Get Your Weekly Digest

Receive the best podcast summaries and insights delivered to your inbox every week.

We respect your privacy. Unsubscribe anytime.

TED Talks Daily

How do you turn hope into action? A doctor and a public health expert answer | David Fajgenbaum and Celina de Sola

with Selena De Sola, David Fagenbaum

Published September 26, 2025
View Show Notes

About This Episode

Host Elise Hu introduces a TED Intersections conversation between public health expert Selena De Sola and immunology researcher David Fagenbaum on how they turn hope into concrete action in their respective fields. Fagenbaum shares how surviving Castleman disease led him to repurpose existing drugs and build the nonprofit EveryCure, now using AI to match old medicines to new diseases, while De Sola explains how her organization, founded in El Salvador, works to create trauma-informed public systems across schools, healthcare, and law enforcement. Together they discuss holding hope and grief simultaneously, navigating setbacks, scaling systemic change, and the leadership, teamwork, and vision required to sustain impact.

Topics Covered

Drug repurposing Artificial intelligence Cancer Mental health Trauma Nonprofit organizations Systems thinking Leadership and management Resilience Personal Development

Disclaimer: We provide independent summaries of podcasts and are not affiliated with or endorsed in any way by any podcast or creator. All podcast names and content are the property of their respective owners. The views and opinions expressed within the podcasts belong solely to the original hosts and guests and do not reflect the views or positions of Summapod.

Quick Takeaways

  • David Fagenbaum's near-fatal battle with Castleman disease led him to discover that an existing transplant drug could put him into long-term remission, inspiring his life's work in drug repurposing.
  • Through EveryCure, Fagenbaum's team uses AI to scan global biomedical knowledge and score 75 million possible drug-disease combinations, identifying promising new uses for old medicines.
  • Selena De Sola's organization, founded in El Salvador, builds trauma-informed ecosystems in schools, healthcare, and law enforcement so children and families can better navigate adversity.
  • Training frontline workers, including police, in mental health and self-regulation not only supports communities but also improves the wellbeing and behavior of the officers themselves.
  • Both guests emphasize that you can hold hope and despair at the same time, and that sitting with pain and grief can deepen commitment rather than undermine it.
  • Scaling impact requires working within existing public systems, engaging people at all levels of government, and treating them as key resources rather than obstacles.
  • Effective leadership, they argue, blends clear vision, mission-driven teams, humility, curiosity, and relentless, incremental action.

Podcast Notes

Show introduction and context

Host sets up theme of hope and realism

Elise Hu introduces question of how to hold on to hope while staying realistic about the work required[2:28]
• She frames the episode around facing immense challenges and still moving forward with necessary work
Explanation of TED Intersections format[2:32]
• TED Intersections is described as an original series featuring unscripted conversations between speakers and experts
Introduction of guests and their domains[2:40]
• Public health expert Selena De Sola sits down with immunology researcher David Fagenbaum
• They will discuss moving forward with bold life-saving ideas even in the face of setbacks
Framing of emotional themes[3:04]
• Elise notes they will explore keeping an open mind and learning to hold space for both hope and grief

Opening reflection on holding hope and despair

Concept of holding conflicting emotions

Selena reflects that it is possible to hold hope and despair simultaneously[3:10]
• She notes that if you are trying to be hopeful, you cannot always let go of sadness, despair, and frustration
Challenge of channeling mixed emotions into work[3:34]
• She asks how to hold hope and despair in a way that enables continued working, learning, and collaborating

Introducing each other's work

David describes his mission and organization

David states his mission is to save and improve lives with drugs that already exist[4:02]
• He explains they use an AI platform to scan global knowledge of every drug and disease to find new uses for existing medicines

Selena describes her organization and focus

Selena explains her organization was founded in El Salvador[4:19]
• They aim to create systems that are more trauma-informed and trauma-friendly
Focus on helping children and families navigate adversity[4:28]
• The goal is for kids and families, especially in contexts of violence, to be able to navigate adversity and thrive rather than just struggle with stress and trauma impacts
Work in public schools as safe spaces[4:38]
• Her organization works in public schools to make them safe spaces where children can learn and receive needed support

Why Selena targeted system-level trauma understanding

Observed lack of understanding of stress and trauma[5:04]
• She and her colleagues realized that most of society, including teachers, nurses, and doctors, lacked sufficient understanding of the impacts of stress and trauma
Aim to equip all system touchpoints[5:13]
• They wanted to provide knowledge and skills so everyone children interact with in systems like education, health, and law enforcement can offer more trauma-informed services

