Jack: Tonight, the cancer medication shortage putting the lives of over 100,000 at risk.

How doctors are treating the crisis.

Then, NYC pride march grand Marshal in the decades long struggle for LGBTQ rights and where the movement is headed next.

MetroFocus starts right now.

♪ Announcer: this is MetroFocus with Jack Ford and Jenna Flanagan.

MetroFocus is made possible by Sue and Edgar Wachenheim the third.

The Peter G Peterson and Joan Ganz Cooney Fund.

Bernard and Denisha Schwartz.

Jody and John Arnhold.

The Ambrose Monell Foundation.

The Estate of Roland Karlen.

Jack: Good evening and welcome.

Drug shortages have been making medications of all kinds difficult to get.

But now, vital chemotherapy drugs for cancer patients are also in short supply.

That is leaving hospitals and doctors with difficult decisions about how to treat their patients including the possibility of delaying treatment and rationing doses.

In New York, these kinds of shortages are taking a toll on patients and their physicians.

For a look at what is behind the shortages, how doctors are coping, and what might be done, we turn to Dr. Amanda Nicholas Feder.

She is a professor of gynecology at Johns Hopkins and the President-elect of the society of gynecologic oncology.

Thank you for joining us.

>> thank you for having me.

Jack: Let's start with a couple of big picture questions and we will get the specifics.

To set the stage, give us a sense of just how widespread these shortages are.

>> To put things in perspective, the issue of drug shortages is a chronic problem that has existed for more than a decade.

Specifically, specific -- generic drug shortages.

We know that drug shortages can occur for a variety of reasons, manufacturing or labor issues, quality control.

Inability to secure raw materials.

What is problematic that is happening in the current era is that we are seeing an increase in the number of drugs that are undergoing shortage.

In my field, oncology, life-saving chemotherapy drugs, we are seeing this class is often in the top five of drugs that are in consistent shortage in the United States.

This week, the FDA and the American Society of Hospital pharmacists report that we have 15 indispensable chemotherapy drugs that are in shortage.

Based on national surveys that have been conducted of oncologists and hospital systems , both from the society of oncology and the national network which is an alliance of centers across the U.S., this is a serious nationwide problem.

Through our survey, we found oncologists in more than 40 states and Washington, D.C. reported a shortage of at least one were more of these drugs in their institutions.

The national conference of can Prince that cancer services -- 93% were reporting a shortage of critical chemotherapy drugs.

Jack: For most people, this sounds counterintuitive.

I suspect, most people would think if you are talking about lifesaving drugs, they are going to be our priority.

Those are not the ones where we experience shortages.

Explain to us why, given this counterintuitive nature, why are these drugs that are so integral to saving lives, why are we seeing shortages?

Dr. Nickels: These are among the most important medicines and tools we use to stave lives.

The particular drugs that are in shortage are used in more than 100 different treatment regimens for adults and children from many different cancers from gynecologic cancers, uterine, cervix, breast, lung, prostate, testicular, bladder.

The list goes on.

It is a public health care crisis.

One of the reasons for that is that the most chemotherapy drugs that are in shortage are generic formulations.

Generic formulations are manufactured often by very few companies.

There's a lot of market instability with manufacturing of these drugs.

One of the reasons for that is that generic drugs do not bring in a lot of revenue for manufacturing companies.

And other facilities.

It is difficult for these organizations to invest in production of the drugs because they don't generate revenue.

The second reason is that there is a lot of market consolidation that has occurred, like because of the poor revenue stream.

You have very few companies around the world, sometimes just one or two, that produced the materials needed.

The active ingredients.

Or, one or two companies that are the primary manufacturer progress of the leading lifesaving chemotherapy drugs that we use to treat patients every day.

Jack: I want to give a couple of minutes to this question, what do we do?

Let's focus more on specifics for we are talking about dramatic shortages.

How are doctors responding to this in terms of day-to-day care and treatment?

Dr. Nickels: I can tell you that this is devastating for oncologists.

We live to help our patients live better lives.

