I recently watched the film, Dallas Buyers Club with Matthew McConaughey. It depicts a cowboy who is diagnosed with HIV that led to AIDS. The only available treatment at the time in the 1980s was through double-blind FDA trials with AZT. This drug has an azido group that prevents formation of phosphodiester linkages needed for DNA replication (Yogita et al., 2012). This causes chain termination and thus brings viral replication rates down. The decrease in DNA replication is also what made this a valuable cancer drug. But without the assurance that he would receive the drug, and without the assurance it would even work, he took treatment of his health condition upon himself.
Ron Woodroof (who McConaughey played) went to Mexico and received alternate treatment. Eventually, he found himself shipping these medications back to the US. Here is where the Buyer Club comes into play. Those suffering from HIV/AIDS, without any medications could then purchase a membership, and the drugs would be a part of the fee. So technically, he was never selling the non-FDA approved drugs.
He died six years after diagnosed, although doctors only gave him months to live.
After reflecting on the movie, I could not help but think of our ethical discussions from class. He broke the law to import drugs for other individuals. His intentions were to help them. Although, he did make a profit doing it. Was he being ethical while maneuvering around the legal and medical systems in place? If you were a physician in this circumstance, what could you do to help? Woudl you help? Which of the four biomedical ethical principles did he personify, if any? Should he have just purchased enough for himself instead of buying it for others?
References:
Blair, E. (2013, November 1). The Dallas Cowboy Behind The Real 'Buyers Club'. Retrieved from https://www.npr.org/2013/11/01/242309799/the-dallas-cowboy-behind-the-real-buyers-club.
Kolata, G. (1988, July 10). IDEAS & TRENDS: A Market for Drugs; AIDS Patients and Their Above-Ground Underground. Retrieved from https://www.nytimes.com/1988/07/10/weekinreview/ideas-trends-a-market-for-drugs-aids-patients-and-their-above-ground-underground.html.
Yogita, G. et al., 2012. PharmGKB summary: zidovudine pathway. Pharmacogenetics and genomics.
I had totally forgotten about the "buyers club" portion of this movie and just remember Matthew McConaughey's character in and out of the hospital with Jennifer Garner as the clinical research doctor. When death is on the table, especially death due to a sexually transmitted disease, I think most of us would do anything we could to try to survive. We would make autonomous decisions in doing what we thought would help us live. Though people with AIDS were waiting for this treatment and trials were still underway, I think McConaughey's character had the best intentions at hand by providing these medications to desperately ill patients, however I do not believe it was necessarily ethical. Though AZT showed to be making patients worse which prompted him to go to Mexico for the cocktail of drugs that were targeting ddc and peptide T, unfortunately not all drugs interact well with everyone involved, especially when not "approved." Though it was later learned that AZT trials in France had shown to be ineffective, rendering current AZT trials being done in Texas with the same result, we are faced with an ethical dilemma in regards to what the FDA deems approved and safe. Because trials must be performed before drugs can be approved and the AIDS epidemic was wiping out herds of people in the late 80s and 90s, I don't think it was a bad idea to attempt another drug. However, in an attempt to bring this imported drug to bring "justice" to those suffering, beneficence was the action performed in providing these drugs. However, regarding non-malfeasance, I don't know that the "Buyers Club" was successful in this regard given that each patient is different and has a different metabolism and may not react the same way to Peptide T as another AIDS patient. I think Mr. Woodroof illegally bringing these drugs into the country pushed the FDA and research clinicians into thinking in different directions for treatment, which would have been a prolonged effort had Woodroof not started distributing them himself, however I don't think it was as ethical to be distributing them to everyone. If he knew they made him feel better, once he became friends with the Dr. played by Jennifer Garner, he maybe could have been involved in a new trial (even though he very well may have died before it got underway), or he could have stayed in Mexico and been involved in trials by Dr. Voss or just stayed in Mexico to live his life while legally purchasing peptide T. I think his intentions were in the right place though, given the devastating effects that AIDS had on our nation. My uncle died of pneumonia due to complications of AIDS; had he been aware of a drug, legal or illegal, or a clinical trial I bet he would have wanted to try it out if it meant not suffering so much. The idea of a painful slow death is not what anyone wants for themselves, and I can see why Mr. Woodroof brought the cocktail into the country. But I would not want to be responsible for more people dying because of a drug that may not interact as well with them as it does me.
ReplyDeleteAt the time when Dallas Buyers Club took place, an HIV/AIDS diagnosis was almost a death sentence. I can see why people would take a chance on anew drug given the circumstances, especially if the available treatments didn't seem to be helping. Because there was no cure, I think it would be up to the individual to make a decision about trying non-FDA approved drugs. I could see how this would be very dangerous and how Woodroof would be responsible for anyone who died if the drugs had serious medical complications. Yet, the patients likely knew they were going to die anyways and were willing to take a chance. Woodroof had good intentions, an act of beneficence, in giving these people hope and a different approach to surviving something that was thought to be un-survivable. If he only intended to make money, he would have been in the wrong. From what it sounds like from the article and the movie itself, Woodroof wanted to live and give as many people as possible that chance as well. From a social justice perspective, we can only make real progress when we push limits and sometimes we have to break a few rules to do so. As Alexandra mentioned, the Dallas Buyer's Club helped the FDA to make improvements to their system. Because the rules being broken in this scenario involved people making autonomous decisions without being under deception or being manipulated, Woodruff seems to be in the ethical right.
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