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Since the beginning of the Blog, we have shilled for only one product:  Bexis’ “Drug and Medical Device Product Liability Deskbook” (published by Law.com and updated twice annually).  While Bexis is continuing the blog in 2026 (after he turned 70), he is not continuing to update this treatise.  Frankly, it’s a lot of work, and Bexis in his dotage no longer wants to write things with footnotes.

Over the last year, Bexis has informally attempted to find a successor willing to take over and continue his treatise, but without success.  It is a lot of effort, but it has its rewards, too.  It requires creating Lexis/Westlaw searches that will produce every prescription medical product liability litigation-related decision.  Then, an author must be read, and categorize by relevant chapter(s), all of these cases.  Then, when a chapter update is written, the author must read the cases (or the relevant parts) again, and add citations to each case in the footnote(s), and sometimes text, where it belongs.  Often, entirely new paragraphs suggest themselves.  ALM’s editors then run the changes and provide proofs for final, handwritten edits.  Repeat the process twice a year for different chapters.

The rewards are:  (1) suddenly knowing more than almost all other lawyers about what’s going on in prescription medical product liability litigation, and being able to pick up patterns and predict trends; (2) instant authority, as a name author of one of ALM’s most prominent publications; (3) helping your firm save clients lots of money by having pre-done research available; and (4) research synergies leading to numerous other publication opportunities.  It’s no accident that you can find Bexis’ name all over – the Blog, amicus briefs, DRI publications, 360, FDLI, ACI, PLAC – since he doesn’t have to reinvent the research wheel every time he writes about something.  Whoever took his place would have the same built-in advantages in the thought leadership arena.

Anyone taking over the project would also have some help.  Bexis is continuing with the Blog.  So he has to continue reading the cases that his own searches turn up.  It’s no big deal for him to continue adding new cases to the “chapter update” document that he’s been using for this treatise for the past 20+ years.  Bexis will happily work with any successor author.

So here is the pitch to our readers (and their firms):  If any of you would like to take over the editorial function for the Drug and Medical Device Product Liability Deskbook, feel free to contact Bexis directly.  Don’t kid yourselves, these semiannual chapter updates (at least the way Bexis did them) each take a month to prepare – it’s hard work.  But don’t sell yourself short, either.  All that work will increase your, and your firm’s, profile in the competitive and remunerative prescription medical product liability litigation defense field.

Bexis will put you in touch with his editors at Law.com, and you can take it from there.

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This post is not from the Reed Smith or Dechert sides of the blog.

We hope we’re not the only ones distracted by the Winter Olympics. We’re breathless from Breezy Johnson taking gold in the downhill, Jordan Stoltz emerging as the U.S. speed-skating phenom, Jessie Diggins battling bruised ribs to take bronze in the 10K cross country freestyle, and Ilia Malinin throwing in a back-flip in his skating routine just for kicks—despite it not earning him any points. Not to mention short-track skating, biathlon, luge, moguls, snowboard-cross, bobsledding, the Olympic debut of ski mountaineering, and all kinds of other ski and snowboarding events where the contestants either fly down mountains at cataclysm-embracing speeds or hurl themselves into the stratosphere while contorting themselves in twists and turns that make us dizzy. Combine that competition and athleticism with the Olympic themes of unity and sportsmanship, and you can see why we’ve got Olympic fever.

We were particularly enthralled with the U.S. mixed-double’s curling team. This is from humble bloggers who, other than every four years, have no idea what curling is. But when the Winter Olympics roll around, we’re watching to see who’s dominating the house and who has the hammer. The U.S. mixed doubles team had never taken home a curling medal. This year’s team, Cory Thiesse and Korey Dropkin, absolutely dominated the round robin and earned a spot in the medal round. After a magnificent shot in the last end (like a game winning home run in the bottom of the ninth), the U.S. defeated defending gold-medalist Italy for a chance to play for the gold medal. While “Corey and Korey” ending up taking home silver, it was the first ever medal for the U.S. in mixed curling and the first ever Olympic medal in curling for an American woman. What a run.    

One of the curling commentators noted that Korey Dropkin was one of the best sweepers in the game. While it may be a stretch to connect curling to the legal side of these posts, we think it is fair to note that mass torts defendants often engage in years of clean up after securing victories in mass torts. Call it sweeping the house if you will. Case in point is the Zantac litigation. The defendants secured litigation-ending rulings excluding plaintiffs’ general causation experts in the federal MDL (which we posted about here and here).  Plaintiffs then fled to Delaware (of all places to see mass torts plaintiffs flocking, we continue to be surprised and disappointed at this trend).  The Delaware trial court refused to follow the well-reasoned decisions from the MDL and appeared to give new life to the Zantac litigation (see this post), but the Delaware Supreme Court reversed and remanded with instructions for the trial court to apply Delaware’s Rule 702 consistently with the federal rule (see here).  

Continue Reading The Zantac Defense Has the Hammer in Delaware
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Here in the United States, Lawyers for Civil Justice (LCJ) encourages lawyers to Ask About TPLF, also known as third party litigation funding.   

LCJ and others are advocating for an addition to the Federal Rules of Civil Procedure that would require litigants to disclose the involvement of litigation funders in cases, just like the Rule 26(a)(1)(A)(iv) currently requires defendants to disclose insurance coverage.

The rationale for litigation funding disclosures and insurance coverage disclosures are the same:  Unless these non-parties and their otherwise hidden vested financial interests are disclosed, courts and other litigants are blind to who is controlling litigation decisions, whether there are lurking conflicts of interest, and whether non-litigation interests (the demands of the funder or the terms of the funding agreement) are driving litigation and settlement strategies. 

Another concern:  Without disclosure, do those undisclosed entities have access to your confidential discovery information in violation of court protective orders?

The impending implementation of the European Union’s Product Liability Directive (PLD) had us wondering about the state of TPLF in Europe.  If torts in Europe are going to turn mass, litigation funders will not be far behind. 

In fact, they already are there.  Some U.S.-based litigation funders expanded operations into Europe in recent years, in recognition that the Representative Actions Directive (RAD), with a June 25, 2023 implementation deadline, already was making the continent a more litigation-rich target.  (The RAD also has a feature that we don’t have here in the U.S.: “Qualified Entities” instead of class representatives.  But that is for another post.)

Fortunately, it seems Europe loves a good report, and the European Commission published one last year:  Mapping Third Party Litigation Funding in the European Union, which we will call the “EU TPLF Report” to get in our minimum daily allowance of acronyms. 

The report maps TPLF-related legal frameworks across all 27 EU Member States and certain non‑EU jurisdictions (Canada, Switzerland, the United Kingdom, the United States) in response to the European Parliament’s Resolution of September 13, 2022, Responsible Private Funding of Litigation. 

The ultimate goal was to help the European Union decide if TPLF regulation is needed EU-wide, and on a consistent basis, beyond Article 10 of the EU RAD.  That part of the RAD provides only vague guidance and no hard rules: (“Member States shall ensure that” in representative actions funded by TPLF, “conflicts are prevented” and the litigation funder’s economic interest “does not divert the representative action away from the protection of the collective interests of consumers.”). 

