Dallas Buyers Club – review | Mark Kermode

Terrific performances by Matthew McConaughey and Jared Leto elevate this socio-medical drama out of the realms of the ordinary into something quietly remarkable. While McConaughey's dramatic weight loss may make attention-grabbing headlines, there's much more to his performance than the mere shedding of 30-odd pounds. Continuing the reinvention (dubbed the "McConaissance") which has seen him lay the ghost of grizzly romcoms such as Failure to Launch with harder-edged roles in Magic Mike and Killer Joe, McConaughey is utterly convincing as the ravaged rodeo redneck who is given 30 days to live after being diagnosed with Aids, but who stubbornly refuses to lie down and die. Despite very strong competition from Chiwetel Ejiofor in 12 Years a Slave, odds are that McConaughey will take the Oscar for best actor next month, with Leto similarly triumphing with best supporting actor. Both wins would be thoroughly deserved.

"Inspired by" the real-life story of Ron Woodroof, Dallas Buyers Club walks a delicate line between fact and fiction as it pitches an accidental antihero against the machinery of both the medical establishment and the government, the latter embodied by the lumbering behemoth of the US Food and Drug Administration (FDA). Diagnosed HIV-positive in the mid-80s, and responding badly to AZT (at that time, the only officially approved medication), Woodroof circumvented FDA regulations by importing unlicensed drugs that he distributed "for free" through a club, which instead charged an "admission fee", a loophole that meant technically he wasn't selling the medication. The operation was a scam, but the results were impressive, as David France's Oscar-nominated documentary How to Survive a Plague powerfully points out; people with HIV/Aids often knew better than the medical establishment what was good for them, self-medication playing a key role in the fight against the disease. While the FDA was fatally slow in responding to new treatments, it was those with no time to lose who were at the cutting edge of research and buyers clubs played a significant (if controversial) part in that process.

Crucially, Woodroof's motives were anything but charitable. As played by McConaughey, Ron is a dyed in the wool homophobe and misogynist who believes only "fags" get Aids, and whose first response to his diagnosis is furious macho denial. It is sheer survival instinct that drives Ron across the border to track down alternative medication, and it is hard financial gain that inspires him to run drugs back into the US for sale to the sick and vulnerable. Similarly, Ron's relationship with pre-op transgender Aids patient Rayon – a composite character into whom Leto breathes tender life and soul – is entirely opportunistic; a committed bigot, Woodroof needs a way into the gay community and Rayon is his passport to monetary reward. Only later, when business is booming, does something approaching friendship emerge – in the beginning, it's strictly business.

Although the films are very different in style, there is a comparison to be made with Jonathan Demme's Philadelphia, in which Denzel Washington plays a homophobic lawyer who takes on an Aids-related unfair dismissal case, a move that brings about personal change and reconciliation. Taking a leaf out of Demme's book, screenwriters Craig Borten (who interviewed Woodroof extensively) and Melisa Wallack pitch Ron as a recognisable redneck whose prejudices are whittled away not through benevolence but necessity.

Director Jean-Marc Vallée plays this theme to the hilt, with early scenes of drink- and drug-fuelled thrusting (both in and out of the rodeo ring) establishing Ron as a mean-spirited, selfish, dangerous son of a bitch – a toxic mixture of aggression and cowardice. Many have attested that the real-life Ron was altogether less obnoxious than his screen counterpart, but it suits the drama to portray him thus because doing so makes his change of heart all the more remarkable – and hopefully all the more relatable (a ghastly but appropriate word) for a mainstream audience.

Exhibiting the same lightness of touch that defined his wonderful coming-of-age drama C.R.A.Z.Y., Vallée counterposes comedy and tragedy to engaging effect, the delicacy of incidental detail distracting our attention from dramatic liberties as homophobia turns to hope. Loose-limbed widescreen camerawork by Yves Bélanger combined with diegetic music lend a naturalistic air to the proceedings, more poetic than vérité perhaps, but shot through with a palpable air of realism. Liberated by the hand-held framing, the cast play their roles with an apparent absence of artifice, with McConaughey and Leto becoming a credible odd couple between whom a gruff affection grows.

Plaudits, too, to Jennifer Garner who draws the short straw in another composite-character role, that of the overly sympathetic Dr Eve Saks, whose dealings with Woodroof become emblematic of the changing face of medical practice. In other hands the contrived role could be disastrously twee, but the no-nonsense Garner plays it straight, keeping her character firmly grounded even as she leads the audience by the nose, gently ensuring that the film's finally diagnosis is clearly heard and thoroughly understood.