Host: 03:11

Tell us a little bit about your research into smart prescription bottles, Dr. Butler.

Dr. Butler: 03:16

The particular study that TD Bank has graciously funded here is looking at the adherence to statin medications amongst individuals identifying as Black or African-American. And so the reason why we're doing this research is because there's a lot of information showing that statin medications institute is primary prevention. So if you provide someone with statin before they have a cardiovascular disease event, like a heart attack, or a stroke, or something along those lines, you can actually prevent the incidence of those events. 

So individuals prescribed statins with that primary prevention capacity can reduce the likelihood of negative outcomes. Now, this is great. But, in general, medication adherence is low for most medications. But for statins, within the first year about 60 percent of people who were using them do not use them as prescribed. So there is a lot of opportunity for improvement for getting people to take their medications as prescribed. 

And the reason why we're focusing specifically on individuals identifying as Black or African-American is because individuals who fall within that group have a greater risk of cardiovascular disease, a greater risk of cardiovascular mortality than non-Hispanic whites. And perhaps most importantly, have lower rates of medication adherence than non-Hispanic whites. We wind up in a situation where we have a greater burden of both mortality and cardiovascular disease amongst individuals identifying as Black or African-American, but reduced adherence to potentially life saving medication therapy.

We hope to address this by increasing medication adherence and to bridge, at least partially, some of that disparity between non-Hispanic whites, and Black, or African-American individuals.

Host: 04:55

And Emmet Conlon, what about Mark's and the Feinstein's research prompted TD Bank to provide a $150,000 grant in support?

Mr. Conlon: 05:04

At TD Bank, we're committed to giving back to the communities we serve. And we fulfill that commitment by leveraging our business, our philanthropy and our human capital as levers of focus and impact. The TD Ready Commitment, where this grant came from, is our global corporate citizenship platform. And that guides our work in the local community by targeting community investments that fall under one of our four key drivers, which together help create a more inclusive, and sustainable future for all. 

And one of those four drivers is better health. And the goal of that driver is to support incredible organizations like Northwell Health, and their innovative programs such as this one led by Mark, which focus on breaking down barriers to healthcare access, and improving outcomes overall. And that's exactly what this grant is designed to do, to improve healthcare outcomes for the Black community by launching Mark's new research program, and the first clinical trial to determine the best interventions to reduce cardiovascular disease. 

And really, that's a long way of saying it was really just a perfect match, and and fit into our vision, which matched up perfectly with Mark's.

Host: 06:13

That's awesome. We're talking about a a prime example of philanthropy, opening doors for research focused on historically underserved and undertreated populations. This is a question for Brian and Emmet. What lessons have you learned about how to make an impact through investment?

Mr. Lally: 06:29

Well, I'll take the the lead. Certainly from my experience, a lesson learned is when you fund something along the lines of of Mark's project, you actually can create a bright future. Without the funding, no research. When the research happens, assuming it proves to be effective, it becomes practice. And then it does get funded. And then it turns out that lots and lots of people's lives get saved. That is an impact of philanthropy. And I think that, they call it a lesson learned. But for people who want to make a difference, investing in an organization like Northwell has a huge impact that goes beyond just the dollar in. And it's a much bigger opportunity than that. 

And at the end of that period, we had identified a study that we were both aligned with, and both were willing to move forward with. I think, if you have other sources of funding, there can be a longer, a bit more rigorous process. And there are tradeoffs and benefits. But what I've really enjoyed in this process is, you're able to move ahead quickly, identify something that we both found interesting, and then just engage in it.

Host: 09:34

Is that right?

Mr. Lally: 09:35

Yeah, and I think just to leverage on that, a piece of this is about relationships. So, TD Bank has been a great partner over the years, and and it has become a better partner. And I think that's also on our end, so we're delivering for them, or to them what they want to accomplish in the community. 

Specific to what Emmet said, and I can tell you this from the long experience, the federal government, which is the primary source of revenue for research, doesn't like to fund brand new things. They really liked the fund things that they know will work, which is a little bit of a conundrum, right? 

So how do you actually prove it? You prove it with philanthropy. So when we talked about the ripple effect, it's not just the impact on the community. It's the impact on research itself, so that we actually can get more funding to do more research once we prove the principle.

Host: 10:24

Yeah and what would you be your advice to other health care systems who are trying to address these racial disparities?

Mr. Lally: 10:36

I think it's the same thing, right? It's relationships. The fact that there are underserved communities is not news, right? It's, I mean, these communities have been underserved forever. And what happened in the context of Covid is all of a sudden there's this huge awakening. And Northwell has been doing this and been dealing with this for a very long time. 

We are actually coalescing now in the context of Covid, and really putting a lot more energy into that space. And I think it's a good idea for others to do the same thing. This is not, this is not a simple problem that will get solved in New York, or the New York Metro area. This is a national problem, which by the way, is is an interesting thing, too, from the TD's perspective. 

In the larger scheme of things, this is a modest project that actually can have impact across the United States of America; which is kind of a big deal when you think about it. And it's kind of cool. For $150,000, you can change lives in California. So I'd encourage folks to push into the same space we are.

Host: 11:39

Yeah I think, Dr. Butler, what is interesting, too, is that when you do a research project like this, whatever the outcome is, it raises awareness. I don't think a lot of people knew how much of a problem this is, medication adherence, and what an impact it could have on people's health and communities.