Not surprisingly, the EU TPLF Report found that few EU countries have specific TPLF laws beyond those tied to the gentle suggestions of Article 10 of the RAD, and what limits do exist come from more general contract law, civil procedure, consumer protection rules, and legal ethics, with a smattering of banking and financial regulation thrown in.

Claimants generally can assign their litigation interests, and freedom to contract generally reigns.  Sometimes, in representative actions, disclosure to the court is required, but outside that context disclosure hardly ever is required.   

In loser-pays jurisdictions, litigation funders usually are not automatically or directly liable to the successful defendant who wins an adverse cost award when the funded case fails.   The losing party (the funded claimant) still remains primarily responsible for paying the successful defendant’s costs, although the funding agreement often will require the funder to pay or reimburse those costs, but often only up to a specified maximum. 

The report also concludes that TPLF is widely in use across the EU, including in consumer protection actions.  In terms of the terms:

  • Common structures provide the funder with a percentage of recovery (often in the 20-30% range) and/or multiples of committed costs;
  • “Waterfall” provisions require return of the funder’s investment before remaining proceeds are distributed; and
  • Funders usually control the choice of lawyer and whether settlement occurs, and have a say on strategy.  Sometimes, the funder can terminate the funding agreement mid‑litigation.

As in the U.S., there are TPLF advocates and detractors.  The EU TPLF Report states that proponents perceive TPLF as providing better access to the courts, a higher level of advocacy in complex matters, and a filtering-out effect where weaker claims go unfunded and thus unfiled.   

The perceived problems will sound familiar:  Hidden conflicts of interest, undue funder influence on the course of litigation and settlement, and the promotion of less-worthy litigation aimed at extracting settlements.  One fear: Litigation funders could use a shotgun approach to fund duplicative litigation across jurisdictions against the same defendant, leveraging more claimant-friendly countries and volume pressure to extract settlements.  These concerns were particularly noted (no surprise) for product liability lawsuits, as well as patent litigation. 

Will this result in new TPLF regulation in the EU?  Maybe, we will see.  The Commission will use the study to support policy development in response to the European Parliament’s Resolution.

The EU TPLF Report did conclude that rules requiring disclosure would be the most effective type of regulation.  Just like the proposed Federal Rule of Civil Procedure.   

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Our law school days were long ago.  Reagan was the president. Footloose and Beverly Hills Cop topped the movie box office. Prince made great music, Lionel Ritchie made good music, and Macca and Jacko teamed up to make awful music.  The Soviet Union boycotted the 1984 Olympics, which made the games … really excellent.  

Even way back then, it seemed that asbestos litigation was on its last legs.  The main asbestos manufacturer had plunged into bankruptcy.  When we graduated, we had no expectation or ambition that one day we would work on asbestos cases. It was hamburger law, a machine to grind up defendants and extrude settlements.  There seemed to be an entirely different rule book for asbestos law.  Many courts wouldn’t entertain dispositive motions until the week before trial.  Everything seemed design to churn out a “resolution.”  Most top AmLaw firms looked down on asbestos law, and so did we. 

Cue the flipping calendar pages.  Inventive (euphemism alert) plaintiff lawyers were not quite ready to get off the asbestos gravy train. They found wave upon wave of other defendants. It is as if Nietzsche’s eternal recurrence thought experiment foresaw asbestos law:  “This life as you now live it you will have to live once again and innumerable times again; and there will be nothing new in it, but every pain and every joy and every thought and sigh must return to you, all in the same succession and sequence.”

Good old Nietzsche got asbestos litigation right, except for the “joy” part. Decades later, against all expectation, we found ourselves representing a brake manufacturer in asbestos lawsuits. We huddled in crowded deposition conference rooms, waiting to hear how many of the 80+ defendants named in the complaint would actually be mentioned by the plaintiff. Usually, fewer than a third of the named defendants had anything to do with the plaintiff.  Did the courts care that the complaints were drafted with no concern for reality?  Nope. Just keep the machine humming. The overbroad complaints were the work of slobs – slobs with Porsches and private jets. It was a dispiriting practice. And it appears to be never-ending.  

The asbestos litigation du jour involves talcum powder. We’re talking about cosmetic talc. There isn’t a decent speck of epidemiological evidence showing that cosmetic talc causes any disease whatsoever.  Nevertheless, plaintiff attorney persistence, junk science, and judicial torpor have added up to several eye-watering verdicts.  (Judicial torpor is about as good as it gets when it comes to asbestos litigation.  There are some courts that actively favor the asbestos plaintiff bar. Read the latest ATRA list for horror stories.) 

Cosmetic talc litigation is hardly the crowning glory of the American judicial system.  Rules and science are banished from the courtrooms. It is an uphill run for any defendant.  But we will charge up that hill for our clients, trying to extract at least an ounce of justice and fairness from a flawed system. Again, one thinks of Nietzsche, or maybe the Camus retelling of the myth of Sisyphus. We’ll keep trudging uphill, sweating under the vast indifference of the skies and rank hostility of pro-plaintiff judges. 

We had no involvement in today’s case, In re Talc Based Powder Products Litigation, 2026 WL 318130 (N.J. App. Feb. 6, 2026), and we have not represented its defendant in any talc case. We read the case with interest because it confirms our suspicion that more than a few of the plaintiff asbestos firms take their, ahem, inventiveness to the point where ethical lines get blurred, smudged, or flat-out erased.  We have grown used to plaintiff talc experts who would find asbestos in panda tears.  Sometimes those experts even say that asbestos does not matter at all – that talc qua talc is the villain. Those experts  will also always always always find enough exposure to increase the risk of whatever injury is alleged.  Further, thanks to a recent RICO case filed against a plaintiff asbestos law firm in Illinois, we find our cynicism confirmed when it comes to plaintiffs whose deposition testimony is perfectly scripted to steer between implicating defendants and preserving later claims against various asbestos trusts. Those plaintiffs weave tales of dwelling in clouds of talc, applying talc after each one of their three showers per day.  

But we had never dreamt that plaintiff law firms would hire lawyers who had worked for talc companies as a way to gain advantages in settlement negotiations.  Well, whether we dreamt it or not, today’s case rouses us from our slumber. 

A major plaintiffs’ firm hired a lawyer who had worked for the talc defendant to do the same kind of work (claim evaluation) for it.  That lawyer had “participated for nearly two years in confidential strategy and settlement analysis of the talc litigation.”  He was one of the lawyers who had “led the overall strategy to secure a global resolution of the talc cases.”  Good grief. 

A sentient being might conclude that hiring away the other side’s lawyer would likely run afoul of a raft of ethical rules.  Shouldn’t the plaintiff firm be disqualified after getting access to an opponent’s most sensitive litigation information? What is more sensitive than settlement strategy? But the plaintiff counsel claimed that, because the turncoat was hired in a “non-legal” capacity, none of those ethical rules applied.  The plaintiff counsel also argued that the talc company had not proved that the turncoat lawyer had actually disclosed any client confidences.  Those excuses had been enough for the trial judge, but the New Jersey appellate division unanimously reversed and ordered disqualification.   