David's personal medical story and origin of drug repurposing focus

Transition from healthy med student to critically ill patient

David recounts being a healthy third-year medical student at the University of Pennsylvania[5:41]
• He notes he and Selena were both students at Penn
Rapid multi-organ failure from Castleman disease[5:59]
• His liver, kidneys, bone marrow, heart, and lungs began to shut down
• Over three years, he nearly died five times in the ICU from Castleman disease before receiving a diagnosis and chemotherapy

Discovery of a repurposed drug that saved his life

Identification of a transplant drug as potential treatment[6:12]
• David discovered a drug made for organ transplant rejection that he thought might treat his disease
Self-testing and long-term remission[6:16]
• He began testing the drug on himself and reports being in remission on this medicine for 11 and a half years

How he conceived repurposing as a general strategy

Chemotherapies showed existing drugs could work across diseases[6:33]
• During relapses, he received seven chemotherapy drugs each time, none made specifically for Castleman disease but still life-saving in the short term
• He reasoned that if drugs made for other conditions could help him temporarily, there might be other existing drugs that could work better long-term
Constraint of time and resources pushed toward repurposing[6:55]
• He acknowledges he did not have a billion dollars and 15 years to create a new drug, so finding something that already existed was his only realistic option
Realization of neglected opportunities[7:13]
• He says it has been "crazy" to see how many existing drugs can help more people but have been neglected
• He highlights that substantial funding has already gone into R&D for these drugs, raising the question of how to fully leverage that investment

Selena's background and trauma-informed systems work

Origins in high-violence and humanitarian contexts

Selena describes working in countries with high rates of violence about 20 years ago when they started their organization[7:56]
• She previously did humanitarian aid in countries affected by conflict and natural disasters
Recognition that systems were unequipped for mental health needs[8:15]
• They observed that existing systems were not equipped to deal with many issues, especially mental health and wellbeing
Mental health as foundational for other outcomes[8:19]
• She notes that mental health and wellbeing, better understood after the pandemic, are foundational for outcomes like learning and physical health
• Without emotional wellbeing, people struggle to access learning and their physiological health worsens

Key insight: importance of a caring adult

Science shows best response to childhood trauma is a caring adult[8:38]
• Selena says they understood from science that the best way to address impacts of stress and trauma in children is to ensure a caring adult is present in their lives

Example of trauma-informed work with law enforcement

Involving police in youth-focused work

Selena notes that most organizations working with young people do not usually work with law enforcement[8:59]
• Her team mapped the ecosystem they wanted to make more trauma-informed and decided to include law enforcement because youth interact with police in both good and bad ways

Story of a police officer in a high-violence area

Officer's exposure to constant human suffering[9:27]
• One police officer described how hard it is to take calls in a tough municipality with high homicide and crime rates
• She said constant exposure to human suffering changes you, a point Selena connects to medicine as well
Impact of training on officers and communities[9:35]
• After training many officers, the officer became a trainer and interventionist herself
• The officer reported being better able to self-regulate and feel well, and also to support her peers
• This improved how officers interacted with communities
Shared fears between officers and youth[9:35]
• The officer feared not coming back alive from work, and young people in her community expressed similar fears about daily life

Scaling to national police training

Expansion across three countries[10:10]
• Selena says they have since worked with national police in three countries
Integration into cadet training[10:17]
• Those forces are integrating mental health training as part of cadet training, which she describes as exciting

EveryCure's mission and the story of Joseph

Broad mission and organizational name

David reiterates EveryCure's bold mission to save and improve lives by repurposing medicines[10:46]
• He notes the organization is called EveryCure, reflecting a broad remit

Case study: Joseph with Poem Syndrome

Joseph's critical condition and hospice plan[11:23]
• Joseph had a rare cancer called Poem Syndrome, and his doctors had tried everything they knew
• His girlfriend Tara contacted David's team on a Friday as Joseph was about to be transferred to hospice care on Monday
Recommending repurposed multiple myeloma drugs[11:32]
• David spoke with Joseph's doctor on Saturday and recommended three drugs used for multiple myeloma, a similar cancer, though not used for Poem Syndrome
• They debated whether Joseph could tolerate the medicines and whether to attempt a last "Hail Mary" effort
Dramatic recovery and life change[11:46]
• The doctor decided to try the medicines, and Joseph responded incredibly well, leaving the ICU by Thursday
• After almost a year and a half, Joseph has been in remission, and he and Tara went from planning his funeral to planning their wedding
System failure: drug existed but match was missing[12:23]
• David emphasizes that the drugs were always available for a similar disease, but humans had not done the work to match them to Joseph's condition

