Odette Harris, MD, MPH, Professor of Neurosurgery and the Paralyzed Veterans of America Professor of Spinal Cord Medicine at Stanford, joins The Future of Medicine for a conversation about concussion, traumatic brain injury, and what it takes to change how medicine thinks about the brain. The conversation was recorded in front of a live Medicine Grand Rounds audience.
Dr. Harris has spent her career arguing that concussions should be understood as brain injuries, not minor bumps. She explains her work with the National Academies of Sciences, Engineering, and Medicine to rethink how these injuries are labeled and treated. She also describes how research with the NFL is helping inform safety protocols in other sports. Her message for parents is practical: the children who come to her clinic are more often soccer players, divers, volleyball players, and cheerleaders than football players. She adds that every sport carries some risk, and families deserve better data to make decisions.
She also discusses her research on women with traumatic brain injury in the military. Because so few women were in the studies, their experiences were often lost in the data. When her team examined them directly, they found high rates of depression and balance-related problems that were not being addressed. Women veterans were also having a harder time returning to work and daily life, even though they were better educated than their male counterparts.
Dr. Harris reflects on her own path, from immigrating to the U.S. from Jamaica, to Dartmouth, to Stanford Medical School and neurosurgery training at a time when very few women entered the field. She describes the mentor who told her to "go where you can write the script." That advice led her to spend her Van Wagenen Fellowship studying brain injury in Jamaica. There she found that death rates from brain injury were the same as in wealthier countries. The differences were in how quickly patients died and how well survivors recovered. She also shares stories from her recent Dartmouth commencement address and what it means to have the Congress of Neurological Surgeons name a lectureship in her honor.
Together, Dr. Harris and Euan Ashley discuss concussion science, fairness in medical research, and why the future of brain injury care depends on asking better questions.
The Intro
Think of the mental gymnastics you have to go through to assume that I'm wearing my state rather than that I'm a doctor. What I have done is flipped that.
You probably think you know which kids get concussions. Dr. Odette Harris is a professor of neurosurgery at Stanford and one of the country's leading experts on traumatic brain injury.
"You're not going to take a normal path" was his mantra to me. "Don't try to fit yourself into what everyone else has done."
The year she finished her training, only eight women in all of America graduated from neurosurgery. Her research changed how we understand brain injury. And it's part of why the NFL asked her to join the committee that shapes his concussion protocol.
The numbers of women in combat in brain injury were so small that their experience, I was concerned, was not being well represented.
In our conversation, we explore her path from Jamaica to the United States and talk about head injuries in sports and what medicine still gets wrong, especially in young women.
Welcome to Stanford Department of Medicine's inside look at the future of medicine.
The Transcript
Dr. Euan Ashley: You are a professor of neurosurgery here, of course. You're also the Paralyzed Veterans of America professor of spinal cord medicine. And you also came, you were just telling me, from giving commencement at Dartmouth.
Dr. Odette Harris: Yes.
Dr. Ashley: Tell us about, tell us about that, first of all. Let's just start there. Since we're on your tour now, this is like your national tour.
Dr. Harris: First, I thought it was a joke. And I've done that before. But then I actually read the email and it was like, "Hey, come give commencement here." And I thought, "This is really, really, really scary."
Dr. Ashley: Yeah. And so it's a little scary thought.
Dr. Harris: Well, it's captured on YouTube and I just thought, "Oh my gosh, like I've got to get new clothes. I got to get my hair done." And then my husband's like, "Well, you get to wear a robe." And I was like, "I still need new clothes." And like, you know, the whole thing, right? You got to celebrate the moment, and I'm still going to get like a bag and all these things that are completely irrelevant, but I still think that I deserve them. But in any case, it's such a humbling experience. It took me probably 3 months to figure out what to say and how to sort of begin crafting a talk like that because it's not about me; it's about them. And so that's, you know, we're used to talking about our research. We're used to doing those types of presentations. And here was an ask to sort of flip the script and give advice that, you know, hopefully they listen to. And also speaking to family members, that was also new, right? Because normally we're speaking to our colleagues and other academics. And so I now had to think what would resonate with families as well.
Dr. Ashley: And there's so many examples online now, including of some really, really good ones. You know, that adds a little bit of pressure, right? Steve Carell, like, doing dancing at one of them, I remember—
Dr. Harris: I didn't dance.
Dr. Ashley: Yeah, it sounds like you got a standing ovation.
