By Andrew Barna

We have all seen the adds for prescription drugs and we all know the impact they have had on utilization. Once the pharmaceutical companies started direct to consumer advertisements, utilization of the advertised drugs shot up. It seems the medical device industry was paying attention. This weekend I saw an ad on TV for Zimmer's "Gender Solutions" knee implants - and get this - they are "shaped to fit a woman's anatomy".

Presuming that this will become a trend, the impact of this commercial will be far and wide.

From a hospital strategy perspective, I would revisit my orthopedic volumes after seeing this commercial for sure. I think there is no doubt that commercials like these will translate into higher demand for surgeries. But what about medical necessity, you might ask? There shouldn't be more knee replacements unless baby boomers start playing more one on one, right?

Not necessarily. Along with direct to consumer advertising of pharmaceuticals, we have seen another trend: the medicalization of problems that went untreated in the past (there may be a better word than "medicalization", but I think it does the trick). Now I am not a doctor, but there seems to be a new class of drugs available to treat, for lack of a better descriptor, free-floating symptoms. A drug like Zelnorm, for instance, is advertised to treat "bloating" and "irritable bowel syndrome." I saw another advertisement for a drug to treat "restless leg syndrome." We aren't talking cancer here, but we are creating medical solutions for quality of life issues (again for lack of a better term).

And of course the king of all advertised pharmaceuticals, sexual performance enhancing drugs, leads me to my next point. The arrival of artificial knees designed specifically for women ushers in the era of science and medicine improving the human machine. Today we can get knees that are more comfortable, tomorrow we will have knees that "last forever" or improve our performance on the football field. Combine the trends of consumer driven healthcare with advances in medical devices and even genetics and we could be looking at a healthcare industry that is radically different from the one we have today. Of course there are many ethical considerations here (don't worry ethicists are standing by to take your calls as they have been anticipating this for a few years now), but have we considered the impact on the healthcare delivery system? Will these advances only be available to those that can afford it? Will our focus on prevention and healing shift to a focus on improvement and replacement? Will your blown out knee become your bionic knee?

Who knew a knee could have such an impact?