 354 F.3d 1020 (9th Cir. 2004), than Brookfield or

Promatek. In Playboy, the defendant, Netscape, sold advertisements to

competitors of Playboy and then caused its search engine to pop up banner ads of

its advertisers. Playboy, 354 F.3d 1023. The ads appeared when the consumer-

searcher typed in the search terms “Playboy” and/or “Playmate,” which are

trademark terms owned by Playboy. Id. The search engine operated in this

manner by using “keying” words in its software. Id. at 1022-23. A competitor’s

ad could be keyed to pop up in a banner ad along the margin of the search result

when the searcher entered “Playboy” and/or “Playmate.” Id. at 1023. Thus, the

keying words operated in hidden fashion, much like the meta tags in this case.

Because the banner ads appeared immediately after the searcher typed in the

Playboy trademarks, and invited the user to “click here,” id. at 1023, and

especially because the banner ads did not clearly identify a source (i.e., the

sponsor of the ad), id. at 1025 n.16, 1030, the user was likely to be confused

regarding the sponsorship of the unlabeled advertisements. Thus, the Playboy

                                          19
case involved some actual confusion as to source, unlike the situation in

Brookfield where there was never any confusion as to source or affiliation. The

instant case is more like Playboy than Brookfield. We note, however, that the

source confusion in the instant case is considerably more pronounced than in

Playboy. In Playboy, there was no explicit representation of a relationship

between the source of the ad and Playboy, while there is an explicit representation

in this case of some relationship between Axiom and NAM.

      Judge Berzon wrote a concurring opinion in Playboy in which he

highlighted this distinction from Brookfield. Id. at 1035-36 (Berzon, J.,

concurring). Judge Berzon criticized Brookfield, arguing that it involved merely a

distraction of a potential customer with another choice in a situation in which the

customer was never confused as to source. Id. Rather, the potential customer

merely was provided an opportunity for another choice, which clearly was not the

sponsor of the original search. Id. Such distraction, Judge Berzon pointed out,

was very much like the product placement in a department store. Id. at 1035.

When a customer walks in, asks for the Calvin Klein section, and is directed to the

second floor, no one thinks that there is a trademark infringement because the

store has placed its own (or another competitor’s) clothing line in a more

prominent place as a distraction. Id.

                                         20
       Because Axiom’s use of NAM’s trademarks as meta tags caused the Google

search to suggest that Axiom’s products and NAM’s products had the same

source, or that Axiom sold both lines, or that there was some other relationship

between Axiom and NAM, Axiom’s use of the meta tags caused a likelihood of

actual source confusion. Thus, the instant case is very different from the product

placement in a department store. This case is also very different from Brookfield

where there was never source confusion. Finally, the instant case is not subject to

the criticism leveled by Judge Berzon.

       For the foregoing reasons, and under the particular factual circumstances of

this case, we cannot conclude that the district court’s finding of a likelihood of

confusion is clearly erroneous.10 Because the district court in this case was not

clearly erroneous in finding (1) that plaintiffs possessed valid trademarks; (2) that

defendants used those marks, (3) in commerce, (4) in connection with the

       10
           We note that our holding is narrow, and emphasize what kind of case and what kind of
facts are not before us. This is not a case like Brookfield or Promatek where a defendant’s use of
the plaintiff’s trademark as a meta tag causes in the search result merely a listing of the
defendant’s website along with other legitimate websites, without any misleading descriptions.
This is also not a case where the defendant’s website includes an explicit comparative
advertisement (e.g., our product uses a technology similar to that of a trademarked product of our
competitor, accomplishes similar results, but costs approximately half as much as the
competitor’s product). Although we express no opinion thereon, such a defendant may have a
legitimate reason to use the competitor’s trademark as a meta tag and, in any event, when the
defendant’s website is actually accessed, it will be clear to the consumer that there is no
relationship between the defendant and the competitor beyond the competitive relationship.
Resolution of the foregoing, as well as other factual situations not before us, appropriately await
the day that such factual situations are presented concretely.

