Full opinion text
MEMORANDUM OPINION AND ORDER (1) GRANTING IN PART AND DENYING IN PART WYETH’S MOTION FOR PARTIAL SUMMARY JUDGMENT RE THE LEARNED INTERMEDIARY DOCTRINE/CAUSATION AND (2) GRANTING WYETH’S MOTION FOR PARTIAL SUMMARY JUDGMENT RE CONDITIONS FOR WHICH THERE IS NO EVIDENCE OF CAUSATION SCHELL, District Judge. Pending before the court is ‘Wyeth’s Motion For Partial Summary Judgment Re The Learned Intermediary Doctrine/Causation,” filed by Defendants American Home Products Corporation, Wyeth-Ayerst Laboratories, Inc., and Wyeth Laboratories, Inc. (collectively “Defendants”), on May 25, 1999 (Dkt.# 712, 713). A response was filed on behalf of Plaintiffs represented by the law firms of Provost ★ Umphrey and Ness, Motley, Loadholt, Richardson & Poole on May 12, 2000 (Dkt.# 747). Additionally, a number of Plaintiffs filed individual responses, while some Plaintiffs individually filed join-ders to the response filed by Provost ★ Umphrey, and Ness, Motley, Loadholt, Richardson & Poole, adopting at least some of the arguments made therein. Defendants filed a reply in support of their motion on June 16, 2000 (Dkt.# 758) and a supplemental reply on August 10, 2000 (Dkt.# 762). Defendants contend that they are entitled to partial summary judgment because the learned intermediary doctrine shields them from liability for most of Plaintiffs’ claims. Also pending is “Wyeth’s Motion For Partial Summary Judgment Re Conditions For Which There Is No Evidence Of Causation” (Dkt.# 716, 717), filed on May 25, 1999. Once again, Plaintiffs represented by Provost ★ Umphrey and Ness, Motley, Loadholt, Richardson & Poole filed a joint response (Dkt.# 752), and several Plaintiffs’ responded individually. On June 16, 2000, Defendants replied to the responses (Dkt.# 760). Upon careful consideration of the parties’ submissions in light of the applicable law, the court finds that Defendants’ motion for partial summary judgment regarding the learned intermediary doctrine should be GRANTED in part and DENIED in part. Defendants’ motion for partial summary judgment regarding conditions for which there is no evidence of causation should be GRANTED. TABLE OF CONTENTS I. BACKGROUND 799 I. BACKGROUND This is a multidistrict products liability action involving the Norplant prescription contraceptive device manufactured by Defendants. In 1991, Defendants introduced Norplant to the market after more than two decades of research and development. Norplant is a long term, reversible birth control device that consists of six plastic capsules. See Fact Sheet: Norplant and You (Planned Parenthood Federation of America, Inc., New York, N.Y.), Jan. 1997, at 1, available at, http://www.plannedpar-enthood.org/birth-control/norplant.htm. Each of these capsules contains the synthetic hormone levonorgestrel. Id. The capsules are implanted below the skin of a woman’s upper arm and, while implanted, constantly release a small dose of levonor-gestrel into the blood stream. Id. Levo-norgestrel prevents pregnancy by keeping the ovaries from releasing eggs, thickening the cervical mucus, and deterring sperm from joining with an egg. Id. Statistics show Norplant to be a highly effective method of birth control: fewer than four out of 100 women who use Norplant for five years will become pregnant. Id. at 2. Central to all claims of each Plaintiff in this litigation is the assertion that Defendants failed to adequately warn consumers and their prescribing physicians or healthcare providers about the dangerous side effects associated with Norplant. In their motion for partial summary judgment regarding the learned intermediary doctrine, Defendants seek summary judgment against all Plaintiffs claiming to have suffered any of the 26 primary side effects listed in the “Adverse Reactions” section of Norplant’s physician labeling. Defendants contend that, even if their labeling is shown to be inadequate, the learned intermediary doctrine requires Plaintiffs to put on evidence showing that the inadequate warnings proximately caused their alleged injuries, and they have failed to do so. Defendants also move for partial summary judgment against all Plaintiffs who have allegedly suffered any side effect other than the 26 listed as “Adverse Reactions” in Norplant’s labeling. Plaintiffs collectively allege more than 950 other side effects (hereinafter “exotic conditions”). In short, Defendants argue that summary judgment as to the exotic side effects is proper because Plaintiffs, who have the burden to prove causation, have not come forward with any scientifically reliable evidence on general causation. While the extensive facts of this case are well documented in other orders and opinions and need not be fully recounted here, a brief overview of the procedural history is in order. Beginning in 1994, thousands of lawsuits were filed against Defendants in state and federal courts throughout the nation. Pursuant to 28 U.S.C. § 1407, the Judicial Panel on Multidistrict Litigation transferred all federal Norplant cases to this court for consolidated pretrial handling on December 6, 1994. 28 U.S.C. § 1407(a) (“When civil actions involving one or more common questions of fact are pending in different districts, such actions may be transferred [by the judicial panel on multidistrict litigation] to any district for coordinated or consolidated pretrial proceedings.”). Once transferred to this court, Plaintiffs sought certification of a nationwide class of all persons who have suffered or may suffer injury as a result of using Norplant. The court denied that motion as premature on August 5, 1996, finding that bellwether trials were needed to assess the propriety of certifying such a class under Rule 23(b)(3) of the Federal Rules of Civil Procedure. After several Plaintiffs were selected for the first of three bellwether trials and the parties had completed discovery, Defendants moved for summary judgment on the basis of the learned intermediary doctrine. Similar to the instant motion concerning the learned intermediary doctrine, Defendants argued that the doctrine required them to warn only Plaintiffs’ prescribing physicians about the dangerous propensities of Norplant, not each individual patient, and that there was no evidence that Defendants had failed to adequately do so or that their allegedly inadequate physician warnings were the producing cause of Plaintiffs’ injuries. In re Norplant Contraceptive Prod. Liab. Litig., 955 F.Supp. 700, 702-03 (E.D.Tex.1997), aff'd, 165 F.3d 374 (5th Cir.1999). The court found that the learned intermediary doctrine did indeed apply to the bellwether Plaintiffs’ claims whether asserted under a theory of strict products liability, negligence, breach of implied warranty of merchantability, misrepresentation, or consumer fraud under the Texas Deceptive Trade Practices Act (“DTPA”) because the claims were essentially claims for failure to warn. Id. at 709, aff'd, 165 F.3d 374. Because the bellwether Plaintiffs failed to produce any evidence that their prescribing physicians were unaware of Norplant’s complained of side effects, or that “but for” Defendants’ inadequate warning labels they would not have prescribed Norplant, the court found that the bellwether Plaintiffs failed to prove causation and granted Defendants’ motion for summary judgment on March 4,1997. Id. at 709-11, aff'd, 165 F.3d 374. In reaching that decision, the court declined to recognize an