On the Cutting Edge

Project: Under the Knife...
October 1, 2000

Project: Under the Knife

Description: 3 x 52-minute series about the latest developments in surgical techniques and treatments, told from the perspective of surgeons and patients

Executive producers: Rod Caird, Principal Films; Paul DonVito, TLC

Director: Chris Lethbridge, Principal Films

Coproducers: Principal Films (U.K.), TLC (U.S.), La Cinquième (France)

Pre-sale partners: RTP (Portugal), SBS (Australia)

Distributor: TVF International (U.K.)

Budget: us$1.1 million

Under the Knife isn’t your usual blood-and-guts doc. The idea for the medical science series began with a fascination with surgery’s origins, but soon gave way to curiosity about its future.

‘Program one is primarily about the use of new technology, and the way surgeons are using it to tackle the removal or destruction of tumors,’ explains series producer Chris Lethbridge. ‘Also, how this technology is allowing [surgeons] to do things like key-hole surgery – not just simple operations, like removing a gall bladder, but quite complex operations.’

In episode two, the attention shifts to surgeons as master repairers, primarily of the heart. New experimental techniques include coronary bypasses in which the heart never stops beating, and robotic tools that improve a surgeon’s precision.

‘The last one is the transplant program,’ Lethbridge says. Ethics figure prominently in this episode, as the filmmakers look at such issues as quality-of-life transplants (versus life-saving) and the idea of growing organs.

Suddenly Star Trek doesn’t seem quite so unbelievable


Summer 1998: The genesis of the Under the Knife project begins in the London office of Principal Films, with a suggestion to tackle the history of surgery. Says exec producer Rod Caird, ‘We couldn’t think of it having been done before, so we put together a treatment of our own.’

November 1998: Caird attends the London Programme Market, and runs the idea by John Ford, then general manager for TLC. According to Caird, Ford advises him that a series exploring the present and future of surgery – informed by its history – would be of greater interest to TLC than Principal’s original idea. ‘That was our first benchmark conversation about what we might need to do to make this idea work,’ Caird recalls.

His strategy is to attract some American interest first, rather than fight for a place in the tight U.K. market. ‘We work on the principle that you need a significant American coproduction partner, one other international coproduction partner and a distributor,’ Caird says.

January-April 1999: Intent on bringing TLC onboard (having worked with the U.S. cablecaster in the past), Caird takes Ford’s feedback to heart. ‘We really re-positioned the treatment to make it fit the signals that John Ford was sending about what he thought TLC would be interested in. That was the crucial moment – that was the key thing to do,’ he says.

April 1999: At MIPTV, Caird approaches TLC again – this time with a revised pitch – and meets with a favorable response. Under the Knife’s first copro partner signs on for about 65% of the US$1.1 million production budget.

Summer 1999: Caird contacts Ann Julienne, head of acquisitions and coproductions for French pubcaster La Cinquième. Caird had worked with both TLC and La Cinq once before, on a coproduction called Parachutes, and thought the chemistry might work a second time. ‘There is quite a good match between the editorial approach of La Cinq and TLC,’ Caird notes.

Julienne immediately says she is interested, based on the story pitch and her previous experience with Principal Films. Her only concern is the format – TLC wants one-hours, but half-hours work best for La Cinq.

Understanding the broadcasters’ differing needs, and having been through the process before, Caird is willing to accommodate. ‘It’s not just a question of slicing them down the middle. It’s got to be a more constructive approach than that. Otherwise, it’s not too much of a problem,’ he says.

La Cinq comes onboard for about US$78,000 and agrees to absorb the additional cost of re-versioning to French, which Julienne estimates to be around US$12,500 for the series (6 x 30 minutes). She describes the deal as halfway between a true copro partnership and a pre-buy. ‘If this had been a full coproduction, we would have had equity in the program and we would have taken French language distribution rights, which we didn’t do,’ she explains. ‘That means we can air it on La Cinquième, but we can’t sell it.’

While Caird is in talks with La Cinq, he starts looking for a distributor. Lilla Hurst, head of London-based TVF International, has already caught wind of the project and is interested. Although TVF has not repped Principal before, Caird opts to give the company a try and signs a 12-month contract.