                                                21
advertisement of defendant’s goods; and (5) that such use caused a likelihood of

confusion to consumers, we conclude that the district court did not err in

concluding that plaintiffs demonstrated a likelihood of success with respect to the

trademark infringement claim.

      B. Likelihood of Success on the Merits of the False Advertising Claims

      The district court did not clearly err in its factual findings that Axiom’s

representations are literally false and material to consumers’ purchasing decisions,

and thus NAM and Adagen demonstrated a likelihood on success on the merits of

their false advertising claims. Regarding false advertising, section 43(a) of the

Lanham Act provides, in relevant part, as follows:

      (1) Any person who, on or in connection with any goods or services, or
      any container for goods, uses in commerce any word, term, name,
      symbol, or device, or any combination thereof, or any false designation
      of origin, false or misleading description of fact, or false or misleading
      representation of fact, which –

             (B) in commercial advertising or promotion, misrepresents the
             nature, characteristics, qualities, or geographic origin of his or her
             or another person’s goods, services, or commercial activities,

      shall be liable in a civil action by any person who believes that he or she
      is or is likely to be damaged by such act.

15 U.S.C. § 1125(a) (2006). To establish a likelihood of success on the merits of a

false advertising claim under this section, the movant must demonstrate the



                                           22
following: “(1) the ads of the opposing party were false or misleading, (2) the ads

deceived, or had the capacity to deceive, consumers, (3) the deception had a

material effect on purchasing decisions, (4) the misrepresented product or service

affects interstate commerce, and (5) the movant has been – or is likely to be –

injured as a result of the false advertising.” Johnson & Johnson, 299 F.3d at 1247.

Axiom only challenges the district court’s conclusions regarding the first and third

elements – that is, whether Axiom’s statements are literally false11 and whether the

statements have a material effect on purchasing decisions.

               1. Literal Falsity

       The district court did not clearly err when it concluded that Axiom made

literally false statements in its advertising.12 First, the district court did not clearly


       11
            In the present case, we may only sustain the preliminary injunction as it pertains to
literally false statements, as opposed to those that are merely misleading. As we have explained
before, “once a court deems an advertisement to be literally false, the movant need not present
evidence of consumer deception,” but in contrast, “[i]f the court deems an ad to be true but
misleading, the movant – even at the preliminary injunction stage – must present evidence of
deception.” Johnson & Johnson, 299 F.3d at 1247. Here, the district court ruled that NAM and
Adagen have not offered evidence of deception at this stage of the proceedings, and therefore the
district court acknowledged that it could only enjoin those advertising statements that are literally
false, not those that are merely misleading. Even if the statements are misleading (but not false),
which would satisfy the first element, the second element would remain unsatisfied at this stage,
and a preliminary injunction would be inappropriate. Accordingly, if we rule that any of
Axiom’s representations are not literally false, we would have to reverse that aspect of the
preliminary injunction.
       12
            Whether a statement is literally false is a finding of fact, which is reviewed only for
clear error. Scotts Co. v. United Indus. Corp., 315 F.3d 264, 274 (4th Cir. 2002) (noting that
literal falsity of an advertisement is a factual question subject to the clearly erroneous standard);

                                                  23
err when it ruled that Axiom’s claims about an affiliation with NASA are literally

false. Although one engineer with NASA training or experience participated in

Axiom’s development of the DRX 9000, this does not constitute a joint

collaboration between NASA and Axiom, nor does it support the claim that NASA

engineers developed the DRX 9000 or discovered part of the DRX 9000.

Similarly, although the DRX 9000 used some components that NASA also uses,

that does not mean the DRX 9000 contains or embodies NASA technology.

Perhaps these statements could properly be characterized as misleading rather than

literally false, but it is a fine line, and we will only reverse the district court if its

findings are clearly erroneous. Based on the entire evidence, we are not left with

the definite and firm conviction that the district court clearly erred.13

       Second, the district court likewise did not clearly err when it ruled that

Axiom’s claims about the DRX 9000 being FDA “approved” are literally false.