exception to the learned intermediary doctrine for prescription contraceptives and rejected the assertion that the doctrine should not apply because Defendants had engaged in an aggressive direct-to-consumer advertising campaign. Id. at 705-08, aff'd, 165 F.3d 374. The bellwether Plaintiffs appealed the court’s summary judgment ruling to the Fifth Circuit. On appeal, they argued that the learned intermediary doctrine is a common law defense that does not apply to statutes like the DTPA or to claims for fraud and misrepresentation; that the court should recognize a contraceptive exception to the doctrine given that physicians play a reduced role in the selection of contraceptives and cannot be expected to convey adequate warnings to patients under the circumstances; that the doctrine should not apply because Defendants aggressively marketed Norplant directly to consumers, thereby rendering inadequate the warnings provided to physicians; and finally, that the doctrine should not apply because the FDA required Defendants to provide warnings about Norplant’s side effects. On January 29, 1999, the Fifth Circuit rejected each of the bellwether Plaintiffs’ arguments and affirmed this court’s ruling. See In re Norplant Contraceptive Prod. Liab. Litig., 165 F.3d 374 (5th Cir.1999). Shortly after the Fifth Circuit issued its opinion, Defendants filed the partial summary judgment motions now pending before the court. Not long thereafter, the parties advised the court that they were engaged in settlement negotiations and wanted the court to postpone consideration of Defendants’ motions until the settlement process had run its course. In August 1999, Defendants began the process of making settlement offers that most eligible Plaintiffs in both state and federal cases were expected to accept. That prediction proved to be correct: over the next three years approximately 32,000 Plaintiffs accepted Defendants’ settlement offer while another 2,970 either rejected it or failed to timely respond. The court acknowledges the instant motions have been on file for three years, but, in the interests of judicial economy, the court wanted to wait and see which Plaintiffs would settle before ruling on the motions. Given the large number of Plaintiffs involved, however, the settlement plan moved slowly, taking several years to consummate. The last stipulations of settlement were received in April 2002. Now that the settlement process is complete, the time has come to resolve Defendants’ motions. See, e.g., Manual FOR Complex Litigation, ThiRd, § 31.132, at 253 (1995) (stating that the transferee judge is empowered to rule on motions for summary judgment) (citing In re Trump Casino Sec. Litig.—Taj Mahal Litig., 7 F.3d 357, 367-68 (3d Cir.1993)). At this point, the court notes that, consistent with its findings in the first bellwether case, the claims of all remaining Plaintiffs are fundamentally grounded in the assertion that Defendants failed to warn them of Norplant’s adverse side effects. Therefore, no matter how Plaintiffs characterize their specific claims in each individual complaint — i.e., strict products liability, negligence, fraud, misrepresentation, breach of warranty, et cetera — the court will treat Plaintiffs’ claims against Defendants as failure to warn claims in analyzing these motions for partial summary judgment. II. SUMMARY JUDGMENT STANDARD Defendants seek partial summary judgment in this case pursuant to Rule 56 of the Federal Rules of Civil Procedure. Fed.R.CivP. 56(b). Under Rule 56, summary judgment is proper if “the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.” Id. at 56(c). A material fact issue exists only if “the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). To carry its summary judgment burden, Defendants must demonstrate that Plaintiffs have failed to establish an essential element of their cases. International Shortstop, Inc. v. Rally’s, Inc., 939 F.2d 1257, 1264 (5th Cir.1991) (citing Celotex Corp. v. Catrett, 477 U.S. 317, 322-23, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986)). Because Plaintiffs bear the burden of proof at trial on the issues of adequacy of Defendants’ warning labels and causation, Defendants are not required to “ ‘produce evidence negating the existence of a material fact,’ ” but need “only ... point out the absence of evidence supporting [Plaintiffs’] case[s].’ ” Skotak v. Tenneco Resins, Inc., 953 F.2d 909, 913 (5th Cir.1992) (quoting Latimer v. Smithkline & French Lab., 919 F.2d 301, 303 (5th Cir.1990)); In re Norplant Contraceptive Prod. Liab. Litig., 955 F.Supp. at 710 (citation omitted), aff'd, 165 F.3d at 377-78. If Defendants satisfy their initial burden, the burden shifts to Plaintiffs to “identify specific evidence in the summary judgment record demonstrating that there is a material fact issue concerning the essential elements” of their cases. Douglass v. United Services Auto. Ass’n, 79 F.3d 1415, 1429 (5th Cir.1996) (citation omitted). In that situation, Plaintiffs cannot rest on allegations or denials in the pleadings and must “do more than simply show there is some metaphysical doubt as to the material facts.” Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986). Moreover, “conclusory allegations, speculation, and unsubstantiated assertions are inadequate to satisfy the nonmov-ant’s burden.” Douglass, 79 F.3d at 1429. Of course, all evidence must be viewed in the light most favorable to the nonmoving party and all reasonable inferences must be drawn in that party’s favor. See Colson v. Grohman, 174 F.3d 498, 506 (5th Cir.1999) (citing Anderson, 477 U.S. at 255, 106 S.Ct. 2505). III. DEFENDANTS’ MOTION FOR PARTIAL SUMMARY JUDGMENT REGARDING THE LEARNED INTERMEDIARY DOCTRINE/CAUSATION A. Introduction And Rules In this case, Defendants invoke the learned intermediary doctrine as a bar to Plaintiffs’ recovery. The learned intermediary doctrine provides an exception to the general rule imposing a duty on manufacturers to warn consumers about the risks of their products. See Reyes v. Wyeth Lab., 498 F.2d 1264, 1276 (5th Cir.1974); Sterling Drug, Inc. v. Cornish, 370 F.2d 82, 85 (8th Cir.1966). Under the doctrine, a drug “manufacturer is excused from warning each patient who receives the product when the manufacturer properly warns the prescribing physician of the product’s dangers.” Porterfield v. Ethicon, Inc., 183 F.3d 464, 467-68 (5th Cir.1999) (citing Alm v. Aluminum Co. of America, 717 S.W.2d 588, 591-92 (Tex.1986)). Hence, a drug manufacturer’s duty to warn consumers about the dangers of its prescription drugs extends only to the prescribing physician or healthcare provider, who acts as a “learned intermediary” between the manufacturer and the ultimate consumer and assumes responsibility for advising individual patients of the risks associated with the drug. See Skotak v. Tenneco Resins, Inc., 953 F.2d 909, 912 (5th Cir.1992). The manufacturer’s duty to warn is limited to adequately informing the healthcare provider of any risks associated with the product’s use. See Brooks v. Medtronic, 750 F.2d 1227 (4th Cir.1984); Porterfield, 183 F.3d at 467-68 (observing that the manufacturer relies on the physician to pass on its warnings). “Thus, a warning to the [healthcare provider] is deemed a warning to the patient; the manufacturer need not communicate directly with all ultimate users of prescription drugs.” Kirsch v. Picker Intern., Inc., 753 F.2d 670, 