Iran Road Traffic Crashes and ““Waterpipe”” Antismoking Literature

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NEW SciTopics 2010 (10 Nov):Human Health, ““Waterpipe”” (Hookah, Narghile, Shisha) Smoking…

Unfortunately for the non-specialist of this form of smoking, about one half of the bibliographical references in Drs Soheil SAADAT and Mojgan KARBAKHSH’ study are actually of no help for understanding the “unexpected” relation of road traffic crashes to “”waterpipe”” smoking [

1]. Most of them have been carefully selected from the recent mainstream “”waterpipe”” antismoking literature.Amazingly for a study led in Iran, the bulk of these references come from completely different national contexts (US antismoking institutions) and have been criticised for serious errors, particularly regarding health effects[2][3].

References to the popular press in Saadat and Karbakhsh’ study should have also been avoided. Indeed, independent studies on hookah, shisha, narghile, qalyan and goza smoking, offering another insight than the “classical” antismoking stance, are available in the open English language peer-reviewed literature. Should the authors have a bit balanced their review of the literature, they would have fortunately avoided the error about the “estimated 100 million daily smokers”. This statement has in fact no peer-reviewed basis (except that it has been repeated again and again, for several years now, in the ““waterpipe”” antismoking literature). This clarification has been made available to researchers [


Even relevant Iranian references are missing. What about Ghasemi et al’ recent excellent study on nitric oxide metabolites which, as far as health effects are concerned, has brought more to this field of research than the selection of papers cited by the authors [5]?

Since the authors seemed interested in detailing the origins of water pipes, it is also amazing to see researchers in Iran rely,

once again, on foreign bibliographical sources (mainly US). Sadly enough, the “Indian origin” is once again highlighted whereas the very Iranian literature reveals thatthe first written description of water pipe smoking in the world was authored by Shirazi, an Iranian poet, by year 1535[6][7]:

“Your lips make qalyân draw enjoyment. Its mouthpiece becomes like a sweet. This is not smoke around your face. But a cloud whirling around the moon…”

Another interesting Iranian poet could also be cited here…


The authors made the same mistake as a US-Egyptian team; once again because of what we described as a confusionist nominalist neologism: “”waterpipe”” [

3][8]. This term (in one word, this is important) cannot be found in any of the Persian, Arabic, Hebrew, Urdu, Turkish, Hindi, and even English languages. Furthermore, there are several types of water pipes in Iran (narghile, qalyan, among others). Consequently, when carrying out the survey of Iranian drivers, the interviewers necessarily translated “”waterpipe”” at random by “qalyan”, “narghile” or any other local term. This is not a subtle linguistic detail as this problem has actually invalidated the results of the above mentioned Egyptian study on micronuclei [8].

On a methodological level, deriving from this minimal linguistic minimal precaution, perhaps would it have been interesting to ask the Iranian drivers what type of water pipe they had been smoking. Indeed, each one is characterised by its own set up (charcoal, smoking mixture) and own smoke chemistry (varying temperatures between one hundred and several hundreds of degrees Celsius) with expected different health –including neurologic- effects [


Then, when talking over the phone (the method adopted in the study) in a country like Iran, almost anybody can say that (s)he regularly sits for a qalyan smoking session. Simply, this is because of the very peculiar social nature of the latter. Not only smokers participate in such gatherings but also non-smokers [



The WHO report on ““waterpipe”” smoking was cited by the authors. However, this document actually contains serious scientific errors, misconceptions and biases (particularly bibliographical). As a reminder, its two first sentences are stained by an error and a misquotation about the very origins of water pipes [


Its authors also went so far as stating that “

in South-West Asia and North Africa”,therefore including Iran,“it is not uncommon for children to smoke with their parents”.In fact, all available anthropological data rather describe hookah initiation as a kind of “rite of passage”, particularly in such a conservative society as Iran.DoDrs Saadat and Karbakhsh accept such a groundless analysis by the WHO appointed experts?


Unlike most of the publications of the mainstream ““waterpipe”” literature, this Iranian study could have avoided anthropological wading and shortcuts. Indeed, what was important to know is who, in the Iranian population, actually smokes and what (exactly)?

A recent study in Lebanon even suggested the paradoxical idea that narghile could be “a substitute for food”[10][11]. It would be interesting then to imagine a scenario in which Iranian drivers would, instead of having lunch or dinner, smoke the qalyan or narghile with the subsequent behavioural consequences reflected in Drs Saadat and Karbakhsh’ statistics.

PS: “shisha” is not an Arabic word, as the authors state, but a Persian one (shishe) meaning bottle [7].



[1] Saadat S, Karbakhsh M. Association of waterpipe smoking and road traffic crashes. BMC Public Health. 2010 Oct 23;10(1):639.

[2] Chaouachi K, Sajid KM. A critique of recent hypotheses on oral (and lung) cancer induced by water pipe (hookah, shisha, narghile) tobacco smoking. Med Hypotheses 2010; 74: 843–6.

[3] Chaouachi K. Clarification about bladder cancer and shisha smoking in Egypt. Cancer Epidemiology (The International Journal of Cancer Epidemiology, Detection, and Prevention) 2010; 34: 220. Doi: 10.1016/j.canep.2010.01.001

[4] Khater AE, Abd El-Aziz NS, Al-Sewaidan HA, Chaouachi K. Radiological hazards of Narghile (hookah, shisha, goza) smoking: activity concentrations and dose assessment. J Environ Radioact. 2008 Dec;99(12):1808-14.

[5] Ghasemi A, Syedmoradi L, Momenan AA, Zahediasl S, Azizi F. The influence of cigarette and qalyan (hookah) smoking on serum nitric oxide metabolite concentration. Scand J Clin Lab Invest. 2010 Feb 15. [Epub ahead of print]

[6] Semsar H. L’apparition du narghileh et de la chibouque en Iran. Objets et Mondes (La Revue du Musée de l’Homme) 1971 (printemps);XI (1). Paris, Musée de l’Homme [also exists in Persian].

[7] Chaouachi K: Le narguilé. Anthropologie d’un mode d’usage de drogues douces [Anthropology of Narghile: its Use and Soft Drugs], Paris, 1997, L’Harmattan, 262 pages.

[8] Chaouachi K. Micronuclei and Shisha/Goza Smoking in Egypt. Mutation Research/Genetic Toxicology and Environmental Mutagenesis 675 (2009) 81–82.

[9] Chaouachi K. A Critique of the WHO’s TobReg “Advisory Note” entitled: “Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators.Journal of Negative Results in Biomedicine2006 (17 Nov); 5:17. Doi:10.1186/1477-5751-5-17

[10] 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.

[11] Chaouachi K. [E-Letter to the Editor] Old Errors and Amazing anthropological shortcuts and Contradictions as a Result of Publication Bias in US American University of Beirut’ Study on Narghile Smoking. Eur J Public Health. 2010 (20 Oct).