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Last summer, we have been on a sabbatical leave in the Middle East and while the neighbouring country, Pakistan was, once again, struck by natural catastrophes (water floods), US drones (radio-controled aricrafts) have been shelling civilian populations in an endless war against Afghanistan.

image (left): to the credit of Charpentier for its ethnographic study in Afghanistan (published in Anthropos). Cited and commented in our first book (1997): Chaouachi,K. (1997).

Le narguilé. Anthropologie d’un mode d’usage de drogues douces[An Anthropology of Narghile: its Use and Soft Drugs]. Paris,L’Harmattan.Against this tragic backdrop, ««waterpipe»» publications (only biomedical publications since “official” social and human scientists have left this field wide open to antismoking self-righteous crusades) have virtually been pouring. The objective of such a blitz is twofold:

1) justify smoking bans everywhere in the world on the basis of quantity, not quality: “there is “cumulating evidence” that ««waterpipe»» is at least as harmful as cigarettes.” is a common leitmotiv now… Please note that before our critical interventions in the biomedical press, ««waterpipe»» experts used to say that 1 ««waterpipe»» = 200 cigarettes….

[*] ASH (Action on Smoking and Health).

““Shisha 200 times worse than a cigarette” say Middle East experts””.27 March 2007 (prepared by Martin Dockrell)(accessed 13 June, 2008) [based, among others, on an interview with Wasim Maziak and Alan Shihadeh]. Sub-heading:“Three leading experts from across the Middle East have warned that excluding “shisha bars” when England goes smokefree on July 1 could worsen the grave inequalities in health that already affect ethnic minorities.”

2) “bury” independent studies that come up with “unexpected” “negative” results…; for instance, the most popular study on hookah smoking and cancer led on real human smokers (not biased smoking machines):

[*] Sajid KM, Chaouachi K, Mahmood R.

Hookah smoking and cancer. Carcinoembryonic Antigen (CEA) levels in exclusive/ever hookah smokers.Harm Reduct J 2008 24 May;5(19). Doi:10.1186/1477-7517-5-19

On the site of the journal itself (because there are many other sites where the study is also vailable in open access: PubMed Central, etc.), this study has reached about 50,000 hits so far .

Let us now consider the recent harvest of biomedical ««waterpipe»» antismoking publications whose authors and peer-reviewers, in many instances, are either full members of the antismoking Globalink network or direct colleagues of the latter.

[*] Chaouachi K.

Globalink Undeclared Non-Financial Global Conflicts of Interest in Tobacco Smoking. Knol 2010 (Sep 21)

We will mention the most “visible” publications (supposed to be influential for tobacco policy making) and leave aside a long list of other papers on this very issue.

Narghilistan and Biomedical Revisionism

The issue at stake here is a trilogy of “systematic reviews” by Elie Akl et al (University of Buffalo at New York). These papers are intended at setting the list of “acceptable” and “citable” studies and those which are not, in three fields (so far): health effects, lung function, “survey instruments”.

[*] Raad D, Gaddam S, Schunemann HJ, Irani J, Abou Jaoude P, Honeine R, Akl EA.

Effects of waterpipe tobacco smoking on lung function: a systematic review and meta-analysis.Chest. published 29 July 2010. Doi: 10.1378/chest.10-0991

[*] Akl EA, Aleem S, Gunukula SK, Honeine R, Abou Jaoude P, Irani J.

Survey instruments used in clinical and epidemiological research on waterpipe tobacco smoking: a systematic review.BMC Public Health. 2010 Jul 13;10(1):415.

[*] Akl E, Gaddam S, Gunukula SK, Honeine R, Abou Jaoude P, Irani J.

The effects of waterpipe tobacco smoking on health outcomes: a systematic review.International Journal of Epidemiology. Advance Access published online on March 4, 2010. Doi:10.1093/ije/dyq002

See our critique:

[*] Chaouachi K. [Peer-reviewed comment]

Systematic Reviews” on ““Waterpipe”” (Shisha, Hookah, Narghile) Tobacco Smoking Should Not Recycle Old Errors.BMC Public Health 2010 (13 Aug).

Narghilistan and “Prevalence” Studies

[*] Azab M, Khabour OF, Alkaraki AK, Eissenberg T, Alzoubi KH, Primack BA.