Dr. Harris: I did, and that was really, really, really humbling. You know, I went to Dartmouth undergrad, hence the green on my shoes for any Dartmouth people in the room, you know, and so coming back home and doing that, it felt like a life moment and to feel appreciated in that moment was also super special. But I thoroughly enjoyed it. Um, I, I started by saying, "I'm humbled and I'm scared." Um, which was really true because you don't know how these things are going to go. I don't think anyone's ever been booed at a commencement speech, but you never know. And I just didn't want to be the first.
Dr. Ashley: The first one, right? Any themes you could share with us? What sort of things?
Dr. Harris: I started by talking about my mother, which actually caused me to be a little bit emotional. I was sharing that my mom died this like recently. Not that recently, but still. And I shared the story about growing up, um, as I'm an immigrant to this country. And I came here because of my parents. Obviously, I was a kid. Like, you don't really have a choice, but I learned to embrace their dreams. And I talked about the power of dreams and what that meant. And I shared a story I've shared before, which is that my mother thought that she was going to make us American by feeding us as Americans.
Dr. Ashley: And this was interesting approach.
Dr. Harris: Oh, it was insane. And for those who don't know, you were from Jamaica. Jamaica. Yeah. And she was deep on this, right? And so for several, like, probably at least a year, she decided that American children ate cereal for breakfast. And so she would boil the milk because you shouldn't feed something cold, right? And then she would pour the cereal into the milk, and then she would wake us up, and we would get ready, and we'd come down, and there would be this bowl of congealed, like, warm milk and cereal. And she would tell us, "Eat it," because that's what American kids ate. And we were like, "This is horrible." And my sister and I like would say like, "We don't want to be Americans. Like, this is not good at all." And it took probably a solid year of our complaining. And then a cousin of ours visited and said, "This is not how Americans eat cereal." It was that deep desire to give us all the opportunities that she felt was American and what America represented. So I talked about the fact that, like, you know, for many people in the room, for many of the graduates, it was a pivotal point in their life. And in fact, they were fulfilling not only their dreams but maybe even the dreams of their parents. And so I talked about the power of holding on to those dreams and being guided through life by that. The second theme was I talked a lot about not reducing your experience to a grade, which I think, hopefully, that stuck with them. And I told the story of when I was at Dartmouth. I took a physics class, as premeds do, and, um, and I sucked. And the first class was terrible. And I went to the professor, and I said, "I don't really know anything," and he couldn't believe it. Um, and, you know, and he said, "When did—where did you get lost?" And I said, "Right after you said your name," you know. And then I spent that term meeting with him one-on-one, and ultimately I got an A in that class. But the A doesn't tell the story of just how grateful and how deep, like, that experience was. And the backside to that story was when I got to Dartmouth, and for everyone who knows Dartmouth back in the '90s, very homogeneous place, and you know, we didn't have phones, etc. And people were like, "Oh, you're here because of affirmative action." And I didn't know what that meant. I'd been at an all-girls school and I had to go to the library and look it up. And then I was freaked out and I thought, "Oh my gosh, I'm here because of that." And there were other reasons that happened. And so when I sat in that class and didn't understand anything, I thought, "Oh my gosh, like why am I here?" And it had erased those fears, erased all of the accomplishments that had brought me to Dartmouth, right? And so the professor sort of sitting with me and making me not feel like an idiot, but really understanding what I needed in that moment, was a powerful lesson for me to never just focus on the grade but to understand the journey to the grade. And then the last story I told was, in challenging situations, there's, there's always opportunities. And this is kind of a story that still is ongoing, sadly. But when I, um—one of the first medical meetings I went to after residency, etc.—I was in the elevator and someone said to me, "Hey, are you from Maryland?" And I didn't know what they were talking about. And I thought, "Everyone from Maryland must be super cute." Yeah. Well, that's the obvious. That's the obvious conclusion. And my husband, who never goes to medical things, but I think I was getting an award or whatever, so he had been there. He hates going to these things. And he immediately understood what was meant, as do probably some people in the audience. And I didn't get it. And then I looked down and it said "Odette Harris, MD." And so they thought that I was wearing my state because, you know, everyone does that. Like, do you guys not have California after your names or what have you? So, you know, and, and what I tried to explain was: think of the mental gymnastics you have to go through to assume that I'm wearing my state rather than that I'm a doctor because I didn't fit into their notion of being a doctor. And in that, in telling that story to them, what I said was, you know, you're going to have lots of challenges in life. Like this is part of my journey, might be part of some of theirs. But what I have done is flipped that and spent a career focused on how do we change that narrative? How do we increase access? How do we get, um, more people in medicine that look like me, you know? And some of them can be from Maryland. I don't have a problem with that, you know. Um, so we talked a little bit about that and then we talked about like the opportunities that came from that. Um, not in too much detail because I was telling him you don't want a graduation speech to be like 50 minutes or anything like that. So, yeah, so, I mean—exactly. But those are the themes.
