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power relations

The Wolf of Dallas: Money, Stigma and HIV – Guest Review by Shehzad Kunwar

14 Feb, 14 | by BMJ

A Review of “Dallas Buyers Club” (USA 2013, directed by Jean-Marc Vallee). Released in the UK on Friday 7th February 2014

 

 

Say hello to Ron Woodroof, a ‘typical’ Texan. He loves the rodeo. He wears a white t-shirt, boots, a large belt buckle and, of course, a classic Stetson hat. He is a heterosexual aggressive man who loves drinking, drugs, gambling and women. Not the ‘typical’ person you envisage when you think someone with HIV/AIDS living in the 1980s. But after Ron is diagnosed with “HIV”, he becomes an “overnight champion” for human rights; in particular for the rights of those living with HIV to access unlicensed treatments. In an era where discrimination towards those living with HIV was rife, he is soon shunned by his friends and colleagues, gets evicted from his trailer and ends up in an apartment with a pre-op transsexual. His newest “enterprise” is selling FDA unapproved antiretroviral drugs to fellow end-of-lifers.

 

While acting in his new role pharmaceutical “drug dealer” Woodroof, played by Matthew McConaughey, discovers facts that elude health professionals: such as the significance of patients’ concerns and the value of achieving peace, rather than than prolonging life at all cost.

 

Based on the 1992, ‘Dallas Morning News’ article written by Bill Minutaglio, the script underwent multiple re-writes before funding was secured. With many actors competing for the role, it was McConaughey, who Woodroof’s sister said shared the same swagger and personality as her brother, who eventually secured the role.

 

Armed with a passport, and a strong sense of enterprise, Woodroof travels around the globe acquiring illegal drugs such as alpha-interferon. Ron creates his own pseudo-Big Pharma company in the form of a “Dallas Buyers Club” selling prescription-only drugs deemed illegal by the FDA

 

Moral ambiguity imbues the film, with the question of ethics as a recurrent theme. For example, in the representation of research, Woodroof and Big Pharma run clinical trials in parallel.  The numerous attempts made at shutting down Woodroof’s enterprise by the hospital and Internal Revenue Service, who he tries to bribe to keep his business going, is echoed by the pharmaceutical companies subsidizing the hospitals running the antiretroviral trials on their behalf.

 

Homophobia and ostracizing those who were ‘different’ are evident throughout the film. Director Jean-Marc Velee’s perspective of the deliberate targeting of HIV community groups, amongst the gay scene by Woodroof in selling his drugs, is paralleled by the pharmaceutical companies going straight to human trials of AZT, further exploiting and preying on the “desperate and dying”.

 

The character of Eve, played by Jennifer Garner, represents ethical medicine. She questions the pharmaceutical companies’ intentions in persevering with the clinical trials once the significant side effects of antiretroviral drugs became apparent. Her character also highlights the hierarchy that exists in medicine, then and now. As the film progresses, Eve’s voice as the younger, more empathetic doctor contrasts that of her boss Dr. Sevard. His desire to continue with the trial is directly juxtaposed with her disenfranchisement with it and continuing support for Woodroof’s work.

 

Much hype has surrounded Matthew McConaughey’s weight loss, but that is a small part of his meticulously researched performance. The subtleties and nuances of both his voice and expressions portraying a multi-dimensional figure earned him a well-deserved Oscar nomination.

 

In some aspects it seems that the film is made for the undiscerning viewer, in its stereotypes of corporate America and each characters role displayed clearly in their costume. As another variation of the classic David and Goliath story, nothing is ambiguous here and with the constant voice-overs, there is no doubting the identity of the protagonist. Velee’s perspective is that there is a direct comparison between Woodroof and Big Pharma, with Woodroof’s success in that battle epitomised in his prolonged life beyond the 30 days he was given by the medical profession.

 

This film is a timely way to revisit the HIV/AIDS crisis and continues the work of titles such as “Philadelphia” and “Angels in America”. But unlike Denzel Washington’s character, in Philadelphia, Woodroof’s personal change is guided by greed rather than compassion. Vellee, ensuring that the film’s take-home message is heard loud and clear, amplifies this journey for the mainstream viewer.

 

Dr Shehzad Kunwar (independent film maker, photographer and musician): shehzadkunwar@doctors.org.uk

James Poskett: What to do with patients’ stories?

26 Dec, 11 | by James Poskett

Narrative is a hot topic in the medical humanities. It can also be bewildering. Over the years literary theory has helped to bring the relevance of patient’s stories to the forefront of medical practice. But, as Johanna Shapiro notes in her recent paper Illness narratives, critical approaches to such stories have also complicated the practical matter of listening and talking to patients.

http://mh.bmj.com/content/37/2/68.full more…

Khalid Ali: Film Review: Asmaa: Directed by Amr Salama: Star rating ****

3 Nov, 11 | by Deborah Kirklin

With annual World AIDS Day taking place 1 December, this new Egyptian film, which was shown at the recent London Film Festival, is very topical.