Do not have access to some of the most important medicines is unacceptable.

It is even more devastating for patients.

It is a high-stakes for them.

There is a number of strategies we are using on the oncology side.

One of the initiatives I have been involved with, and other societies including the foundation for women's cancer, the American Society of clinical oncology and the gynecologic oncology foundation are working together to develop mitigation strategies.

Some of the things we are doing are looking at opportunities to preserve the drugs we have and get more mileage out of it for more patients.

We are using special pharmacy tech's that allow us to not waste a single drop of chemotherapy.

And use those drugs as responsibly as possible.

In order to do that, some of the things required include things like rounding the chemotherapy vials down to the nearest dose size.

If you have just a few drops in one file, you can add it to the next to treat the next patient.

These are critical strategies that pharmacies and oncologists are using.

We are developing alternative drug guidelines.

We are using best available evidence from rigorous chemical trials in order to develop recommendations for oncologists so that if one or more of -- these critical doubt -- if there is not a fantastic substitution available, we are creating new guidelines that will enable physicians to take care of patients in the best possible ways with other standards of care.

In many cases, the alternative substitutions recommended will be just as effective as the standard of care drugs that are in shortage, but there are trade-offs.

They have much more toxicity or side effects.

Sometimes permanent side effects.

We need to be thinking about that with our patients and that this is only a temporary strategy.

Jack: You mentioned how precarious the situation is.

I was going to ask about the consequences for patients but you have talked a lot about that.

Let's talk now about the consequences for physicians.

This is sort of a personal question.

This is what you do.

I mentioned before hand, this piece came about because I was having a conversation with my daughter, Dr. Ashley Haggerty, who has been on the program before and recommended I reach out to you.

She is that Hackensack Meridian Riverview.

Maybe anguish is too strong a word, but she was deeply concerned.

What are you suggesting to physicians, especially through the organization's, what are you saying to your members about how to handle this both professionally and personally?

Dr. Nickels: Thank you for asking.

While our patients are singular focused, their health and well-being we are passionate about.

I know for Dr. Ford Haggerty, the same thing.

We are devastated, but we are taking action.

We are creating better opportunities for patients during this tragedy than we could ever imagine.

On top of that, posting educational webinars for members to help them not only with developing oncology policies at their institutions, putting them in contact with foundations that may be able to help them get access to drugs if the manufacturers, if they do not have them available.

We are providing education and support to our members through webinars about how to have difficult conversations with patients for how to support your own wellness.

Having conversations no oncologists would ever want to have.

We have provided a private forum for our oncologists to talk about what is going on at the ground level and how we can best support them.

Similarly, the advocacy arm of this, the foundation for women's cancer led by Ginger Gardner, Memorial Sloan -- How do we support our patients through this?

How do we get the word out and help them get access, work with their local oncologists to receive the best care.

We also have an open survey we have submitted across patient advocate in the U.S. to understand what they are feelings -- with their feelings and thoughts are and how they can come to the table.

The third piece is advocacy.

The advocacy is with the FDA, directly with Capitol Hill legislators and drug manufacturers.

We want to have a seat at this table to develop long-term solutions so that this never happens again.

This is not sustainable.

Lives are going to be affected if we do not get a handle on this quickly.

Also, not just mitigate short-term, but look at long-term solutions as well.

Jack: You talked about what is being done now to prevent this from happening in the future.

Quickly, are you optimistic that in the short term we are making progress in terms of making these drugs more available?

Dr. Nickels: I am cautiously optimistic that we are starting to move in the right direction.

We still have a number of health care systems and patients across the country that are affected by the drug shortages, but drug supply of the key chemotherapy drugs in short supply are starting to trickle in.

Some manufacturers who went off-line due to quality control issues, one of the leading causes of the shortage, are now back online.

The FDA is working diligently on this for what they can control, including exploring and identifying sources of chemotherapy overseas for importation to the U.S. for emergency use.

That is going to be happening for at least one or two of the drugs that are in shortage.

Jack: Thank you so much.