‘We decided to work with TVF because they’re quite a small organization, and that can have benefits in terms of focus, enthusiasm and commitment. Sometimes when you work with very big distributors, there’s a very slight feeling that your title might disappear into the catalog and never be seen again,’ he reasons.

October 1999: TVF brings in SBS Australia as a pre-sale.

January 2000: TVF brings in RTP Portugal as a pre-sale. Caird says neither pre-sale was huge financially, but they helped him realize that the project would be a sustainable risk. ‘If it’s going to make pre-sales in certain territories, it’ll probably make catalog sales as well,’ he says. Principal fronts the cost of the rest of the budget through self-financing.

February 2000: Caird works with series producer Chris Lethbridge and TLC exec producer Paul DonVito on fleshing out the stories. DonVito explains that TLC prefers a character-driven approach, rather than a heavy emphasis on the technology. Caird and Lethbridge both agree.

Explains Caird, ‘The balance you have to strike on a project like this is between the personal storytelling and technology. Surgery is very interesting from a technical point of view, but it’s going to really work [best] for TV as personal stories. You get personal stories from two directions on this – the patients, who tell about what they’ve been through and the reasons they’ve been through it, and the surgeons, who are on the whole fairly charismatic people with stories to tell about what they do and why they do it.’

In searching out the interviews, however, Caird and Lethbridge also consider their commitment to La Cinq. Says Caird, ‘We were looking for personal storytelling to support the overall arc of the series, with the knowledge that we’re addressing a lot of different audiences – not all of which are English speaking. Therefore, the series can’t be too interview heavy.’

March/April 2000: Research begins. Much of the initial contact is conducted via e-mail and the Internet. To find stories and arrange for clearances, Lethbridge and Caird also go on a ten-day recce to the U.S.

On the European front, one of the most promising stories to emerge is from Leipzig, Germany, Lethbridge says. ‘Leipzig has a very high-tech cardiac surgery unit that’s experimenting in robotic heart surgery, which is quite intriguing because, in a way, Europe has often been the test-bed for developing new techniques before they get FDA [Food & Drug Administration] approval in the States.’

Another central story develops on the topic of transplantation in France. Lethbridge explains: ‘There’s recently been a double hand transplant operation, where they took the arms and hands of someone who had died in an accident, and put them on to someone who had blown their hands off ten years before.’

The production team develops a rough structure by looking at what surgeons do: remove tissue, repair the body and transplant tissue. The next step is to strike out and accumulate a critical mass of footage from which to craft the series.

May 2000: The crew spends the first three weeks of May filming most of the North American material, traveling to hospitals in Boston, Baltimore, Louisville, New York and Pittsburgh.

As part of the monthly follow-ups with TLC, DonVito tells Caird and Lethbridge that the final product could air as a series or as individual shows. DonVito explains, ‘We had to make sure they were created in such a way that one program did not lead directly to the next and did not refer to a previous program.’

June 2000: Staying closer to home, the crew shoots in the U.K., France, Germany and Scandinavia.

July 2000: Team members at Principal Films immerse themselves in editing.

August 2000: Principal delivers a rough-cut of episode one to TLC and La Cinquième. At the U.S. cablecaster’s home base in Bethesda, Maryland, DonVito is pleased. ‘The rough-cut is strong. We won’t be making significant changes,’ he says.

One of the issues that does arise, however, is musical style. ‘It tended to be more classical, more orchestrated – to put it in the most general way, it was more traditional documentary,’ DonVito says. ‘We’re trying to make our factual programming as accessible as possible, and not intimidating to any audience, and we thought music is one of the ways that we can do that.’ DonVito agrees to work with the composer Principal has hired to create an original score.

In Issy-les-Moulineaux, La Cinq’s Ann Julienne is also happy. ‘My initial reaction is that this is even better than I imagined it could be,’ she says. However, she too has some requests. ‘I did have the sense, though, that I would have fewer patients being interviewed.’

Julienne recognizes that while she prefers fewer interviews, TLC prefers more. ‘Commissioning editors of English-speaking television tend to like talking heads – they like a lot of people. For this kind of program, French people tend to like fewer people butting in all the time, and more explaining of what the point of the program is,’ she says.

Confident in the abilities of Lethbridge and Caird, she expects to make only one three-day trip to Principal’s London office to deal with the edit changes.

September 2000: Work continues in post-production.

October 2000: TVF International presents Under the Knife at MIPCOM.

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