The subject of HIV in European and American cinema has of course been explored in many films (such as “Savage nights” (1992), “Philadelphia” (1993), “The Hours” (2002), and “Angels in America” (2003)). However depictions of HIV positive characters in Arab cinema have been scarce, characteristically portraying HIV patients as promiscuous sinners who deserve to be ill, or else as victims of an American conspiracy to spread HIV infection amongst young people in the Arab world. more…

“A supremely worthwhile, if sometimes unbearably demanding job”: Ray Tallis on doctoring

10 Aug, 10 | by Deborah Kirklin

I’d hazard a guess that no matter how much editors like to think that readers enjoy having their ideas and prejudices challenged, theres nothing in practice that the average reader likes better than an opinion that chimes neatly with their own. Which, I’ve no doubt, is why I enjoyed reading Ray Tallis’s article in yesterday’s Times newspaper as much as I did. An erudite and amusing thinker, Ray Tallis writes about the impact of the European Working Time Directive (EWTD) on surgeons and on hospital doctors in general. In describing the unintended but, sadly, highly predictable consequences of the  EWTD on continuity of care, levels of provision, and training and mentoring opportunities, he argues that doctors are in danger of being  “reduced to cogs in a standardised service and discouraged from giving full expression to a commitment to patients for whom they feel personally responsible.” more…

Vitamin D, a Public Health Issue: listen again with the BBCiPlayer to learn more

6 Aug, 10 | by Deborah Kirklin

I’ve got a confession: I, and indeed a significant number of my fellow GPs, have got an unhealthy obsession with vitamin D. Or, to be more precise, vitamin D deficiency and the apparent inability of the NHS to make available to me, as a prescriber, the means to treat it in my patients. You see we can’t, quite literally, get the fix they need, at least not using our tried and trusted prescribing pad. more…

Clinical Ethics Conference: London 8-9th July 2010

13 Jun, 10 | by Deborah Kirklin

On the 8th and 9th of July 2010 the Faculty of Health and Social Care at London South Bank University will be hosting a pioneering conference focusing on Best Practices in Clinical Ethics Consultation and Decision Making. For the first time in the UK, this conference will bring together an international and inter-professional dialogue between different stakeholders with the aim of fostering and developing best practice in clinical ethics consultation and decision-making across all sectors of healthcare. more…

District 9 and Man’s Inhumanity to Man: a filmic guide to dehumanisation

28 Sep, 09 | by Deborah Kirklin

I am fortunate enough to count Professor Jonathan Glover, a world renowned medical ethicist, amongst my former teachers. A very modest and thoughtful man, Jonathan Glover spent a number of years writing a similarly thoughtful book in which he tries to understand what he terms man’s inhumanity to man (Humanity: a Moral History of the Twentieth Century. Pimlico, London 2001). His starting premise is that, given the wrong circumstances, we are all capable of doing evil things to other human beings. At the heart of his efforts are a desire to understand, for all our sakes, what it  has taken in the past, and by extension what it would take in the future, for people- just like you and me- to be willing to take part in our own equivalent of the Holocaust and the Rwandan genocide.

more…

What if you haven’t got a flu friend?

17 Jul, 09 | by Deborah Kirklin

There are always, within the population, individuals who have no one to collect medicines for them when they are ill. The group predominantly affected are the elderly but, especially in a situation in which a significant proportion of the population is affected by a flu pandemic, there will be others. In normal circumstances we have a tried and trusted system of asking local pharmacies to deliver medications, including emergency medications, to people’s homes. more…

Homelessness: what’s the right response?

13 Jul, 09 | by Deborah Kirklin

Over the weekend, mixed with the harrowing coverage of the loss of soldiers’ lives in Afghanistan, and for news cycle reasons I’ve inadequate information to understand, the fate of London’s homeless population prior to the 2012 Olympics was discussed on television and in print. The organising committee of the London Games had apparently committed itself to ensuring that no one would be sleeping rough on London’s streets by the time the world’s elite athletes arrived. The question of the weekend was whether this goal would be achieved and at what price, both economic and in terms of human dignity. more…

In the UK government’s dystopian world patients told to ‘hang on’

9 Jul, 09 | by Deborah Kirklin

If you want to refresh your memory of the comings and goings in Geroge Eliot’s classic, Middlemarch, then look no further than Professor Rosin’s analysis in the June 2009 issue of Medical Humanities.

http://mh.bmj.com/cgi/content/short/35/1/43?q=w_mh_current_tab

If you want to follow a contemporary equivalent of medical marketplace machinations then you need look no further than what is currently happening to general practice in England and Wales. And specifically to the Orwellian world in which carers and cared for find themselves. A world where government announcements to the national news media of the universal introduction of Cognitive Behavioural Therapy are followed by the systematic reduction of mental health care services in primary care. In my own practice, in the past 6 months, first the PCT provided mental health care worker was removed and more recently the practice counsellor of 17 years standing was ‘let go’. But hey ho, never mind, NICE guidance has after all told us what to do: if a patient is suitable for CBT and it isn’t available (!) we can (and should) tell them to ‘hang on’. more…

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