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7 February 2014

"Screw the FDA, I'm Gonna DOA"

To my surprise, Jean-Marc Vallée's last film, Café de Flore, ended up being one of my favourites of 2012. His latest work, Dallas Buyers Club, is very different in terms of topic, theme and mood, but both films tell of ordinary lives writ extraordinary and offer strong performances at their core.

Matthew McConaughey plays Ron Woodruff, an electrician and former rodeo bull rider in small-town Texas who is told he is HIV-positive and has 30 days to live. The Ron we first meet isn't easy to like: he's racist, sexist and homophobic, addicted to drugs and women. Initially, he rejects the diagnosis, telling Dr Eve Saks (Jennifer Garner) and her boss Dr Sevard (Dennis O'Hare) that he can't be HIV-positive because he's the straightest, most macho man in all of Texas. After doing some research, however, he realises that his intravenous drug use may have had a role in the infection and that a promising new drug, AZT, might be the answer to his prayers. But AZT clinical trials are only just kicking off and it hasn't yet been approved by the FDA, and Ron can't even buy the stuff.

For a while, he steals discarded vials of the drug from the dumpsters at the back of the hospital, washing down the meds with beer and following up with a cocaine chaser, but when his supply dwindles, a tip from a janitor sends him to Mexico in search of a doctor who can hook him up with some AZT. When he arrives, though, Dr Vass (Griffin Dunne), tells him the AZT he has been taking has actually been worsening his compromised immune system, and instead gives Ron several other treatments that he says will alleviate the symptoms. After his health improves greatly, and Ron realises that he can make some money and potentially help others with HIV if he imports some of Dr Vass's drugs to the US for resale.

Sale of unapproved medical products in the US is, of course, illegal, so instead he launches the Dallas Buyers Club after reading about a similar concept in New York. Members pay Ron a $400 monthly membership fee and in return, they can have access to all the drugs they want. Ron's problem is that he doesn't know many would-be members, so he recruits Rayon (Jared Leto), a transvestite prostitute, to find potential clients. This leads to a cat-and-mouse game with the FDA, who keep trying to block Ron's supply and shut down his operation, and Dr Sevard, who seems to have been compensated by the manufacturer of AZT for allowing his hospital to participate in AZT trials.

McConaughey is fantastic as Ron — and almost unrecognisable, with his 'tache and gaunt, painfully thin frame. He injects just the right amount of black humour and edge (and impeccable comic timing) into a complex and sympathetic portrayal. Leto, also nearly unrecognisable, is very good too, and the chemistry between them works well, especially as their friendship develops. It was also fun to see Dennis O'Hare, who plays the bleeding-heart-liberal Judge Abernathy in the Good Wife, as the hard-nosed, brusque Dr Sevard. Another Good Wife actor, Dallas Roberts, has a small role as Ron's lawyer too. Dallas Buyers Club is entertaining and compelling, but is a good, rather than a great, film that will probably be remembered as the film that earned — or nearly earned — McConaughey his first Oscar.

The science bit
One thing that irritates me about Dallas Buyers Club is the way it seems to distort how the medical research process works. Some people will watch the film and think, "gee, aren't the FDA and drug companies terrible?" because they were preventing patients with HIV from taking AZT. One asks why the clinical trials can't be expedited. If only it were that simple. I'm not saying that the FDA and Big Pharma are perfect, but handing out potentially effective drugs willy-nilly on the basis of some promising results in an animal model would not end well. I work in scientific publishing and see dozens of research papers offering potential new therapeutic treatments for disease each week, but the percentage of these that end up proving both effective and safe in humans is very small. I think Vallée could have done a better job of portraying such a complex issue.

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