Mr. Butler: 11:57

Piggybacking off of Brian's point about the federal government not liking to fund new, innovative things, I think TD has been very generous because we're doing a bunch of different things here. And I think that regardless of the outcome of the trial, the information we collect will be very important. 

Because we have a virtual behavioral intervention for individuals on medications. We have a smart pill bottle, and then we have a focus group testing before, and satisfaction surveys afterwards to incorporate, basically, the idea of how people feel about the trial before it occurs, as well as afterwards.

In this current trial, we have a very cool thing; traditionally medication adherence is measured in a bunch of different ways. Self-report is one where if I ask you, "Did you take your medication?" Odds are if I am your doctor, you're going to lie to me because I told you to take it, and you didn't. So that is not the best way to do it. Pharmacy refills are another way where you track whether the prescription was filled and  taken out.

But what we're doing is tracking medication adherence in real-time using a smart pill bottle where you dump all the medication in. There is a weight sensor at the bottom of the pill bottle, which registers individual pills being removed, and taken. So not only that happens, but when the weight sensor measures a change, it transmits information via cell signal to an online portal. 

So we essentially have real-time medication adherence data, which we are then using to inform our intervention. So I am telling people, "You took your medication as prescribed yesterday. You did not take your medication as prescribed yesterday." So we can titrate our intervention based on actual performance. And I think that's pretty cool. 

We're incorporating a lot of very theory-based things from the Human Behaviour-Change Project, which is a group that breaks down behavioral interventions to its component parts. So we actually have, in our intervention components that relate to all those kinds of behaviors you just talked about. And it's, you know, there's a– it's a multi component intervention that addresses those different causes of medication, non-adherence, and provides feedback on real-time. If you're frazzled and you're forgetting, to help build a system where you do take your meds.

Host: 15:58

It's awesome. Emmet, when you hear this talk, and you had mentioned it before about communities Why is it so important for an organization like TD Bank to have healthy communities?

Mr. Conlon: 16:09

So look, we're, you know, we're your neighbors. We operate in the same community in which Northwell operates in, and which all of these institutions which we support are in. And I do think companies across all industries are increasingly understanding the importance of giving back to the communities in which they do business. We look to see if our support will help create meaningful impact and greater equity? And you couldn't have a better example than what Mark is working on here. 

Finally, I says, it's so important for organizations like TD and Northwell to come together. I, I I think because together we have the resources, and the expertise to really address these inequities, to improve healthcare outcomes, and to ultimately create a more sustainable, inclusive future for everyone in that community. And that's why it's so important.

Host: 17:00
Yeah and Emmet, I want to ask you a question. It's the same question I asked Brian. I asked Brian before about, is important for other healthcare organizations to get involved with philanthropy. What about you? Is it – do you talk to other banks, or businesses about the importance of doing what you're doing?

Mr. Conlon: 17:15

I think the importance is, at its core, this corporate, and citizenship that's thrown around. It's really about customers, colleagues, and communities. And as I've mentioned, time and again, I think we have a responsibility to show up in the communities in which we operate, and to be a driver for positive change. 

And, I think we have that unique culture at TD where our colleagues across the entire footprint are really passionate, and want to get involved in supporting their local communities, and, and whatever changes they can bring. We have a lot of the people who show up to the Northwell Annual Walk.

And we have, just people that really just want to get engaged. And institutions like Northwell give us a lot of opportunity for that. So I think [00:18:00] being a really good corporate citizen is more than just supporting causes and organizations financially. They can really mean being the inclusive and sustainable policies, and practices that you can embed into your business, and creating opportunities for your employees to, to give back individually.

And I think you've seen a lot of organizations realizing that. And it's, it's really, it's, it's not just good for business. It's good for our customers, it's good for our colleagues, and it's really just great for the community. And there's that word again, right?

Host: 18:34

With 165,000 donors, tell us about the various types of donors we have. We have Emmet here today from TD Bank. And they're also individuals like Leonard and Susan Feinstein who donate because of firsthand experience.

Mr. Lally: 18:47

Yeah, yeah. So think about this, 165,000 organizations and people have made a gift to Northwell Health in the last few years. That's a lot of people, right, which is a great, it's a great corollary to what we've been talking about. This is a community that's reaching out to us. They're, they're connecting to us. And people who have supported this campaign thus far include people who have given us, literally, tens of millions of dollars of their own wealth, which is extraordinary; and other people who have given $10.00 or $25.00. 

And organizations like TD Bank who have partnered with us. And Emmet, Emmet mentioned the Health Walk. Because this grant is significant, but not the only thing that TD Bank does. And yeah, I'll take it a step further. There are, there are people who work for TD Bank who are participating in this walk. And and they're writing personal checks to Northwell Health. So they're committed to the organization.

They understand what we're doing and they're trying to make a difference. For a lot of people, it, for a lot of people, it has something to do with their own personal experience. So they've had a health situation, and it's prompted them to want to give back. But for other people, and this is, this grant is a perfect example of that, they, they're looking at this from a much bigger perspective. 

They're looking at this from the societal perspective, from the civic duty. And what can we do to make society better? And there is a lot, a lot of people who are committed to us in that space, 165,000, and more. Yeah we're not done yet.

Host: 20:11

Brian Lally, Dr. Butler, Emmet Conlon, thank you so much for joining us here on 20-Minute Health Talk. And for you, the listener, thank you so much for tuning in. I'm Rob Hoell, have a great day, and stay safe.