671 (8th Cir.1985) (citation omitted). This is because the prescribing healthcare provider is a medical expert and can weigh the benefits of the medication against its potential dangers. Reyes, 498 F.2d at 1276-77. If the learned intermediary doctrine applies, Plaintiffs must prove the following in order to recover for failure to warn: (1) that the product warnings given by the drug manufacturer to healthcare providers are inadequate; and (2) that the inadequate warnings were a producing cause of and/or proximately caused Plaintiffs’ subsequent injuries. See Porterfield, 183 F.3d at 468. Because the Judicial Panel on Multidistrict Litigation transferred these Norplant cases to this court pursuant to 28 U.S.C. § 1407, the undersigned is obligated to apply the substantive law of the transferor courts and treat each case as if it were pending in the district from which it was transferred. See In re Dow Sarabond Prods. Liab. Litig., 666 F.Supp. 1466, 1468 (D.Colo.1987) (citing In re Plumbing Fixtures Litig., 342 F.Supp. 756, 758 (J.P.M.L.1972) (citation omitted)); see also Van Dusen v. Barrack, 376 U.S. 612, 643-46, 84 S.Ct. 805, 11 L.Ed.2d 945 (1964). Moreover, given that Plaintiffs’ claims are in federal court on the basis of diversity jurisdiction, the court looks to the law of the forum state to determine which jurisdiction’s law governs each case. See Huddy v. Fruehauf Corp., 953 F.2d 955, 956 (5th Cir.1992) (citing Klaxon v. Stentor Elec. Mfg. Co., 313 U.S. 487, 496, 61 S.Ct. 1020, 85 L.Ed. 1477 (1941)) (citation omitted). While the vast majority of jurisdictions recognize and apply the learned intermediary doctrine to prescription drugs like Norplant, at least one state recognizes an exception to the rule that may significantly impact its applicability here. The Supreme Court of New Jersey has held that the doctrine does not apply when a drug manufacturer engages in direct-to-consumer advertising. Perez v. Wyeth Lab. Inc., 161 N.J. 1, 734 A.2d 1245 (1999). Massachusetts has exempted oral contraceptives from the reach of the learned intermediary doctrine. MacDonald v. Ortho Pharm. Corp., 394 Mass. 131, 475 N.E.2d 65 (1985). Hence, when determining the applicability of the learned intermediary doctrine with regard to this motion, choice of law questions quickly arise. For example, if a hypothetical plaintiff who had Norplant inserted in New Jersey filed suit in Texas, an apparent conflict would arise between New Jersey law, which does not apply the learned intermediary doctrine to prescription contraceptives that are directly marketed to consumers, and Texas law, which does. In that instance, the court would have to apply Texas choice of law rules to determine which state’s law governs. Because Texas follows the Restatement’s “most significant relationship test,” which presumes that the law of the state where the injury occurred should govern unless another state has a more significant relationship to the occurrence or the parties, it very well may be that New Jersey law would control and the learned intermediary doctrine would be inapplicable to this hypothetical plaintiff when considering the instant motion. See Tomngton Co. v. Stutzman, 46 S.W.3d 829, 847-50 (Tex.2000) (applying the “most significant relationship” test to resolve Texas choice of law issue); Sanchez v. Brownsville Sports Center, Inc., 51 S.W.3d 643, 668 (Tex. Ct. App.-Corpus Christi 2001) (citation omitted); Restatement (Second) of Conflict of Laws § 6, 145 (1971). The above scenario is merely hypothetical. As a practical matter, there will not be an actual conflict of laws with regard to the claims of most Plaintiffs who filed their suits in jurisdictions different from the one where their Norplant devices were surgically implanted because most jurisdictions would reach the same result under the learned intermediary doctrine. Nonetheless, the court will deal individually with Plaintiffs who either filed their lawsuits or had Norplant inserted in jurisdictions that limit the applicability of the learned intermediary doctrine in cases like these. Defendants base their first motion for partial summary judgment on the learned intermediary doctrine and directed it exclusively at Plaintiffs who claim they suffer from one or more of the 26 primary side effects listed in the “Adverse Reactions” section of Norplant’s physician labeling. Defendants contend they are entitled to partial summary judgment with regard to those claims because there is no competent summary judgment evidence demonstrating that (1) Defendants failed to adequately warn Plaintiffs’ prescribing healthcare providers about those side effects; and (2) the inadequate warnings were a producing cause of and/or proximately caused any alleged injuries. See Porterfield, 183 F.3d at 468. Defendants’ motion focuses on the second of those two elements — the causation prong — and emphasizes the absence of evidence showing that prescribing healthcare providers were unaware of Norplant’s 26 primary side effects before they prescribed the drug, or that “but for” Defendants’ inadequate warnings they would not have recommended Norplant to their patients. Defendants note, for example, that every healthcare provider to testify in a Norplant case thus far, either by affidavit, deposition, or at trial, has declared that he or she was aware of and adequately warned about the 26 potential side effects. Defendants argue that Plaintiffs’ claims cannot survive summary judgment without a proper showing of causation. Plaintiffs respond that the question of causation is still at issue in this litigation. They point to the fact that one state court jury in Jefferson County, Texas, found that Defendants’ physician warnings were inadequate and that the inadequate warnings were the producing cause of injuries to four plaintiffs. They also argue that, although all testifying healthcare providers have admitted to being aware of the 26 side effects prior to prescribing Norplant, there is a fact issue about whether they were adequately warned about the potential severity of the side effects for each Plaintiff. Additionally, Plaintiffs argue that the learned intermediary doctrine has no application here because Defendants engaged in aggressive direct-to-consumer marketing and over-promotion of Norplant, thereby nullifying the impact of Defendants’ physician warnings. According to Plaintiffs, the product information Defendants provided to consumers was misleading and deceptive. Plaintiffs further contend that an exception to the learned intermediary doctrine should be recognized for contraceptive drugs and that the doctrine does not apply to claims of misrepresentation and fraud, or violations of the DTP A. B. Applicability Of The Learned Intermediary Doctrine To Each Case Before analyzing the substance of Defendants’ motion for partial summary judgment, the court must determine to what extent the learned intermediary doctrine governs Plaintiffs’ failure to warn claims at issue. Determining whether the doctrine applies in each state or territory is essential to deciding this motion because such a determination will inform the court exactly which Plaintiffs’ cases are subject to this motion. After the court knows to whom the motion applies, it can proceed to resolve whether the motion should be granted or denied as to those Plaintiffs. Defendants correctly note in their motion that this court and the Fifth Circuit previously