Dr. Ashley: Oh, that sounds amazing. Thank you for sharing that with us. I think we're grateful. So many levels of wisdom in what you're saying there and, I think, lessons for all of us, regardless of our journey. We like, uh, when we do these kind of sitdowns, to, to delve a little bit more even into people's background and you offered some just by virtue of the commencement speech. But, uh, yeah, you know, we talked initially about you, where you are today, professor of neurosurgery, you know, national leader in traumatic brain injury. We'll get to that soon. There's plenty of topics there. But we left you at, well, you told us a little about coming to the country. We left you at Dartmouth maybe in your undergrad. Trace a path for us from there to here.
Dr. Harris: Yeah. So, first of all, I just want to thank you guys for this opportunity. Um, it's rare that a neurosurgeon is in a space like this, but I want to give a special call out to my roommate in medical school who is an internist. Neridge knows her, and I'm going to hold this over her head for the rest of our lives. So, that I'm like giving grand rounds as a neurosurgeon.
Dr. Ashley: Yes. Like we occasionally let surgeons into the room, you know.
Dr. Harris: I went to Dartmouth as an undergraduate. It was a pivotal experience in my life and I still hold that it was probably one of the most powerful decisions I made because I think that Dartmouth is very much a cult in a good way.
Dr. Ashley: Okay.
Dr. Harris: And, um, in a way that is lifelong, like a nurturing and a sense of community that extends beyond those four years. And that's been really important to me to have those friendships and those bonds. You know, at one of my, my pivotal birthdays, or sometimes just a regular birthday, I took a picture once, and there were nine of my sorority sisters, like, from Dartmouth, like, in the picture. And, you know, and when I took my oldest to kindergarten, um, there was a class of 17 in Menlo Park, and there were five of my sorority sisters in that class—their kids, not them themselves. They had graduated. We were truly friends and I think that's unusual. Um, you know, I don't think my husband is in touch with five people, much less nine and, you know, double digits. Um, but I learned a lot at Dartmouth. Um, it was not, um, I tried to sort of hint at the fact that, you know, when we tell our stories, we tend to gloss over all the ups and downs because we think it's nicer to talk about the joys and the A's and all the rest of it. But, as I alluded to in this the previous talk is that it's actually the challenges that shape us. And, you know, Dartmouth was a challenging place to be, um, when I was an undergraduate. Um, it was, you know, the tail end of, like, the shanties and, you know, South Africa and, um, and lots and lots of things that you would imagine in an environment that's incredibly homogeneous. Um, but when I left Dartmouth—
Dr. Ashley: Did you know at that point that you wanted to go into medicine?
Dr. Harris: I definitely—I went to Dartmouth thinking I wanted to be a pediatrician, an accountant, or a kindergarten teacher.
Dr. Ashley: Okay, that's a pretty diverse.
Dr. Harris: It was very, very diverse. I'm not any of those things. So, um, so again, I think what Dartmouth afforded me, it sort of expanded my worldview, and expanded my perception of my own abilities.
Dr. Ashley: I mean, from where you started, that's a pretty amazing contribution.
Dr. Harris: Yeah.
Dr. Ashley: From the institution. I mean, you built that yourself through yourself and your peers and your work. But to have gone from where you started, which you described a few moments ago, to the point that you felt empowered to do anything.
Dr. Harris: Exactly. Yeah. And I think that's the power of—we always about a liberal arts education. We wonder about what the ROI is. And, you know, I always joke, and again, my husband thinks this is so anti-intellectual, but, like, my favorite class at Dartmouth was called TV: A Critical Approach to Viewing. We called it Cosby for Credit. And, you know, and you might say, like, "I don't understand. Why is that important?" But I went to Dartmouth as the typical, like, geek, right? You know, "I'm going to be a premed. I'm going to do this, etc." And I got to Dartmouth and I had to pause, and I had an opportunity to appreciate the world, to appreciate what an intellectual environment could bring, how it could inspire, how you could grow from that. I got to do research at a deeper level and understand the value of being curious and inquisitive. The reason I love that class so much was I got to appreciate the art and the structure behind something that I had taken for granted in terms of just watching television. And it was a deeper appreciation of the arts, ironically. Um, and I think that when I look at my life now and the things that I value the most, it stemmed from that experience of somebody or an institution forcing me to open my mind to what else was out there other than important part of.
Dr. Ashley: Truly, a liberal education. But you mentioned you were already interested in a premed track, almost. So when did you first get the urge to care for people for a living?