Very informative.

Helping us understand the aspects of this critical issue.

And the progress we are hopefully going to be making.

Thank you for spending time with us and all the work you have been doing for your patience and the organization.

I look forward to talking to you soon to see how all of this is working out.

Dr. Nickels: Thank you.

Jack: The countdown is on for this pride weekend and at the annual NYC pride March the event is a highlight of the New York City calendar, a celebration of diversity of the LGBTQ+ community and also of New York's activists central role in the movement for equal rights.

That aspect has prediction -- given the increasing violence against LGBTQ+ people in the record numbers of bills in statehouses targeting their rights, especially those of transgender youth.

To drive home that point, the theme of this year's pride is strength in solidarity.

Organizers have chosen five grand marshals.

Among them is Randy Ricker, a Trail Blazer in the movement dating back to the 1960's.

1962, he organized the first radio broadcast where homosexuals spoke for themselves.

1964, he led the first public protest against anti-gay discrimination.

1966, he participated in a demonstration to bring greater awareness to New York laws preventing bartenders from serving LGBTQ+ people.

That was just the beginning of a career in active synthetic and news strong to this day.

Joining us now to talk about that career and the current climate on the upcoming parade's activists, author and archivist Randy Ricker.

Thank you for joining us.

>> It is a pleasure to be here.

Correction.

Jack: Go ahead.

>> I started in 1958.

I've been in the movement for four years by the time they broke into radio and television.

Jack: Perfect, my first question was going to be, looking back at all of those years, what was it that caused you to say this is something that you felt you needed to get actively involved with all the way back in the 1950's?

>> When I came out, we were criminals in every state.

Whenever you saw any representation of gay people on TV or radio, except maybe -- fighters.

-- killed a kid for fun.

Psychiatric professionals said we were sick.

We were sinners by almost every standard, except the Quakers.

It was ridiculous because when I finally found gay life, I -- here are all of these boys going to Brown, just graduated from Columbia, young people, average looking like me.

We weren't screaming queens, we weren't running around in drag.

I turned on the TV and you would hear people on the radio, to the extent they talked about the "sickness" of homosexuality, it was all about the business of mental illness.

So they would be there talking about, well, we can save your kid.

If he is gay, if he is a homosexual, we can straighten him out and get him on the right path in just six sessions.

Of course if it didn't work, they just said you needed six more sessions.

There was no discussion about whether or not they were curable or not.

1962, I was so annoyed, they had a panel on WBA I I can a supposedly liberal station in New York and I said wait a minute, we homosexuals, we are the authorities on homosexuality.

You are facilitating fraud.

Working on these psychiatrists who claim they can change a homosexual.

They were open to the idea.

Jack: Let me ask you about that.

It is a dramatically different time.

I am sure there are people who are part of the movement now who might not even know about the fact that social activity amongst gay people was criminalized in so many states.

You go to the radio people and to say, give us a chance to talk.

To explain things.

What was their reaction?

Did you get pushback?

>> No.

They listen to because they had never seen anybody in a coat and tie saying, we are authorities on our own things.

WBAI said, get me a panel together and we will do an interview.

I got a panel of my friends, an interracial couple, a bisexual, my Puerto Rico friend didn't show up, but we had an hour and a half discussion that it was announced that WBAI would have programs they were doing and a week or two before the program itself,?

Brian.

-- Jack O'Brien came up with this article that said that these Pur's were on the air, these sick and sad people.

Something panel where they would discuss homosexuals.

The venom that dripped from that article.

I took it as the greatest PR piece I was ever handed.

This attack on me from the New York Times, a suit and tie homosexual, a little old man would say, does this card mean what it says?

I said, what else would it mean?

So and so, homosexual is here.

Jack: That was your calling card.

>> That was my calling card.

Jack: A respectable individual.

>> -- to short list to show to the reporter that I really am somebody.

I am speaking as a homosexual with other homosexuals, which had never been done before.

Jack: What was the public reaction?

>> It was the most famous show.

