A new monthly series in The Lancet, led by Dr. Seth Holmes of the University of California, Berkeley, aims to broaden the scope of medical case studies by including social context and perspectives from outside traditional clinical frameworks.
Dr. Holmes, Chancellor’s Professor of Environmental Science, Policy and Management at UC Berkeley, is a physician and anthropologist who studies global health disparities. He co-chairs the Berkeley Center for Social Medicine and co-directs the joint medical anthropology Ph.D. program between UC Berkeley and UCSF.
Traditional case studies in medical journals typically focus on diagnosis and treatment from a strictly medical perspective. The new series seeks to integrate insights from the social sciences and humanities as well as community members worldwide. This approach intends to address not only biological but also cultural and social factors influencing patient outcomes.
“We hope that these cases will help orient health care practice and become a source of solidarity as we organize to confront obstacles to health and well-being for all in an interconnected world,” Holmes wrote in an introductory essay for the series.
The first case study highlighted a 22-year-old woman in Japan with a rare genetic disorder who faced barriers due to fragmented healthcare services—a concept termed “medical compartmentalization.” The research team used her experience to illustrate how rigid categorizations can negatively affect patients with complex conditions.
Holmes explained: “We want a middle-range theory that can be relevant in lots of other clinics, hospitals, policies and countries in the world but also really touches ground with this particular patient or case. And then we try to make sure the theory would both show the depth of social theory and be really understandable.”
Another recent case examined the experience of an asylum seeker dealing with kidney stone complications while navigating healthcare systems on both sides of the U.S.-Mexico border. Carlos Martinez, lead author of this piece and assistant professor at UC Santa Cruz, emphasized that clinicians should recognize when expertise beyond medicine is needed. “They, of course, cannot be experts in all those systems,” Martinez said. “What we’re really asking is that clinicians become familiar with the other experts who could help in a given patient’s care.”
The project has roots going back more than two decades when Holmes was a student interested in combining medicine with social science perspectives. A similar effort began previously at the New England Journal of Medicine but focused mainly on U.S.-based cases.
For The Lancet series, hundreds of cases were solicited globally from researchers and practitioners. A team—including MD/Ph.D. students from UC Berkeley and UCSF—reviewed over 400 abstracts to select those most applicable for illustrating social concepts.
Last year, contributors gathered at a three-day conference in Chicago supported by UC Berkeley and funded partly by the National Institutes of Health. Attendees included healthcare professionals, scholars from various disciplines, community organizers, Indigenous health workers from Brazil’s Amazon region, and physicians working with refugees in Algeria.
“One of the goals of the team was to reach out as far as we could beyond the usual places,” Holmes said. “To support people whose lives, stories, health, health care and concepts could be really important for the world to read but who might not usually have as easy a time publishing in a place like TheLancet.”
The series is planned for at least 12 months with potential extension based on its impact amid changing political climates worldwide.
“How much can one article a month do in the midst of active authoritarian regimes? I’m not sure,” Holmes said. “But we’re all working hard to develop these articles to keep people who care about health thinking critically and aware of what’s going on, to have empathy and solidarity for people who they might otherwise consider quite different than them.”
More information about Dr. Seth Holmes’s work can be found on his website (https://sethholmes.berkeley.edu/). The introductory essay launching this initiative is available via The Lancet (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02609-2/fulltext), along with links to published case studies (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00768-5/fulltext;https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01254-7/fulltext).