Rule of Professional Conduct (RPC) 5.3 lays out the circumstances in which a lawyer is responsible for the conduct of nonlawyers within or outside the firm that would be a violation of the RPC if engaged in by the lawyer.  It did not matter if the turncoat lawyer was technically acting as a restructuring consultant rather than a lawyer.  It does not matter if the turncoat lawyer was technically not employed by the plaintiff firm.  He was clearly “associated” with the plaintiff firm. 

Once RPC 5.3 was triggered, as it was here, the issue is the applicability of RPC 1.9, which provides that “a lawyer who has represented a client in a matter shall not thereafter represent another client in the same or a substantially related matter in which that client’s interests are materially adverse to the interests of the former client unless the former client gives informed consent confirmed in writing.”  

The plaintiffs’ firm “knowingly collaborated” with the turncoat lawyer on the same issue and in the same litigation on which the turncoat had formerly been on the other side.  The plaintiff firm admitted that it could not have employed the turncoat lawyer as a lawyer without offending RPC 1.9. But whether or not you call what the turncoat did legal work, it involved strategy for settling litigation.  

And now we get to high (or low) comedy.  The turncoat argued that his work on behalf of the plaintiff firm was aligned with the interests of his former client, because both the former client and the plaintiff firm wanted resolution of the talc claims.  We have said before that the word “disingenuous” is overused in our business, but the appellate court rightly used that word here. Indeed, “chutzpah” would also have worked.  Sure, both the plaintiff firm and talc company were looking to settle the litigation, but does anyone doubt that the plaintiff firm wants to receive as much money as possible, and the defendant would prefer to pay as little as possible? The turncoat lawyer had played an important role for the talc company in devising its settlement strategy.  How could the plaintiff firm’s access to such settlement strategy not adversely affect the talc company’s interest? The plaintiff firm and the turncoat admittedly “collaborated” on a settlement proposal to the talc company. That collaboration occurred with the plaintiff firm’s knowledge that the turncoat had “previously negotiated on a settlement of these same talc claims.”  The appellate court concluded that disqualification of the plaintiff firm was necessary: “The rules of professional behavior are not branches which bend and sway in the winds of the job market but are instead the bedrock of professional conduct.” 

The plaintiff firm says it will appeal this disqualification.  It is a big deal.  Of course, having been around the block a few times with asbestos litigation, we suspect that this sort of ethical line-stepping is merely the tip of a very rotten iceberg. 

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As our slew of recent posts on standing demonstrate, plaintiffs’ lawyers continue their search for a version of federal jurisdiction that does not require anyone to have been hurt. This time, the vehicle was a box of band-aids—and the court declined to take the ride, dismissing the case in its entirety.

In Aronstein v. Kenvue, Inc., 2026 WL 266713 (D.N.J. Feb. 2, 2026), plaintiffs brought a putative class action alleging that certain adhesive bandages contained PFAS at “harmful” levels. What they did not allege is that anyone was actually harmed. No rashes. No illness. No adverse health effects. No malfunction. Just the existential disappointment of learning—after the fact—that the band-aids they purchased allegedly contained something plaintiffs would have preferred they did not.

The court’s standing analysis was straightforward. Article III requires an injury in fact, and plaintiffs failed to allege one. Undeterred by the lack of actual injury, plaintiffs relied on a “benefit of the bargain” theory. According to the complaint, plaintiffs claimed that because the bandages contained PFAS they were worth less than what plaintiffs paid for them.  The complaint never claimed that plaintiffs suffered any adverse health consequences from using the bandages. Nor did it allege that the bandages failed to work as intended. To the contrary, plaintiffs got exactly what they paid for—a bandage that stuck. It covered their scrapes, cuts, and wounds. Id. at *5. That, it turns out, still counts as performance.

Plaintiffs also alleged they were misled by statements such as “we use better ingredients” and “safety is our top concern.” The court rejected that argument as well, holding that these generalized marketing statements are classic product puffery. Crucially, none of the statements referenced PFAS or made specific representations about chemical composition. Id. at *5-6. Aspirational claims about quality and safety do not become actionable simply because plaintiffs wish they meant something more precise. And the statements could all be true even if PFAS were present. Beyond alleging that testing detected some PFAS, plaintiffs cited no studies showing that the presence of PFAS in adhesive bandages causes harm or adverse health consequences to users. Id. at *6 & n.8. There were no allegations regarding dose, exposure, or any plausible mechanism of injury. Temporary contact with a bandage on intact skin, standing alone, was not enough.

Nor did Plaintiffs allege any facts to support a price premium theory. They did not allege what they paid, what they should have paid, or what other presumably PFAS-free products cost. While the complaint contained “passing reference” to two other brands, plaintiffs did not allege they would have purchased those brands or what those brands cost.  Id. at *7. Instead, the complaint relied on the now-familiar formulaic assertion that plaintiffs paid more than they otherwise would have, untethered to any factual support. The court had little trouble concluding that this was insufficient.

Plaintiffs’ request for injunctive relief fared no better. Injunctive relief is about the possibility of future harm. But speculative risk, without facts making it plausible, does not satisfy Article III. “[T]o pursue injunctive relief, the risk of harm must be sufficiently imminent and substantial such that exposure to the risk of harm itself generates an independent injury.” Id.

First, plaintiffs alleged that they had stopped using the bandages altogether. The court noted that once a consumer claims to know about a potential health risk, the law assumes they act rationally—by discontinuing use. Having made that allegation, plaintiffs effectively pled themselves out of any plausible risk of future economic injury. An injunction, after all, cannot protect someone from a product they already say they will not buy or use again.

Second, and more fundamentally, because plaintiffs failed to allege any actual harm that would be caused from using the bandages in the first place, they necessarily failed to allege any credible risk of future harm. Speculation about what might happen someday is not enough to establish standing for injunctive relief—especially where the complaint offers no facts suggesting the product ever posed a real risk to begin with. An injunction is not a fallback remedy when standing is missing.

This case is a clean reaffirmation of several principles that continue to matter, even in creative consumer class actions. Standing requires an injury in fact. Benefit-of-the-bargain theories require facts, not labels. Puffery remains non-actionable. And alleged future harm must be plausible, not hypothetical.

Strip away everything else and this case is simple. Plaintiffs bought band-aids. They were supposed to stick. They did stuck. That’s not a legal injury. It is product performance.

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Not too long ago one of our bloggers (McConnell) critiqued a p-side law review article he had received from a lawyer on the other side with whom he was friendly.  Bexis isn’t as friendly with opposing counsel – Paul Rheingold being a rare exception.  But probably due to his activity in the American Law Institute, law professors on occasion have asked Bexis to review a law review article or two.  The articles are usually pro-plaintiff, as are most law professors.

