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Hi, Otty. Hey, Otty. Hey, Otty.

This.

Is an assignment. Good afternoon. I'm calling with an assignment.

I have.

An assignment that I've.

Been thinking about a lot. Thank you, Otty, for your time and and I'll look forward to talking to you. Bye.

Hey, everybody. Thank you so much for calling. I know I'm always asking you to leave me voicemails with ideas that you'd like us to look into for the show and I love hearing from you. So this week we're actually going to bring you two assignments straight from our voicemail box. The first comes from Mara, a first time listener from New Jersey. And to answer her question, we asked Jacqueline Howard to come back to the show to help us out. So, Jacqueline, just reintroduce your sofa those who don't know. What's your beat. What do you do here at CNN?

I'm a health reporter for CNN, and I cover all aspects of health and science, from cancer to maternal health issues, infectious diseases, these outbreaks. That's my beat. That's my focus.

Thank you for coming on because we got an assignment that is on your beat, and it comes in the form of a voicemail from a listener named Mara. We thought you could help us with it. Let's take a listen.

Hi there. I was listening to CNN five things this morning, and they were talking about the shortage of chemotherapy drugs going on in this country. I don't know if it's just in our country or if it's around the world. So my question is, why are we in a shortage? What is our government doing to help those that need that drug, as well as what about other possibilities that people can use instead of the drugs that we have a shortage on? Thank you very much. I don't know if I said this. Maura from New Jersey.

Thanks to Maura for that question. Also, thank you for doing it in assignment format with three bulleted questions at the end. So let's take them one by one. Jacqueline to start. Why are we in a shortage? Is this something that you're seeing?

It is something we're seeing, Audi. And thanks for having me on to talk about this because this is actually an ongoing problem here in the US. Right now, we are seeing a shortage of about 200 drugs, and 84 % of them are generics. So this is something that the US has really faced for some time. We saw it exacerbated during the COVID-19 pandemic. It's still ongoing, and I think it's something that will definitely require attention as we head into the new year.

But she's talking about cancer specifically. Yes. I don't think of that as just generics. Can you tell me what's going on in that world?

Well, specifically with the chemotherapy's carboplatin and cisplatin, which we have discussed in the news cycle as being a part of this ongoing shortage. So many of those are generic drugs. And we have seen this impact the majority of large cancer centers here in the US. There was a survey of cancer centers that found more than 80 % of them reported shortages of either carboplatin, Cisplatin, or a combination of these chemotherapies. And these chemootherapies are often used for many different types of cancers. But the patients that were seeing most impacted right now are those with blood cancers. And this specific population does not have many alternatives to the commonly used chemotherapies. As for why these anti-cancer drugs are being impacted as part of this overall shortage, that is something that we can connect back to manufacturing issues and supply chain issues. But those same issues are the reason why some other drugs are also in shortage. So I don't think it's necessarily something unique to the chemotherapy, manufacturing, and supply chain. It's just that, sadly, these are the patients that are bearing the brunt of this ongoing shortage.

How are doctors and hospitals actually handling the shortages? Are people going without them? You said in some cases, there aren't very many alternatives. So what has been the approach?

So hospitals have actually had to set up departments and have staff whose job is solely to find solutions for the patients who are using medications that are in shortage. Sometimes for some specific types of cancer, there are alternatives. I know patients who have recurrent gynecologic cancers may use another type of chemotherapy. Axeloplatin is one that can be sometimes substituted for carboplatin or cisplatin. But sometimes there are patients who are relying on these chemotherapies. Surgery is not an option for them. Radiation is not an option for them. Some other types of drugs like immunotherapies are not an option for them. And sadly, there have been reports of patients having to pause their treatment because their chemotherapy medication is in shortage. Much. This is something that is causing some patients to stall or have to pause their treatments, and it really is concerning. This is having a direct impact, which is why people have questions about it, and which is why we've seen lawmakers hold hearings to discuss this problem as a national issue.

