Worth the Work with Jason Dana Costa
Worth the Work with Jason Dana Costa explores what it really takes to build organizations that matter.
Hosted by healthcare executive, consultant, and mission-driven leader Jason Costa, each episode features honest conversations with CEOs, nonprofit executives, healthcare innovators, and community leaders who are tackling meaningful challenges with curiosity, trust, and operational excellence.
From leadership and organizational strategy to healthcare innovation, culture, financial sustainability, and navigating complex change, Jason uncovers the lessons that don't make it into business books. These are conversations about building organizations that create lasting impact, earning trust when it matters most, and doing work that's truly worth the work.
Whether you're leading a healthcare organization, nonprofit, business, or growing team, you'll walk away with practical insights, fresh perspectives, and the inspiration to lead with purpose.
Worth the Work with Jason Dana Costa
David Esposito - Chief Executive Officer, ONL Therapeutics
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What does leadership look like when the plan falls apart?
On this episode of Worth the Work with Jason Dana Costa, Jason sits down with David Esposito, CEO of ONL Therapeutics, to explore leadership through success, failure, uncertainty, and organizational change.
David is a healthcare executive, biotech leader, West Point graduate, and combat veteran whose career has included successful company exits as well as bankruptcies, restructurings, and controlled wind-downs. Those experiences have given him a unique perspective on what it takes to lead when the stakes are high and the answers aren't obvious.
David shares how lessons from the military still influence the way he leads today: get clear on the mission, build a plan, and be prepared to adjust when circumstances change. He and Jason discuss why leaders need the humility to admit what they don't know, how trust can be rebuilt when something goes wrong, and why taking responsibility matters even when a problem happens far from the C-suite.
They also explore the often-overlooked importance of remaining calm during a crisis. Leadership isn't about pretending everything is fine. It's about creating enough stability for a team to understand the problem, make good decisions, and move forward.
David also shares one of the simplest lessons that has stayed with him throughout his life. Growing up, his mother would tell him to "keep your chin up." Decades later, that reminder still helps him face difficult moments and rally teams around problems worth solving.
The conversation closes with a look at the future of leadership, including AI and emerging technology. While new tools may make organizations faster and more efficient, David believes the human responsibility of leadership remains: finding purpose, building relationships, rallying people around a mission, and helping teams overcome obstacles.
This is a conversation about resilience, trust, purpose, and what it really means to lead when the work gets difficult.
Hi, welcome everybody to Worth the Work with Jason Dana Costa. Today, our guest is David Esposito, who is the Chief Executive Officer of ONL Therapeutics. And amazingly, he's a combat veteran, a healthcare executive, accomplished biotech leader. And throughout David's career, he's experienced some pretty extraordinary success and some of the toughest challenges that a leader can face, from scaling a company through successful acquisition, navigating bankruptcies, organizational turnarounds, restructuring. Those expertise clearly has shaped his leadership philosophy and grounded it from what I can perceive anyway in resilience, trust, discipline, and a relentless commitment to serving others, which we at Worth the Work think is the most important thing that you could do. David, welcome. I'm so excited to have you.
David EspositoHey, Jason, thanks for having me. Love your program. You're putting out some great work. So I'm just grateful for be able to have the invite and the conversation with you. Thank you very much.
Jason Dana CostaExcellent. I'm always excited with somebody who's like me with a whiteboard in the background, always drawing out there. I think they're the best tools sometimes. Many leaders need a whiteboard all the time. So, I mean, you went to West Point and have been leading healthcare companies through some incredible wins and some difficult seasons. And worth the work, I try to connect my upbringing to some of my leadership development. So I'd love to know in your upbringing, what taught you that really prepared you for both success and failure?
David EspositoSure. A wonderful question. So you mentioned West West Point, and I think some of those ties to what I'm doing today or leadership in the Army. You know, I think one of the core tenants is your at least my upbringing in the military, you're very clear on the mission. Like, what are you trying to accomplish very clearly? And then build a plan around that. And then, like anything, be prepared to adjust that plan if the situation changes. And I think those have been very translatable skills to my work in biotech. I mean, we're working on eye disease right now. Other companies I've been with, cancer diagnostics. So you're very clear on the mission to meet a certain unmet need, and then ultimately build a plan around that. And inevitably, at least in the world in biotech, you'll get a change in data points or something like that. You got to adjust the plan, pivot, whatever. So I think those skills I learned as a young infantry officer have been applicable to my journey in biotech for sure.