Dr. Harris: We had to wait for our bus to school, like my high school, in a hospital. And so I would sit there, and you'd see all this stuff happening. And then ultimately, like, I volunteered at the hospital. And I also, truth be told, like, I'm an immigrant, right? So there's like a list of like five things you could do as an immigrant child and make them proud, right? You know, you could be a doctor, a lawyer, you could even be an engineer. There was also this category of businessman, which I didn't understand. I still don't. It was just such a narrow list of opportunities. So much so that, like, with my own children, I'm like, "I don't want to even know what you're thinking of majoring in until you're a sophomore," because I don't want to constrain their world view. But for my parents, they had no problem saying, you know, "You should do these things," kind of a thing. And if you were smart and you liked the sciences—
Dr. Ashley: They were looking for you to do one of those five.
Dr. Harris: I think so, yeah. And, you know, I think I dated a guy who majored in communications and my parents were like, "What's that?" And again, they didn't go to college, so it was like, "What do you mean?" Like, they just had no world view. I think I didn't escape being influenced by that, right? And so when I went to college, I think it sort of imprinted in me that I needed to, in order to succeed, like I needed to kind of do one of those things. And I was, you know, good at science and math. And so medicine seemed like a very like clear-cut path. And the other thing is, again, we're not immune to these things. Like I think I was, you know, as a Black woman, like you worry about the glass ceiling and business and all of these things and things that I thought were less appreciative of my objective talents.
Dr. Ashley: Yeah. Yeah. So then medical school that, you know, draws that line. Medical school through—
Dr. Harris: I went to this really terrible medical school. Yes. I went to this medical school that, you know, like they beg people to come to, which was here. And, you know, the funny thing about Stanford Medical School is like when I was applying to medical school, I had a roommate who was from California at Dartmouth and she was, in my mind, what Californians looked like. Again, I'd never been to California, but she was blonde and she was like a size zero and, you know, she was super smart and all the rest of it. She was one of my sorority sisters and I think she's amazing. But in any case, I was like, "I really don't want to go to California because I don't look like that." And I was super afraid. And in those days, though, a testament to something we don't do anymore: they would heavily recruit you and fly you out and, you know, really open your perspective. And I'm really, really grateful for that because I think had they not done that, had I not come out and seen Stanford and seen what it looked like, I think I might have sort of fallen back on my own prejudices around what that might have been. I came to Stanford ultimately because of the research opportunities as an undergraduate. And the flip to that was that you benefited from it financially as well, right? Because in those days you could do a med scholar that would cover most of your tuition costs. So I thought, "This is a win-win if I'm going to do research anyway," you know, and—
Dr. Ashley: So you already had an academic sense.
Dr. Harris: I did a lot of research as an undergraduate. Yeah. I think I did research at the medical school. I was at Howard Hughes as an undergraduate.
Dr. Ashley: You were already a good fit for—you just didn't know it yet.
Dr. Harris: I didn't know it yet. Um, yeah, but I had already shifted to the neurosciences. Like I had was thinking genetics and pediatrics again.
Dr. Ashley: The pediatrician—genes and kids are important, you know.
Dr. Harris: Yeah. Yeah. I'm so glad I did not do that. I would not have been a good, uh, pediatrician. Trust me. Yeah. I would have been terrible.
Dr. Ashley: But surgery started to appeal to you.
Dr. Harris: Yeah. Surgery is awesome. Anybody who's undecided, be a surgeon.
Dr. Ashley: You're not going to find too much in this.
Dr. Harris: You can always retrain.
Dr. Ashley: Well, I always, like—I was talking about it this morning, actually. I also like to remind people that in Britain, where I trained, you have to do surgery before you—as part of your first year as an intern. So I was an orthopedist for six months.
Dr. Harris: Oh my God. Was that good for you?
Dr. Ashley: It was good, actually. I like sports medicine and I like trauma. I actually talked to one of my students who just had an ACL fixation and I was remembering helping. Not much. I wasn't helping much. Let's be clear. I was holding things, but I was in the room.
Dr. Harris: I think surgery is addictive, like, um, if you're the right person. You know, in my senior year—
Dr. Ashley: Tell us more.
Dr. Harris: Well, in my senior year at Dartmouth, I did a neurology, a neuroscience class where we operated on crayfish. They have a very advanced nervous system. Their nerves are like hair, and just to be able to isolate that and see that—and then all of a sudden, I was just hooked. Um, I'm also a fidgeter, so I think that also helped.
Dr. Ashley: And your early surgery was like on the nerves of a crayfish.
Dr. Harris: Yeah.