I want to talk about the government also. Just as you said, there are hearings, which usually just means airing out the fact that there is a problem. But I know at one point the Biden administration was talking about having some focus on supply chain issues. This has been on the radar for a really long time. So are there any new policies, initiatives that are designed to help?

Exactly. Yeah. This has been, like you said, an ongoing problem and part of big discussions. There have been solutions put forth. There's actually one in particular, Senator Elizabeth Warren introduced what's called the Affordable Drug Manufacturing Act. And this is something that would establish what's called the Office of Drug Manufacturing within the US Department of Health and Human Services. This proposal to establish this office is so that possible office will directly address shortages as well as could be authorized to manufacture generic drugs that are currently in shortage under certain key conditions. That's one possible solution that has been proposed. But overall, I'm hearing from a lot of lawmakers and just public health experts in this space that we need more transparency from manufacturers and suppliers as to when shortages occur. What exactly in the supply chain? What exactly happened?

Yeah, I have to say. The silence from the private sector on this is deafening. And we've been out of the pandemic for some time now. Are people concerned that this is a price issue? I don't want to sound conspiratorial, but what's the explanation from the industry?

Well, it seems to be several different factors. We do hear when it comes to manufacturing, specifically low cost generics, and generic drugs make up about, again, 84 % of the shortage, we do know that there's more manufacturers who tend to leave the market than enter the market because these are low cost. As a company, they don't see much.

Profit per dose. The ones that goes generic and cheaper, they're like, Okay, we're out of this business. We'll leave it to someone else to make.

That's one issue. The other is the supply chain itself. Many suppliers are outside of the US, some, for instance, in China or in India, and that makes it difficult to track exactly what caused hiccups when the supplier is not here in the US. So there aren't requirements for them to tell us. It's just simply difficult for us to find out what is the issue. So that has been brought up in some discussions. And then lastly, the overall lack of transparency. The reason why that has been a major issue in finding solutions, it's because there has been one possible solution put forth to say, Well, why don't we incentivize hospitals and pharmacies to purchase their drugs from wholesalers and manufacturers that we know have a dependable supply? Well, how do we know who has a dependable supply if we aren't tracking this data? And if we don't know what can cause a hiccup or what is causing a manufacturer to not have a dependable supply. So this is where the lack of transparency discussion is important. And that is as we try to find solutions.

Well, Jacqueline, I really appreciate this. So does our listeners. There are so many people out there who are touched by cancer and are affected by this illness and their relatives are, et cetera. So it seems like it's outside the frame of the news, but it's something that really affects people. And I appreciate that you have done so much reporting on it.

Yeah, absolutely. And just to give people hope out there, I mean, overall, when you look at data around cancer in the US, over time, we have seen the number of cancer deaths decline. And that's because we do have the tools to help fight this disease. We do have the medications. We do have surgical approaches. We do have immunotherapies. So that's why it's really heartbreaking to see we have the tools to fight cancer. It's just getting those tools into patient's hands is what's needed here. And so when we see disruptions in the supply chain, when we see shortages, that's why it's such a frustrating situation. And hopefully in the new year, I'm hoping that as a nation, we'll be able to find some solutions here.

That was CNN Health reporter, Jacqueline Howard, answering a question from our listener Maura. Coming up, we have an assignment from our listener, Adam. That's after the break.

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One, we called up Tracy Gendron. She's the Chair for the Virginia Commonwealth University Department of Gerontology and the Director for the Virginia Center on aging. In a minute, you will know why we have called her. But first, Tracy, welcome to the program.

Thank you so much for having me.

I want you to listen to this voicemail.