Water pipe tobacco smoking among university students in Jordan.Nicotine Tob Res. 2010 Apr 23. [Epub ahead of print]

Comment: Surveys about “prevalence” of shisha smoking in any country are all flawed (“fatally flawed” to use the jargon of antismoking researchers themselves):

“In any case and on a global scale, how can one seriously «assess [individuals] beliefs about narghile’s adverse health consequences» in the context of a world actions against tobacco smoking ? Intensive press campaigns (as the one against shisha smoking) exclusively supported by interviews with «« waterpipe»» antismoking experts (no confrontation of viewpoints at all) are certainly known for their “brainwashing” effect. We are afraid these are artifacts, not sound science… However, a backlash effect is that such communication techniques eventually discredit science and, beyond, public heath interventions.”.[*] Chaouachi K. [Peer-reviewed comment]

Errors and Publication Bias in Jordanian Study on Narghile (Hookah, Shisha) Tobacco Smoking.Harm Reduction Journal 2010 (01 Sep)

Azab et al’ study is also stained by a striking publication bias.

[*] Harrabi I, Maaloul JM, Gaha R, Kebaili R, Maziak W, Ghannem H.

Comparison of Cigarette and Waterpipe smoking among pupils in the urban area of Sousse, Tunisia.Tunis Med. 2010 Jul;88(7):470-3.

A paper almost exclusively written, not by the first author (Imed Harrabi) but by the last but one: Wasim Maziak (chief co-author of the WHO flawed report on ««waterpipe»» smoking – in which we can read that parents of North Africa (therefore of Tunisia, smoke the ««waterpipe»» with their children…).

As the WHO flawed report (which contains one error and a misquotation in its first two sentences…), this “Tunisian” paper begins with a grossgeographical error : setting Tunisia in the North-East of the Mediterranean… the article is also stained by other tragic errors and a striking publication bias. It aims at demonstrating the trueness of the Gateway (cigarette to hookah smoking) hypothesis (see further down).

[*] Dar-Odeh N et al.

Narghile (water pipe) smoking among university students in Jordan: prevalence, pattern and beliefs.Harm Reduction Journal 2010, 7:10. Doi:10.1186/1477-7517-7-10

Comment: Stained by a long series of errors and a striking publication bias. See our online critique

[*] Chaouachi K. [Peer-reviewed comment]

Errors and Publication Bias in Jordanian Study on Narghile (Hookah, Shisha) Tobacco Smoking.Harm Reduction Journal 2010 (01 Sep)

[*] Afifi RA, Yeretzian JS, Rouhana A, Nehlawi MT, Mack A.

Neighbourhood influences on narghile smoking among youth in Beirut.Eur J Public Health. 2010; 20:456-462. ?

Our comment: numerous serious errors and strange anthropological shortcuts such as the following one:

“It [narghile] may be perceived as an ideal substitute for food”…[*] Hikmet Jamil, Dalia Elsouhag, Spencer Hiller, Judith E. Arnetz, and Bengt B. Arnetz.

Sociodemographic risk indicators of hookah smoking among White Americans: A pilot study.Nicotine Tob Res. 2010; 12:525-529.

Comment: really (sorry for the world) “junk” parroting science.

[*] Poyrazoğlu S, Sarli S, Gencer Z, Günay O.

Waterpipe (narghile) smoking among medical and non-medical university students in Turkey.Ups J Med Sci. 2010 Aug;115(3):210-6.

Comment: really (sorry for the world) “junk” parroting science.

[*] Erika Dugas, Michèle Tremblay, Nancy C.P. Low, Daniel Cournoyer, and Jennifer O’Loughlin.

Water-Pipe Smoking Among North American Youths.Pediatrics 2010. Doi: 10.1542/peds.2009-2335

Comment: really (sorry for the world) “junk” parroting science.

[*] Amin TT, Amr MA, Zaza BO, Suleman W.

Harm Perception, Attitudes and Predictors of Waterpipe (Shisha) Smoking among Secondary School Adolescents in Al-Hassa, Saudi Arabia.Asian Pac J Cancer Prev. 2010;11(2):293-301.Comment: really (sorry for the world) “junk” parroting science. Blatant lies about oesophageoal cancer, etc. The most serious problem is the bias publication which led the supposedly Saudi team to completely discard the highly valubale work of other independent Saudi researchers because the latter came up with “negative” results…

[*] Jordan HM, Delnevo CD.

Emerging tobacco products: Hookah use among New Jersey youth.Prev Med. 2010 Sep 1. [Epub ahead of print] PMID: 20817023

No comment so far.