held that the learned intermediary doctrine defines Defendants’ duty to warn of the potential risks associated with the use of Norplant. See In re Norplant Contraceptive Prod. Liab. Litig., 955 F.Supp. 700, 703-09, aff'd, 165 F.3d 374. The court’s ruling in the first bellwether trial, however, does not foreclose all argument in the present cases. Since the bellwether Plaintiffs had Norplant implanted in Texas, the previous rulings interpreted the application of the learned intermediary doctrine under Texas state law only. This motion is much broader in scope because it applies to all of the active Plaintiffs who claim they suffer from one or more of the 26 primary side effects listed in the “Adverse Reactions” section of Norplant’s physician labeling. These Plaintiffs come from disparate jurisdictions throughout the United States. Thus, to decide how many Plaintiffs are subject to this motion, the court must initially determine which jurisdictions apply the learned intermediary doctrine, and whether any jurisdictions apply a relevant exception to the doctrine. To make such determinations, the court ■will survey the substantive law of each state and territory within the jurisdiction of the United States regarding the learned intermediary doctrine. 1. Jurisdictions That Apply The Learned Intermedia'ry Doctrine Without An Exception Relevant To Norplant The overwhelming majority of jurisdictions to address the issue apply the learned intermediary doctrine to define a pharmaceutical company’s duty to warn of risks associated with the use of a prescription drug like Norplant. As illustrated in the table below, the doctrine either applies or is recognized, without an exception relevant to the Norplant cases, in 48 states, the District of Columbia, and Puerto Rico. Jurisdiction_Case Law Applying The Learned Intermediary Doctrine_ (1) Alabama Stone v. Smith Kline & French Lab., 447 So.2d 1301,1303 n. 2 _(Ala.1984)._ (2) Alaska Shanks v. Upjohn Co., 835 P.2d 1189,1195 n. 6 (Alaska 1992) (recognizing the learned intermediary doctrine under Alaska law) (citing Polley v. GIBA-GEIGY Corp., 658 F.Supp. 420, 422-23 _(D .Alaska 1987))._ (3) Arizona Byer v. Best Phamacal, 577 P.2d 1084 (Ariz.1978); Piper v. Bear _Med. Sus., 180 Ariz. 170, 178 (Ariz.1993)._ (4) Arkansas West v. Searle & Co., 806 S.W.2d 608 (Ark.1991) (“[W]e are convinced that the stated public policy reasons for the learned intermediary doctrine are present with respect to oral _contraceptives.”)._ (5) California_Carlin v. Superior Court. 920 P.2d 1347 (Cal.1996)._ (6) Colorado Caveny v. CIBA-GEIGY Cotp., 818 F.Supp. 1404,1406 (D.Colo. 1992); Hamilton v. Hardy, 549 P.2d 1099 (1976) (applying the learned intermediary doctrine to oral contraceptives), disapproved of on other grounds by, State Bd. of Md. Exam’r v. McCroskey, _880 P.2d 1188 (Colo.1994)._ (7) Connecticut Goodson v. Searle Lab., 471 F.Supp. 546 (D.Conn.1978) (applying the doctrine to oral contraceptives); Vitanza v. Upjohn Co., 778 _A.2d 829, 838-39 (Conn.2001)._ (8) Delaware Lacy v. G.D. Searle & Co., 567 A.2d 398, 400-01 (Del.1989) (applying the doctrine to intrauterine devices). District of MacPherson v. Searle & Co., 775 F.Supp. 417 (D.D.C.1991) (apply-Columbia_ing the doctrine to oral contraceptives)._ (9) Florida Felix v. Hoffinann-LaRoche, Inc., 540 So.2d 102,104 (Fla.1989); Zanzuri v. G.D. Searle & Co., 748 F.Supp. 1511 (S.D.Fla.1990) (applies the doctrine to intrauterine devices, but a fact issue as to whether the manufacturer supplied adequate warnings blocked _summary judgment)._ (10) Georgia Presto v. Sandoz Pharm. Corp., 487 S.E.2d 70 (Ga.Ct.App.1997); Walker v. Merck & Co., 648 F.Supp. 931 (M.D.Ga.1986), aff'd without op., 831 F.2d 1069 (11th Cir.1987) (applying the doctrine _to prescription vaccines)._ (11) Hawaii Craft v. Peebles, 893 P.2d 138 (Haw.1995) (applying the doctrine to _breast implants)._ (12) Idaho Silman v. Aluminum Co. of America, 731 P.2d 1267,1270-71 (Idaho 1986) (taking guidance from a Texas case and applying the _doctrine).__ (13) Illinois Martin by Martin v. Ortho Pharm. Corp., 661 N.E.2d 352 (111.1996) _(applying the doctrine to oral contraceptives)._ (14) Indiana Ortho Pharm. Corp. v. Chapman, 388 N.E.2d 541 (Ind.Ct.App.1979) _(applying the doctrine to oral contraceptives)._ (15) Iowa Petty v. United States, 740 F.2d 1428,1440 (8th Cir.1984) (intimating that the doctrine is part of Iowa’s common law, but refusing to _apply it in a mass immunization context)._ (16) Kansas Humes v. Clinton, 792 P.2d 1032 (Kan.1990) (applying the doctrine _to intrauterine devices)._._ (17) Kentucky Snawder v. Cohen, 749 F.Supp. 1473, 1480 (W.D.Ky.1990) (acknowledging the doctrine, but not reaching the issue of whether it _applies in this case)._ (18) Louisiana Mikell v. Hoffman-LaRouche, Inc., 649 So.2d 75, 79-80 (La.Ct.App. 1994); Rhoto v. Ribando, 504 So.2d 1119 (La.Ct.App.1987) (holding that the warnings supplied by drug manufacturers adequately informed the patient through her doctor of known risks associated _with normal use of their product).__ (19) Maine Violette v. Smith & Nephew Dionics, Inc., 62 F.3d 8,13 (1st Cir.1995) (recognizing and applying the doctrine under Maine _law)._ (20) Maryland Odom v. G.D. Searle & Co., 979 F.2d 1001,1004 (4th Cir.1992) (applying the doctrine to intrauterine devices under Maryland law); Doe v. American Nat’l Red Cross, 866 F.Supp. 242, 248 (D.Md.1994); Lee v. Baxter Healthcare Corp., 898 F.2d 146 (4th Cir.1990) (applying the doctrine to Maryland law in a breast _implant case)._ (21) Massachusetts MacDonald v. Ortho Pharm. Corp., 475 N.E.2d 65 (Mass.1985) (holding that the doctrine applies, but creating an exception for oral contraceptives). But see Linnen v. A.H. Robins Co., Inc., No. Civ. A. 97-2307, 2000 WL 89379 (Mass.Super.Ct. Dec. 14, 1999) (refusing to extend the exception created in MacDonald to fen-phen, arguing that MacDonald created a narroiv exception to the doctrine which is confined only to oral contraceptives where the FDA required the manufacturer to warn the consumer direct-_isi_ (22) Michigan Reaves v. Ortho Pharmaceutical Corp., 765 F.Supp. 1287,1291 (E.D.Mich.1991) (applying the doctrine to oral contraceptives); see also this courts discussion in In re Norplant Contraceptive Prod. Liab. Litig., 955 F.Supp. 700, 704-05 n. 21, 22 (E.D.Tex. 1997) (determining that the correct reading of Michigan law shows that the learned intermediary doctrine applies), ajfd, 165 F.3d 374 _(5th Cir.1999)._ (23) Minnesota Mulder v. Parke Davis & Co., 181 N.W.2d 882 (Minn.1970); Kociemba v. G.D. Searle & Co., 680 F.Supp. 1293 (D.Minn.1988) (applying the doctrine to intrauterine devices under Minnesota law); Klempka v. G.D. Searle & Co., 769 F.Supp. 1061, 1065 n. 4 _(D.Minn.1991) (citing Kociemba)._ (24) Mississippi Wyeth Lab., Inc. v. Fortenberry, 530 So.2d 688, 691 (Miss.1988) (applying the doctrine in a case involving paralysis after flu _vaccination).__ (25) Missouri_Johnston v. Upjohn Co., 442 S.W.2d 93, 94-95 (Mo.Ct.App.1969). (26) Montana Davis v. Wyeth Lab., Inc., 399 F.2d 121,130 (9th Cir.1968) (applying the doctrine using Montana law); Hill v. Squibb & Sons, E.R., 592 P.2d 1383 (Mont.1979) (“As a general rule, the duty of a drug manufacturer to warn of the dangers inherent in a prescription drug is satisfied if adequate warning is given to the physician who _prescribes it.”)