I recently sat down in my local cinema to watch Dallas Buyers Club. The film was truly outstanding with amazing performances from Matthew McConaughey as the real-life AIDS patient Ron Woodroof and Jared Leto as the fictional Rayon. The story centres around McConaughey's caricature Ron who believed that a number of unapproved pharmaceutical drugs were helping alleviate his symptoms. He then begins to smuggle these drugs into America and distributes them to his fellow suffered by establishing the Dallas Buyers Club. The reason the film gives as to why Ron has had to go to extreme lengths to survive is that he believes that the drug on offer (AZT also known as Zidovudine) is poisonous and responsible for a lot of death and suffering. Most of the main cast also share Ron's opinions about AZT with the exceptions of the one-dimensional, bland caricatures who are promoting the drug and who also predictably only care about profits and not the well-being of people. The movie really puts AZT in a bad light whilst conversely making Ron out to be a white knight who fights the establishment and offers effective drugs that are not approved by the Food and Drug Administration (FDA). But was the movie correct about AZT?
At first glance the movie is completely wrong. AZT is very effective against HIV and works by slowing down the viruses replication allowing people to live longer. It is so effective that it is still used today although alongside with other antivirals to prevent resistance developing. AZT is basically thymidine with an azide group at the 3 position instead of a hydroxyl. It works by selectively inhibiting reverse transcriptase (the enzyme HIV uses to copy its RNA into DNA) by preventing extension onto the 3 position. Like any drug it does have side effects - especially in high doses, as it has been shown to inhibit DNA polymerise (however to a certain extent your body can repair the damage). It can also cause bone marrow toxicity but this is easy to diagnose and can be reversed by lowering the dosage or stopping the drug altogether.
The problem was that in the eighties no one knew what dose to use to fight the virus. Too little and it would be practically useless, too much and the patient would suffer from unnecessary side effects. Unfortunately at the beginning when no one knew anything about this virus they prescribed too high a dosage and people suffered as a result.
Although the movie spoke about AZT in overwhelmingly negative terms it contradicts itself at the end by saying that AZT went on to save millions of lives as part of HAART (highly active antiretroviral therapy). It also contradicts itself early on when Jennifer Garner’s caricature Dr. Eve Sake changes her mind about AZT. Even though she is distributing flyers warning people against AZT, she decides not to remove her patients off the drug but instead bizarrely in the context of the movie to lower their dose.
Having said all that, I have a theory that the writers were aware of the effectiveness of AZT and that they put it in the movie for all to see. This theory all revolves around Jared Leto’s character Rayon who we first meet in the hospital after Ron regains consciousness. We found out that he is HIV positive and on a drug trial testing the effectiveness of AZT. At the time he looks healthy and seems to be in good spirits. He’s not underweight nor is he suffering from skin lesions like he is at the end of the movie. He also does not seem to be suffering any adverse side effects from the AZT (although it is possible that he is on the placebo). After beating Ron at poker, Rayon admits that he has been selling half of his AZT to a friend for $5000. As discussed earlier the initial dose of AZT given to the HIV infected people in the trial was too high, and as a result they were suffering from the side effects. It is possible that Rayon accidentally found the ideal dose between effectiveness and side effects, and thus was responding well to the medication. Rayon later comes off the medication (presumably encouraged by Ron) and begins to work at the Dallas Buyers Club. He starts to take the drugs and remedies offered by the club and his health begins to deteriorate. Over the course of the film we see him rapidly lose weight and develop lesions. This all leads up to an emotional scene where Rayon in sat on his bed saying “I don’t wanna die” whilst crying. Rayon is then taken to the hospital by his partner and soon dies of AIDS related illnesses.
But thats just my theory.