Trustees of Columbia University v. Columbia/HCA Healthcare Corp.

OPINION AND ORDER

This case concerns a dispute over the right to use the mark “Columbia,” alone and in combination with other words or phrases, in connection with the provision of medical and healthcare services. The plaintiff, The Trustees of Columbia University in the City of New York, alleges that the use of the name “Columbia” by the defendant, Columbia/HCA Healthcare Corporation, in connection with the provision of medical and healthcare services is likely to cause confusion, or to cause mistake, or to deceive the public as to the source or sponsorship of the defendant’s services and the services of its affiliated physicians and to mislead the public into believing that the defendant’s services emanate from, are approved or sponsored by, or are in some way associated or connected with the plaintiff. The plaintiff asserts claims under the Lanham Act, as amended, 15 U.S.C. § 1051 et seq., for false designation of origin, infringement of a registered trademark, and dilution of a famous mark, under New York’s anti-dilution statute, and under the common law for trademark infringement and unfair competition. The plaintiff seeks injunctive relief, damages, an accounting for profits, treble damages, prejudgment interest, attorneys’ fees, and the costs and disbursements of the action. The plaintiff also asks that the defendant be required to run a program of corrective advertising.

Following an eight-day non-jury trial and after reviewing all of the submissions of the parties and having assessed the credibility of all of the witnesses, the Court makes the following findings of fact and conclusions of law:

FINDINGS OF FACT

1. This Court has jurisdiction over the federal causes of action for alleged violations of the Lanham Act under 15 U.S.C. § 1121 and 28 U.S.C. §§ 1331 and 1338(a). Jurisdiction over the supplemental state-law claims exists under 28 U.S.C. §§ 1338(b) and 1367(a).

2. The plaintiff is a non-profit corporation organized and existing under the laws of the State of New York, having its principal place of business in the City of New York within this judicial district. (Joint Pre-Trial Order, Undisputed Facts (“UF”), ¶ 4a.)

3. The defendant is a for-profit corporation organized and existing under the laws of the State of Delaware, having its principal place of business in Nashville, Tennessee. The defendant, through numerous subsidiaries, joint ventures and/or partnerships, owns and operates proprietary hospitals and ambulatory health care facilities throughout the United States, which it advertises and promotes in television and print advertising that is broadcast or circulated throughout the United States, including New York. (UF ¶ 4b.)

4. The plaintiff has long been one of the world’s leading research and teaching universities that offers post-secondary and postgraduate education in a wide variety of intellectual and professional disciplines, including medicine. (UF ¶ 4c; Morris Witness Statement (“W.S.”) ¶ 2.)

*737 5. Originally named Kings College upon its founding in 1754, the college was renamed Columbia College following the American Revolution and was subsequently renamed Columbia University. (UP ¶ 4d.)

6. The plaintiff uses the name “Columbia University” in connection with various educational services. It is the owner of a federal registration for the service mark “Columbia University” in connection with “educational services.” (Pl.’s Ex. 1.)

7. The plaintiff has over a period of 200 years established itself as one of the preeminent names in medical education. The Columbia University College of Physicians and Surgeons, known generally as Columbia Medical School (the “Medical School”), as well as the School of Dental and Oral Surgery, the School of Nursing, and the School of Public Health, are regarded as among the most distinguished centers for medical education in the United States. (UP ¶ 4e; Weisfeldt W.S. (Pl.’s Ex. 229) ¶¶ 16-17; Polf W.S. (Pl.’s Ex. 230) ¶ 7.) The Medical School attracts some of the most highly qualified applicants from the United States and abroad, and medical interns and residents from around the world seek out facilities associated with the plaintiff for their training. (Weisfeldt W.S. (Pl.’s Ex. 229) ¶ 16; Morris W.S. (Pl.’s Ex. 226) ¶ 10.)

8. The plaintiffs faculty physicians have garnered widespread public recognition and fame for the quality of their medical skills, research, and leadership in education. A number of them have been awarded Nobel prizes and have been responsible for major medical breakthroughs, including the development of heart catheterization, the development of the first blood test for cancer, the first medical use of a laser, and the first successful transfer of genes from one cell to another. In recent years, the plaintiff has risen to fourth place among all medical institutions in the United States in the amount of federal funding that it has received for biomedical research. (Morris W.S. (PL’s Ex. 226) ¶ 9; Weisfeldt W.S. (PL’s Ex. 229) ¶ 17; PL’s Exs. 7-9,10b.)