._ (27) Nebraska Freeman v. Hoffmmv-La Roche, Inc., 618 N.W.2d 827 (applying the _doctrine in reference to the Restatement (Third) of ToRTS § 6). (28) Nevada Allison v. Merck & Co., 878 P.2d 948 (Nev.1994) (recognizing the doctrine, but applying an exception for mass immunization to manufacturer of measles, mumps, and rubella vaccine); Moses v. DanekMed., Inc., No. CV-S-95-512PMP RLH, 1998 WL 1041279, *5 (D. Nev. Dec. 11, 1998) (applying the doctrine in a _case of spinal implantation)._ (29) New Brochu v. Ortho Pharm. Corp., 642 F.2d 652, 656 (1st Cir.1981) Hampshire (applying New Hampshire law); Nelson v. Daikon Shield Claimants Trust, No. 84-276-SD, 1994 WL 255392, *4 (D.N.H. Jun.8, 1994) (applying the doctrine to intrauterine devices under New _Hampshire law)._ (30) New Mexico Sema v. Roche Lab., 684 P.2d 1187 (N.M.Ct.App.1984); Hines v. St. _Joseph’s Hosy., 527 P.2d 1075 (N.M.Ct.App.1974)._ (31) New York Martin v. Hacker, 185 A.D.2d 553, 554-55 (N.Y.App.Div.1992); Lindsay v. Ortho Pharm. Corp., 637 F.2d 87 (2d Cir.1980) (apply-_ing the doctrine to oral contraceptives under New York law). (32) North Foyle v. Lederle Lab., 674 F.Supp. 530, 535-36 (D.N.C.1987) (apply-Carolina ing the doctrine after acknowledging the great weight of authority supporting the doctrine’s application — “[t]his ‘learned intermediary’ doctrine requires that defendant’s motion for summary judg-_ment on the claim of failure to warn be [granted].”)._ (33) North Dakota Harris v. McNeil Pharm., No. CIV 3:98CV105, 2000 WL 33339657, *4 n. 4 (D.N.D. Sept.5, 2000) (“It is well recognized that the duty an eithical [i.e., prescription] drug manufacturer owes to the consumer is to warn only physicians or others permitted to dispense prescription drugs of any risks or contraindications associated with that drug.”) (citing Stanbeck v. Parke, Davis and Co., 657 F.2d 642, 643 (4th Cir.1981) (discussing the learned _intermediary doctrine))._ (34) Ohio Tracy v. Merrell Dow Pharm., Inc., 569 N.E.2d 975 (Ohio 1991) (applying the doctrine to manufacturer of nicotine chewing gum); Seley v. G.D. Searle & Co., 423 N.E.2d 831 (Ohio 1981) (applying _the doctrine to oral contraceptives)._ (35) Oklahoma Edwards v. Basel Pharm., 933 P.2d 298 (Okla.1997) (applying the doctrine, but noting an exception for nicotine patches because the FDA mandated direct warnings to consumers); McKee v. Moore, 648 P.2d 21, 24 (Okla.1982) (applying the doctrine to intrauterine _devices).__ (36) Oregon McEwen v. Ortho Pharm. Corp., 528 P.2d 522 (Or.1974) (applying the doctrine to oral contraceptives); Allen v. G.D. Searle & Co., 708 F.Supp. 1142,1148 (D.Or.1989) (applying the doctrine to _intrauterine devices under Oregon law)._ (37) Pennsylvania Taurino v. Ellen, 579 A.2d 925, 928 (Pa.Super.Ct.1990) (applying the doctrine to oral contraceptives); Breaker v. Cutler, 578 A.2d 481 (Pa.Super.Ct.1990) (applying the doctrine to intrauterine devices). Puerto Rico Pierluisi v. E.R. Squibb & Sons, Inc., 440 F.Supp. _691 (D.P.R.1977) (applying Puerto Rican law)._ (38) Rhode Island Hodges v. Brannon, 707 A.2d 1225 (R.I.1998) (indicating that the doctrine applies in Rhode Island because the court mentioned a jury instruction given by the trial court showing that it had _applied the doctrine at trial)._ (39) South Brooks v. Medtronic, Inc., 750 F.2d 1227,1231 (4th Cir.1984) Carolina (applying South Carolina law); Odom v. G.D. Searle & Co., 979 F.2d 1001 (4th Cir.1992) (applying the doctrine to intrauterine _devices under South Carolina law)._ (40) South Dakota McElhaney v. Eli Lilly & Co., 575 F.Supp. 228 (D.S.D.1983) (apply-_ing South Dakota law), aff'd, 739 F.2d 340 (8th Cir.1984)._ (41) Tennessee Pittman v. Upjohn Co., 890 S.W.2d 425, 429 (Tenn.1994); Dunkin v. Syntex Lab., Inc., 443 F.Supp. 121 (W.D.Tenn.1977) (applying the _doctrine to oral contraceptives under Tennessee law)._ (42) Texas In re Norplant Contraceptive Prod. Liab. Litig., 955 F.Supp. 700, 703-05 (E.D.Tex.1997), aff'd, 165 F.3d 374 (5th Cir.1999); Wyeth-Ayerst Lab. Co. v. Medrano, 28 S.W.3d 87, 91 (Tex. Ct.App.-Texarkana 2000); Porterfield v. Ethicon, Inc., 183 F.3d 464, 467-68 (5th Cir.1999) (citing Aim v. Aluminum Co. of _America, 717 S.W.2d 588, 591-92 (Tex.1986))._ (43) Utah Barson v. E.R. Squibb & Sons, Inc., 682 P.2d 832 (Utah 1984) (recognizing that the duty of a prescription drug manufacturer is _to adequately warn the medical profession)._ (44) Virginia Pfizer, Inc. v. Jones, 272 S.E.2d 43 (Va.1980) (holding that drug manufacturer was not liable for warnings adequately given to _physicians).___ (45) Washington Terhune v. AH. Ruobins Co., 577 P.2d 975 (Wash.1978) (applying _the doctrine to intrauterine devices)._ (46) West Virginia Pumphrey v. C.R. Bard, Inc., 906 F.Supp. 334 (N.D.W.Va.1995) (applying the doctrine and promulgating two reasons why the _court believes that West Virginia would adopt the doctrine). (47) Wisconsin Lukaszewicz v. Ortho Pharm. Corp., 510 F.Supp. 961, 963 (D.Wis. 1981) (recognizing the doctrine under Wisconsin law, but applying an exception for oral contraceptives because federal regulations _require the manufacturer to warn the patient directly)._ (48) Wyoming Jacobs v. Dista Prod. Co., 693 F.Supp. 1029,1036 (D.Wyo.1988) (applying Wyoming law). Accordingly, the learned intermediary doctrine applies or is recognized, without relevant exception, in the 48 states listed above, along with the District of Columbia and Puerto Rico. In jurisdictions where the doctrine is merely recognized and not specifically applied in the common law, the court will defer to the great weight of case authority, which shows that the doctrine is applicable in the majority of jurisdictions in the United States, and consider the learned intermediary doctrine germane to the common law. Further, the highest courts in certain jurisdictions listed above have not yet decided the precise application of the doctrine. Instead, state appellate courts and federal district or appellate courts have applied the doctrine when analyzing state law. “Where the issues involved are ones upon which the state supreme court has not yet ruled, federal courts must attempt to predict how the state supreme court, if presented with the question, would decide the issue.” In re Norplant Contraceptive Prod. Liab. Litig., 955 F.Supp. at 703-05 (citing Vernon v. City of Los Angeles, 27 F.3d 1385, 1391 (9th Cir.1994)), aff'd, 165 F.3d 374 (5th Cir.1999). For all of those jurisdictions, the court will make an Erie guess that each state supreme court would find the learned intermediary doctrine applicable regarding the Norplant cases. Id. at 703 n. 12 (stating that federal courts may consider lower state court opinions in making an Erie guess); see also Erie v. Tompkins, 304 U.S. 64, 58 S.Ct. 817, 82 L.Ed. 1188 (1938). With reference to Vermont, which is not listed in the table above, the court could not find any case making reference to the learned intermediary doctrine when discussing Vermont law. It is possible that no state or federal court in Vermont has decided whether the doctrine applies in that state. Nonetheless, based on the sheer number of jurisdictions that apply the doctrine, the court will make an Erie guess that the Vermont supreme court, if presented with the issue, would hold that the learned intermediary doctrine applies in Vermont without an exception relevant to the Norplant cases. Two more states merit further discussion: Massachusetts and New Jersey. Massachusetts, as noted in the table above, recognizes