Dr. Ashley: It's an interesting place to start.
Dr. Harris: It is. And then my actual first surgery was with a guy named John Adler. If anyone knows him, the man is hilarious. And John, um, is my mentor, um, still, and the voice in my head still.
Dr. Ashley: Yeah.
Dr. Harris: And, um, John and I ended up working on a project in Eric Shooter's lab. Um, and as an aside, he said, "Do you want to come to the O?" And I was like, "I'm in." And we took out an infected bone flap. I was sold. And most people would be like, "That's disgusting." But for me, if you've ever—I mean, obviously you've all walked into an operating room. It's like being in Vegas. Like no windows. You know, the time is somewhere; you're not really sure. And I think they pumped something into the room, but no one's confirmed that.
Dr. Ashley: I was doing a little creative writing recently and contrasting the world of a radiologist with the world of a surgeon. You think about radiologists spent a lot of time in darkened rooms with very poor ventilation, you know, staring in kind of darkened gray corners of scans. Surgeons are performing kind of under bright lights or, or conducting an orchestra around. I'm no anesthesiologist here to comment on that analogy, but it is a very different environment. You're right.
Dr. Harris: Yes. I think there's something in the air, and if anyone wants to do a side project, let me know.
Dr. Ashley: So it was always neurosurgery for you. So it's like from the earliest point.
Dr. Harris: Yes and no. So I had a deep desire to do something that was community-based coming from a developing country and all the rest of it. And so at one point I had a freak out, and I thought, "How is neurosurgery going to translate into the developing world?" Like, you know, it didn't seem transferable at all. And I remember thinking, "Maybe I should be an OB/GYN or something of that sort." And I went to Adler, like, in this moment of, you know, "Oh my gosh," and he gave me just really solid advice at the time. He said, "You know, you got to do what you love, and you'll make it work. If not, life is long and, like, too long," you know. And he said, "If you want to do global health or community work in the context of neurosurgery"—at that time, there was no roadmap for that—but he's like, "We'll figure it out." And we did. And ultimately, in my third year of residency, I decided to go to Berkeley, or apply to Berkeley, for a master's in public health, and I ultimately did that. We get our fourth and fifth year out of the operating room, technically a little bit out. In those days, those were our academic years. And so I spent my fifth year at Berkeley, and that fit the pieces together for me.
Dr. Ashley: And that was a new direction in some ways.
Dr. Harris: Yeah, that, that was, you know—now people get MHS all the time. In those days, that was not part of the surgery training, and we were expected to go to the bench for that year, um. And so that was a difficult, um, decision. And Adler really, behind the scenes, orchestrated and smooth that for me. Right.
Dr. Ashley: It's another great example of what a mentor can do for you. Right.
Dr. Harris: Yes. And to give me that push to like, you know, he's like, "You're not going to take a normal path" was his mantra to me. He was like, "Don't try to fit yourself into what everyone else has done."
Dr. Ashley: So, I think that's really good advice. Yeah. That takes you to the point where you start to circle around the idea of traumatic brain injury as a focus to paint the picture of what it was like.
Dr. Harris: I mean, and some of you were my professors during this time, so you know. But, you know, neurosurgery was a different world. We took one person a year. Everyone sort of did what you were supposed to do kind of a thing. And here I was like wanting to do this and wanting to do something different. And just to again paint the picture, the year, uh, I graduated neurosurgery, there were eight women in the United States. So seven other women in the entire country graduated neurosurgery. And this is not ancient history. This is like 20 years ago, right? Maybe that is ancient history according to my children. Sorry. And Adler had said, like, you know, "What do you want to do?" And trauma then—and less so now—but was seen as a little bit quote-unquote pedestrian. And so there was this notion of, like, "Why would you do that? Like, you've trained at Stanford. Like, why wouldn't you do vascular or oncology or what have you?" And again, Adler is just a brilliant person. I mean, again, very much an iconic class, but brilliant because one of the advice, one of the piece of advices he gave me was, in our specialty, people are always looking for validation of what you're doing. And so during my residency, he made sure that if I wanted to do something crazy, that I got external validation for that because, again, seven other women. It wasn't like people were going to just inherently trust that. So, you know, I would go off and do a fellowship somewhere, and I would make sure I got a grant or an institutional, like, you know, recognition of that. So I had done that. And then at the end of my residency, I was really, really, really lucky to be selected for something called a Van Wagenen Fellowship. And in our field, it's sort of just a culmination of, um, of, like, accolades. And what they do is you're allowed to go anywhere to study anything. And so again, being a bit of a challenge person, I decided to go to the Caribbean, to the developing world, which had never been done before. Everyone went to Europe or, if you were being really crazy, Canada.