9. As an institution, the plaintiff is not engaged in the practice of medicine and is not licensed to provide medical services. (Morris Trial Test, at 196-98, 389; Polf Trial Test. 535.) The plaintiff permits the members of the faculty of its medical school to engage in the private clinical practice of medicine through its physician practice plans. Patients treated under the practice plans are billed directly by the plaintiff, and all monies paid by these patients are deposited into accounts owned by the plaintiff. After payment of the medical staff salaries, the plaintiff and its medical departments receive approximately five to ten percent of the total income from the practice plans. (Weisfeldt W.S. (PL’s Ex. 229) ¶5, 9; Weisfeldt Trial Test, at 475-80; PL’s Exs. 74f, 75.)

10. In 1921, the plaintiff entered into an alliance with The Presbyterian Hospital in the City of New York, a non-profit hospital, to form the world’s first academic medical center. The twin goals of the alliance were to secure the best possible medical treatment for the sick and injured, and to provide for medical education and research of the highest order. The medical center uses the name “Columbia-Presbyterian Medical Center.” (UF ¶ 4f; Morris W.S. (PL’s Ex. 226) ¶4; PL’s Ex. 19a; PL’s Ex. 24 at P4056.)

11. The present day Columbia-Presbyterian Medical Center is comprised of several different hospital centers, doctors’ offices, and institutes for the treatment of patients including the Presbyterian Hospital 1 and the plaintiff’s various Health Sciences schools, including the Medical School, the School of Nursing, the School of Public Health, and the School of Dental and Oral Surgery. (UF ¶ 4g.)

12. Pursuant to the alliance between the Presbyterian Hospital and the plaintiff, all attending physicians on the staff of the Presbyterian Hospital are nominated by the plaintiff from the faculty of its Medical School. Moreover, the academic department *738 heads at the plaintiffs Medical School all serve as the chiefs of the Presbyterian Hospital’s clinical services. (UF. ¶ 4h; Morris W.S. (Pl.’s Ex. 226) ¶ 6; Morris Trial Test, at 384-85; Pl.’s Ex. 19a.) Notwithstanding their affiliation, the Presbyterian Hospital and the plaintiff are separate entities that maintain separate trustees, officers, and public relations offices.. (Morris Trial Test, at 329.) Article One of the operative Alliance Agreement between the plaintiff and the Presbyterian Hospital expressly provides that each institution is to maintain its own independent existence and control. (Pl.’s Ex. 19a; Morris Trial Test, at 329.)

13. Pursuant to the alliance, the plaintiff has orally authorized and licensed the use of the Columbia name to be combined with the name of the Presbyterian Hospital as part of the joint mark “Columbia-Presbyterian Medical Center” that is used by both parties for the services provided by the center. The terms and restrictions of the license are reflected and confirmed in the 1994 Public Relations/Media Guidelines for the Columbia-Presbyterian Medical Center. (Polf W.S. (PL’s Ex. 230) ¶¶ 11-12; Morris ¶5; PL’s Ex. 76.)

14. Pursuant to the alliance, the plaintiff has also orally consented to the use of the “Columbia” name by the Columbia-Presbyterian Medical Center Fund, Inc. (“the Fund”), which owns a federal service mark registration for the “Columbia-Presbyterian Medical Center” mark 2 for “medical care services.” (Morris W.S. (PL’s Ex. 226) at ¶5 & n. 1;. PL’s Ex. 2.) The Fund has granted the plaintiff and the Presbyterian Hospital an irrevocable license to use the “Columbia-Presbyterian Medical Center” logo. (Def.’s Ex. CU.) There is no agreement between the plaintiff and the Presbyterian Hospital that provides that the Presbyterian Hospital cannot continue to use the Columbia-Presbyterian name if the alliance between the two institutions were discontinued. (Morris Trial Test, at 332.)