The DRX 9000 is a Class II medical device, which is only eligible for FDA

see also Time Warner Cable, Inc. v. DIRECTV, Inc., 497 F.3d 144, 158 (2d Cir. 2007); Hickson
Corp. v. N. Crossarm Co., Inc., 357 F.3d 1256, 1261 (11th Cir. 2004) (“The first element of the
Lanham Act test requires that the plaintiff show that the statements at issue were either ‘(1)
commercial claims that are literally false as a factual matter . . . .’ ” (quoting United Indus. Corp.
v. Clorox, 140 F.3d 1175, 1180 (8th Cir. 1998))).

       13
           Furthermore although Axiom objects that several of its statements regarding NASA
only appeared in a video that was never released to any potential consumers, the record contains
ample evidence of additional statements, beyond those in the video, that support the district
court’s ruling of literal falsity.

                                                  24
“clearance” rather than FDA “approval;” FDA approval is a separate process that

applies only to Class III devices.14 See 21 U.S.C. §§ 360c, 360e (2006). Compare

21 C.F.R. § 807.81(a)(1) (2006), with 21 C.F.R. § 814.1(c) (2006). As such,

Axiom’s statements that the DRX 9000 is FDA “approved” are literally false. In

fact, FDA regulations state that it “is misleading and constitutes misbranding” to

claim FDA approval when a device is merely FDA cleared. See 21 C.F.R. §

807.97 (2006). Although these regulations use the term “misleading,” they also

describe such a misrepresentation as “misbranding,” and again, it is often a matter

of degree whether a statement is literally false or merely misleading. Based on the

entire evidence, we are convinced that the district court did not clearly err in

judging Axiom’s statements literally false.15

               2. Materiality to Consumers’ Purchasing Decisions



       14
           Regulation of medical devices is governed by the Federal Food, Drug, and Cosmetic
Act, 52 Stat. 1040, as amended by the Medical Device Amendments of 1976, 90 Stat. 539, 21
U.S.C. § 301 et seq. See Buckman Co. v. Plaintiffs’ Legal Comm., 531 U.S. 341, 345, 121 S.
Ct. 1012, 1015 (2001). Under these regulations, medical devices are divided into three
categories: “Class I devices are those that present no unreasonable risk of illness or injury and
therefore require only general manufacturing controls; Class II devices are those possessing a
greater potential dangerousness and thus warranting more stringent controls; Class III devices
‘presen[t] a potential unreasonable risk of illness or injury’ and therefore incur the FDA's strictest
regulation.” Id. (quoting § 360c(a)(1)(C)(ii)(II) (1994 & Supp. V)).
       15
          Furthermore, despite Axiom’s arguments to the contrary, the district court did not step
into the FDA’s shoes when it ruled that the DRX 9000 was not approved. The district court was
not making a determination whether the device should be approved, it merely noted what the
FDA had already determined.

                                                 25
      The evidence amply supports the district court’s conclusion that Axiom’s

statements are material to consumers’ purchasing decisions. Even when a court

finds that a defendant’s ads are literally false, the plaintiff, to succeed on a claim

of false advertising, must still “establish that ‘the defendant’s deception is likely to

influence the purchasing decision.’ ” Johnson & Johnson, 299 F.3d at 1250

(quoting Cashmere & Camel Hair Mfrs. Inst. v. Saks Fifth Ave., 284 F.3d 302,

311 (1st Cir. 2002)). “The materiality requirement is based on the premise that not

all deceptions affect consumer decisions.” Id.

      The types of false claims that the district court enjoined – regarding NASA

affiliation and FDA approval – logically would influence a doctor’s decision to

purchase the DRX 9000 over a competing machine without those qualities. These

statements not only represent the quality of the device, but they provide marketing

opportunities to the purchasing doctor when he or she in turn is advertising to

prospective patients. In fact, after the onset of litigation against Axiom, several

doctors who had purchased DRX 9000s sent letters to Axiom expressing their

dissatisfaction with the possibility that they might not be able to use Axiom’s

claims, if the claims proved untrue, to attract patients. These letters provide clear

evidence that Axiom’s representations would affect doctors’ decisions whether to

purchase a DRX 9000. Based on this and all other evidence currently in the

                                           26
record, the district court did not err in its conclusion that these false statements are

material to consumers’ purchasing decisions.