Dr. Ashley: Those wild people.
Dr. Harris: Those wild people. And to put it in context, at the time, something like 70%, over 70% of the people who received this became chairs of neurosurgery, right? So this was like, "Oh my gosh, you're—you've gotten this." Like, I mean, it was a moment in my life that I still treasure because it was such an honor in our field. And then I decided to go to Jamaica, and everyone was like, "What? What? Where? How?" You know, so. But that was a move to figure out how to create an academic platform for trauma. And for those who don't know, Jamaica University Hospital of the West Indies is the tertiary referral center for the Eastern Caribbean, and so I was going to sort of the mecca for that area. And, you know, the Grady Hospital, where I ultimately landed at Emory, you know, they are the second largest volume of traumatic brain injury in the US at the time. And the hospital in Jamaica saw nine times that, just to put it in perspective. And so it was a very powerful move to decide to go to the Caribbean. And Adler's point was, again, like, "Go where you can write the script." And I thought that was just so great. So instead of following what everyone else thought I should do, he was just like, "Be bold and go somewhere else because no matter what you do, you're going to be the first person to do it because of who you are." And so I took that advice. I went to Jamaica. And when you receive this award, it's such a big deal in our field that job offers just are like flying at you, etc., and I chose to go to Emory because of Grady Hospital. And so my first job, like, right off the bat, was to be chief of neurosurgery at Grady for Emory.
Dr. Ashley: Wow.
Dr. Harris: You know, and I was like—I mean, anyway, it was just like this moment where I was like, "Wait, what? Where do you park? What do you do?" Like, I mean, I was so clueless. You know, Grady funded me in Jamaica, and I created this project. And the project was based on my epidemiology background and all the rest of it. And the root of that project was, again, Adler in my head saying, "What are we not challenging in medicine and neurosurgery?" and sort of pushing me to think outside the box. And that became the premise of that work and then subsequent work which led to trauma. And so in that work, I was trying to show that this notion that developed countries did trauma better was not true. It was just that we hadn't used the appropriate methodologies to understand what was happening. And what I found in this large cohort study over the course of like a year and a half or so was that the mortality rates were actually identical. It was the time to death that was different because in the developing countries, they didn't have the pre-hospital care, so they died immediately, kind of a thing. But the numbers were the same, and it was the morbidity that was different. Meaning that in the developing world, they didn't—in these countries that we were looking at, they didn't have established rehab units like we do here. So the morbidity was different, but it just completely changed this notion that we were somehow better at saving lives, right?
Dr. Ashley: I think that's really powerful. I think it's a major element that you've contributed to that field: this focus on both things like mortality, and also when is a mortality, but also the functional status during that period. Which is—it's really been—I was enjoying over the last few days reading, you know, your work and diving into it a little bit. I believe there's also—you also now have a named lectureship, right, named after you?
Dr. Harris: Oh my God, that is so—yes, and I'm so—can I just, like, brag for a second?
Dr. Ashley: I just asked you to, please.
Dr. Harris: Again, it's one of those emails that you get, and you're like, "This is a joke," and I, like, deleted it, you know, or ignored it. And then finally I get a call, like, "We can't name a lectureship after you without your permission," and I was like, "What?" Then, of course, I was sharing with my friends that there was going to be a named lectureship after me, and they said—'cuz my friends, or a couple of my friends, are in academics—and they were like, "But you're not dead," you know. So that became, like, a joke in my friend group, like, "Hey, I'm still alive." It was a life honor, like—so the Congress of Neurological Surgeons, which is our main group, you know, everyone has their main group, decided to endow an Odette Harris lectureship. And I got to give the eponymous lecture in October, and it was the most humbling experience of my life to be in a room of my peers, um, to be celebrated in that way, especially because the path I've taken is just so different than would have been expected, and for the organization to say, "This is actually worthy." It was worthy of incredible pause for me, and, um, it was humbling, and I'm still standing in extreme gratitude.
Dr. Ashley: Well deserved and not surprising to any of us.
Dr. Harris: Thank you. Thank you. And by the way, most of the people who have named lectures are—actually, all of the other people who have named lectureships, I think there are four or five of them—they are dead.
Dr. Ashley: Yes. Yeah. So you have a long way to go.
Dr. Harris: Yes. Knock on wood.
Dr. Ashley: One of the ways that people know about you is because of the work you've done with concussion, obviously, and with the National Football League and other sports. So that's obviously a very topical concern. Tell us how you got involved with that, but also where are we today with sport and concussion? Maybe we don't have so many in the audience whose kids are literally playing football, but soccer is an increasing sport for participation. And I was reading recently that the rates for concussion, particularly in young girls, are higher. So tell us a little about the work you've been doing there and the important things we should know.