and applies the learned intermediary doctrine, but its supreme court recognizes a special exception to the doctrine for oral contraceptives. See MacDonald v. Ortho Pharm. Corp., 394 Mass. 131, 475 N.E.2d 65 (1985). In MacDonald, the Massachusetts Supreme Court held that the learned intermediary doctrine does not shield a manufacturer of birth control pills from its duty to warn the consumer directly of the dangers inherent in the use of birth control pills. Id. at 68. The court declared that “[ojral contraceptives ... bear peculiar characteristics which warrant the imposition of a common law duty on the manufacturer to warn users directly of associated risks.” Id. at 69. Specifically, the court reasoned that oral contraceptives differ from other prescription drugs in five ways: (1) patients participate directly in decisions relating to the use of oral contraceptives; (2) the use of oral contraceptives presents substantial risks; (3) the FDA has explicitly required manufacturers of this particular oral contraceptive to provide the consumer with warnings directly; (4) the physician’s role in prescribing oral contraceptives is limited; and (5) oral communications between physicians and consumers may be insufficient to fully apprise consumers of the product’s dangers. Id. at 69-70. Given the reasoning behind MacDonald and recent Massachusetts state court opinions, the court does not believe that MacDonald creates an exception to the learned intermediary doctrine that renders the doctrine inapplicable to the Norplant cases. First, Norplant is an implant and not an oral contraceptive. Although some concerns voiced by the Massachusetts Supreme Court may relate to Norplant since, like oral contraceptives, it is a prescription contraceptive, one major difference is apparent: with Norplant, the FDA did not expressly require Norplant’s manufacturers to warn the consumer directly. Also, at least two Massachusetts state courts interpreted MacDonald as a “narrow exception to the learned intermediary rule,” thereby limiting its application to oral contraceptives only. “Massachusetts has not extended this narrow duty to warn consumers directly, even for manufacturers of other forms of birth control.” Linnen v. A.H. Robins Co., Inc., No. Civ. A. 97-2307, 2000 WL 89379, at *2 (Mass.Super.Ct., Dec. 14, 1999) (citing Raimer v. Searle, Civil Action No. 870248, (Berkshire Super. Ct., Jan. 31, 1990) (holding that a manufacturer of intrauterine devices had no duty to warn the consumer about the product’s risks where no federal regulations required the manufacturer to warn the consumer directly)). Thus, the court finds that the learned intermediary doctrine should be applied, without exception, to the Norplant cases in this multidistrict litigation to the extent Massachusetts law governs. Consequently, the court will apply the doctrine, without exception, to any Plaintiff who both filed her case and had the Norplant device implanted in a state or territory listed in the table above, as well as Vermont. In looking at each case, if both jurisdictions are enumerated in the above table, the court need not conduct a conflict of laws analysis because no conflict exists when the learned intermediary doctrine applies or is recognized in the jurisdiction of filing and the jurisdiction of implantation. A different problem arises with Plaintiffs who failed to supply the court with the jurisdiction in which Norplant was implanted. On February 17, 1998, the court signed an order “directing all joined plaintiffs in any single case filed on or after October 4, 1996, who have failed to allege in their original complaints the state in which each joined Plaintiff had the implantation of Norplant performed, to provide the court such information via an offer of proof on or before April 17, 1998.” Order of Feb. 17, 1998, at 1. The court warned that it would dismiss without prejudice all joined Plaintiffs who failed to provide the court with the requested information by the aforementioned deadline. Id. at 2. The court further ordered “all joined plaintiffs in any single case filing Norplant claims after [February 17, 1998] to allege in their original complaints the state in which Norplant implantation was performed for each joined plaintiff.” Id. Thus, by now all pending Norplant Plaintiffs should have furnished the court with both the jurisdiction of filing and the jurisdiction of implantation. Notwithstanding the previous order, the court believes that the most efficient resolution of the pending cases is by way of these motions for partial summary judgment. Accordingly, for purposes of deciding these motions, the court will proceed as follows: if Plaintiffs failed to supply the court with the state of implantation, or for some reason that information is not readily available, the court will assume the jurisdiction of implantation is the same as the jurisdiction in which Plaintiff filed her case. Thus, no choice of law analysis is necessary for those Plaintiffs. 2. The New Jersey Exception To The Learned Intermediary Doctrine In Norplant Cases The New Jersey Supreme Court has held that the learned intermediary doctrine does not apply when a manufacturer of prescription drugs or medical devices markets its product directly to the consumer. In Perez v. Wyeth Lab. Inc., 161 N.J. 1, 734 A.2d 1245 (1999), the New Jersey Supreme Court recognized the learned intermediary doctrine, but refused to apply it in a case involving the Norplant contraceptive device because it was advertised directly to consumers in popular magazines. 734 A.2d at 1248, 1257-58. The court reasoned that such advertisements allow patients to actively participate in the choice of medication. Id. at 1256-57. Additionally, the court determined that the advertisements “encroach” on the doctor patient relationship by encouraging consumers to ask for advertised products by name. Id. at 1256. The court found that consumer advertising of Norplant “alters the calculus” of the doctrine and “belies ... the premises on which the learned intermediary doctrine rests.” Id. at 1254, 1256. “[W]hen mass marketing of prescription drugs seeks to influence a patient’s choice of a drug, a pharmaceutical manufacturer that makes direct claims to consumers for the efficacy of its product should not be unqualifiedly relieved of a duty to provide proper warnings of the dangers or side effects of the product.” Id. at 1247. Since Perez, no other court in any jurisdiction has directly addressed an advertising exception to the learned intermediary doctrine, making New Jersey the only jurisdiction to recognize this exception. Accordingly, New Jersey’s advertising exception renders the learned intermediary doctrine wholly inapplicable to Norplant cases in this multidistrict litigation, but only to the extent that this court is required to follow the substantive law of New Jersey in deciding the instant motion. This means that New Jersey law is in direct conflict with the law of every other jurisdiction in the United States. Because the court must determine which jurisdiction’s law to apply by looking at each individual case in this litigation, the court will examine pending cases that have a factual nexus to New Jersey and perform a choice of law analysis, if necessary. The court will primarily consider the jurisdiction where each Plaintiff had the Norplant device implanted, as well as the jurisdiction in which each Plaintiff