Dallas Buyers Club & Public Health

images-2A movie about an AIDS-riven Texan “good-old boy” who distributes unapproved drugs, is a clear Oscar contender, and a public health primer.

 

 

Not really that impressed with Matthew McConaughey’s attempts at respectability after seeing Mud and Paperboy, I had low expectations for a movie that looked like it was a cynical Oscar-vehicle. I put on the dvd of Dallas Buyers Club resigned to be mildly entertained at best. I thought I’d already seen the main Oscar winners with 12 Year A Slave (best movie, best actor) and Blue Jasmine (best actress).

 

Dallas Buyers Club was a huge surprise for being such a great movie.

 

It depicts the true-story of a working class electrician in Texas with a sex-addiction, Ron Woodruff (played by McConaughey). He discovers he has AIDS, and after aggressive denial, then some research, he first self-treats by procuring AZT from a hospital porter. When this doesn’t work, he procures other unapproved drugs from abroad, and distributes them to other AIDS-patients through a “buyers club” – people pay a monthly free and then get free drugs (so it’s not actually a sale). Until his death, Woodruf is battling the medical establishment and the Federal Drug Administration, who are trying to thwart his efforts.

 

images-1Reviews have talked about McConaughey’s 50 pound weight-loss, but his physical commitment goes beyond this. He totally inhabits the role – the desperate look in his eyes, the swagger; and later in the movie, the physical and mental demise of a man dying of AIDS.

 

It also had professional resonance, otherwise I wouldn’t write about it here. I have long been an advocate for the RCT – or at least some kind of evidence for public health decision making. But this film pushes back by depicting the plight of people with no time to wait for research results.

 

As someone who has worked at the periphery of the AIDS industry, I have had eyebrows permanently raised at the skewing of health financing towards one disease, and the poor results to show for it (until access to ARVs changed the game). But this film is a reminder that combatting a disease such as HIV/AIDs is plain expensive, and requires massive community-level effort.

 

imagesThe other great lesson learned from the film is to listen to patients. In the movie doctors and researchers were deaf to patients who needed help managing symptoms of AIDS, such as pain, migraines, dementure, cancer, fever and coughing. McConaughy’s Woodruf loudly points out that symptom management is a bigger priority than killing the virus (this is when AZT was delivered in doses that also killed the patient). The movie shows us how easily modern medicine can fail patients, and how research does not always address the most pressing questions.

 

Ron Woodruff’s efforts were one small part of a larger social movement – led the gay community and their allies. “Buyers Clubs” distributed drugs and treatment information to those suffering of AIDS across the US. This social movement around access to medicines still benefits many in the developing world today. After the work of ACT-UP and the Treatment Action Campaign against big pharma, manufacture of generic drugs now means access to drugs is more affordable globally. Cheaper ARV drugs have now reduced HIV/AIDS from a death sentence to a chronic condition. This larger movement was invisible in the movie, sacrificed for the “lone-ranger” cowboy element of the story. However, the access to medicines movement is the Hollywood happy ending for the field of public health.images-3

 

While the most important part of the story is obscured, this is still a great movie to watch, with many important lessons for our field.

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