15. At present, the plaintiff and the Presbyterian Hospital are separately, or jointly, affiliated with several other hospitals and ambulatory facilities located in New York, New Jersey, and Connecticut. For example, the plaintiff has a University affiliation with Harlem Hospital Center, New York State Psychiatric Institute, and St. Luke’s-Roosevelt Hospital Center in New York City; with Helen Hayes (New York State Rehabilitation Hospital) and Mary Imogene Bassett Hospital in upstate New York; and with Overlook Hospital in New Jersey. The plaintiff and the Presbyterian Hospital are jointly affiliated with Horton Hospital, Lawrence Hospital, Nyack Hospital, St. Francis Hospital, and White Plains Hospital Center in New York; The Valley Hospital in New Jersey; and New Milford Hospital in Connecticut. (Morris W.S. (PL’s Ex. 226) ¶ 16; Morris Trial Test, at 81-82; Tenenbaum Trial Test, at 559-61; PL’s Ex. 22.)

16. In connection with recent merger talks between the Presbyterian Hospital and New York Hospital, which is affiliated with Cornell University’s medical school, faculty physicians from the plaintiff and Cornell University have formed an alliance designated “Columbia-Comell Care.” The Columbia-Cornell alliance was formed to help increase marketing and advertising of the services of the affiliated physicians and to negotiate more favorable contracts with HMOs and managed care medical insurers. (Weisfeldt W.S. (PL’s Ex. 229) ¶¶ 31-33; Weisfeldt Trial Test, at 442-44, 500-03; Tenenbaum W.S. (PL’s Ex. 231) ¶ 22; Pardes W.S. (PL’s Ex. 228) ¶ 8.)

17. The Presbyterian Hospital, the Columbia-Presbyterian Medical Center, and the Columbia-Presbyterian Medical Center Fund are not parties in this action.

18. Although the media often shortens the full terms “Columbia-Presbyterian Medical Center,” “Columbia-Presbyterian,” or “Columbia University,” to “Columbia” in the course of reports, those reports almost always contain the other identifying names. 3

*739 lb. The plaintiff publishes and distributes promotional materials aimed at public consumers, primarily under the names “Columbia University,” “Columbia-Presbyterian,” and “Columbia-Presbyterian Medical Center.” 4 (Pl.’s Exs. 24-39, 42-65, 68.) It has sponsored only one print advertisement relating to medical services in The New York Times entitled “Columbia University Doctors Are New York’s Best.” (Pl.’s Ex. 5; Polf Trial Test, at 537-38.) The plaintiff has never advertised any healthcare services on television or radio. The hospitals that are affiliated with the plaintiff and/or the Presbyterian Hospital advertise and promote this affiliation in print and on radio. (Morris W.S. (Pl.’s Ex. 226) ¶ 16; Tenenbaum W.S. (PL’s Ex. 231) ¶ 8; PL’s Ex. llc-d.)

20. In early 1996, the plaintiff and the Presbyterian Hospital retained the advertising firm, Bozell Worldwide, to prepare a coordinated advertising campaign to promote the services of the Columbia-Presbyterian Medical Center. Both the plaintiff and the Presbyterian Hospital intend to share the expense of the campaign, which is budgeted at approximately $2 million. (Polf W.S. (PL’s Ex. 230) ¶ 18; Rose Trial Test, at 112-14; Weisfeldt Trial Test, at 440-42; PL’s Ex. 14.) The major thrust of the campaign is scheduled to begin in 1997 towards the end of the winter. (Polf W.S. (PL’s Ex. 230) ¶ 20.)

21. The plaintiff maintains an Internet Web page at “Columbia.edu” with a well-known and highly regarded medical information service under the name “Go Ask Alice.” The Columbia-Presbyterian Medical Center similarly maintains a “CPMC” Web site that is linked to the plaintiffs site. (Tenenbaum W.S. (PL’s Ex. 231) ¶ 28.)

22. The plaintiff does not own, nor has it attempted to secure, any United States Registration for the mark “Columbia University” or any other variation of the “Columbia” name in connection with medical, hospital, or healthcare services. (Morris Trial. Test, at 91.)

23. The word “Columbia” is a term with historic, patriotic, and geographic connotations. An article entitled “Topic of the Times,” which appeared in the New York Times on October 12, 1996, explained that the word “Columbia” is a term derived from Columbus and is sometimes used as a synonym for America. (Def.’s Ex. MB.) Webster’s Ninth New Collegiate Dictionary defines it as “the United States.” (Def.’s Ex. EQ.)

24. The defendant is the largest provider of healthcare services in the United States, operating approximately 340 hospitals, 130 surgery centers, and over 200 home healthcare agencies, all of which use some variation of the “Columbia” name. Since its founding in 1987, the defendant has grown to become the ninth largest private employer in the United States with over 285,000 employees. (Scott Dec. ¶ 5, 7.)