Bexis can be a glutton for punishment – but knowing and being prepared to respond to what the other side might throw at us has some value.

Anyway, the article is by Luke Meier, a professor at Baylor Law School, who admittedly is at the plaintiffs’ end of the legal spectrum when it comes to prescription medical product liability litigation:

On one end of the spectrum is the notion that pharmaceutical defendants should be strictly liable (that is, liable even though the product was not defective) for injuries caused by their products.  I happen to fall into this camp. . . .

L. Meier, “Failure-to-Warn Suits Against Pharmaceutical Companies:  Physician Testimony, Causation, & Summary Judgment,” at p.46 (emphasis added).  It’s available here, although we caution that it doesn’t at all look like a finished product.  There are loads of citation-related typos and inconsistencies, a totally unattributed block quote (p.37), and a humorous “disinterred witness” typo that just happens to be in a hypothetical about shoveling (p. 42).  The article’s treatment of the law, however, is in no sense humorous.

Before it gets to its main thesis, however, the article makes some “background” points we can agree with.  Concerning manufacturing defects, “it is extremely rare for a pharmaceutical company to allow a product that has not been manufactured correctly to enter the market” (p.6 (footnote omitted)).  Concerning design defect claims, the article recognizes that “[p]ractically speaking, a plaintiff has very little chance of winning a design defect suit against a pharmaceutical manufacturer” (p.10 (footnote omitted)).  We agree, although with respect to design defect claims, our primary reason is not the common-law quirks that the article addresses, but rather preemption.  As the Supreme Court has recognized, “[o]nce a drug − whether generic or brand-name − is approved, the manufacturer is prohibited from making any major changes to the ‘qualitative or quantitative formulation of the drug product, including active ingredients, or in the specifications provided in the approved application.’” Mutual Pharmaceutical Co. v. Bartlett, 570 U.S. 472 (2013) (citation omitted).  The FDCA’s “major change” category extends to anything that could cause the type of injuries involved in product liability litigation – as we’ve discussed many times, such as here.

Thus the article pushes informationally based “warning” liability as a plaintiff’s last, best hope.  The learned intermediary rule (in addition to preemption in many cases) stands in the way of the author’s pro-liability point of view, so it must somehow be neutered.  How does the article propose to do that?  By ignoring the time-honored requirement that a tort plaintiff has the burden of proving causation, to start.  “Burden of proof” appears exactly once in this 47-page article, in a footnote quotation from one of Bexis’ favorite cases.  Meier Article p. 20 n.147.

The traditional tort burden of proof in a warning case requires the plaintiff to establish, with affirmative facts, that a different warning would have prevented his or her claimed injury.  In non-learned-intermediary situations, the person being warned is the plaintiff, so the plaintiff is his or her own primary witness to establish what we call “warning causation.”  Thus, extremely self-interested plaintiffs can be expected to testify to whatever is necessary to establish a prima facie warning causation case.  The article acknowledges that, in some jurisdictions, plaintiffs receive the benefit of a “heeding presumption” (something we have long detested) in warning cases, but dismisses the presumption as “weak” in learned intermediary rule cases because the same affirmative evidence that defeats causation under the learned intermediary rule also rebuts this presumption (p. 8).  See also Beck & Vale, Drug & Medical Liability Deskbook §2.05[4], at 2.05-92-97 (updated 2024) (discussing ways to rebut a heeding presumption).  That is also true.

What’s critically different in a learned intermediary situation is essentially the reason for this article.  Causation testimony does not come from an interested plaintiff. Ironically, the article spends significant ink attacking the “credibility” of medical professionals, Meier Article pp. 3-4, 38-39, whereas the plaintiffs themselves – who would have to testify to causation if the learned intermediary rule were somehow disabled – get a free pass despite their far worse credibility problems.

Under the learned intermediary rule, to prove causation, evidence must exist that, if believed by the finder of fact, an additional warning would have made some change (often defined as not prescribing the product) in the prescribing physician’s treatment of the patient that would have prevented the injury.  The plaintiff bears the burden of coming forward with such evidence.  But the physician is ordinarily independent and thus not beholden to the plaintiff.  So the plaintiff must obtain warning causation evidence to meet the burden of proof from a witness whose testimony may well be adverse.  If the plaintiff does not, then s/he fails to meet the applicable burden of proof.  If the plaintiff does, then usually disputed issues of fact exist, and the case goes to trial.  The article criticizes that as “asymmetrical risk” (pp.26-27) and “presum[ing] causation is lacking” (p. 30), but that is simply how summary judgment works in the adversary system – requiring the party bearing the burden of proof to meet that burden before a trial is warranted.  The party with the burden of proof must come forward with evidence, not allegations and not speculation.  It’s that simple.

Several types of physician testimony will leave the plaintiff without facts sufficient to meet the usual burden of establishing the possibility of materially different treatment, thus entitling the defendant to summary judgment.  These are compiled in Bexis’ book (and often on the blog as well).  Here are the most common warning causation roadblocks in learned intermediary rule causation cases:

  • The prescribing physician never read the allegedly inadequate warning.  Bexis’ book §2.05[2], at pp. 2.05-35 to -40; blogpost.
  • The prescribing physician testified that s/he already knew the information omitted from the allegedly inadequate warning.  Id. §2.05[2], at pp. 2.05-18 to -29; blogpost.
  • The prescribing physician testified that, even had s/he received the warning the plaintiff demands, s/he would have done nothing differently.  Id. §2.05[2], at pp. 2.05-43 to -48; blogpost.
  • The prescribing physician did not consider the risk severe enough to affect the prescription decision.  Id. §2.05[2], at pp. 2.05-41 to -42; blogpost.
  • The prescribing physician testified that, after the plaintiff was injured s/he did not change any relevant treatment protocols.  Id. §2.05[2], at pp. 2.05-1 to -3.
  • There is no evidence at all concerning the prescriber, either because s/he was never deposed or s/he had died, and there is no heeding presumption to flip the burden of proof.  Id. §2.05[2], at pp. 2.05-53 to -57; blogpost.
  • Further, it is hardly impossible for plaintiffs to establish warning causation under the learned intermediary rule, as the numerous citations to summary judgment denials in Bexis’ book demonstrate.  Id. §2.05[3], at pp. 2.05-69 to -78.

Thus, the law on learned intermediary causation is exactly as stated in Bexis’ book:

In a learned intermediary case, it is “well settled” that a manufacturer’s inadequate warning is causal only if a different warning would have changed the physician’s (or use) decision, or would have altered the physician’s conduct in some other that would have prevented the plaintiff’s injury.

Id. at 2.05-6.  The accompanying footnote extends for nearly six pages of small (10 point) type and cites literally scores of cases.  That is the magnitude of what the Meier article proposes to do away with.