filed her case. If both of these states are New Jersey, no choice of law discussion is necessary because New Jersey law clearly applies in that case and, as such, the instant motion would not pertain to that Plaintiff. However, no remaining Plaintiffs fall into this category. In the event that a Plaintiff filed her case in a jurisdiction such as Texas, but had the Norplant device implanted in New Jersey, the court would need perform a choice of law analysis because Texas law directly conflicts with New Jersey law regarding the learned intermediary doctrine. In this scenario, because the court must apply the law of the state in which each case was filed, the court would utilize Texas choice of law rules to resolve which state’s substantive law applies to that particular Plaintiff. See Huddy v. Fruehauf Corp., 953 F.2d 955, 956 (5th Cir.1992). Alternatively, if a Plaintiff filed her case in New Jersey, but Texas was the state of implantation, the court would apply New Jersey choice of law rules to that Plaintiff. After a comprehensive choice of law analysis in all necessary cases, the court will know with certainty to whom this motion applies. a. Plaintiffs Who Filed In New Jersey, But Had Norplant Implanted In Another Jurisdiction The first group of cases the court will examine are those wherein Plaintiffs filed in New Jersey, but had the Norplant device implanted in another jurisdiction. Because Plaintiffs addressed in this section filed in New Jersey, its choice of law rules apply. Emy v. Estate of Merola, 171 N.J. 86, 792 A.2d 1208, 1212 (2002) (citing Fu v. Fu, 160 N.J. 108, 733 A.2d 1133 (1999)). i. New Jersey Choice Of Law Rules New Jersey recognizes the Restatement (Second) of Conflict of Laws when determining choice of law issues. Id. at 1213. Under section 172 of the Restatement, the law of the site of the conduct and injury provides the presumptively applicable law. Id. at 1215-16; Restatement (Second) of ConfliCT of Laws § 172 (1971). New Jersey courts additionally employ a flexible “governmental-interest” analysis to determine which jurisdiction has the greatest interest in governing the specific issue that arises in the underlying litigation. Seiderman v. American Inst. for Mental Studies, 667 F.Supp. 154, 156 (D.N.J.1987) (citing Melik v. Sarahson, 49 N.J. 226, 229 A.2d 625 (1967)). “The first prong of the governmental-interest test requires the Court to determine whether there is an actual conflict between the laws of the states involved.” Erny, 792 A.2d at 1216 (citations omitted). Here, there is unquestionably an actual conflict between the application of the learned intermediary doctrine in New Jersey versus every other United States jurisdiction. The New Jersey Supreme Court fashioned an exception to the learned intermediary doctrine when a manufacturer of prescription drugs markets its product directly to consumers. Perez, 734 A.2d at 1257-58. In contrast, every other jurisdiction recognizes the learned intermediary doctrine without an exception for direet-to-consumer advertising. See Table Summarizing Case Law, supra, at 806-09. Those jurisdictions, though they may permit different exceptions to the doctrine, excuse a drug manufacturer from warning patients who receive its product when the manufacturer properly warns the prescribing healthcare provider of the product’s dangers regardless of any marketing to consumers. The second prong of the governmental interest analysis requires the court to determine the interests each jurisdiction has in applying the learned intermediary doctrine, or relevant exception, to the parties in this litigation. Erny, 792 A.2d at 1216 (citation omitted); see also Veazey v. Doremus, 103 N.J. 244, 510 A.2d 1187, 1189 (1986) (Courts must “identify the governmental policies underlying the law of each state and how those policies are affected by each state’s contacts to the litigation and the parties.”) (citations omitted). “If the contacts do not align with the policies, the state has no interest in applying its law.” Erny, 792 A.2d at 1216-17 (citations omitted). Five factors culled from section 145 of the Restatement guide courts in applying the governmental interest analysis: (1) the interests of interstate comity; (2) the interests of the parties; (3) the interests underlying the field of tort law; (4) the interests of judicial administration; and (5) the competing interests of the states. Id. (citing Fu, 733 A.2d at 1140-41); Restatement (SeCOnd) of Conflict of Laws § 145 (1971). The primary factor is the competing interests of the states. Erny, 792 A.2d at 1217. Within that factor, the court should initially focus on the policies that the New Jersey Supreme Court intended to protect by applying the advertising exception to domestic concerns, and, then, whether applying the exception to the mul-tistate situation will further those concerns. Id. (citing Fu, 733 A.2d at 1142). The other four factors also require individual consideration. “When considering the interests of interstate comity, a court must determine ‘whether application of a competing state’s law would frustrate the policies of other interested states.’ ” Id. (quoting Fu, 733 A.2d at 1141). “When determining the interests underlying the field of tort law, a court must consider ‘the degree to which deterrence and compensation, the fundamental goals of tort law, would be furthered by the application of a state’s local law.’ ” Id. (quoting Fu, 733 A.2d at 1141). The court should give less weight to the final two factors in making choice of law determinations. The interests of the parties is relatively unimportant because “a person who causes an unintentional injury is not necessarily aware of the law that may be applied to the consequences of his actions.” Id. (citing Fu, 733 A.2d at 1141). Lastly, the interests of judicial administration offer courts the opportunity to consider the “practicality of applying a specific law in a given situation; however, to the extent that that factor conflicts with a strong state policy, the factor yields.” Id. (citing Fu, 733 A.2d at 1142). To give context to the governmental interest analysis, the court also must review the actual contacts of the parties with each related jurisdiction. The factual contacts that the court considers in determining which jurisdiction’s laws should apply include the following: (1) the place where the injury occurred; (2) the place where the conduct causing the injury occurred; (3) the domicile, residence, nationality, place of incorporation, and place of business of the parties; and (4) the place where the relationship, if any, between the parties is centered. Id. (citing Fu, 733 A.2d at 1142); see also Wuerffel v. Westinghouse Corp., 148 N.J.Super. 