Nutritional practices and experiences of people on vegan diet with healthcare system: a qualitative study.

OBJECTIVES: The growing popularity of diets that restrict the consumption of animal-based foods is an important new challenge for the public healthcare system in Czechia. While the environmental and health-related benefits of plant-based diets are widely discussed in the media, people who follow these diets may lack professional support in terms of nutritional advice and even access to healthcare. The present study aims to map the nutritional practices and experiences with the healthcare system of people in Czechia who follow vegan diets. METHODS: In a qualitative study we conducted semi-structured interviews with twenty-one self-reported adult vegans (14 women and 7 men; 18 with university education) who were on a vegan diet for at least a year. We were specifically interested in their motivation for why and how they became vegans; their everyday diet and eating routines; their use of health care and experiences with medical professionals; their nutritional knowledge and use of supplementation; and their perception of their health and embodiment. RESULTS: The primary motivations for going vegan are ethical, environmental and health-related. Vegans see themselves and their diet as generally healthier, but for this to be true they must spend a considerable amount of time researching nutritional requirements and what dietary supplements they need. To this end, they tend to rely mainly on non-medical sources of information. Because of the lack of acceptance of veganism among primary-care physicians, vegans tend not to seek out medical advice or tell their doctor about their eating habits in order to avoid conflicts and negative experiences. CONCLUSIONS: We identified a perceived lack of accessible educational materials and potentially limited access to primary healthcare recommendations for people who eliminate the consumption of animal-based foods. These findings deserve further research and public health risk-mitigation strategies.

Sympoietic growth: living and producing with fungi in times of ecological distress.

Drawing upon ethnographic research on human living and producing with fungi, and Haraway's theorization of sympoiesis and the model ecosystems of mycorrhizae developed in current mycological research, we offer a concept of sympoietic growth. Sympoiesis is a concept that suggests a way of thinking about growth as a more-than-human process and provides an alternative political imaginary both to current forms of economic growth and to the idea of "degrowth." We explore human-fungi co-operation in forests, an urban park, and a shopping mall, on a miso production farm, and in a Catholic parish to provide insights into the logic and relationships involved in sympoietic growth in the field of agriculture and food production. We argue that this form of food provision has a sustainable, (re)generative potential not only in ecological and social but also economic terms. In conclusion, we highlight three patterns of sympoietic growth: the absence of any urge to "take (back) control" over the multispecies dynamic on the part of the humans; a non-instrumental passion for more-than-human life; and a combination of intellectual and manual labor as a form of attachment to the more-than-human world.

Disability and the (dysbiotic) gut: Sensing, tasting and knowing with food.

This article offers insights into eating practices, conceptualising and making of 'good' food by people living with chronic disease. Based on ethnographic research focussing on people with Inflammatory Bowel Disease (Crohn's disease, ulcerative colitis and undefined IBD) in the Czech Republic, we explore what it would mean to conceptualise disability from the non-normative gut. We trace the practices of tinkering with foods and one's body, and ways of learning to sense (with) dysbiotic guts that people with IBD develop. Departing from the established notions of digestion and metabolism as universal biological processes, people with IBD create an embodied crip archive of knowledge through their eating practices, ways of making and sensing food and metabolic sampling. Most importantly, these practices offer, as we argue, new pathways into exploring crip embodiments as a place from which to acknowledge and do more-than-human collaboration, heath and ecologies.

Situating biologies of traditional Chinese medicine in Central Europe.

Since the concept of 'local biologies' was proposed in the 1990s, it has been used to examine biosocial processes that transform human bodies in similar and different ways around the globe. This paper explores understandings of biosocial differentiation and convergence in the case of Traditional Chinese Medicine (TCM) in the Czech Republic. Specifically, it examines how Czech TCM practitioners view TCM as universally applicable while fine-tuning it to situated biosocial conditions, experimenting with the compatibilities of various human and plant bodies as part of their generalised, clinical practice. Drawing upon ethnographic research among TCM practitioners in the Czech Republic, it suggests that in addition to the individualization of TCM therapeutics to suit particular patients, Czech TCM is characterised by collective particularization, shaped by local concerns over ethnic, environmental and cultural differences. By looking critically at TCM practitioners' sensitivities to localised biological similarities and differences it aims to contribute to understandings of the expansion of TCM in Central Europe, as well as more broadly to current social science debates over the risks and opportunities inherent in abandoning the assumption of a universal human body and biology.

Neither magic bullet nor a mere tool: negotiating multiple logics of the checklist in healthcare quality improvement.

Over two decades, the checklist has risen to prominence in healthcare improvement. This paper contributes to the debate between its proponents and critics, making the case for an Science and Technology Studies-informed understanding of the checklist that demonstrates the limitations of both the "checklist-as-panacea" and "checklist-as-socially-determined" positions. Attending to the checklist as a socio-material object endowed with affordances that call upon clinicians to act (Allen 2012, Hutchby 2001), the study revisits the efforts of a recent improvement initiative, the Enhanced Peri-Operative Care for High-risk patients trial. Rather than a singularised simple tool, this study discusses four different and relationally enacted logics of the checklist as a stop and check tool, a clinical prompt, an audit tool and a clinical record. Each logic is associated with specific temporality, beneficiaries, relationship with material forms, and interpellates (Law 2002) clinicians to initiate specific actions which can conflict. The paper seeks to make the case for intervention to improve such tools and consciously account for the consequences of their design and materiality and calls for supporting such settings and arrangements in which incoherences collected in tools can be locally negotiated.

Equality, efficiency and effectiveness: going beyond RCTs in A. L. Cochrane's vision of health care.

A. L. Cochrane's Effectiveness and Efficiency frequently appears as a key reference in debates over, and a justification for, contemporary evidence-based medicine. Cochrane's concern in this text with the equality of care as the ultimate rationale for why effectiveness and efficiency of cure are needed has, however, largely disappeared from debate. In this article, we reconsider Cochrane's approach through the use of case studies of plural forms of medicine in the Czech Republic, namely traditional Chinese medicine, homeopathy and spa care. In addition to bringing equality back into the picture, we also identify four expansions to Cochrane's original vision arising from the difficulties of separating cure from care; the overlap between prevention and cure; the complex actions of some multi-faceted therapies; and recent reconceptualisations of the placebo effect. In conclusion, we suggest that instead of the widely used strictly vertical "evidence pyramid", a descriptor of the horizontal and additive ordering of evidence might be more appropriate. We also argue that in healthcare systems characterised by a multiplicity of approaches, if we want to truly benefit from this heterogeneity, we must take seriously each medical tradition's approaches to prevention, cure, care, as well as efficiency, efficacy and equality.

Exploring Biomedicalization Through Complementary and Alternative Medicine in a Postsocialist Context.

Drawing on fieldwork in the postsocialist Czech Republic, we explore the transformative processes of biomedicalization, both within and in relation to complementary and alternative medicine (CAM). We argue that it would be simplistic to understand evidence of these processes in CAM as a sign that CAM has fallen prey to biomedicine. Instead, we show how particular CAM practices play a groundbreaking role in shaping developments in contemporary health care. In this respect, we question the utility of the concept of biomedicalization, arguing that it reduces the transformative processes to aspects of biomedicine.