Jason Dana CostaWow, that's exciting. When getting to know you, I did some biotech work myself specializing in type 1 diabetes. So we ran an organization called T1D Exchange, which was a kind of like the Framington Heart Study, a sort of national-based study that looked at type 1 diabetes following around 35,000 people. And one of the more interesting things I found is everyone knows what diabetes is, but didn't necessarily know the differences of type 1 diabetes. Specifically, most people know it as juvenile diabetes. I'm curious, given that you're working in eye disease right now with ONL therapeutics, is it really one of those kind of diseases where a lot of people don't know sort of those disease states that are really on the fringes of the bell curve, as they say, sort of those orphan types of diseases. Are you hitting those kind of barriers yourself?
David EspositoTerrific point. So at ONL, where our therapeutic target is a receptor called the FAS receptor, FAS on retinal cells. And that is the common core pathophysiologic response to disease. And so an eye disease, to your question, yes, we are addressing orphan indications, one specifically called retinal detachment, which is an acute condition. It's not the trauma-induced price fighter retinal detachment you think about. It's more of the disease of the aging, but it's still a small number of patients. But then also, given the commonality of this receptor to other disease states, we are active in clinical trials for large disease states that your audience is probably familiar with, things like open-angle glaucoma, also age-related macrodegeneration. So these are millions of patients in the U.S., multiple millions worldwide. So there are both the small orphan and the large disease states, and ultimately building a development plan to try to address all of them, but then ultimately make some choices based on investors and that kind of stuff.
Jason Dana CostaExcellent. That's really cool. So does ONL sort of bringing the drug developers together, sponsoring studies, or what's sort of its thrust in the work that it does?
David EspositoSure. So we're an early stage biotech company, uh typical what you may describe a university spin-out technology. So our scientific founder, Dr. David Zachs, is a retina specialist at the University of Michigan. It was David's original research that identified the relevance of this receptor. And then here we are 15 years into it with regards to developing how can you, in our case, block that receptor, develop a therapy to do that, a therapeutic. And then we've been through a number of clinical trials. And so we are privately venture capital funded. But ultimately the research starts that. And then we are a small team, about 15 people, even though we have a global reach on these trials. We work with contract research organizations to really extend our reach into the trial sites.
Jason Dana CostaOh, that's excellent. I'm very familiar with some of the similar work that you've done with type 1 diabetes. We partnered, you've heard the Jabe Center. Yes. Yes, I have. So the Jabe Center both does the kind of work you do in eye disease as well as type 1 diabetes. So they were the individuals that were our study partners when we did the T1D Exchange study, both its initial study, which ran for I want to say it ran for 10 years. Now they're in their second study. And I want to say we were in the ballpark of like 75 assays and publications. So it was a like I didn't connect it to the Frameton Arts Study. Well, with a small thought, it really has been, at least in the U.S. anyway, a pivotal study. So I have such an appreciation, David, of what your work is and the hard work that's doing it. I'm making a leap of faith here. I think you might be like me. I'm not a scientist. I'm a CEO executive with an accounting training, but spend a lot of time in nonprofits. So it's really exciting, at least for me anyway, and I hope the same is true for you, to be part of things that impact people's health and lives, even though it's not like our subject matter expert. It's not what we do every day when we go to work.
David EspositoA great point. No, I think that's what's into my maybe earlier comments. This is very purposeful work treating these diseases, addressing these. We're in the work of trying to help patients literally see the future. And so it is very purposeful work. Well phrased. I love that. Yeah, no, that's our vision for the company, help patients see the future. And I'm not a scientist by training either. So you know what's interesting with these early tech ventures and probably very similar to what you've experienced. We can have great scientific ideas, but you got to move those forward. That takes capital to do that, or it takes other skill sets. So building a team beyond just the science has been just an interesting journey for me to be able to lead and guide the building of those teams because you can't swing too far one way or the other, can't just be focused on the science or think about progress. But that's where the I think the healthy tension in a team to make those decisions over time always comes to play.
Jason Dana CostaOh, it will lead into a couple of my other questions I'd love to talk to you about. So trust is an easy to talk about, but hard to earn, particularly for professionals like ourselves, because the scientists will look at you and go, Well, you don't really understand what that science is. Can you share a time where you either lost trust as a leader and had to rebuild it from the ground up, or just sort of ways that you just made sure trust stayed in that environment? Because when it comes to research organizations, that timeline is long, you know, and building and sustaining that trust is not an easy task, at least in my experience. How about yours?