327, 372 A.2d 659, 662-63 (1977) (quoting Restatement (SECOND) CONFLICT OF LAWS § 145 (1971)). ii. Analysis Of New Jersey Choice Of Law Rules The court will proceed by noting the facts considered most significant to the governmental interest test. The court derived this factual information from close perusal of the record and by examining each Plaintiffs complaint or amended pleading. Because the court has already sifted through the specific facts of each case in preparing to draft this opinion, the court need not set forth the facts of each case here ad nauseam. Such attention to the minutia is unnecessary in this opinion and would prove tedious. This opinion will broadly present the facts gathered, noting any discrepancies or exceptions to the generalities where necessary. (1) The place where the injury occurred: the court believes that the jurisdictions where Plaintiffs had Norplant implanted qualify as the places where their injuries occurred. There is no evidence indicating that any Plaintiffs injury occurred in a place other than the jurisdiction of implantation. Thus, for all Plaintiffs in this section, the places where their injuries occurred are jurisdictions other than New Jersey. None of the Plaintiffs who filed in New Jersey were implanted with Norplant in New Jersey. (2) The place where the conduct causing the injury occurred: the court finds that the jurisdictions where Plaintiffs had Norplant implanted are also the places where the conduct causing the injuries occurred. No evidence suggests otherwise. Thus, for all Plaintiffs in this category, the conduct causing the injuries occurred in places other than New Jersey. (3) The domicile, residence, nationality, place of incorporation, and place of business of the parties: (a) Plaintiffs in this category reside in jurisdictions other than New Jersey. (b) Defendant American Home Products Corporation is a Delaware corporation with its principal place of business in New Jersey. Defendant Wyeth-Ayerst Laboratories, Inc., subsidiary of American Home Products Corporation, is a Delaware corporation with its principal place of business in Pennsylvania. Defendant Wyeth Laboratories, Inc., is a New York Corporation with its principal place of business in Pennsylvania. (4) The place where the relationship, if any, between the parties is centered: the places where Plaintiffs had Norplant implanted are the places where the parties’ relationships are centered. Plaintiffs in this category all had Norplant implanted in jurisdictions other than New Jersey. The aforesaid contacts are relevant to the extent that they implicate the policies underlying the conflicting applications of the learned intermediary doctrine. Erny, 792 A.2d at 1218 (citing Fu, 733 A.2d at 1142). The court next will apply the five factors drawn from section 145 of the Restatement to determine whether New Jersey or another jurisdiction, depending on the particular case, has the most significant relationship to the occurrence and parties in question. That determination is made by identifying the governmental policies underlying each jurisdiction’s application of the learned intermediary doctrine and then deciding how the contacts listed above influence those policies. Id. at 1218. As mentioned above, the competing interests of the states is the primary factor, followed by the interests underlying tort law, the interests of interstate comity, the interests of the parties, and the interests of judicial administration. Id. (citation omitted). First, the court will examine the competing interests of New Jersey as opposed to the other jurisdictions. As previously mentioned, the learned intermediary doctrine has long acted as an exception to a manufacturer’s duty to warn by allowing a drug company to warn the healthcare provider instead of the patient directly. See Porterfield v. Ethicon, Inc., 183 F.3d 464, 467-68 (5th Cir.1999). State courts generally identify four theoretical justifications for the doctrine. First, states want to preserve the doctor-patient relationship, which could be undermined if patients received warnings from drug manufacturers that differed from their doctor’s warnings. Perez, 734 A.2d at 1255 (citing Lars Noah, Advertising Prescription Drugs to Consumers:' Assessing the Regulatory and Liability Issues, 32 Ga. L.Rev. 141, 157-59 (1997)). Second, physicians are in a better position to convey information to patients than manufacturers. Id. Third, manufacturers lack an efficient means to communicate warnings to individual consumers. Id. Finally, states are concerned that patients cannot comprehend complex medical information, and it is too burdensome for pharmaceutical companies to translate the medical jargon into understandable language. Id. At bottom, states that recognize the learned intermediary doctrine reduce the exposure of pharmaceutical corporations to liability for product warnings. New Jersey also recognizes the learned intermediary doctrine in certain circumstances. Perez, 734 A.2d at 1250, 1257 (“ Tn New Jersey ... we accept the proposition that a pharmaceutical manufacturer generally discharges its duty to warn the ultimate users of prescription drugs by supplying physicians with information about the drug’s dangerous propensities.’ ”) (citation omitted). With the Perez decision, however, the New Jersey Supreme Court refused to apply the learned intermediary doctrine to Norplant because Defendants advertised Norplant directly to consumers. Id. at 1248, 1257-58. This decision was the first and only to recognize such an exception to the doctrine for Norplant and, in so doing, broke with every other jurisdiction on the application of the learned intermediary doctrine. See Table Summarizing Case Law, supra, at 806-09. The Perez court reasoned that direct-to-consumer advertising undercuts all four theoretical justifications for the learned intermediary doctrine. Perez, 734 A.2d at 1255-56. The court also emphasized the increasingly important part played by patient choice in modern drug prescription. Id. at 1257. The court concluded that direct advertising unduly influences consumers and belies the necessity of a learned intermediary. Id. at 1247, 1257-58. Perez essentially declines to afford drug manufacturers the benefit of using the learned intermediary doctrine as a shield from liability if they attempt to influence consumers via advertising. Thus, the policies underlying New Jersey’s advertising exception to the learned intermediary doctrine promote accountability for drug manufacturers if they choose to advertise their products directly to consumers. Unlike New Jersey, however, every other jurisdiction considers the doctrine appropriate in litigation like Norplant. Some jurisdictions recognize different exceptions to the doctrine, but none carve out an exception for direet-to-con-sumer advertising. New Jersey’s policies thus reflect the minority view regarding the scope of the learned intermediary doctrine. The overwhelming majority of jurisdictions either disagree or have not yet adopted the exception as law. The court must next examine the interests of interstate comity and determine whether application of a competing state’s law would frustrate the policies of other interested states. Erny, 792 A.2d at 1217. Plaintiffs at issue filed their cases in New Jersey and, thus, the court must consider its interests. But, keeping in mind the actual contacts of the parties, New Jersey is relatively unimportant: Plaintiffs’ injuries and the conduct causing the injuries occurred in jurisdictions other than New Jersey; Plaintiffs and Defendants — except Wyeth-Ayerst Laboratories, Inc., which has its principal place of business in New Jersey — reside in jurisdictions other than New Jersey; and the places where the parties’ relationships are centered are jurisdictions other than New Jersey. Hence, Plaintiffs’ contacts with New Jersey are minimal at best. If the court decided to apply New Jersey law to the affected Plaintiffs, it would thwart the policies of many other jurisdictions in the United States. In addition to the above factors, the court must consider how the laws in issue