Managing setbacks, grief, and motivation

David on losing patients and staying driven

Inevitable cases without a repurposed drug[12:57]
• David acknowledges many cases where they cannot find a repurposed drug and patients die from their disease
Setbacks as both heartbreaking and motivating[12:50]
• With a personal mission, such losses are heartbreaking, but they also motivate the team to work harder
• Successful cases like Joseph's further motivate them, creating a circuit between setbacks and successes
Perspective on relative suffering[13:53]
• When struggling with nonprofit and research challenges, David reminds himself that their difficulties pale compared to the suffering of patients

Selena on emotionally difficult cases

Recent case of a vulnerable girl[14:15]
• Selena shares a text from a nurse about a girl who had survived violence and was pregnant, in a very tough situation with concerns about teen suicide and needed support
Balancing urgency, exhaustion, and hope[15:17]
• She describes days of feeling exhausted and as if she is running in place while everything feels urgent
• She draws inspiration from successes and from the determination of the people they work with in government and nonprofits

Holding hope and despair together

Selena's acceptance of dual emotions[15:10]
• She reiterates that one can hold hope and despair at the same time and that it's okay to do so
• She notes that trying to be hopeful does not erase sadness, despair, or frustration; the challenge is to hold them in a way that enables continued work, learning, and collaboration

David on sitting with pain and learning from it

Importance of sitting with pain[15:40]
• David interprets Selena's comments as a call to sit with pain and with loved ones of patients who did not survive
Understanding stakes and drawing strength from successes[15:54]
• He says sitting with suffering clarifies the stakes, while leaning on the positivity from successful cases offers balance

Scaling impact and working with systems

Selena on scaling from volunteering to systems change

Early days of volunteering in schools[16:18]
• She recounts starting 20 years ago by volunteering in schools to be caring adults for kids
Identifying underlying trauma-related issues[16:38]
• While meeting basic needs like infrastructure and after-school programs, they saw underlying impacts of stress and trauma
Treating their work as R&D for systems[16:47]
• She likens their approach to R&D for systems: learning deeply from students, parents, and teachers when working long-term in communities
Non-clinical mental health work and Audacious funding[17:04]
• They recognized an opportunity to do non-clinical mental health work through psychoeducation and trauma education
• With funding from the Audacious Project, they gained resources to expand
Rising demand and integration into professional training[17:28]
• She notes that stigma around mental health has improved since the pandemic, and demand for mental health support is now huge
• Systems want mental health training as part of their core work for reasons like human resource retention, performance, and quality of care
• Mental health curricula are being integrated into teachers' colleges, medical and nursing schools, child protection, and judicial training
Need to work with public sector and frontline workers[18:12]
• Selena emphasizes that working with the public sector is essential to reach as many people as possible
• She sees frontline workers as a huge resource in achieving systems change

David on scaling via AI and EveryCure

From single patient to thousands via repurposed drugs[18:47]
• After repurposing a drug for himself, David began seeking drugs for other Castleman patients and related rare diseases
• They have now repurposed 14 drugs for diseases they were not originally intended for, with thousands of patients alive as a result
Creation of EveryCure and link to AI emergence[18:56]
• About three years ago, they created EveryCure to significantly scale their efforts, coinciding with the emergence of artificial intelligence
Limitations of traditional lab work vs AI scale[18:52]
• David's lab at the University of Pennsylvania can study a few drugs for a few diseases each year and is proud of that work
• By contrast, AI can scan knowledge of every drug and every disease almost instantly and prioritize new uses systematically

AI platform performance and uncovering hidden signals

Computational scale: 75 million drug-disease scores[19:39]
• He explains there are 4,000 drugs and 18,000 diseases, yielding 75 million possible drug-disease combinations
• The first AI platform run took 100 days to compute all 75 million scores, but now the same task takes about 17 hours
Accurate predictions from scattered research breadcrumbs[19:56]
• The AI generates accurate scores that, for example, suggest lidocaine could potentially help breast cancer patients-connections not obvious to human intuition
• Many insights are built on prior human research that showed promise but was not pursued due to lack of profitability or career incentives
• He likens these partial findings to breadcrumbs scattered across the medical research system that AI is especially good at connecting