To replace all this law – hundreds, if not thousands, of decisions throughout the country – the Meier article offers the concept of “counterfacts” (pp. 41-45).  We’d never heard of that before, and this section of the article is notably lacking in supporting precedent, so we did what we usually do.  We researched it.  On Westlaw, allcases, the term appears exactly eleven times, and none of those cases use it the way the Meier article does, which is:

For purposes of failure-to-warn claims against pharmaceutical defendants, the “material” inquiry is whether the plaintiff would have avoided injury if the defendant had given the warning proposed by the plaintiff.  But this “material” point is not a “fact” − it is a “counterfact.”  As discussed above, the causation inquiry necessarily requires speculation about a world that never existed:  “Hypothesis and speculation are essential for determining causal connection, since every statement of causal connection asserts what would have happened if the facts had been different.

*          *          *          *

The pertinent question . . . is whether this testimony justifies summary judgment for the defendant.  On this point, the difference between “facts” and “counterfacts” matters. The complicated body of law regarding when the evidentiary record justifies summary judgment on a material fact simply cannot be applied the same with regard to counterfacts.  It is one thing to require a certain amount of evidence regarding a disputed event that actually happened, but it is nonsensical to apply this same standard to a hypothetical event that must be imagined.

Id. at 43-44 (footnote omitted).  For these propositions – including calling the opposite proposition “nonsense” – the Meier article cites no precedent and only the most general sort of tort treatises.

Thus, the Meier article would replace the plaintiff’s burden of proof with respect to “counterfacts” – defined as facts bearing on the likelihood of a possible alternative result – with nothing, that is to say “hypothesis and speculation.”  It proposes to overturn precedent nationwide (see Bexis’ book if you doubt us), and not just decisions having to do with the learned intermediary rule.  Most tort cases involve proof of what would qualify as “counterfacts” as the Meier article defines them.  All warning cases involve “what if” questions predicated on different warnings; only the recipients differ.  Crashworthiness, for another example, involves determining what a plaintiff’s injuries in a vehicular accident would have been with a differently designed vehicle.  Plaintiffs in other product liability litigation often claim that, had an additional safety feature been available, they would have used it.  Damages, particularly in commercial torts, are generally intended to place the plaintiff in the position s/he would have been in had the tortious conduct not occurred.

The article’s “counterfact” concept, in short, is not only unprecedented, but proves far too much.  That rationale – allowing “hypothesis and speculation” to substitute for facts in any case where an element of a claim involves an alternative set of facts – would push the law firmly towards the sort of absolute liability regime that Prof. Meier states that he favors.  Needless to say, we do not agree.

The article also advocates (pp. 32-33) relaxing the causation burden by inserting the plaintiff into the causation matrix with allegations that, while the recommended treatment might stay the same, the accompanying informed consent discussion might have mentioned the alleged risk.  We’ve addressed both of the two cases the article cites (as does Bexis’ book (pp 2.05-14 to -15).  We continue to think that they are directly contrary to one of the primary policy bases for the learned intermediary rule:  to prevent the law from interfering with or disrupting existing physician-patient relationships (Bexis’ book pp 2.03-6 to -9).  The only way that a plaintiff establishes causation in this informed consent variant is to claim that, had s/he received the additional informed consent information, s/he would have disregarded the prescriber’s medical advice and refused the recommended drug.  The article does not even address that inherent feature of letting plaintiffs testify (as they invariably will) that they would have rejected the medical treatment that their prescribers recommended.

Finally, we feel obliged to point out another way in which the Meier article diverges from the great weight of precedent, without acknowledging that it does so.  On several occasions, it suggests that FDA-approved drug warnings are somehow superior to, or more impactful than, other sources of medical information that doctors and other health professionals rely on.  Meier article at 3 (“a physician who is aware of academic literature discussing a particular risk might view that risk differently − and act differently − if a manufacturer deems the risk important enough to provide a warning”); 34 (“It is one thing for a doctor to be aware of information or risks because of the doctor’s own professional reading or conversations.  It is quite another thing, however, for a doctor to receive an explicit warning accompanying the drug”); p. 35 (“a doctor who was already aware of the risk might nevertheless refrain from prescribing the drug if explicit warnings are given by the manufacturer”); p. 35 n.2 (“manufacturer warnings . . . facilitate a potential medical malpractice claim”).  None of these statements is supported by any authority at all.

In this aspect, as well, the article (perhaps unintentionally) is contrary to established law.  Most medical malpractice cases hold that manufacturer warnings do not establish the medical standard of care, and in many jurisdictions FDA-approved drug warnings are not even admissible.

[D]rug manufacturers do not design package inserts and PDR entries to establish a standard of medical care.  Manufacturers write drug package inserts and PDR warnings for many reasons including compliance with FDA requirements, advertisement, the provision of useful information to physicians, and an attempt to limit the manufacturer’s liability. . . . Those considerations highlight the reasons expert testimony must accompany the introduction of PDR warnings to establish the applicable standard of care in prescribing a drug.

Morlino v. Medical Center, 706 A.2d 721, 729 (N.J. 1998).  For a complete discussion of the law on this subject, see our post here.  Far from being somehow superior to other sources of medical knowledge, a prescription medical product’s FDA-approved warnings are at best only a piece of the informational mix in medical malpractice/informed consent litigation, and they are in no way controlling or entitled to greater weight as the Meier article seems to suggest.

The author sought our views on his proposal.  You asked for it; you got it.

Photo of Steven Boranian

Sometimes we feel as though we have gone back in time.  The Super Bowl is in San Francisco this week, as it was 10 years ago, although this time around, the atrium lobby of our building has been converted into an ESPN studio.  We are the temporary home of the Rich Eisen Show, with the likes of Hall of Famer Kurt Warner and performer O’Shea Jackson, Jr. gracing our presence.  It is quite the spectacle.  A Tech Boom accelerated about 10 years ago in San Francisco with companies like Salesforce and Twitter rapidly expanding, and now it’s happening again with AI and self-driving cars.  Justin Bieber was at his peak 10 years ago, and we are told that he totally nailed it just last week with a killer performance at the Grammys.  Good times.

The catalyst for this nostalgic romp is the district court’s order in Bynum v. Red River Talc, LLC, No. 24-7065, 2026 WL 242063 (D.N.J. Jan. 29, 2026), where a New Jersey federal judge put the kibosh on a medical monitoring class action.  Some of our earliest work in the product liability space was pushing back on class actions seeking future medical surveillance for individuals who have suffered no alleged injury.  Way back in 2006, we wrote an article for the Washington Legal Foundation (with our colleague and frequent guest blogger Kevin Hara) entitled Medical Monitoring: Innovative New Remedy or Money for Nothing?  You can guess which side of the debate we came out on. 

We like the order in Bynum, which strikes the plaintiffs’ class allegations and dismisses medical monitoring claims under New Jersey and Washington law.  The plaintiffs in Bynum allegedly used talcum powder and are part of the long-running In re J&J Talcum Powder MDL.  Of the five named plaintiffs on the class action complaint, some alleged illness caused by the products, and others alleged no injury at all. 

That difference was the downfall of their putative class action.  As a group, the plaintiffs sought certification of five classes: Three classes seeking medical monitoring on behalf of exposure-only consumers who experienced no injury, and two classes seeking compensatory and punitive damages on behalf of both injured and uninjured individuals.