David EspositoSure. I think really great point. So may I say a couple things. I think one is with regards to building trust for the team, is especially around science, where, well, I didn't grow up with that scientific background as we as we shared. I mean, I think the openness to be very candid and clear of what you know and what you don't know, and ask good questions to build a team around that. I think that in and of itself, not trying to talk your way through something that you really don't know about, say, boy, you know what, I'm deep into this thing. Can somebody can help clarify this thing in real clear language? I think those go a long way to building trust, to not speaking out of turn of things you really don't know. So I think that it's one way, at least in my experience, has been helpful to build trust, is just being really open and honest when you don't know something and seek help around it. The other aspect maybe I'd put out there, I've been a commercial guy by birth, grew up as a sales rep. And so, you know, leading commercial teams in addition to now we're OL is not commercial. So we've been on, at least my tenure with the company about seven years or so, been on a development path for it. But in prior experiences, leading large commercial teams, this idea of trust, the one particular instance where further down throughout the organization of the big team, you have some activities that are not consistent with the culture that are also not consistent with the laws and regulations here in the U.S. And you got to deal with a few of those things. So I think as a as a leader, those were situations I feel like trust was broken. And as the leader, you assume some responsibilities for that. And I think those are hard to overcome, especially in in life sciences where patient lives, patient health is at risk. Those are big ones. So I think that would be a side where perhaps I, as a leader, lost trust because I was running the organization, even though you could say it happened a lot further down that hey, you're in charge of it. You got to take it with the take the lumps with it.
Jason Dana CostaSo what'd you do to try to rebuild that trust? I'm with you. I have had moments where let's say surprises happened down the organizational structure. For me, particularly, it's happened in multi-state, multi-site organizations where, you know, I'm 500 miles away, sometimes multiple time zones, but yet, you know, you have that C-suite role and and you have to take responsibility for those things that you uh I was curious, what did you do to rebuild trust in those instances when it happened to you?
David EspositoNo, it's not an easy task, but I do think it starts a little bit to the way I answered it before. Like I you got to get to the bottom of it in a very honest, clear issue, identification. Sometimes you say autopsy without blame. Let's just get to the facts, it's important, but also to the fact that you got to own it, even though to your point, as you were describing, very similar situation, multi-state, decentralized organization. You still got to own it as a leader. But I think get to the facts quickly, own up to it, and then you begin to war game. All right, what happened? How do we ensure that's not gonna happen going forward to rebuild that trust? But you know, Jason, some of these things, when you cross a line on some of those things that are impacting to patients, I'd be I kidd myself if I didn't say that stuff that drags you into those things. It's hard to overcome. It really is. And that's why you don't want too many of those things to happen.
Jason Dana CostaYeah, it's true. I agree with you. I'm curious in your career, because I know you've got bankruptcies, restructure, and turnarounds for organizations. So have you ever had the experience where you knew that was the problem coming in? I have in my experience a couple of times sort of I I look at it like the picking up a trash can lid, you're like, ooh, boy, that's more than I thought. That kind of thing. So when you've walked into an organization that either you found out has to get rebuilt or you knew it in advance in there, because it's of course this podcast is about worth saving and worth to work. I wonder what sort of things you looked at first to help confirm that this thing was worth the saving or worth the work to turn it around.
David EspositoYeah, I would say, boy, that's a really thoughtful way to dive into it. I I feel like, at least in my journey. So my first half of the career is with a large pharma company. Back half of my 30 plus year career has been early stage biotech companies. I think in the early stage, you can only do so much diligence around the science in the team. That's the hard part of that reality. Like you can dig deep, you can get it. But I found until you're really into the weeds, that trash can example as you say, you know it's you're somewhat in there. And so I think for me, assessing the state of the technology, at least at a relative dish diligence level, does it appear to have the potential to address this need you're getting after? And I think also the people side. Uh I would value the team on the front lines in their assessment of the technology a little bit more heavily than perhaps current investors into the program because there's all kinds of biases around. It's like with the team, do you think you have it? So I do feel like the assessing the technology and the team is important. But then to my comment earlier, I think sometimes you just got to make a decision when you're in or not. And when you're in, then we're into problem solving. And you realize with most of these early technologies, nothing is super clean. You're always solving problems with it. And hopefully on these you can solve them to keep going. But I've had a few experiences where you just couldn't solve it all and you had to close the doors on a company, which is always painful.
Jason Dana CostaHow do you feel you balance sort of that? I I found anyway, particularly when I came into a few of the organizations that clearly had a challenge. I found it to be a balance of both to your point a couple of minutes ago about, yep, there is something real here. There is a technology worth it. I I can see the pathway. I think that's a factual reality, because sometimes there isn't a pathway, and we have to be honest. Going back to the prior comment, you got to be honest up front. Here's the situation. I've also found it's sort of almost a demeanor with the leadership in some regards. That's that stability, that confidence and practical nature. And I'm almost kind of curious if your military background helped in that area, because it was not something I necessarily knew in my career early on, that just being confident and calm in and of itself is a tremendous skill and a tremendous value. And I I lean into that a lot now professionally, even if I don't a hundred percent know, I know what I know and I know what I don't know, and then just be calm about it. Has that helped you in your career?