Hey, Audi. This is Adam from Minnesota. I have an assignment that impacts every listener, one of the most undiscussed and yet most pervasive forms of prejudice worldwide, ageism. Ageism refers to the stereotypes of how we think, the prejudice of how we feel, and the discrimination in how we act towards others or ourselves based on age. I'd love you to bring forward a conversation to help people understand how it impacts them and how they're impacting others. If it's helpful, I've curated a list of my favorite resources on our Minnesota Leadership Council and Aging website. I'd also note that every day is an opportunity to address how ageism intersects and exacerbates all the other isms, too. Thank you so much for what you do.

So, Tracy.

Yeah.

I think this is in the ether, in part, because of a certain president's age. Yeah. People are talking a lot about being old, so to speak, and being too old to do things, et cetera. Can you talk about Adam's question in terms of the definition? What is ageism to you?

Yeah, I love Adam's question. I'm absolutely thrilled that he reached out to you, and I think he's asking some of the right questions. So first, it's really important to understand what ageism is because I think a lot of people misunderstand or they miss the opportunity to understand what it is as a whole. So on its space, ageism is discrimination, oppression, marginalization towards people that we see as other-aged. That could be towards older people or towards younger people. And it does happen towards both. So anytime we make an assumption or a judgment about someone because we see them as being either too old or too young, we're falling into the trap of ageism. But that's just one form of ageism. That's the externally driven form. Ageism is also internally directed. It's how we think and feel about our own aging. That's actually really powerful and probably the piece of it that we don't talk about quite as much.

Is it as pervasive as what he was saying?

Yeah. And it's all relational, and it creates this cycle. So if you live in a culture that values youth, which we do, if you live in a culture that directs you that aging is something to be feared, that we should battle against, that we lean into this militaristic language, of course, we're going to be afraid of getting older. Of course, we're not going to envision a later life that could be really meaningful and purposeful. So when we carry that fear with us, that's internalized ageism. When we disassociate with our own aging, when we feel shame around saying how old we are, all of that is internalized ageism. And then that feeds the externalization of it. So it creates this vicious cycle that just perpetuates freely throughout society.

So on a recent episode of our show, we spoke about whether President Biden is too old to run for re-election, which is something that's coming up in a lot of polling. A few listeners actually called in to share their opinion with us. I want to place some of those messages for you.

My name is Joe. I'm 83 years old. I don't think Biden should run again because even at 80, I started mind blocks and I just slowed down to talking. And it's not the same. I believe a younger person should run for President. I know I'm 83 and it's not a wise thing for him to do. Hi. My name is Roger Staneislaw. I'm 80 years of age. And there are a lot of things that I won't do because of my age. And absolutely one of them would be is to take on the responsibility of running a country, much less my own home. My memory and my agility have suffered greatly at 80 years of age. I can't remember things. I get people mixed up. Many problems occur when you're 80 years of age. It's going to happen to just about everyone. Joe Biden has no business running for the United States presidency.

Tracey, what do you hear in those comments? Yeah, I.

Hear a few things. I definitely hear some internalized ageism. But what I hear really is people making an assumption about somebody else based on their own personal experiences. And part of the issue when we're talking about what it means to be 80 is that that's vastly different for every individual. When you've met one 80-year-old, you've met one 80-year-old. And later life is just the opposite of early life. In early life, we have milestones and markers. We know about when someone's going to crawl, when they're going to walk, when they're going to eat solid foods, that thing. Later life doesn't have the same pattern. It's actually vastly different for each person. So knowing somebody's age doesn't really tell you anything meaningful about them. I think what they're really talking about is competency, capability, but we are conflating that with age, and that's.

What makes me really concerned. Right. Because it's often pointed out that Donald Trump is just a few years younger. Correct.

This really isn't a story about age. We're asking the wrong question if you ask me.

I wonder if it's because boomers and as a generation are really reckoning with reaching this age.

That's also internalized ageism and the fact that we live in a culture that also doesn't value what it means to be older.

Right. I feel like they're the generation that told us not to trust anyone over 30.

Exactly. So there's a lot that we need to unpack in there and a lot of assumptions, I think, that we need to challenge.