We have known since the Supreme Court’s opinions in Amchem Products, Inc. v. Windsor and Ortiz v. Fibreboard that putative class actions on behalf of both injured and uninjured individuals present intractable conflicts of interest.  That is because injured claimants want to maximize their recovery and do so as soon as possible, while uninjured claimants favor preservation of resources to pay their claims later or over time. 

That conflict alone led the district court in Bynum to rule that the class representatives were not adequate, which doomed all the class allegations.  The court explained it this way:

Plaintiffs seek to litigate a class action on behalf of individuals who allege a present cancer diagnosis, as well as individuals who allege no present injury at all. As the Supreme Court recognized in Amchem and Ortiz, these groups have materially divergent interests.  Those already diagnosed with cancer may reasonably prioritize immediate compensatory and punitive damages, while those without a cancer diagnosis may reasonably prioritize a fund for medical monitoring, long-term preservation of resources, and protections against premature valuation of their claims.

Bynum, at *5 (citations omitted).  The plaintiffs could not overcome these conflicts.  They did not identify separate counsel for the different classes, nor any other safeguard to protect one class against another.  And, their principal authority in support was the train wreck class certification order from the Valsartan MDL, which was our number one worst case of 2023 and which the district judge here wisely distinguished.  In the end, “the proposed class suffers from a fundamental adequacy defect that cannot be cured through discovery . . . and Plaintiffs’ class allegations will be stricken from the Amended Complaint.”  Id. at *6. 

There is more.  After striking the class allegations, the court still had plaintiffs from New Jersey and Washington pressing individual claims for medical monitoring.  Those claims went nowhere either because neither plaintiff alleged a present, existing injury, which both New Jersey and Washington require for a medical monitoring claim.  The plaintiffs pivoted to assert that monitoring costs constitute a present economic injury, but the court found the 189-page amended complaint lacked nonconclusory factual allegations establishing any economic loss.  More fundamentally, even if the plaintiffs had plausibly pled an economic loss, the court held that economic harm alone cannot sustain a medical monitoring claim in either jurisdiction.  The court dismissed the medical monitoring claims without prejudice.

We have a few closing observations about this order.  First, nothing has changed since Amchem and Ortiz.  Mixing present-injury and exposure-only claimants is inherently fraught with conflicts, rendering class representatives inadequate under Rule 23(a)(4).  Second, courts remain willing to strike class allegations pre-discovery where the complaint discloses legal barriers.  A motion to strike was once considered innovative, but not anymore.  A motion to strike can be productive, especially in mass tort contexts with entrenched conflicts and anticipated predominance/superiority issues. 

Third, medical monitoring remains jurisdictionally constrained.  The requirement of a present, physical injury under New Jersey and Washington law was dispositive here, and other states’ laws would have predicted that same result.  Many states, however, still have not clearly addressed medical monitoring, making outcomes under some states’ laws uncertain. (See our 50-state survey on medical monitoring here.)  Fourth, this court did not reach predominance and superiority to reject this putative class action, but it could have.  This class action presented all the usual minefields for medical monitoring classes—individualized medical histories, individual issues on causation, state-law variability, etc.  All these factors weigh against class certification, and correctly. 

Photo of Eric Alexander

We are writing about another tenofovir case.  But this is not a product liability case or a foray into how far California law can be expanded to discourage innovation.  See here, here, and here for some of the bad ones.  Instead, this is a class certification ruling on a proposed class of purchaser suing for alleged violations of the Missouri Merchandising Practices Act and common law unjust enrichment.

Two things we have pointed out that seem to recur in decisions where courts favor drug and device plaintiffs are that they omit meaningful discussion of the benefit of product and/or the burdens on the plaintiffs.  The decision in Searcy v. Gilead Sciences, Inc., No. 4:20-cv-1523-MTS, 2026 U.S. Dist. LEXIS 11787 (E.D. Mo. Jan. 22, 2026), does not have these failings.  It starts with an affirmative statement of the important role that tenofovir has played in reducing the mortality of HIV in general and in treating the purported class representatives in particular.  It also makes clear that plaintiffs bore the burden to establish every requirement of Fed. R. Civ. P. 23.  It also displays the sort of common sense we sometimes find missing in decisions where complicated cognitive contortions are necessary to reach a pro-plaintiff result in a bogus case.  Plaintiffs’ basic contention was that each purchase of prescription drugs containing tenofovir disoproxil fumarate for twelve years before tenofovir alafenamide came to market was automatically an overpayment because an alternative world allegedly existed where drugs containing the later version of tenofovir were approved and came to market much sooner.  This being a proposed class, the plaintiffs defined the class to exclude anyone who claimed to have suffered a personal injury of any sort.  Instead, purchasing any of the tenofovir-containing drugs for any price during the twelve years was supposedly an economic injury for each class member.

Even before getting to the requirements of Rule 23, the Searcy court was wise to look at standing.  Perhaps because cases involving medical products are getting more tenuous, it seems that we have been seeing quite a few over the last two years dismissed for lack of standing, often because the plaintiffs cannot plausibly allege an injury in fact.  See, e.g., here and here.  In the class context, it is not enough for a proposed class rep to have standing, but the entire proposed class must have standing.  That makes sense, because “a named plaintiff cannot represent a class of persons who lack the ability to bring a suit themselves.”  2026 U.S. Dist. LEXIS 11787, *6-7 (quoting Avritt v. Reliastar Life Ins. Co., 615 F.3d 1023, 1034 (8th Cir. 2010)).  While one of the plaintiffs alleged an injury in fact by overpaying for his prescriptions of tenofovir-containing medications, the class included people—potentially a majority of the class—who paid nothing themselves for their prescriptions.  Id. at *9-10.  You cannot overpay when you do not pay.  This is particularly so when the medications were acknowledged to have value in treating HIV, even if they were allegedly suboptimal compared to drugs containing a later version of tenofovir.  Id. at *11.  The court also rejected the argument—applicable to the statutory claim not the common law claim—that people who “paid nothing or miniscule amounts still suffered an Article III injury because Missouri law entitles them to benefit of the bargain damages,” distinguishing between the required injury in fact and the legal fiction of an injury created by a legislative act.  Id. at *11-12.

That was enough to end the class—the real reason for bringing a case like this—but the Searcy court went ahead and made it clear that plaintiffs did not carry their burden as to multiple Rule 23 requirements.  On the big requirement, “individual issues predominate [over common issues] because prescribing decisions are patient-specific and give rise to individual issues that are central to questions of causation and loss.”  Id. at *14.  It could not be assumed that all class members had certain expectations about the risks and benefits of the medications they were prescribed to make a further assumption that they would not have purchased the medications if the defendant had behaved differently.  Similarly, individual proof would be required to address the knowledge and decision making of both prescribing physicians and purchasing patients.  Id. at *16.  Even the named plaintiff who the court said had alleged an injury in fact had a record of prescription, purchase, and use of medications containing both versions of tenofovir that emphasized the importance of individualized proof (and undercut his core contentions).  This discussion of the record on Rule 23, which we have presented briefly, makes it clear that plaintiffs cannot find another route to class certification by tweaking their proposed class definition or offering some other late amendment.

