Dallas Buyers Club Nails the FDA

Originally published on EconomicPolicyJournal, April 8, 2014.

Libertarians are raving about Dallas Buyers Club and with good reason. One of our biggest frustrations is the near-universal tendency of human beings to form political opinions not through a rational examination of the facts and theories, but through emotional attachments. Many of these attachments are derived from stories and mythology that no amount of scholarly journal articles or sound arguments can ever successfully refute.

So it is exciting when someone comes along and
distills all of the work that has been tirelessly cranked out for years by free-market analysts, and turns it into a compelling story about the indisputable evil that is the FDA.

The film is based (with a few liberties) on the life of Ron Woodroof, an electrician and rodeo enthusiast who was diagnosed with AIDS in 1985. In the film, he spends most of his time drinking, snorting coke and engaging in unprotected sex. He has no visible aspirations or humanitarian sentiments, he’s interested in nothing more than his hedonistic pursuits, and is kind of a jerk.

None of that changes when he is diagnosed with AIDS and is given approximately 30 days to live. After clarifying with the medical staff that he “...ain’t no faggot!”, Woodroof storms off into a booze and coke-filled orgy of denial. Only as the 30-day deadline approaches does he admit to himself that he is sick and decide to do something about it. He begins by bribing a hospital employee to get him a supply of AZT, then learns that the FDA-approved-for-trials drug is actually harming patients more than helping them, and ultimately finds out about some unapproved treatments that seem to be helping.

As Woodroof then struggles to first get these unapproved treatments into the US from other countries, and out to paying customers, something changes. He is transformed. Not into something warm and cuddly, but into something more believable and in a way, more moving. He is still rough and crude, still a jerk to those around him, including his transgendered business partner. He is still kind of an asshole. But he’s an asshole on a mission, and there is something beautiful about that.

Throughout, the film is clear about who the bad guys are: The FDA and its agents who forcibly prevent people from having access to treatments they believe may help them. This is something libertarians have been screaming about for decades - mostly to deaf ears.

The Independent Institute, for example, has done great work analyzing the costs vs. the benefits of the FDA. The Institute’s Daniel B. Klein offers empirical examples to demonstrate that the agency is entirely unnecessary, that drug quality and safety could easily be provided through voluntary institutions and the tort system. He writes:

“How is safety assured in other industries? In electronics, manufacturers submit products to Underwriters’ Laboratories, a private organization that grants its safety mark to products that pass its inspection. The process is voluntary: manufacturers may sell without the UL mark. But retailers and distributors usually prefer the products with it.

“Suppose someone proposed a new government agency that forbade manufacturers from making any electronic product until approved by the agency. We would think the proposal to be totalitarian and crazy. But that is the system we have in drugs...”

And:

“The FDA was much less powerful before 1962. The historical record-decades of a relatively free market up to 1962—shows that free-market institutions and the tort system succeeded in keeping unsafe drugs to a minimum. The Elixir Sulfanilamide tragedy (107 killed) was the worst in those decades. (Thalidomide was never approved for sale in the United States.) The economists Sam Peltzman and Dale Gieringer have made the grisly comparison: the victims of Sulfanilamide and other small tragedies prior to 1962 are insignificant compared to the death toll of the post-1962 FDA.”

That death toll is estimated to be in the hundreds of thousands. According to drug regulation expert Dale Gieringer, “The benefits of FDA regulation relative to that in foreign countries could reasonably be put at some 5,000 casualties per decade or 10,000 per decade for worst-case scenarios. In comparison … the cost of FDA delay can be estimated at anywhere from 21,000 to 120,000 lives per decade.”

It is astounding to think that the FDA is not widely recognized as the threat to public health that it is. What is so wonderful about Dallas Buyers Club is not that it expresses what so many of us already knew, but that it turns reams of policy analysis into a compelling story line with characters we care about in a way that might actually get the message through to a wider audience - including many who aren’t the least bit interested in reading policy papers.

The film also articulates the more central point about drug regulation: That nobody has the right to dictate to anyone else (with obvious exceptions such as children) what they may or may not put into their own bodies. And in one brief statement, the protagonist is able to sum up the corrupt relationship between the regulatory agency and the pharmaceutical companies it purports to regulate. Says Ron Woodroof in the film:

“Oh I’m a drug dealer? No, you’re the f***ing drug dealers! I mean goddam, people are dying. And y’all are all up there afraid that we’re gonna find an alternative without you! See, the pharma companies pay the FDA to push their product. So f*** no, they don’t want to see my research! I don’t have enough cash in my pocket to make it worth their while!”

There is another point to the film, one that was likely exaggerated for dramatic effect but is nonetheless valid. In the film, Ron Woodroof did not create the Dallas Buyers Club in order to help other AIDS victims, he created it to help himself, and in the process also ended up helping a great many other people with AIDS. The story brings to life the critical point made so long ago by Adam Smith: That one need not be motivated by a love of one’s fellow humans or concern for their welfare in order to benefit them, that free markets enable people to make each others’ lives better regardless of whether they care about each other or of what they think of each other. It is a point that those who insist that promoting liberty and free markets is “not enough” would do well to take to heart.