Example of Leucovorin and systems-level barriers

Leucovorin repurposed for certain children[21:01]
• David describes a drug called Leucovorin, originally developed for chemotherapy patients decades ago
• A fraction of children have antibodies that prevent a vitamin (folate) from entering their brains; giving them Leucovorin can help get folate into the brain
• For some of these children, the treatment can improve their ability to speak and their verbal communication skills
Lack of incentives to complete the "last mile"[21:33]
• He notes that brilliant work was done to make this connection, but the last mile of disseminating and implementing it widely was not taken
• Because Leucovorin is a cheap, old drug with no sponsoring company, no one is incentivized to spread the information, even though no one is actively suppressing it
• He presents this as a systems problem similar to issues Selena encounters, where small tweaks could unlock large amounts of value and potential

Advice on moving from individual work to systems change

David's advice on understanding and filling system gaps

Start by asking what the system already does[22:59]
• He suggests that when you observe a major problem, you should first ask what is already being done within the system instead of reinventing the wheel
Discovering absence of a coordinating entity[22:31]
• He questioned physicians, researchers, pharmaceutical companies, and government agencies to find out who was responsible for finding new uses for old medicines
• He learned that no such coordinating entity or system existed, revealing a gap he could help fill
Emphasis on action before perfect knowledge[22:46]
• He cautions against endless fact-finding and encourages getting into the space, helping people, and trying to fix the problem while continuing to ask questions
Need for a complementary team[23:10]
• David stresses assembling an excellent team, noting his own strengths in drug repurposing and immunology but need for colleagues skilled in systems and policy

Selena on local grounding, alignment, and government partners

Value of a diverse team and local roots[23:27]
• She agrees that teams should include different skills and thinking styles, and emphasizes being a local organization founded and based in Latin America
Continuous listening and questioning[23:41]
• Selena underscores continually asking questions and listening to understand the systems they work in and their priorities
Finding alignment despite differences[22:52]
• She notes that even if they do not align on everything, such as politics, they can find areas of alignment to drive change together
Working across government levels and roles[24:22]
• For sustainable systems change, they work not only with high-level officials but also with teachers, administrators, mid-level professionals, and regional coordinators
• She points out that many government staff outlast political administrations and often have a vocational drive to be in those systems
Balancing big thinking with deep work[25:09]
• Selena argues that one can think big while still maintaining depth of work with individuals, young people, and communities
• She believes that without deep understanding of challenges, it is hard to work effectively on systems change and scale

Mental models for facing big challenges: vision, people, and incremental steps

David's three ingredients for overcoming big challenges

Having a clear vision[25:36]
• He believes you must have a vision for what you are working toward, especially during tough times
• In the ICU, he visualized one day searching for treatments in memory of his mother and possibly marrying his partner Caitlin
Having the right people by your side[26:09]
• He cites the importance of an amazing team and support system, which he had while he was sick and now in his organizational work
Taking one step at a time[26:27]
• He warns that the overall challenge can feel overwhelming, so breaking it into tiny, bite-sized pieces makes it manageable
• He suggests that if someone had demanded their current scale of impact at the outset, he would have felt it was impossible, but small steps made it achievable

Selena on visualization and hope

Reference to Viktor Frankl and envisioning[26:58]
• Selena mentions Viktor Frankl's "Man's Search for Meaning" and notes his use of visualizing
Hope requires envisioning better outcomes[27:05]
• She suggests that having hope often requires being able to envision a different future, such as David in the hospital after being told he could not be saved
• She connects visualization and hope to the need to avoid burnout in their sector

Hope, action, and leadership philosophies

David on hope that drives action

Distinguishing helpful vs passive hope[27:41]
• David observes that while hope is powerful, overly passive hope can lead to assuming others will solve problems and reduce personal action
Hope-action feedback loop[27:59]
• He praises the kind of hope that drives action: seeing what you are hoping for-such as helping young people or patients-motivates concrete efforts
• He describes a circuit where hope fuels action, which in turn increases hope and drives more change

Selena on drawing hope from others

Cyclical nature of hope and action[28:22]
• Selena agrees that hope and action are cyclical; even when setbacks require "12 steps back," they return to the grind
Relying on surrounding people for energy[28:33]
• She acknowledges often needing to draw hope and energy from the people around her

Selena's leadership philosophy

Leadership as collective work and stepping back[29:14]
• She sees leadership as doing things together and knowing when to get out of the way
Learning to ask for help[28:58]
• Selena admits she has historically found it hard to ask for help, but nearly 20 years into the organization she is more comfortable doing so
Building a diverse, dynamic team[29:22]
• She emphasizes the importance of recognizing her own weaknesses, others' strengths, and building a team with diverse skills, knowledge, approaches, and attitudes