It became the most watched show.

A rave review by Jack Gould comminuted columnists in the New York Times.

A full page in Newsweek called "minority listening."

Religious conservatives were watching.

They were running things in Florida, they went to the Federal Communications Commission and said, you should revoke the license of WBAI.

They are putting perverts on the air.

The Federal Communications Commission issued a ruling where they decided to cancel -- decided not to cancel WBAI's license saying homosexuality was a legitimate subject for discussion on the airwaves.

That opened the door to radio and television and suddenly all of the TV and radio stations that were afraid to even touch the subject were calling that a shame.

Jack: You broke down the door and a lot of ways.

Coming up and getting in on the air.

Me ask you another thing, this may be something that people just don't understand what's taking place at the time.

I mentioned your being part of the protest at a bar that focused on rules that prevented bartenders from serving gay people.

Explain that to us.

>> I was a member of the -- Society of New York, which was a conservative gay group started by Harry hey in Los Angeles.

There's a whole 20 year history before Stonewall.

In those days, it was -- regulations to allow homosexuals to allow homosexuals together on your premises or to be served drinks.

That meant that every bar, every gay bar was run by the mob, they had to pay off the police to operate.

If I went there with -- or anything that would say, you can't get that in here.

Until they try to throw me out, nobody was interested in the literature because for some reason people had the idea that we don't want people to know we homosexuals are just like normal people.

As long as I think we all wear mascara and have high-pitched voices and run around looking obvious, we are say.

Because we look normal.

I was the only personal that person to -- the other was a member of -- there were other people that were intelligent, articulate, probably better informed than me many ways, but they had jobs.

In those days, there were no -- at all.

You could be subject to being fired by your boss or corporation.

You could be evicted from your apartment.

It wasn't a hate crime, it was just a decent citizen beating up a filthy, dirty pervert.

That was the mentality in the 1950's.

And then we changed.

Once we got on the air, the question went from being, what can we do to cure the sickness of homosexuality?

We started bringing up studies that showed we were not mentally ill. And then the question was coming more and more, are they sick or aren't they sick?

The theological circles had started asking the question, are they sinners or not?

That started to open the door.

But, it took 65 years from when I joined.

I am a 65 year veteran.

I began at the age of 20 and I am now 85.

Jack: Looking at what has taken place between the 1950's, when you first got involved, and today.

This is the last question, we have got admitted and a half.

-- What you have lived through.

A lot of people have to look back, but you lived through it.

As you sit here today, do you remain fearful about the human rights progress we have made?

Or, are you optimistic?

Or, somewhere in between?

>> I am optimistic.

There is always backlash.

After backlash, it ends up with more education.

Just like in recovery, we have much more to do.

The real key, I didn't have an answer when they asked me this at another station about trans people.

Go on the Internet.

On the Internet, people -- trans people are able to meet one another and educate each other.

You can find more about trans people by watching their videos on YouTube.

That is how trans people discover themselves.

That includes gay people as well in her and countries.

They don't even dreamed that there is a place to see videos on YouTube about Gay pride events or gay people talking about their lives, and it gives them hope.

That is the way to go forward, keep hope alive.

As long as you have uncensored communication and a way to spread the message of hope, love is more powerful than hate.

Love will ultimately triumph.

Jack: Randy Wicker, the perfect way to wrap up this conversation is distress this notion of hope, as you have done.

We talked about the fact that you have lived this history and you are a wonderful repository of memories and important moments and what needs to be done in the future.

Thank you for spending time with us.

Take care of yourself.

We look forward to talking again sometime soon.

>> Thank you so much.

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♪ Announcer: MetroFocus is made possible by Sue and Edgar Wachenheim the third.

The Peter G Peterson and Joan Ganz Cooney Fund.

Bernard and Denise Schwartz.

Barbara Hope Zuckerberg.

And by Jody and John Arnhold, Dr. Robert and Tina Sohn foundation, The Ambrose Monell Foundation, the Estate of Roland Karlen.

♪ Briana Vannozzi ♪