While refraining from ruling on the admissibility of plaintiffs’ economics expert at trial, the Searcy court took pains to call out his “damages model for calculating class-wide benefit of the bargain damages.”  We have long found the use of economics/pharmacoeconomics/econometrics to establish injury or causation under the guise of opinions on damages to be a stretch, albeit one that occasionally gets some traction when courts struggle with the class action requirements.  See, e.g., here, here, and here.  A calculation of “the difference between the ‘as represented’ value of the product and the ‘as is’ or ‘actual’ value of the product” will inevitably be used to prove that there was a misrepresentation of value and that it caused an overpayment, issues the court had already rightly determined to require consideration of individualized evidence for prescription medications used to treat a potentially fatal condition.  Only with very firm limiting instructions should such flimflam be presented to try to establish damages only.  But, even when offered solely on damages, this model was flawed.  For one thing, because the model failed to account for out-of-pocket payments by the patient-purchasers versus payments by third-party payors, calculated losses could greatly exceed what the plaintiff actually paid.  Id. at *23-24.  It also determined the value of branded medications by looking to the price of much cheaper generic medications.  In addition to looking like a shameless attempt to inflate damages, it is ironic because plaintiffs claimed the alleged delay in bringing the later version of tenofovir to market was because the manufacturer wanted to use its patent exclusivity to delay the entry of generics.  In terms of class damages, though, this model was not designed to “measure only damages attributable to [plaintiffs’] theory,” so it could not be used to support class certification.  Id. at *26 (internal citation omitted).

Another irony here is that these massive failings do not end the case.  They just end any chance at certification of the class as alleged.  Searcy has been pending since 2020.  Surely, the amount of time and effort spent on a fundamentally flawed case, simply because it includes a class allegation, is out of whack.  After all, as the court asked up front,

Plaintiffs, two HIV-positive men, were prescribed and took medications, as directed by their healthcare providers, that Gilead manufactured. The medications they took worked exactly as prescribed, effectively managing their HIV. What is more, the medications did so safely; neither Plaintiff alleges that he suffered any personal injury from taking them. So why have they sued Gilead after taking its lifesaving medications without adverse effect?

Id. at *3.  We have not seen an answer that would justify the longevity of this case.

Photo of Stephen McConnell

We do not quite fit the stereotype of the fat cat – at least (we hope), not anymore.  But there was a time when at least one evening per week would be marked by scotch and cigars. Our antiquity and iffy physical constitution have now reduced such festivities to two or three times per annum. (We missed last week’s Bobby Burns Night Dinner; missed the poetry, missed the peaty firewater, and missed the conviviality of old friends, some of whom, sadly, have passed on.) Still, as the most interesting man in the world might say, while we do not always smoke cigars, when we do, we like Rocky Patel cigars. So imagine our curiosity when Bexis sent us a case with Rocky Patel in the caption. The case is Rocky Patel Premium Cigars, Inc., et al. v. Bonta, 2025 WL 3903972 (S.D. Cal. Dec. 23, 2025).  That “et al.” on the plaintiff side includes some other fine cigar makers, such as A. Fuente, as well as distributors and trade associations. Fuente cigars, such as the Hemingway Short Story, are splendid. We had a rooting interest in this case. The defendant, Bonta, is the California Attorney General. So we really had a rooting interest. On the theory of smoke’em if you’ve got’em, we could not resist scribbling about the Rocky Patel case this week, even if its application to our daily practice is even more iffy than our geezerish health.

We previously blogged about a tobacco decision that applied Buckman preemption against an Iowa consumer fraud law clamping down on vape tobacco products. The Iowa law created a registration regime that explicitly incorporated federal premarket standards as a determinative factor for market access. That is, Iowa was asserting enforcement authority that belonged exclusively to the Food and Drug Administration (FDA). Hello, Buckman preemption. Iowa’s law would have had a better chance of surviving if it was a flat-out ban.

Now we come to today’s case, a decision from the Southern District of California that goes the other way, but still offers backhanded support for Buckman preemption in the drug/device area.  The Rocky Patel case concerns California’s ban of flavored tobacco products.  The statute at issue is Cal. Health & Safety Code section 104559.5. The California AG established and maintained a list of unflavored tobacco products (“UTL”).  Any tobacco product not appearing on the UTL after it is published shall be deemed a flavored product banned by the statute. There is an out “if the FDA has indicated that the product does not require such approval.”

The cigar sellers argued that “premium cigars, as defined by federal regulations, are exempt from the federal premarket tobacco product application process” and, therefore, they cannot be flavored products within the meaning of the California statute. Just a little thought should lead one to the conclusion that premium cigars are not the sort of flavored tobacco products that the California solons had in mind. It is not as if kids are looking to puff on $30 cigars because they have the flavor of .. of what?  Not fruit or vanilla or treacle; rather, it is the flavor of tobacco. Really good tobacco. It is a grown-up flavor. It is an acquired taste. And, just possibly, it is a flavor preference that is none of the government’s business. People gripe about Big Tobacco. What about Big Nanny? What would Winston Churchill and Sigmund Freud say about California’s silly law? (Or have they both been canceled?)

In any event, the cigar sellers challenged the California statute.  They asserted five causes of action: (1) violation of the First and Fourteenth Amendments; (2) violation of the dormant Commerce Clause; (3) violation of the Supremacy Clause (implied preemption); and (5) violation of the Due Process Clause.  The complaint sought injunctive relief. The first test for a preliminary injunction is likelihood of success. In assessing that likelihood, the court focused on express preemption, implied preemption, and the First Amendment.

The federal law at issue is the Family Smoking Prevention and Tobacco Control Act (the TCA), which amended the Food, Drug, and Cosmetic Act (FDCA) to give the FDA regulatory authority over aspects of tobacco. The structure of the TCA makes preemption something of an adventure. The TCA contains a broad “preservation” clause allowing states to regulate more stringently (including outright bans) than federal law, followed by multiple preemptive carveouts, in turn followed by a savings clause allowing state regulation of tobacco “sales.” This byzantine preemption/savings structure renders the express preemption aspect of the Rocky Patel opinion not perfectly analogous to our drug/device sandbox. 

First, the court held that the plaintiff’s express preemption argument was unlikely to succeed. The issue was whether the state’s UTL statute and implementing regulations “establish requirements relating to premarket review that are different from or in addition to those established by the TCA … or whether the UTL regime establishes requirements relating to a permissible sales ban on flavored products, such that it falls within the Preservation and Savings Clauses.” This issue turned on an interpretation of what “premarket review” means. The court ultimately decided that the preservation of “premarket review” as a basis for express preemption would cover a fraud on the FDA claim or a state redefinition of categories subject to PMA, but not this flat sales ban. 