David EspositoNo, it's that's a terrific point. I mean, I do think it is one of those, I'd say, burdens of effective leadership that perhaps we don't talk enough about. That if you're walking into an organization and your hair and everybody else's hair is on fire about something, and it's like who's leading what? And you know, instilling a state of fear is not helpful to anybody. So I do think it is one of those important elements of leadership that despite the chaos, it is like, hey, I'm here to assess what's going on, bring calm so that we can make effective decisions going forward. It's not easy. I mean, your experiences of mine too, you sleep with a little bit of this, there's certainly a little bit of a grind in your stomach or whatever you want to describe up that angst. Yeah, right, yeah. It's just it is important to realize, all right, hey, people are looking at somebody to be calm and effective in a role of making decisions, and the leader needs to do that. But it's certainly not easy, but it is uh an important part, I think, to your point, walking into an organization, if there is a lot of chaos like that, you have to really assess again it was it the technology and the concern, or is there like a real leadership issue that's got to be addressed? But I agree wholeheartedly with you that the leader needs to remain a sense of calm, even in chaos, but to sort through it, not to be foolish in that state of calm, but to be kind of resolute that, hey, it's a problem, we can solve it, let's get after it.
Jason Dana CostaYeah, and it's interesting too, because I found particularly in startups, and at least in my experience in biotech, being adjacent to Boston, all of Cambridge's biotechs. And it's an interesting combination of these just telegenic individuals that you have to be excited, excitable to be able to move those forward and get people to rally behind you and particularly gain some funds. I mean, obviously, you've got to convince people to put money into these situations where the outcome is not guaranteed. And I found it's been an interesting dynamic because of many of my career prior to becoming CEO, I don't know, I think you said sales as you moved in through some of your previous work. My background has been in accounting and finance. So by default, we're paid to be skeptics in a little bit of uh uh doctor no, as I like to say it. And honestly, in my career, how I pivoted it, particularly coming into the CEO role over time, is I've become more doctor maybe. Like, okay, what's the idea? Why is it worth that investment? But it's been interesting to now balance as I've sat into the CEO role. My natural tendency, of course, was conservativism and calm in the storm, how to pay your CFOs to do. I've had to learn that skill of excitement in some regards and build the vision that was a muscle that was available to me, but wasn't as as well developed, let's say, in my career over time, just because my other part of the job was green visor, no. Let's say no, you can't do that kind of thing. It's been really interesting to kind of pivot that, at least in my professional career, to more of the doctor, maybe and setting the vision while still being that calm-centered person. Because there's certainly lots of professional books out there that talk about the not telegenic leader that has been just as successful bringing sort of those big brands forward.
David EspositoYeah. Thanks for me growing up in the sales side. Noah, it's like if it's high adventure with a high degree of uncertainty, I'm an easy sale. So that but that's not that's not always a great characteristic as a CEO. So to your point, I probably had to swing more a little bit later. Let's be a little bit more thoughtful on this thing. Do we make these choices or not? And I think that's what makes the journey of building a team really cool too, because you do need a variety of these perspectives to ultimately move, especially in early stage technology. You don't have an existing business, you're trying to find a fit and a need. You need these varied experiences to really put the most effective plan together and then execute it. There's you read a lot or see these, hey, maybe it's just a one-person show that drives all that. That's really not reality.
Jason Dana CostaYeah. That breaks after a while.
David EspositoRight? No, it's a good team of a variety of skills that ultimately moves these things forward. At least it's been my experience.
Jason Dana CostaI agree with you. So, what shaped your leadership style most early in your life? What's one lesson that still guides you in difficult decisions you do today?
David EspositoSo I maybe I give you one that maybe is not textbook. I could give you maybe the military background or things that have a forest. We want to know you, David. So I was going to say, I'm going to give credit to my mom, who's still alive, thank goodness, you know, 84. And, you know, my mom when I was a kid growing up, whenever you'd have the normal kind of elementary, middle school slump of a kid wondering, hey, if I'm going to make the team or do all these things, she would just always say to me, Hey, so she's Scottish, born and raised in Scotland. So an accent I won't do it justice, but she'd say, David, just keep your chin up, keep your weak chin up, she'd say, keep your weak chin up. It'll all work out okay. And I find myself repeating that. Jason, there's a little bit of stature of keeping your eyes up and looking as opposed to hanging your head. Just that physical change gave me a little bit uh stronger footing as a kid. And I find myself with that voice in the back of my head in these current challenges to say, just keep your chin up, it'll be okay. And sure enough, these problems we've got to solve, and whether it's building a biotech company or something else, I mean, they are pretty difficult. But I have found that not everything gets solved, but for the most part, you rally a team around, hey, we could we've solved these before, let's get after this. Somehow you get there. And so I'd say my my mom's early advice has been super helpful, even as uh an old guy running a team now.