      C. Presumptions of Irreparable Harm

      Even though we hold that NAM and Adagen have established a substantial

likelihood of success on the merits of their trademark infringement and false

advertising claims, we must still evaluate whether NAM and Adagen have

demonstrated, with respect to each claim, that they will suffer irreparable harm in

the absence of an injunction. In reaching its conclusion that NAM and Adagen

satisfied this element of the preliminary injunction test, the district court relied on

two presumptions, one regarding the infringement claims and one regarding the

false advertising claims. For the reasons that follow, we vacate the preliminary

injunction with respect to both the trademark claims and the false advertising

claims.

             1. Irreparable Harm in False Advertising Cases

      The district court erred when it presumed that NAM and Adagen would

suffer irreparable harm in the absence of a preliminary injunction merely because

Axiom’s advertisements are literally false. The district court cited a case out of

the Northern District of Georgia, Energy Four, Inc. v. Dornier Medical Systems,

Inc., 765 F. Supp. 724, 734 (N.D. Ga. 1991), for the following proposition: “In

                                           27
false advertising cases, ‘[p]roof of falsity is sufficient to sustain a finding of

irreparable injury for purposes of a preliminary injunction.’ ” This quote,

however, is an incomplete statement of the law. Proof of falsity is generally only

sufficient to sustain a finding of irreparable injury when the false statement is

made in the context of comparative advertising between the plaintiff’s and

defendant’s products. See McCarthy, supra, § 27:37 (“Where the challenged

advertising makes a misleading comparison to a competitor’s product, irreparable

harm is presumed. But if the false advertising is non-comparative and makes no

direct reference to a competitor’s product, irreparable harm is not presumed.”

(internal footnotes omitted)). Although some cases, such as the one cited by the

district court, employ language that may suggest a more expansive presumption,

such quotes take the original principle out of context without explanation.

       Once this presumption is properly stated, it becomes evident that NAM and

Adagen are not entitled to the presumption’s benefits because Axiom’s statements,

although false, do not mention NAM’s products by name or in any way compare

Axiom’s products with NAM’s products.16 This is not to say that NAM and

Adagen could not demonstrate, absent the presumption, that they will suffer



       16
          In reaching this conclusion, we need not address whether this conclusion is also
indicated by eBay Inc. v. MercExchange, L.L.C., 547 U.S. 388, 126 S. Ct. 1837 (2006).

                                               28
irreparable harm from Axiom’s false advertising, but the district court abused its

discretion by relying solely on the presumption to find irreparable harm.

Accordingly, we vacate the preliminary injunction to the extent it proscribes

Axiom’s false advertising, and we remand to the district court to determine

whether NAM and Adagen will suffer irreparable harm in the absence of a

preliminary injunction.

             2. Irreparable Harm in Trademark Infringement Cases

      Regardless of whether NAM deserves a presumption of irreparable harm on

its false advertising claims, our prior cases do extend a presumption of irreparable

harm once a plaintiff establishes a likelihood of success on the merits of a

trademark infringement claim. Our circuit has acknowledged as much on several

occasions. See, e.g., Tally-Ho, Inc. v. Coast Cmty. Coll. Dist., 889 F.2d 1018,

1029 (11th Cir. 1989) (“ ‘It is generally recognized in trademark infringement

cases that (1) there is not [an] adequate remedy at law to redress infringement and

(2) infringement by its nature causes irreparable harm.’ ” (quoting Processed

Plastic Co. v. Warner Commc’ns, 675 F.2d 852, 858 (7th Cir. 1982)));

McDonald’s Corp. v. Robertson, 147 F.3d 1301, 1310 (11th Cir. 1998).

      Nonetheless, although established law entitles NAM and Adagen to this

presumption in the trademark infringement context, a recent U.S. Supreme Court

                                         29
case calls into question whether courts may presume irreparable harm merely

because a plaintiff in an intellectual property case has demonstrated a likelihood of

success on the merits. See generally eBay Inc. v. MercExchange, L.L.C., 547 U.S.