David's leadership priorities

Team size and structure[30:01]
• David notes about 50 people are part of EveryCure and about 20 are part of his lab
Recruiting mission-driven people[30:05]
• He prioritizes assembling people who are there to help patients rather than just for a paycheck, calling recruiting "so important"
Setting and reinforcing a clear vision[30:23]
• He constantly reminds the team of the vision: saving and improving lives with repurposed drugs
• He tells each person they are the best in the world at their specific role (e.g., building the AI platform) in service of that mission
Using patient stories to sustain motivation[30:40]
• He finds it powerful to literally show patients who are alive because of repurposed drugs and those still waiting for treatments
Overcommunication and remote collaboration[30:47]
• David stresses overcommunication to avoid misalignment when tackling big challenges
• Because their teams are in multiple locations and cannot just bump into each other at lunch, they must be intentional about communication

Selena on communication, partnerships, and humility

Communication challenges across countries and time zones[31:01]
• She notes that working in different countries and time zones with a large team makes communication hard
Leadership beyond internal teams[31:43]
• She frames leadership as also about which interactions and partnerships they build outside the institution
Humility and curiosity with public systems[32:12]
• They try to maintain humility as an organization, recognizing they are not within government systems and cannot fully understand all their constraints
• They aim to stay curious about what it is like for government partners, what they need, and what their priorities are

Closing emphasis on humility and curiosity

David underscores value of humility and curiosity in solving hard problems[32:12]
• He says if these problems were easy, someone else would have solved them already, so teams must be humble and curious to tackle them

Show outro and credits

Identification of speakers and series

Elise notes that the conversation was between Selena DeSola and David Fagenbaum for TED Intersections[32:55]

Pointers to watch more and production credits

She directs listeners to TED.com to watch this and other Intersections conversations and mentions curation guidelines[33:11]
She lists members of the TED production team and notes that the talk was fact-checked by the TED Research Team[33:17]

Lessons Learned

Actionable insights and wisdom you can apply to your business, career, and personal life.

1

Transforming a personal crisis into a mission can unlock powerful, sustained motivation, especially when you translate your experience into a concrete vision of who you want to help and how.

Reflection Questions:

  • • What difficult experience in your life could be reframed as a source of insight or mission rather than just a setback?
  • • How clearly can you visualize the people or situations you want your work to positively impact over the next few years?
  • • What is one small, specific step you could take this week to turn a painful experience into something that guides your decisions or priorities?
2

Effective systems change starts with deeply understanding what already exists-listening, mapping current efforts, and identifying gaps-before trying to design new solutions.

Reflection Questions:

  • • Where in your work or community are you tempted to "reinvent the wheel" without first understanding current structures and efforts?
  • • How could you better listen to frontline people in your system (customers, staff, residents, patients) to uncover unseen needs or opportunities?
  • • What is one existing process, program, or resource you could study this month to identify a small but meaningful improvement or gap to fill?
3

Hope is most powerful when it actively drives action: envisioning a better outcome should translate into concrete steps, while also allowing space for grief and discomfort instead of denying them.

Reflection Questions:

  • • In what area of your life do you feel hopeful but relatively inactive, and what is holding you back from taking the next step?
  • • How might acknowledging your fears, sadness, or frustration alongside hope actually make you more committed and resilient?
  • • What is one tangible action you could take in the next 48 hours that would turn your hope about a situation into measurable progress?
4

Scaling impact requires both big-picture ambition and on-the-ground depth: you need a bold vision, but you also must stay close to real people and contexts to keep solutions relevant.

Reflection Questions:

  • • Where might your current goals be either too narrow (only local) or too abstract (only high-level) to create the impact you want?
  • • How could you spend more time with the actual users, beneficiaries, or stakeholders of your work to test whether your ideas fit their reality?
  • • What is one way you could adjust your current project so it both reaches more people and preserves or improves the depth of impact for individuals?
5

Building mission-driven, diverse teams-combined with clear communication and humility toward partners-creates the conditions for tackling complex, long-term problems.

Reflection Questions:

  • • Do the people you work most closely with feel aligned around a shared mission, or are there mixed motivations that need to be surfaced?
  • • How might bringing in people with different backgrounds, thinking styles, or sector experience strengthen your ability to solve hard problems?
  • • What communication habit (for example, regular check-ins, clearer vision-sharing, or more listening to partners) could you adopt this month to improve alignment and collaboration?

Episode Summary - Notes by Riley

How do you turn hope into action? A doctor and a public health expert answer | David Fajgenbaum and Celina de Sola
0:00 0:00