Why Modern Medicine Is Looking Beyond Biology and Turning to Social Context
Modern medicine has made extraordinary advances in diagnosing and treating disease, yet many patients still fall through the cracks. A new global initiative published in The Lancet argues that the problem isn’t always a lack of medical knowledge—it’s the narrow way medicine often looks at illness. This new series, called Cases in Global Social Medicine, makes the case that health outcomes are shaped just as much by social, political, legal, and economic forces as by biology. And if medicine wants to improve, it needs to take those forces seriously.
A New Direction for Medical Case Studies
For decades, medical journals have relied on traditional case studies as a core teaching tool. These cases usually focus on symptoms, diagnoses, and treatments, all framed within strict biomedical logic. While useful, this approach often leaves out the broader realities of patients’ lives—things like immigration status, disability systems, poverty, racism, or fragmented health institutions.
The new Lancet series challenges that limitation. Led by Dr. Seth M. Holmes, a physician and medical anthropologist at UC Berkeley, the project introduces what the authors call a translational social medicine toolkit. The idea is simple but ambitious: just as biological research is translated from the lab to the clinic, insights from social sciences and the humanities should also be translated into everyday medical practice and health policy.
Dr. Holmes is uniquely positioned to lead this effort. He is a Chancellor’s Professor of Environmental Science, Policy and Management at UC Berkeley, co-chairs the Berkeley Center for Social Medicine, and co-directs a joint medical anthropology PhD program between Berkeley and UCSF. His career has focused on understanding how social hierarchies and structural inequalities shape illness and access to care across the globe.
Breaking Out of Medical Silos
One of the central problems highlighted by the series is how medical compartmentalization harms patients with complex needs. Modern healthcare systems are often divided into rigid specialties, institutions, and bureaucracies that do not communicate well with one another. Patients who don’t fit neatly into one category can end up being passed from office to office without receiving meaningful care.
The first case in the series illustrates this clearly. It focuses on a 22-year-old woman in Japan living with chromosome 22q11.2 deletion syndrome, a rare genetic condition that affects both physical and cognitive health. Despite needing coordinated support, she was repeatedly denied help. Officials rejected her admission to a special elementary school because her impairments were judged “not severe enough.” Psychiatrists declined to prescribe medication because it might worsen her heart condition. During a health crisis, a hospital refused to admit her due to staffing shortages.
The case demonstrates how fragmented systems can unintentionally exclude patients who fall between categories. By pairing clinicians with social scientists, the authors show how this fragmentation is not just a technical problem, but a structural one, rooted in institutional design and policy choices.
Health Doesn’t Stop at the Border
Another powerful case in the series examines the experience of a 45-year-old asylum seeker suffering from kidney stone complications near the U.S.–Mexico border. A volunteer clinician in Tijuana provided initial treatment. After the man crossed into the United States and was detained in an Immigration and Customs Enforcement (ICE) facility, he received inadequate medical care.
A nonprofit organization attempted to advocate for him, but when they requested his medical records, the original doctor became concerned about privacy laws and legal liability across national borders. The patient’s care stalled—not because of medical uncertainty, but because of overlapping legal, political, and bureaucratic systems.
This case introduces the concept of structural intercompetency, which goes beyond traditional ideas of cultural competence. Instead of expecting clinicians to master every system that affects health, the framework encourages them to understand how law, immigration policy, economics, and governance interact with medicine—and to collaborate with experts in those areas when needed.
A Truly Global and Collaborative Project
The scope of the project is intentionally global. The editorial team solicited hundreds of case submissions from clinics, universities, and researchers around the world. From more than 400 submitted abstracts, a 15-member team—including MD/PhD students from Berkeley and UCSF—selected cases with the greatest potential to illuminate social concepts that could be applied across different settings.
The collaboration extended far beyond academia. Contributors included a human rights organizer from Florida, an Indigenous health worker from the Brazilian Amazon, and physicians working in Sahrawi refugee camps in Algeria. Doctors, nurses, social scientists, and humanities scholars gathered at a three-day conference in Chicago to discuss how social theory could meaningfully reshape medical case studies.
One of the explicit goals of the project was to amplify voices that are often excluded from elite medical publishing. Many contributors came from regions or communities where access to journals like The Lancet is limited, despite having insights that could benefit global health systems.
Why Social Context Matters in Medicine
The series argues that ignoring social context leads to incomplete care. Factors such as poverty, migration status, disability policy, housing, labor conditions, and legal systems directly shape whether patients can follow treatment plans or even access care in the first place.
By embedding social theory into concrete cases, the authors aim to provide what they call middle-range theories—ideas that are grounded enough to be practical, yet broad enough to apply across countries and health systems. These frameworks are designed not just for clinicians, but also for healthcare leaders and policymakers who shape how systems operate.
Importantly, the approach does not dismiss biomedical expertise. Instead, it expands it. Biology remains central, but it is no longer treated as the whole story.
Looking Ahead
The Cases in Global Social Medicine series is scheduled to run for 12 months, with the possibility of extension. Dr. Holmes has noted that the work feels especially urgent in a time of growing political instability and widening global inequalities. While no single article can fix systemic problems, the series aims to keep health professionals critically engaged, socially aware, and globally connected.
At its core, the project is a reminder that medicine is not practiced in a vacuum. Patients live in social worlds shaped by power, policy, and history. Understanding those worlds may be just as important as understanding their lab results.
Research References
Translational Social Medicine for Global Health: Introducing Cases in Global Social Medicine – The Lancet
https://doi.org/10.1016/S0140-6736(25)02103-8
Medical Compartmentalisation: A Patient with Chromosome 22q11.2 Deletion Syndrome in Japan – The Lancet
https://doi.org/10.1016/S0140-6736(25)02267-6
Structural Intercompetency: An Asylum Seeker with Abdominal Pain in Tijuana, Mexico – The Lancet
https://doi.org/10.1016/S0140-6736(25)02423-7