Jason Dana CostaOh, David, I can't agree more. I mean, for my own part, my guiding star has been my father. Unfortunately, he passed away six years ago at this point, but he was the individual that really drove many of the beliefs, which I think are the fundamental foundation of anything that I've done in management. So I couldn't appreciate more the fact that you leaned into your family's background at some of those lessons that they gave you, because that's exactly where I am. Even if you're it's funny, I'll use this as an antidote for my dad. He had this great phrase that when I was growing up, he always said, I'm only mad for the moment, because there's gonna be something that will frustrate you, something that may not be what it is, but you only worry about it for a few minutes. Have the worry, then it's behind you. I'm only mad for the moment. You gotta move into the next thing.
David EspositoTake that one. That's good advice, man. That's good.
Jason Dana CostaYeah, there's many Dana Costa anecdotes. The reason why my middle name's in there, that's my dad's name. He's given me a lot of those, so I couldn't appreciate more. And who knew in looking you up? That's something you would say. So I that's to my heart. I love it. That's fantastic. But we want to try to keep the podcast here. So I got one more question I want to make sure we execute. As I said, this podcast is worth the work and everything that you've experienced, how you do what you do as a person, a team, or an organization, you know, making truly what it's worth, what you invest in, those things can be difficult. So continuing to invest and even looking ahead down the road, what do you see as the most difficult things that organizations are facing today? What project for us for the future, David, what you see as some of the challenges that are worth the work to put the energy in?
David EspositoYeah, well, uh, no, that's a really good one. So, I mean, I do think what's consistent in the past and will be going forward is teams or companies or individuals, you really have to find purpose and meaning in what you're doing. So it usually is what problem, unmet need are we really trying to solve? Can I see myself as a part of that purposeful work to serve that bigger cause than myself? I feel like that'll be the consistent thread going forward. But I do hope with the tools now going forward, you talk a lot about AI and all that, can get us more efficient going forward. And at the end of the day, hopefully those tools or technologies can help us solve these problems better and faster going forward. I do think the tools and technologies are gonna be great to accelerate that. But what I'd also say, at least these new changes of AI are moving really fast. But I do believe that I think at the end of the day, the things we were talking about leadership and in the moment, the situation, how do you guide and rally a team? I don't think I'm gonna reach to my phone to get a spit-out response for the team. I think I'm in the moment. I better be sharp and leading. So I do feel that's probably what the future still will hold is leaders need to just rally a team, encourage them to get over obstacles. And I don't know if a tool in the moment's gonna solve that one. So I think that would be consistent.
Jason Dana CostaOh, I agree with you so much. I mean, at in a pharmacy that I run as well, the team was very skeptical of AI and its possibilities. They were so worried that it was somehow going to replace and remove people. And not the case at all. It was really about increasing their scope of service, what they're providing, to connect with some of the facilities and customers. You didn't ask, but you can see right over my head there. That's what Horizon Pharmacy is. It's one of the organizations I work with. And we both see AI as not only the future, clearly is. We're hearing a lot about it, but it really is just a tool to use to grow the relationships that I think were the almost the center thread of most of our conversations. We start out our relationship with our parents and how they informed us into both of our careers. And clearly it's relationships that will grow an organization and move the interesting missions forward. If you can rally people around an excellent mission and vision, they understand it, believe in it. Boy, we could change the world. And I really hope you can too at ONL. As a person who worked in an orphan disease state, it's always great to hear somebody that's gonna really do things that impact real people's life. And what a great phrase you said earlier. Really, I think you said something like helping people see. Is that what you said?
David EspositoHelp patients see the future. Yep, that's the vision of the company.
Jason Dana CostaThat is a great way uh that to it. So, David, I want to thank you so much for joining me today to remind everybody who's joined the podcast. This is David Empesino. He's the chief executive officer of ONL Therapeutics. You're a great person doing the work that you do. And I can't thank you enough for joining us here at Worth the Work with Jason Data Casa. So thank you so much for joining us today.
David EspositoJason, thanks for having me. It's a great show. Really appreciate the work you're doing as well. All the best to you, and thanks again for having me.
Jason Dana CostaYou're welcome.