How do you suggest people intervene when they see or hear things that, as you said, sound like ageism?

I think it's how we learn to intervene when we look at any form of discrimination.

Which we're also not good at.

No, we're not because it's scary. And it takes us to be brave and it takes us to get out of our comfort zone. And it takes us to think about things in a different way than we're used to thinking about things. But when we're trying to challenge something, it means that we need to make the invisible visible, that we need to ask people questions, that we need to say, What do you mean by that? That we need to ask like, Huh, let's take a step back. Tell me, what does old mean to you? What does young mean to you? And I'll ask you, Addy, what does old mean? How would you even define it?

For me personally, I'm not even sure because I've had relatives that lived deep into their 90s and others that have been in rough shape in their 50s and 60s. I do take your point, though, that it is very much the dialog that people just take the Annec data from their own life and apply it. Very much so. So they'll say, say, like our callers did, I'm going through this. How could he possibly run the free world? Or someone will say, You don't want to give, quote-unquote, you always heard this, give grandma the keys, or taking away your parents' keys at a certain point from driving. And people overlay that over most discussions about aging because they've seen aging or experienced it in a way that felt like it wasn't ideal.

Exactly. And because we have such a decline-based narrative of what it means to grow old and be old, we tend to talk about the losses. We tend to talk about the abilities we no longer have. We don't contextualize that aging and growing old also means that we grow and develop and evolve.

And if we think of it differently, it's almost a novelty hence the success of The Golden Bachelor. Yes, exactly. It was like, look at these people. They're walking, they're dating. Yup. It is so the story less told. They're dating.

Yep. It is so the story holding conversation.

You're holding conversation? You're like, what? What? They're not back from The Grave. It's not The Ghost Bachelor. These people are- Who.

Are just living normal lives. Yes. Yes, which we can thrive at all ages, but we don't talk about the ways that we grow and develop. So all of that adds to this culture of ageism in which we live.

So what are you going to be thinking about next year as we hear a lot about this? I'm guilty of it, too. I have said repeatedly that we're living in a gerantocracy because I felt like I feel like there's a generation of people who are not allowing for others to move into positions of power. Yeah.

I think the next year is going to be rough for many different reasons. I think as a gerantologist, though, it's going to be an opportunity to continue to push this conversation. And that's the bright side for me is that people like yourself and others are starting to question this. And that's a step in the right direction. We weren't questioning this before.

We haven't- Questioning what?

Questioning ageism, questioning what does old mean, questioning what does competency mean in later life. What are advantages of being older? We haven't asked these questions, especially within the mainstream culture. So this does pose an opportunity in terms of it being a gerryandocracy, it's interesting that we pick on age when truly our elected officials are not representative of the general population in any way. It's not in terms of race, it's not in terms of gender, it's not in terms of ethnicity, but yet we're focusing on age. Why is that? So I think that in ways there's going to be really challenges in the next year and in ways there's going to be opportunities because it's going to get people thinking about this and hopefully thinking critically.

Well, Tracy Gendron, thank you so much for jumping in to answer these questions for our listeners. You were great.

Oh, thank you. My pleasure.

That's it for today's episode. Special thanks to everyone who called in to leave us an assignment, and we love making these episodes. It's really great to hear from you. So if you or someone you know has an assignment you'd like us to consider for a future episode, please call and leave us a voicemail at 202-854-8802. The assignment is a production of CNN Audio. This episode was produced by Isoke Samuel. Our senior producer is Matt Martinez. Our engineer is Michael Hammond. Dan de Zula is our technical director, and Steve Licktie is the executive producer of CNN Audio. Support from Haley Thomas, Alex Manassary, Robert Mathers, John Dianora, Lenny Steinhardt, James Andruss, Nicole Pessarou, and Lisa Namarau. Special thanks, as always to Katie Hinnman. We will be back in your feeds on Tuesday. Give us a follow or a review, and thank you so much for listening.

Did.

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