Dr. Harris: Yeah. So there's a lot in that and I want to touch on some of them because it does span my actual research plus this work plus advocacy. So we'll come back to the gender differences as well. Um, but also I just want to point out that like anybody under 20 apparently like follows me through Reddit threads, which I had to ask my admin, "Can you show me the Reddit threads?" Like, because I, you know, I don't know because I don't have social media, so they like form these groups or what have you, but anyone over 20 would know this stuff. I have worked really hard for us to think about concussions as brain injuries. And in fact, the CDC guidelines that came out right before the Trump administration, like that summer, that was our work in changing what people—like, how we labeled it. We tried to put in concussion/TBI, etc. Just because I really feel like when people say concussion, it's almost sort of like, “Eh, that's not a big deal.” And you know, for two years, we worked with the National Academy of Science, Engineering, and Medicine to think about what that meant in terms of the care and the outcomes and what have you. My work did not start out in concussion and did not start out to be something that was sort of generalized in that way. I really was looking at traumatic brain injury. And my first question was, like, "What am I holding without questioning?" And it was this notion of mortality, right? And if we don't know what's impacting those rates, how do we then change our clinical guidelines and what have you? And then from there I forayed into guidelines, right? And working with that and so on and so forth. And then there was this marriage of like my clinical work and my research. Slowly but surely, my research segued into gender and traumatic brain injury, something that I'm super proud of because of the impact that that has had. Yeah. What I learned very early on was that the numbers, particularly in the military, the numbers of women in combat in brain injury were so small that their experience was noise in the data set. Everything we were finding out about these—all of the algorithms, the treatments, the recommendations—were all geared towards the major components of the cohort, understandably so. And the experience of women, I was concerned, was not being well represented. And the story I tell is take Framingham, right? Where, you know, you have a cohort that did not include people that looked like me and the recommendations might not be applicable to me and might in fact be deleterious, right? And so, um, so I wanted to not have us in trauma go down that same rabbit hole, particularly in an era of blast injury, where this was becoming the signature—which was the signature wound of those conflicts. So I started looking and using sort of different methodologies to look at women in the cohort. And my first foray was just to do sort of apples-to-apples comparison. And what I found was shocking to me: that, in fact, women were having an entirely different experience. And at that time everyone was very excited about PTSD. They still are, but it was just, like, all over the news, all over the literature. And women at rates of like 90% plus were experiencing depression, right, and other mental health issues that we were not diverting resources to, right? And so that was concerning. They were also having a lot of like vestibular issues and sort of sensory neural issues that were not represented at all. And then the thing that really, really pushed me was we had done multi-levels of examining. We were doing cohort analysis. Then we were doing a matched analysis. We were doing brain-behavior interface with our neuroradiology colleagues. Now we're looking at, with our neuropsychologist, looking at adverse exposures. And, you know, so we were doing all these layers, and at some point, we were called DC to the Pentagon to talk about our work. There were like seven of us, you know, we were asked to talk about what this meant for women. And what was most shocking about the data set was that women were not only having this disparate experience, but also they were better educated than their male counterparts, but their reintegration indices were worse, right? And so you could imagine that what was happening then is that this, the, the Department of Labor was sort of thinking, "Okay, well, if women aren't doing, doing as well, maybe we should be putting money into, you know, retraining efforts and re-education efforts," because that's what we reflexively think. And I sort of had to say, "Actually, no. Like, they're better educated than their male counterparts. So it's not education." And that followed from the Department of Defense like then over to the Department of Labor. But the other thing that happened in the Department of Defense, which was an eye-opener for me because, again, I was very junior at the time, was how data can be weaponized. And I think you probably all have experienced that in your own lives, and we see it now, but how data can be weaponized, right? And so here I am saying women are having this experience in their recovery. And this was right as women were entering into combat, and there was this question of, like, "Well, women shouldn't go to combat." And I was sort of like, "That is not what I'm saying because, by that, let's not put men in combat then, cuz I'm not saying that they're not having the same experience. It's just different." So at that moment, I realized just how powerful perception versus the actual data could be and how it could be weaponized. So I sort of forayed into this. I hope that our data, you know, led to—and I know it did—led to changes in how we think about recovery efforts and all the rest of it. But then from there, because I was doing all this stuff, I got tapped to, um, work with the NFL. Yeah. And I went to Stanford and I said, you know, "I'm interested in this from the research standpoint." And they sort of approved it. But I was also clear that I knew nothing about football. And I tell the story often because the way they tap you to come work with them is, you know, you're just talking to people. I thought I was giving advice, which I normally do about my work. And then they said, "So, would you consider like working with the, you know, that, this, the research piece, the head and spine piece?" And I said, "Um, oh gosh, no. Full disclosure, I know nothing about football." And they said, "Yeah, you said NHL five times."