25. The defendant’s CEO, Richard Scott, who was trained as a lawyer rather than a doctor, initially selected the name “Columbia” because it sounded positive and national in scope, which was consistent with his vision for the company. In selecting the name, Mr. Scott was not aware of any potential conflicts with any entities in the healthcare industry that use the name. Although he had heard of the plaintiff and its law school, he was not aware at that time that the plaintiff had a medical school and was not aware of the Columbia-Presbyterian Medical Center. (Scott W.S. (Def.’s Ex. HG) ¶ 3; Scott Trial Test, at 652, 654.) The defendant has continuously used the word “Columbia” as part of its corporate name since 1987. (UF ¶ 4i.)

26. Defendant is the successor to the Columbia Hospital Corporation, which was first formed in 1987 and owned and operated hospitals or other medical facilities in Texas. Through additional acquisitions, the Columbia Hospital Corporation grew to a base of approximately 12 hospitals located in Texas and Florida by 1991. (UF ¶ 4j.)

27. By 1992, the defendant owned and operated 24 hospitals in Texas and Florida. In September 1993, the defendant merged with Galen Health Care Corporation and in *740 creased its size to 115 facilities in 18 states. In February, 1994, the defendant merged with Hospital Corporation of America (“HCA”), which then operated more than 90 hospitals, and the defendant changed its name to the present Columbia/HCA Healthcare Corporation. In April 1995, the defendant merged with Healthtrust, Inc. — The Hospital Corporation, and increased its size to approximately 327 hospitals. (UF ¶ 4k; Scott Trial Test, at 746-49; Pl.’s Exs. 80j-k.)

28. Prior to 1995, the use of the “Columbia” name and logo by the defendant’s hospitals was optional. (Scott Trial Test, at 751.) At its Spring 1995 Leadership Conference, the defendant discussed “the process of moving to one identity,” including putting the “Columbia” name on all facilities. (Scott Trial Test, at 751; Richardson Trial Test. 1028-29.) The defendant developed and began to use its Diamond <C$ logo with its name. In March 1995, the defendant issued a Merger Communications Plan regarding the up-coming merger with Healthtrust, which contained guidelines for the use of its name and Diamond <C$ logo in connection with its services and facilities. (Def.’s Ex. GK.) By August 1995, there were at least 45 facilities that were officially reported to be using “Columbia” as part of their name and in signage on their facilities. (Def.’s Ex. 10; Scott Trial Test, at 831-32.)

29. In August 1995, the defendant conducted a trademark search to make sure that the Diamond <C$ Columbia, without the HCA, did not conflict with any other uses of “Columbia.” (Def.’s Ex. 101; Richardson Trial Test, at 986-89, 1011-12.) The defendant then published particular graphics standards for use of the Diamond <C$ Columbia on all its facilities in a uniform way and on November 22, 1995, sent them to all division presidents and facility CEOs. (Def.’s Exs. FB, FJ; PL’s Ex. 98.)

30. In early 1996, the defendant distribuí ed Identity Conversion Guides to its facilities to help them develop a more consistent approach in complying with its required policy . that the facilities incorporate the Columbia name and Diamond <C$ logo. (Pl.’s Ex. 100; Bowling Trial Test, at 1077-79.) By August 1996, ninety-eight percent of the new signage was up on the defendant’s facilities. (Bowling Trial Test, at 1080.)

31. The defendant and its activities have been the subject of extensive media coverage, both local and national, particularly since 1992. (Def.’s Ex. GF, JH-JK, JM-JK; UF ¶ 4q.)

32. In late 1994, the defendant established an information and physician referral service using the telephone number 1-800-Columbia, and acquired exclusive rights to the number by January, 1995. (Richardson Trial Test, at 1000; Pl.’s Ex. 161; UF ¶ 40.) Calls to the number were initially received in the corporate office. (Fetherling Trial Test, at 1206-07.) The number was advertised by local facilities, (Def.’s Ex. KJ; Richardson Trial Test, at 1036) and has been featured on the defendant’s Internet Web site since April 1995. (Fetherling Trial Test, at 1206.) It was also featured in the defendant’s 1994 Annual Report. (Def.’s Ex. LY.) Due to increasing call volume, calls to the defendant’s 1-800-Columbia number are now handled by a computerized centralized call center in Dallas, Texas.. (Fetherling Trial Test, at 1207.) Beginning in April 1995, the defendant’s 1-800-Columbia number was featured in print advertisements. (Def.’s Ex. KJ.)