As for implied preemption, the court agreed that a state enforcement system “parasitic” on the FDCA (like the Iowa vaping statute in our earlier blogpost) would be preempted.  But the court deemed California’s flavored tobacco ban as being non-parasitic.  The court distinguished (and somewhat demeaned) the Iowa decision. According to the Rocky Patel court, California’s ban on flavored tobacco was a public health measure, and thus the dreaded presumption against implied preemption applied.  As the court saw it, the federal tobacco regulation generally constituted a mere floor that state laws could exceed.  A state ban does not rely on FDA regulatory standards as an enforcement mechanism.  Since the federal tobacco statute intended to preserve a large role for the states, nothing in drug (Nexus Pharmaceuticals) or device (Buckman) cases prohibited state reliance on FDA determinations to enforce its ban.  The ban does not rely on the FDCA; rather, it relies on historic state power to govern tobacco sales and the statutorily established federal regulatory floor for regulation of tobacco products.  In the context of tobacco sales regulation, incorporating federal standards into a state sales’ requirement is not “enforcement” of federal law. 

The plaintiffs argued that the California statute “restricts the manner in which premium cigar manufacturers and importers may describe their products and thus their commercial speech.” The court rejected this First Amendment argument, but at least did acknowledge that the ban triggered First Amendment scrutiny under the Central Hudson test for evaluating restrictions on commercial speech. In applying that test, the Rocky Patel court held that that statute’s “creation of a rebuttable presumption where a manufacturer describes its product as having a characterizing flavor is narrowly tailored to serve the State’s interest in banning flavored tobacco products.” Moreover, the UTL “does not prohibit manufacturers from using any descriptions but merely seeks to further the goal of ferreting out flavored products by drawing special attention to these products that the manufacturer itself describes as being flavored.” 

That “merely” is doing a lot of work.  But we think the “ferreting” word is appropriate. Maybe Big Nanny is also Big Ferret. Maybe the California UTL law is constitutional, but it is also, as Justice Stewart said in his Griswold dissent, an “uncommonly silly” law.   

Photo of Michelle Yeary

Some cases feel brand new. Others feel like a remake you didn’t ask for—but somehow know all the lines to already. This one is firmly in the latter category. For those of us who have been around long enough to remember dial-up internet and the original pedicle screw litigation, this case reads like a throwback. In fact, one of this blogger’s very first cases (working with Bexis) was the Bone Screw MDL—the one that gave us Buckman Co. v. Plaintiffs’ Legal Committee. So, Elowson v. Alphatec Spine Inc., 2026 U.S. Dist. LEXIS 13591 (D. Ariz. Jan. 26, 2026), a negligence per se claim based entirely on alleged FDCA violations, involving pedicle screws, gave us a distinct sense of déjà vu. Spoiler alert: Buckman still wins.

The plaintiff underwent spinal surgery in 2019 to remove a tumor on her lumbar spine. Part of the procedure required spinal fusion using a plate-and-screw system. Things went along just fine—no complaints, no complications, no litigation—for half a decade. Then, in 2024, plaintiff began experiencing pain. An x-ray revealed that one screw had broken at some point before the bone fully fused. Id. at *1.

Cue the lawsuit. Never mind that the device lasted five years. Never mind that the product warnings expressly state that screws may fail if fusion does not occur. Never mind that pedicle screws are subject to the immutable laws of physics. Plaintiff sued anyway, alleging among other things negligence per se based entirely on supposed violations of the FDCA and FDA regulations.

That claim did not survive defendant’s motion to dismiss. And for good reason. Plaintiff’s negligence per se theory was simple in concept and fatal in execution. According to plaintiff, the manufacturer had a duty to update the device design because it was based on an allegedly “outdated” “European style of design” and because U.S. manufacturers supposedly use a design that reduces the risk of fracture. Id. at *4-5. Plaintiff alleged that the “source” of that duty was the FDCA and its regulations, id. at *5-6, rather than any traditional state-law tort principle. That is a problem.  A Buckman-sized problem.

As the court correctly held, negligence per se claims premised exclusively on alleged FDCA or FDA regulatory violations are preempted. Full stop. The Supreme Court settled this decades ago. Id. at *7. If Buckman had a walk-on song, this would be its moment.

The negligence per se claim here would not exist without the FDCA. Plaintiff did not identify any independent state-law duty requiring manufacturers to update designs based on evolving regulatory expectations or comparative international practices. Instead, plaintiff attempted to bootstrap FDA regulations into a state tort claim. That is exactly what Buckman forbids: private litigants bringing private enforcement actions of the FDCA under the guise of state law.

Negligence per se is not a free-floating cause of action. It applies only where a defendant violates a “specific legal requirement, not a general standard of care.” The plaintiff’s problem was that the only “specificity” she could point to came from FDA regulations. Without those regulations, there was no duty, no breach, and no claim.

Courts have consistently recognized that claims not tied to traditional state tort duties—but instead dependent on federal regulatory schemes—are preempted. Allowing them to proceed would invite juries to second-guess FDA regulatory decisions and enforcement priorities. That, again, is Buckman territory. The court declined that invitation.

The court did, however, allow plaintiff’s strict liability design defect claim to survive the pleadings stage. Defendant argued that Arizona follows either the Second or Third Restatement of Torts and that under either it would reject strict liability design defect for a medical device. On the former, the court concluded that whether comment k applies—whether defendant’s screws are unavoidably unsafe—is a question of fact that can’t be resolved on the pleadings. Id. at *11-12. On the latter, the court disagreed with defendant that Restatement Third §6c was Arizona law. Under §6c, a strict liability design defect claim would require plaintiff to plead that a reasonable health-care provider, knowing the risks and benefits of the medical device, would not prescribe the device to any class of patients. Id. at *12. The Arizona Supreme Court, however, in a case that pre-dates the Restatement Third, adopted the standard risk/utility test for strict liability design. As a federal court sitting in diversity, the Elowson court was bound to apply that standard. Id. at *13. Plaintiff’s allegations sufficiently alleged a design defect (the “outdated” European style); an alternative design (the “smooth” U.S. style), and that defendant’s “failure to design screws that remain intact and do not break caused her injuries.” Id. at *15. That was enough to survive a TwIqbal challenge.

But perspective is important. Pleading survival is not victory—it is a timeout. The case now proceeds with discovery, expert scrutiny, and the inconvenient reality that spinal fixation devices, by their very nature, carry a risk of mechanical failure. To date, no bone screws—whether designed in the U.S., the U.K., or on Mars——are immune from breakage, especially in the absence of fusion. Gravity and biomechanics remain undefeated. Warnings here explicitly addressed the precise risk that materialized. The device functioned for five years. And the alternative design theory exists, for now, only on paper. In other words, this looks far more like a temporary setback than a turning point.

The more important takeaway is that this decision reinforces a familiar but critical principle: plaintiffs cannot manufacture negligence per se claims by repackaging alleged FDCA violations. Buckman remains the OG pedicle screw case—and it still has teeth. Sometimes, the old rules still work—much like those screws did, for half a decade.

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