“I’m not supposed to be here.” How horizontal thinking helped save Dr. David Fajgenbaum’s life

Do you think outside the box? Or within it?

In 2004, Dr. David Fajgenbaum’s mother died of brain cancer. Before she passed away, Fajgenbaum promised her he’d become an oncologist to cure others in her memory. But in his third year of medical school, Fajgenbaum nearly died himself after all of his vital organs stopped working.

“My liver, my kidneys, my bone marrow, my heart and my lungs just shut down,” said Fajgenbaum, now an associate professor in translational medicine and human genetics at the University of Pennsylvania School of Medicine.

He was diagnosed with idiopathic multicentric Castleman disease (iMCD), a disorder that causes an overgrowth of cells in the body’s lymph nodes. According to the Mayo Clinic, its causes are unknown with roughly 5,000 Americans of all ages being diagnosed each year.?

Fajgenbaum was put on aggressive chemotherapy treatments, but to no avail. At 25, after an experimental drug failed and the country’s leading doctor ran out of options, Fajgenbaum’s dreams were crushed. Instead of giving up, he vowed to find a cure for iMCD.?

Fajgenbaum then began analyzing his own blood samples at a University of Pennsylvania laboratory. He soon began to suspect a drug known as sirolimus, which had been used for decades as treatment for organ transplant rejection, could be a fit for him, despite it never having been used for Castleman’s. Since Fajgenbaum was prescribed sirolimus in 2014, he’s been in remission.?

Fajgenbaum later discovered that Castleman patients who didn’t respond to the only drug currently approved by the U.S. Food and Drug Administration (FDA) for the disease could also benefit from sirolimus.?

“We’re helping patients all over the world with cures that are hiding in plain sight,” said Fajgenbaum, who has since pioneered clinical trials for sirolimus on Castleman patients.?

Fajgenbaum, whose fight to survive is documented in his 2019 memoir “Chasing My Cure,” explained he saved his life by channeling the transformative power of horizontal thinking.?

"Vertical thinking is when you see a problem in front of you and you say, I'm going to dig really, really deeply into that problem to try to understand it and come up with a solution for this problem,” he said.?

Fajgenbaum's journey is a prime example of how different thinking styles can lead to groundbreaking solutions in the face of adversity. By taking a solution from one problem and applying it to another, horizontal thinking can organically spark innovation and adaptability, he said.

“Horizontal thinking is when you see the same problem in front of you, but you say, I'm not going to dig really deeply into this problem to solve it,” Fajgenbaum said. “I'm going to look horizontally at all of the other problems and all the other solutions that may be able to potentially fix this problem. Repurposing drugs, which is what I did to save my life — and what we've done now repeatedly for many other patients — is the ultimate horizontal thinking problem."

Are you a vertical or a horizontal thinker? Share your thoughts in the comments! And don't forget to watch the full episode of Catalyst to discover how you, too, can become a lateral problem-solver.?

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Written by Dorian Geiger