33. In January 1995, the defendant began to publish its Columbia One Source quarterly magazine. Distribution has risen from 800,000 households to approximately 5 million households. • (Scott Trial Test, at 799-800; Richardson Trial Test, at 1027-28; Bowling Trial Test, at 1126.)

34. Beginning in May 1995, the defendant piit up its “home page” on the Internet at “Columbia.net.” (UF ¶41; Def.’s Ex. HC.) It appears under a banner bearing the word Columbia along with the defendant’s design and' logo style for the Columbia name. Using hypertext links, the defendant’s web page is linked to a “Columbia Physicians Corner,” which provides transcripts of real time online conversations with “Columbia Physicians” on a variety of medical topics of interest to the general public. There is also a linked web page for “Columbia Physician to Physician,” which is intended to be a computer bulletin board where physicians can view or submit *741 articles written about their particular medical specialty and a “Columbia Physician Links” web page where individual “Columbia Physicians” are allowed to create links to their own individual web sites on which the physicians advertise and promote themselves. (UF ¶ 4n.) Currently, the defendant’s Internet site receives about one million hits per month. (Fetherling Trial Test, at 1161.)

35. In August 1995, defendant entered into an agreement with America Online, a major online computer and Internet service provider, to provide a variety of medical information and referral services “online” to America Online customers and other Internet users using the Internet domain name “Columbia.net.” Those services became available to the public in October 1995. (UF ¶ 4m; Fetherling W.S. (Def.’s Ex. HJ) ¶ 8.) A similar service has been offered on CompuServe since July 1996. (Fetherling W.S. (Def.’s Ex. HJ) ¶ 9.)

36. In September 1995, the defendant introduced a “Columbia” Visa card, which uses the Diamond <C$ Columbia logo. (Def.’s Ex. FI.)

37. From the inception of the company until approximately 1995, the individual or regional hospitals owned by the defendant were responsible for their own local advertising. (Bowling Trial Test, at 1113-14; Bowling W.S. (Def.’s Ex. HI) ¶ 9; Richardson W.S. (Def.’s Ex. HH) ¶ 6.)

38. Between August 1994 and October 1995, the defendant conducted three national surveys designed to measure the level of awareness of the defendant. (Pl.’s Exs. 92-93.) The report summarizing the three waves of consumer research concluded that “the vast majority (85%) of the United States population was not familiar with or aware of Columbia/HCA Healthcare Corporation.” (Pl.’s Ex. 93 at D1427-28 (emphasis in original); Richardson Trial Test, at 975.)

39. In December 1994 and January 1995, the defendant sponsored its first national television advertising. (Def.’s Ex. GG; Richardson W.S. (Def.’s Ex. HH) ¶ 6.) Between May and December 1995, the defendant also ran a series of national full page print ads featuring the Columbia name and Diamond <C$ logo in USA Today. (Def.’s Exs. FC-FF.)

40. In the fall of 1995, the defendant set in motion the process of selecting an advertising agency to conduct a “brand” campaign. (Richardson Trial Test, at 958.) In contrast to a mark, which consists of a company’s name and/or logo, a brand is a set of values, attitudes, and perceptions about the company that are associated with the company’s mark. (Adams Trial Test, at 251-52, 291-92; Adams W.S. (Def.’s Ex. HK) ¶ 5.)

41. In January 1996, the Martin Agency began work on the defendant’s “brand” campaign. The main goal was to build brand preference, not simply name awareness. (Adams Trial Test, at 248.)

42. Modem Healthcare’s January 1, 1996 issue predicted that “Columbia will become a name brand in healthcare.” (Pl.’s Ex. 174; Richardson Trial Test. 1032-34.)

43. In August 1996, the defendant commenced its nationwide television and print brand advertising campaign. Each print and television ad uses the defendant’s distinctive version of Columbia with the Diamond <C$ logo in a particular type style and in a particular color. (UF 4p; Def.’s Ex. GE.)

