“««Waterpipe»» Addiction”: one of the Greatest Fallacies in Tobacco Research

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Shisha smoking is more addictive than cocaine, expert says” (Gulf News, 26 Oct 2013)

The cited ««expert»» is Wasim Maziak: the same who chiefly authored the WHO junk report ; the same who recently published a pro-NATO ««public health»» paper denying the reality of 1 million deaths in Iraq and; unsurprisingly, a Syrian political ««opponent»» simultaneously heading the mysterious US-Syrian «Research» Centre in Aleppo

Closed (useful) parenthesis…

nicotineFirst of all, it must be clear that nicotine is not carcinogenic and absolutely not the most dangerous toxic chemical in tobacco smoke. This clarification is of utmost importance because one can regularly read in the mainstream media pseudo-scientific statements like: “hookah users believe their hookah is less dangerous than cigarette smoking because the nicotine content is lower” or the “fact” that “hookah smoking may result in higher nicotine intake”.

As far as tabamel/moassel (i.e. the world growingly popular flavoured tobacco-molasses smoking mixture) is concerned, the myth that hookah is addictive is the most ludicrous one for two main reasons:

1. First, we have seen when debunking Myth 3 that hookah users sitting for a one hour session would not get more nicotine in their blood than the smokers of one (two at the most) cigarette(s), consumed each, for memory, in about 5 minutes [22]. So, the question is:  how “these people”, smoking on average 2 to 3 times a week, will get “hooked on hookah nicotine”?

2. Second, nicotine is not exclusively responsible for the addiction phenomenon in general so that phrases like “nicotine addiction” or “nicotine dependence” are, from the outset, unscientific although they can be found in most of the antismoking literature of the last decades. Even the designer of the main tool to assess tobacco addiction (the so-called “Fagerstrom Test for Nicotine Dependence”, used as a reference all over the world) has recently admitted he was led astray: “By changing the title of his famous and universal test known until recently as “dependence to nicotine” to “dependence to cigarettes”, Karl Fagerström recognizes that nicotine dependence does not sum up one’s dependence to tobacco. This article should have the effect of a bomb. However, one can assume that it will not be echoed anywhere and this in spite of the author’s notoriety”(recapitulation by French top tobacco authority)[30][31].

In one study only, carried out by the US-Egyptian team, one can read that “waterpipe smokers exhibit many of the same features of nicotine dependency attributed to cigarette smokers”[32]. One interesting detail about the preparation and set up in this country is that the participants in the study had been smoking for 20 years or so and their “average daily consumption was 4 ± 8 hagars (tobacco units)”[32]. With such a dramatic consumption over a so long period of time, it seems natural that the corresponding individuals may display some signs of dependence in the long term, doesn’t it? Furthermore, the exact profile of participants (ex-cigarette smokers having more or less recently switched to shisha or goza smoking; exclusive shisha smokers, mixed smokers, etc.), the type of pipes, charcoal, etc., is always surrounded by a great confusion…

As another example of global confusion, the objective of a recent study by the US-Syrian ««waterpipe»» antismoking team was “to examine the relative effectiveness of cigarettes and ««waterpipe»» in reducing tobacco abstinence symptoms in dual cigarette/««waterpipe»» smokers“. Its findings would show “the ability of ««waterpipe»» to suppress abstinence effects comparably to cigarettes and its potential to thwart cigarette cessation”[33]. Here, few observant readers will have paid attention to the epithet “dual”. What is the point of studying ««waterpipe»» “addiction” among non-hookah exclusive smokers? A relevant methodological example to meditate upon is the Pakistani study on hookah smoking and cancer which showed clearly different symptoms (and a dose-response effect) between dual cigarette-hookah and hookah-only smokers [1].

Most of these biased studies have a first objective: trying to “demonstrate” the “gateway hypothesis” (smoking hookah would lead to cigarette smoking) even if, for many reasons (biological, psychological, social, cultural, etc.), no data supports it as, leaving aside anthropological studies, an Australian independent epidemiological study involving an important panel of participants showed [34].

The strong focus on addiction (see how many stories in the popular press appear with such headlines as “hooked on hookah”) is motivated by a political reason (prohibition agenda) but also an economic one: offering medical “alternatives” produced by the pharmaceutical companies (nicotine patches, etc.).  In these conditions, the emergence of (online) services such as Njquitline or Quitshisha (among others) is no surprise… The right question here is: who funds them and who funds the studies on hookah “addiction”? Correlatively, why does a journal like Nicotine and Tobacco Research keep on hammering that  “««waterpipes»» are addictive, too”[35]? Why does Jack Henningfield, peer-reviewer of the WHO flawed report [8], insist in a so pathetic way if he were not senior leader at a Big Pharma company (Pinney Associates)(ABC News, 01 Jun 2011)?

The bottom line is that as far as hookah (prepared with flavoured moassel) is concerned, “nicotine addiction” is a fraud. This complex issue was tackled in a relevant online interview (see also: SciTopic glob. epid.). Finally, this is also in agreement with laymen’s and anthropological observations: « Le but n’est pas de fumer pour satisfaire une dépendance ou calmer une anxiété mais de prendre le temps pour parler, s’écouter et partager, à tour de rôle, en se tendant fraternellement, rituellement et symboliquement le tuyau d’aspiration. Toute la mise en scène ne serait que prétexte à l’émergence d’une « situation » au sens sociologique du terme (Erving Goffman)

Source: Kamal Chaouachi. Myth 4. In: Ten Post-11/9 Great Myths about Hookah (Shisha, Narghile) Smoking & Public Health. 12 May 2012


See also : Entrevue avec le Dr Dussart : « La dépendance au narguilé est une mystification »


See also : Dar R, Frenk H. Can one puff really make an adolescent addicted to nicotine? A critical review of the literature. Harm Reduction Journal 2010, 7:28. Doi:10.1186/1477-7517-7-28 (online: 10 Nov 2010)


Note: publishing flawed “studies” (easy to design) on this issue is a juicy business.


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