388, 126 S. Ct. 1837 (2006). In eBay, after a jury had found patent infringement

by the defendant, the district court denied the plaintiff’s motion for permanent

injunctive relief. Id. at 390-91, 126 S. Ct. at 1839. In so doing, the district court

“appeared to adopt certain expansive principles suggesting that injunctive relief

could not issue in a broad swath of cases.” Id. at 393, 126 S. Ct. at 1840. On

appeal, the Federal Circuit reversed the denial of injunctive relief, articulating a

categorical rule that permanent injunctions shall issue once infringement is

established. Id. at 393-94, 126 S. Ct. at 1841. The Supreme Court reversed the

Federal Circuit and admonished both the district and appellate courts for applying

categorical rules to the grant or denial of injunctive relief. Id. at 394, 126 S. Ct. at

1841. The Court stressed that the Patent Act indicates “that injunctive relief ‘may’

issue only ‘in accordance with the principles of equity.’ ” Id. at 393, 126 S. Ct. at

1839. Because the Court concluded “that neither court below correctly applied the

traditional four-factor framework that governs the award of injunctive relief, [it]

vacated the judgment of the Court of Appeals, so that the District Court may apply

that framework in the first instance.” Id. at 394, 126 S. Ct. at 1841. The Supreme

                                           30
Court held that while “the decision whether to grant or deny injunctive relief rests

within the equitable discretion of the district courts, . . . such discretion must be

exercised consistent with traditional principles of equity, in patent disputes no less

than in other cases governed by such standards.” Id.

      Although eBay dealt with the Patent Act and with permanent injunctive

relief, a strong case can be made that eBay’s holding necessarily extends to the

grant of preliminary injunctions under the Lanham Act. Similar to the Patent Act,

the Lanham Act grants federal courts the “power to grant injunctions, according to

the principles of equity and upon such terms as the court may deem reasonable.”

15 U.S.C. § 1116(a) (2006). Furthermore, no obvious distinction exists between

permanent and preliminary injunctive relief to suggest that eBay should not apply

to the latter. Because the language of the Lanham Act – granting federal courts

the power to grant injunctions “according to the principles of equity and upon such

terms as the court may deem reasonable” – is so similar to the language of the

Patent Act, we conclude that the Supreme Court’s eBay case is applicable to the

instant case.

      However, we decline to express any further opinion with respect to the

effect of eBay on this case. For example, we decline to decide whether the district

court was correct in its holding that the nature of the trademark infringement gives

                                           31
rise to a presumption of irreparable injury. In other words, we decline to address

whether such a presumption is the equivalent of the categorical rules rejected by

the Court in eBay. We decline to address such issues for several reasons. First,

the briefing on appeal has been entirely inadequate in this regard. Second, the

district court has not addressed the effect of eBay. Finally, the district court may

well conclude on remand that it can readily reach an appropriate decision by fully

applying eBay without the benefit of a presumption of irreparable injury, or it may

well decide that the particular circumstances of the instant case bear substantial

parallels to previous cases such that a presumption of irreparable injury is an

appropriate exercise of its discretion in light of the historical traditions. See eBay,

547 U.S. at 394-97, 126 S. Ct. at 1841-43 (concurring opinions of Chief Justice

Roberts and Justice Kennedy, representing the views of seven Justices).

Accordingly, we also vacate the preliminary injunction as it applies to the

trademark infringement claim, and remand to the district court for further

proceedings not inconsistent with this opinion, and with eBay.



                                     IV. CONCLUSION17



       17
          We also reject Axiom’s argument that the district court failed to exercise its discretion
with respect to the bond issue. The district court did exercise its discretion not to require a bond.

                                                 32
      In sum, we affirm the district court’s findings with respect to the likelihood

of success on the merits of the trademark claims and the false advertising claims.

However, we vacate the preliminary injunction with respect to both, and we

remand to the district court for further proceedings not inconsistent with this

opinion.

      AFFIRMED IN PART, VACATED AND REMANDED IN PART.




                                         33