44. The plaintiff has been aware of the defendant, its history of growth and expansion, and its press coverage for several years. (Rose W.S. (Pl.’s Ex. 227) ¶ 7,14; Rose Trial Test, at ¶ 129; Morris W.S. (PL’s Ex. 226) ¶ 22; Morris Trial Test, at 347-48; Weisfeldt W.S. (PL’s Ex. 229) ¶ 34; Weisfeldt Trial Test. 454-55; Tenenbaum W.S. (PL’s Ex. 231) ¶ 4; Tenenbaum Trial at 561; Polf W.S. (PL’s Ex. 230) ¶21; Pardes W.S. (PL’s Ex. 228) ¶ 2.)

45. In February, 1993, the plaintiff appointed Richard Scott, the founder of Columbia Hospital Corporation and now the Chief Executive Officer of the defendant, to the plaintiffs Health Sciences Advisory Council. In Mr. Scott’s letter of acceptance to the Health Sciences Advisory Council, the letterhead displayed a prominent use of the word Columbia independent of the formal name of the company in the upper left hand corner. In announcing Mr. Scott’s appointment in its *742 1993-1994 brochure, the plaintiff described the defendant as follows: “Columbia was recently identified as the fourth fastest growing company in the United States.” Mr. Scott was reappointed to the Health Sciences Advisory Council in 1994 and in 1995. (Def.’s Exs. BH, BJ, BK; UF ¶ 4r.)

46. In September 1995, the plaintiffs School of Nursing gave Mr. Scott its “Second Century Award.” (UF ¶ 4r; Def.’s Exs. BL, BM, HE(c).) After the awards ceremony, Mr. Scott met with Dr. Rose, who is Director of the Surgical Service at the Presbyterian Hospital, Chairman of the Department of Surgery at the Columbia University College of Physicians and Surgeons, and Surgeon-in-Chief at the Columbia-Presbyterian Medical Center. (Rose. W.S. ¶ 1; Rose Trial Test, at 134.) Mr. Scott told Dr. Rose that the defendant would like to expand into the New York area if the legal prohibitions against such expansion were removed and that he expected that it eventually would happen. (Rose Trial Test, at 135-36.)

47. Prior to September 13, 1996, the day this action was filed, the plaintiff did not express any objection to the defendant regarding the defendant’s use of the word “Columbia.” (OF ¶ 4s.)

CONCLUSIONS OF LAW

1. The plaintiffs first and second claims for relief are for trademark infringement and false designation of origin under Section 32(1) and Section 43(a) of the Lanham Act, 15 U.S.C. §§ 1114(1) and 1125(a). Section 32(1) provides protection against the “reproduction, counterfeit, copy, or colorable imitation of a registered mark” and its application to “labels, signs, prints, packages, wrappers, receptacles or advertisements” where “such use is likely to cause confusion, or to cause mistake, or to deceive.” 15 U.S.C. § 1114(1). Section 43(a) protects both registered and unregistered marks against the use of any symbol or mark that “is likely to cause confusion, or to cause mistake, or to deceive as to the affiliation, connection, or association of such person with another person, or as to the origin, sponsorship, or approval of his or her goods, services, or commercial activities by another person____” 15 U.S.C. § 1125(a).

2. To succeed on its claims, the plaintiff must, as a preliminary matter, show that it has a valid mark that is entitled to protection. See Estee Lauder Inc. v. Gap, Inc., 108 F.3d 1503, 1508-09 (2d Cir.1997); Sports Auth., Inc. v. Prime Hospitality Corp., 89 F.3d 955, 960 (2d Cir.1996); Les Ballets Trockadero de Monte Carlo, Inc. v. Trevino, 945 F.Supp. 563, 569 (S.D.N.Y.1996). The plaintiff claims that its use of the mark “Columbia,” alone and in combination with other words and phrases, is entitled to protection in the field of medical or healthcare services.

3. The plaintiff is not entitled to a presumption of an exclusive right to use the Columbia mark in connection with medical or healthcare services. According to Section 7(b) of the Lanham Act, a certificate of registration of a trade or service mark issued by the United States Patent and Trademark Office is “prima facie evidence of the validity of the registered mark and of the registration of the mark, of the registrant’s ownership of the mark, and of registrant’s exclusive right to use the registered mark in commerce on or in connection with the goods or services specified in the certificate____” 15 U.S.C. § 1057(b). Although the plaintiff has obtained federal service mark protection for the name “Columbia University” for educational services, “the presumption of an exclusive right to use a registered mark extends only to the goods and services noted in a registration certificate.” Arrow Fastener Co., Inc. v. Stanley Works, 59 F.3d 384, 397 (2d Cir.1995); see also McGregor-Doniger Inc. v. Drizzle, Inc., 599 F.2d 1126, 1137 (2d Cir.1979). The plaintiff does not own any federal trademark registrations for Columbia, Columbia-Presbyterian, Columbia University, or any other mark in connection with medical or healthcare services.