Narghilistan and the Tobacco Smoking Prohibition Agenda

[*] Nakkash R, Khalil Joanna.

Health warning labelling practices on narghile (shisha, hookah) waterpipe tobacco products and related accessories.Tob Control 2010 19: 235-239. Doi: 10.1136/tc.2009.031773

Scientically empty. A political paper in line with the Prohibition Agenda (Globalink, FCTC, “Regulatin” and “Tobacco Control” as an euphemism for Prohibition, etc.: see the other corresponding Knols. See

[*] Chaouachi K.

Prohibition Through the Hookah Looking-Glass (Speech). Version 14. Knol. 2010 Apr 3.

Narghilistan and the Newborn Babies Scare

Finally, many of the recent health scares have focussed on the hazards supposedly caused to the newborn babies (pregnant women):

[*] England LJ, Kim SY, Tomar SL, Ray CS, Gupta PC, Eissenberg T, Cnattingius S, Bernert JT, Tita AT, Winn DM, Djordjevic MV, Lambe M, Stamilio D, Chipato T, Tolosa JE.

Non-cigarette tobacco use among women and adverse pregnancy outcomes.Acta Obstet Gynecol Scand. 2010 Mar 15. [Epub ahead of print]

Comment: none so far.

[*] Nassar AH, Abu-Musa A, Hannoun A, Usta IM.

Authors’ reponse: nargile smoking and its effect on in vitro fertilization: a critical eye on the available literature, 12 July 2010. European Journal of Obstetrics & Gynecology and Reproductive Biology. September 2010 (Vol. 152, Issue 1, Page 116). Doi:10.1016/j.ejogrb.2010.06.016

IN the above paper, the US-American University of Beirut authors respond to our critique:

[*] Chaouachi K.

More rigour needed when evaluating effects of female narghile tobacco smoking on in vitro fertilisation outcome.European Journal of Obstetrics & Gynecology and Reproductive Biology 152 (2010) 115–116. Doi:10.1016/j.ejogrb.2010.04.012

They expose their definitive ignorance of the existing literature (blood nicotine levels in shisha smokers) and of the basics of tobacco science is striking. For instance, they believe that tar is to be found in the tobacco plant when it appears only when smoke is produced. They also go so far as stating that the Moassel and Jurak (two main smoking products) are almost similar when one of the great differences is the glycerol component…

Narghilistan and Toiling Toxicological Studies

[*] Sepetdjian E, Saliba N, Shihadeh A.

Carcinogenic PAH in waterpipe charcoal products.Food Chem Toxicol. 2010 Aug 28. [Epub ahead of print] PMID: 20807559

A rapid comment: Charcoal has been used for ages in hookahs, just like in barbecues… This study by the antismoking ««waterpipe»» experts of the US-American University of Beirut is stained, among other flaws, by a striking publication bias.

[*] Khabour OF, Alsatari ES, Azab M, Alzoubi KH, Sadiq MF.

Assessment of genotoxicity of waterpipe and cigarette smoking in lymphocytes using the sister-chromatid exchange assay: A comparative study.Environ Mol Mutagen. 2010 Aug 25. [Epub ahead of print]

A rapid comment: in this study led by antismoking researchers, the genotoxicity of light shisha smokers (the majority of today’s shisha smokers, particularly in the USA) is less important than that of those 1 pack-and-a-half-a-day cigarette smokers… The career of shisha smokers is not given an y detail (probably for some intended reason…). The study is stained by a striking publication bias.

Narghilistan and the Gateway (Cigarette to Hookah Smoking) Scare

[*] Jensen PD, Cortes R, Engholm G, Kremers S, Gislum M.

Waterpipe use predicts progression to regular cigarette smoking among Danish youth.Subst Use Misuse. 2010 Jun;45(7-8):1245-61.

Comment:(sorry for the world) “junk” parroting science. Furthermore, the title reflects the dishonest intention of the authors: make believe the (wo)man in the street and other parroting researchers that the gateway hypothesis is true. It is not and one has to read the paper to realise that the interviewees were all previous or present cigarette smokers… See also the previously mentioned Harrabi et al’s paper which shares the same objective.

Narghilistan and ««Waterpipe»» Scare Fund Raising Editorial Activities

War, again and again:

[*] Maziak W.

The Global Epidemic of Waterpipe Smoking. Addictive Behaviors 2010 (August)