Dr. Ashley: I was about to ask, at what level do you define “nothing,” but now you've done that for me.
Dr. Harris: Nothing. I knew nothing. Okay. And I said, "Yeah." Okay. So, you get it. Like, I don't know anything about ice. Yeah. But to your question about soccer, I think for me it was an important moment in my career to think, "Okay, what would being involved with this mean, and what does that data mean, and how does this impact larger cohorts?" And I'm so glad that I, I said yes to that opportunity. It's intellectually exciting. But here's the thing, nobody talks about soccer, basketball, cheerleading, right? In fact, my family doesn't know what I do. And I remember a dinner with my extended family and someone saying, you know, "I'm never gonna put my kids in football because it's too dangerous. That's why I signed him up for ice hockey." And then I said, you know, "That's kind of dangerous, too." And the response was, "What do you know?" And I was like, "You know what? I'm not even going to argue this." But the reality is this is happening on so many different levels where people think, like, "Oh, my kid's in cheerleading. They're safe." I can tell you that the kids who come to my clinics are not football players, right? Volleyball players, polo players, divers, soccer players.
Dr. Ashley: And what does the data show? Are there some sports that genuinely per are of participation?
Dr. Harris: Well, like what you're saying, soccer, and there is a gender disparity in the outcomes for sure, right? Because of some of the stuff that we're looking at. And I think that why I'm excited about the work we're doing is because nobody else would do that, right? You know, they don't, they don't, they don't have the political pressure and they don't have the resources, right? Cheerleading is not going to divert resources to study this. And so what we're learning in the realm of football translates into other, other sports who hopefully are heeding this. And some of the protocols we see the high schools putting in place are the result of that. I will say, however, again, I'm not advocating for any one sport, right? Because I did archery in high school, and I suck at that too.
Dr. Ashley: Is the concussion rate high in archery?
Dr. Harris: No. No. But the rate of people caring is also very low. Right. The reality is that parents, you know, are rightly skeptical, but the data just isn't there for them to make the decisions. And a lot of parents will say, "I don't want to do football," right, "because I'm scared of that." And then they'll move to something else, and they have no idea about that data. So part of what I want to do, or what I hope to do with some of the policies and things that we're working on, is to broaden people's understanding because we're not going to bubble-wrap the children, right? I'm not—like, you can't tell your kid, no, they can't cheerlead; no, they can't swim; no, they can't dive. But people need to appreciate that there are risks associated with all of these sports, not just football, right? And what are we learning about concussion and brain injury?
Dr. Ashley: And there are some things you can do influenced by that. I know under a certain age, they don't hit the soccerball with their head.
Dr. Harris: Exactly, but people have to take it seriously, and the data has to be there. And then the other thing, just because you guys are all internists, etc.—let me step on my, um, you know, soap box—is that the literature is increasingly more clickbait-focused. And so some of what we're seeing in the literature doesn't wholly represent, um, the scientific basis of some of these things. And so, you know, like, I, I can't tell you how many people are like, "Oh, does so-and-so have CTE?" And I'm like, "Are they alive?" Like, we don't know. Like, let's talk about other things because the literature fails to kind of really understand what's happening. Recently, I think it was maybe three years ago or so, so not recent by my kids' standard. There's a group in Boston that publishes a lot and I was reviewing one of the papers and everything now is in the supplemental, right? And you have to click like 10 times to get to the supplemental. When you get to the supplemental and you start looking at the data sets, you're like, "This is all invalid." You know, it's invalidated by this diagnosis and this diagnosis. And so, none of this data is really relevant. But unless you go to the supplemental and then understand the supplemental, do you understand that the data sets that are in the main paper are actually invalidated? And so I think it's really confusing for the lay public to understand.
Dr. Ashley: Improving the science for the public. Well, unfortunately we've, believe it or not, run out of time. But I did want to finish with one question, which is, have you learned the rules of American football? Because if you have, I'd love you to explain them to me.
Dr. Harris: So I'm Jamaican, which is part of the Commonwealth. So we still say football for not American football, right? But no.
Dr. Ashley: We are hosting the World Cup of soccer in this part. Anyway, it's been such a pleasure. Thank you for coming.
Dr. Harris: Thank you.