4. Where a mark is not registered, the plaintiff has the burden of proving that its mark is a valid trademark. See Reese Publishing Co., Inc. v. Hampton Int’l Communications, Inc., 620 F.2d 7, 11 (2d Cir.1980); GMT Prods., L.P. v. Cablevision of New York City, Inc., 816 F.Supp. 207, 210 (S.D.N.Y.1993). The strength of a trademark in the marketplace and the degree of

*743 protection to which it is entitled are analyzed under four categories of marks that indicate increasing distinctiveness and proteetability: (1) generic; (2) descriptive; (3) suggestive; (4) arbitrary or fanciful. See Estee Lauder, 108 F.3d at 1508-09; Sports Auth., 89 F.3d at 961. Arbitrary or fanciful are sometimes described as separate categories. See Two Pesos, Inc. v. Taco Cabana, Inc., 505 U.S. 763, 768, 112 S.Ct. 2753, 2757, 120 L.Ed.2d 615 (1992). Generic marks are not protectable. Descriptive terms are protectable only with evidence of secondary meaning. Suggestive, arbitrary, and fanciful marks are eligible for protection without proof of secondary meaning. See Thompson Medical Co., Inc. v. Pfizer Inc., 753 F.2d 208, 212-13 (2d Cir.1985); Les Ballets Trockadero, 945 F.Supp. at 569.

5. The mark “Columbia,” used alone and in combination with other words and phrases, is arbitrary. It has a dictionary meaning — “the United States” — that bears no relationship to medical or healthcare services. See Gruner + Jahr USA Publishing v. Meredith Corp., 991 F.2d 1072, 1075-76 (2d Cir.1993) (“An arbitrary term is one that has a dictionary meaning — though not describing the product — like IVORY for soap.”); Jordache Enters., Inc. v. Levi Strauss & Co., 841 F.Supp. 506, 515 (S.D.N.Y.1993) (“Arbitrary marks consist of words that neither suggest nor describe any characteristic of the particular good or service with which it is used.”). The mark “Columbia” is therefore eligible for protection without proof of secondary meaning.

6. Once a mark is found to be entitled to protection under the Lanham Act, the central question is whether “numerous ordinary prudent purchasers are likely to be misled or confused as to the source of the product in question because of the entrance in the marketplace of the defendant’s mark,” Gruner, 991 F.2d at 1077; see also Estee Lauder, 108 F.3d at 1510; Sports Auth., 89 F.3d at 960; Arrow Fastener, 59 F.3d at 390-91, “or that there may be confusion as to [the] plaintiffs sponsorship or endorsement of the junior mark.” Hormel Foods Corp. v. Jim Henson Prods., Inc., 73 F.3d 497, 502 (2d Cir.1996); see also Dallas Cowboys Cheerleaders, Inc. v. Pussycat Cinema, Ltd., 604 F.2d 200, 204-05 (2d Cir.1979). Proof of actual confusion is not necessary. See Centaur Communications, Ltd. v. A/S/M Communications, Inc., 830 F.2d 1217, 1227 (2d Cir.1987); Web Printing Controls Co., Inc. v. Oxy-Dry Corp., 906 F.2d 1202 (7th Cir.1990). However, proof of actual confusion is probative of a likelihood of confusion. See Tisch Hotels, Inc. v. Americana Inn, Inc., 350 F.2d 609, 611 (7th Cir.1965); David Sherman Corp. v. Heublein, Inc., 340 F.2d 377, 380 (8th Cir. 1965).

