In his “Stories I’d like to see” column, journalist and entrepreneur Steven Brill spotlights topics that, in his opinion, have received insufficient media attention. This article was originally published on

1. When Madison Avenue pitches artificial knees, do we all pay?

Americans — personally, or through private insurance or Medicare — spend more than $12 billion a year on artificial knees and hips. That’s more than Hollywood takes in at the box office.

A TV ad I’ve seen recently for artificial knees and hips made by Smith & Nephew, a British medical technology company, may help explain why we spend so much on these implants. It is not the kind of ho-hum ad we now see so regularly, urging us to seek relief from a disease we’ve never heard of by taking a pill with so many side effects it takes the pitchman half the air time to recite them. Instead, Smith & Nephew’s ads look more like a pitch for Nike.

Here’s how the ads are described in an article I found on the website of a trade publication, Pharmaceutical Executive:

A gray silhouette moves seamlessly, flowing like ink through water — swimming, golfing, playing tennis. The only discernable, solid characteristics in these figures in motion are the hip and knee replacement devices from Smith & Nephew. Chief creative officer Jonathan Isaacs and group account director Ann Woodward from Ogilvy Healthworld, part of Ogilvy CommonHealth Worldwide, are two of the many creative people who took part in developing the ad campaign for Smith & Nephew hip and knee replacement products, encouraging patients to “rediscover their go.”

This DTC [Direct to Consumer] campaign manifested as TV spots aimed to showcase joint replacement devices in a nonconventional way, delivering the message that “this isn’t your grandfather’s hip,” according to Isaacs. “I think we tried to do something that felt much more state-of-the-art. This literally is the next generation of hip and knee replacement.”

Given how much we spend on these devices, including the money spent by Medicare for seniors who opt for them, I’d like to see an article that explores whether these ads create demand rather than shift market share among manufacturers. What do Smith & Nephew’s reports to stock analysts, or even its own internal reports, say about whether the ads are a good return on investment and are creating demand?

When did these commercials start running? (There have apparently been ads like this on US TV for at least the last five years, but they seem more prevalent lately.) What is the ad budget? And what are the profit margins on the company’s knees and hips?

I know from my recent reporting on the outsized US healthcare costs that Americans buy artificial hips and knees at far higher rates per capita than patients in any other country. Is this one of the reasons?

The last paragraph of the celebratory Pharmaceutical Executive article seems to imply that creating demand is exactly the goal:

Another differentiating factor for the Smith & Nephew campaign was that it aimed to reach a broader audience. … We were trying to make the point that anybody who is active can create wear and tear on their bodies, and there are a lot of folks — young and old — that can need joint replacement,” Isaacs says.

Is this kind of television advertising allowed in other countries? I’m not in favor of the government prohibiting speech, even corporate speech — especially speech that presents a choice that people can make.

But reporting that pins down what we might be paying for that speech would contribute to the debate over whether what is often an optional medical choice should be protected by the same kind of insurance the covers medical necessities.

2. Failing your way on to TV:

Many may only know Marcia Clark as a name appearing in recent weeks under an attractive brunette talking head who has been opining on television about defense and prosecution strategy in the case of George Zimmerman, the man accused of murdering teenager Trayvon Martin. As she critiques each side’s strategy, Clark is typically described as a former prosecutor and expert legal analyst. That’s like describing the captain of the Titanic as a former cruise ship captain or nautical expert.

For Clark was the lead prosecutor who lost what may have been the highest profile — and, more important, easiest to win — murder case of the last century: The O.J. Simpson trial 18 years ago.

So why can’t a television or legal reporter use Clark’s popularity as an expert analyst as an opening to ask TV producers if there is anything other than fame (and good looks) that goes into decisions about whom to book for these appearances discussing Zimmerman and other cases?

Steven Brill , the author of Class Warfare: Inside the Fight To Fix America’s Schools, has written for magazines including New York, The New Yorker, Time, Harper's, and The New York Times Magazine. He founded and ran Court TV, The American Lawyer magazine, ten regional legal newspapers, and Brill's Content magazine. He also teaches journalism at Yale, where he founded the Yale Journalism Initiative.