7. The plaintiff alleges that there is a likelihood of both forward confusion and reverse confusion. Forward confusion is the traditional form of confusion in which the junior user uses the mark to sell goods or services based on the misperception that they originate with the senior user. See Sterling Drug, Inc. v. Bayer AG, 14 F.3d 733, 740 (2d Cir.1994); Sunenblick v. Harrell, 895 F.Supp. 616, 625 (S.D.N.Y.1995), aff'd, 101 F.3d 684 (2d Cir.), cert. denied, — U.S. -, 117 S.Ct. 386, 136 L.Ed.2d 303 (1996). “Reverse confusion exists when a subsequent user selects a trademark that is likely to cause consumers to believe, erroneously, that the goods marketed by the prior user are produced by the subsequent user.” Lang v. Retirement Living Publishing Co., Inc., 949 F.2d 576, 583 (2d Cir.1991); see also Sterling Drug, 14 F.3d at 741 (“Allowing such confusion claims comports with the dual purposes of the Act — namely, to protect the public from confusion as to the source of goods, and at the same time to protect the trademark holder from misappropriation of its mark.”); Sunenblick, 895 F.Supp. at 625 (describing reverse confusion as “the phenomenon in which the junior user’s advertising so greatly overshadows that of the senior user that consumers come to the mistaken conclusion that the junior user is in fact the source of the senior user’s goods.”).

8. In Polaroid Corp. v. Polarad Elecs. Corp., 287 F.2d 492 (2d Cir.), cert. denied, 368 U.S. 820, 82 S.Ct. 36, 7 L.Ed.2d 25 (1961), the Court of Appeals for the Second Circuit set forth eight non-exclusive factors that courts are to consider when determining whether a likelihood of confusion *744 exists. See also Estee Lauder, 108 F.3d at 1510; Sports Auth., 89 F.3d at 960-65; Hormel Foods, 73 F.3d at 502-05. In Polaroid, the court declared that:

[T]he prior owner’s chance of success is a function of many [v]ariables: the strength of his mark, the degree of similarity between the two marks, the proximity of the products, the likelihood that the prior owner will bridge the gap, actual confusion, and the reciprocal of defendant’s good faith in adopting its own mark, the quality of defendant’s product, and the sophistication of the buyers. Even this extensive catalogue does not exhaust the possibilities— the court may have to take still other variables into account.

Polaroid, 287 F.2d at 495. The decision as to whether a mark infringes requires a “comprehensive analysis of all the relevant facts and circumstances.” Vitarroz Corp. v. Borden, Inc., 644 F.2d 960, 968 (2d Cir.1981). The Court of Appeals for the Second Circuit has instructed that:

[T]he Polaroid factors are not, of course, “exclusive” and should not be applied “mechanically.” No single factor is dispositive, and cases may certainly arise where a factor is irrelevant to the facts at hand. But it is incumbent upon the district judge to engage in a deliberate review of each factor, and, if a factor is inapplicable to a case, to explain why. The steady application of Polaroid is critical to the proper development of trademark law, for it is only when the Polaroid factors are applied consistently and clearly over time that the relevant distinctions between different factual configurations can emerge.

Arrow Fastener, 59 F.3d at 400 (citations omitted). When the likelihood of confusion is in doubt, the question will be resolved in favor of the senior user. See Telechron, Inc. v. Telicon Corp., 198 F.2d 903, 909 (3rd Cir.1952); E.I. DuPont de Nemours & Co. v. Yoshida Int’l, Inc., 393 F.Supp. 502, 510 (E.D.N.Y.1975); Lambert Pharmacal Co. v. Bolton Chem. Corp., 219 F. 325, 326 (S.D.N.Y.1915) (Hand, J.).

9. First, the .Columbia mark, used alone and in combination with other words and phrases, is not a strong mark entitled to a wide scope of protection in the medical or healthcare field. The “strength” of a mark is a measure of “ ‘its tendency to identify the goods [or services] sold under the mark as emanating from a particular, although possibly anonymous, source.’ ” Sports Auth., 89 F.3d at 960-61 (quoting McGregor-Doniger, 599 F.2d at 1131) (alteration in original). As discussed above, the plaintiff is not entitled to the presumption of an exclusive right to use its registered mark “Columbia University” for medical or healthcare services because its registration is for “educational services.”. See Arrow Fastener, 59 F.3d at 397; McGregor-Doniger, 599 F.2d at 1137. Furthermore, although the plaintiff’s Columbia mark, used alone and in combination with other phrases, is arbitrary and therefore “among the strongest and most highly protected class of trademarks,” Charles of the Ritz Group Ltd. v. Quality King Distribs., Inc., 832 F.2d 1317, 1321 (2d Cir.1987), it does not signify an exclusive source of medical or healthcare services. The Court of Appeals for the Second Circuit has explained:

[Although denominating a mark “arbitrary” can be useful in focusing the inquiry, the strength of a mark “depends ultimately on its distinctiveness, or its origin-indicating’ quality, in the eyes of the purchasing pu