The LWDS (««Lebanese»» ««Waterpipe»» ««Dependence»» Scale) Un-reliability and In-validity

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We did not have in mind to comment, once again, on this issue, believing our previous note was enough for any honest reader wanting to know what is actually wrong with this type of widely advertised unnecessarily scaremongering research [1]. However, after reading an interview with Pascale Salameh, head of the faculty of pharmacy at the Lebanese University and actually leading a vehement crusade against a so-callled ««waterpipe»» ««dependence»» [2], we felt we had to react, for several reasons.

1-History will not forget those bearing the name of scientists who will have kept silent while an ocean of totalitarian science has been swallowing the world for one decade now in defence of the economic interests of pharmaceutical cartels (Big Pharma).

2-In the course of the above mentioned interview, by the way run in the wake of the first world festival of ««waterpipe»» prohibitionist science (Emirates, 20-23 Oct 2013) in which she participated [2][3], Dr Salameh, speaking in the name of a so-called “”scientific” community” (strangely excluding all independent researchers from Asia and Africa, including from great countries like Russia and China), stated: “Scientifically, we all agree”, i.e. with the would-be “emerging consensus similar to that which developed around cigarette smoking”(sic)[2]…

Salameh continued in an even more tasteful stonewalling way: “It has been decades that we’ve been trying to talk about waterpipes, but research was just very rare”[2]. No need to say that the corresponding “rare” research was not the one funded by US-prohibitionist “public health” agencies with money from Big Pharma. In the decades before year 2002 (“official” year for the Commencement of Research, i.e. ««waterpipe»» codenamed research), research was just independent (from both the tobacco industry and Big Pharma) and it was quite correct. It was officially evacuated since 2002 because its findings were, most of the time, negative, i.e. confirming that the Middle East peace pipe is the oldest natural tobacco harm reduction technique of the world.

3-The third reason the present note was needed is that we are just fed up with wars, in the Middle East and in Syria and Lebanon in particular. We just cannot figure out how researchers from this very last region may spend their energy in waging stupid battles (actually US-prohibitionists’ proxy battles) against the daily material culture of Asian and African peoples: as if those raging in their own countries were not enough [4]… and as if there were not more urgent problems to solve as, for instance, that of hunger in the world which actually kills thousands every day…

No, Dr Salameh, and her antismoking colleagues from the Globalink secret society (an antismoking Big Pharma front organisation whose members are to be found everywhere in biomedical journals, particularly public health ones) and from the US-American University of Beirut (US-AUB), seem surprisingly more concerned with ««waterpipe»» ««dependence»» [2]… And, of course, it is no surprise that they would find wide open the columns of such a Big Pharma antismoking militant journal as “Nicotine and Tobacco Research” or those of a not less militant one like the British Medical Journal in which her last intervention was published [2][6].

The Lebanese ««waterpipe»» antismoking researchers are keen on linking a purported substantial ««dependence»» pattern with health effects. Interestingly, their last paper states: “««waterpipe»» is thought to contain toxic substances similar to those contained in cigarettes”[2]. In other words, Dr Salameh and her colleagues show that they are not “sure” anymore of themselves and this, in spite of a world “consensus” (sic) and more than one decade of so-called ««waterpipe»» heavily funded (millions of dollars from taxpayers’ money, mainly in the USA) research on its so-called toxicity, particularly carried out by their colleagues of the US-AUB [2][3]…

A fatally flawed ««waterpipe»» “”dependence”” scale…    

-First of all, the so-called “dependence” scale was built upon various materials; the main one being a previous world renowned tool named the “Fagerström Nicotine Dependence Test” which, few researchers know, has been criticised on several occasions for its flaws and by other not less world famous scientists [7]…

-By using the flawed ««waterpipe»» neologism, the so-called “LDWS” (««Lebanese»» ««Waterpipe»» ««Dependence»» Scale) does not distinguish between a great variety of products in use in the Middle East, this leading to many confusion factors and scrambled responses… This was rather unexpected from Lebanese researchers supposed to have a deep knowledge of the daily culture of their country, and of what the Middle East peace pipe (MEPP) actually is and involves, wasn’t it?

-“Like it or not, you are dependent!”, seems to say this kind of research to MEPP users. One main bias here (actually a serious methodological artefact on which no independent researcher can gloss over) is that the continuous brainwash pressure (psychological war) from this kind of flawed studies (for more than one decade now) and their systematic echo in systematically flawed “systematic reviews” and in the mainstream media, just explains how targeted volunteers in such surveys eventually “admit” that they are dependent…

-The underlying premises upon which the scale was elaborated contain many errors, often reflecting arbitrary choices which have nothing to do with the scientific method. For instance, let us consider the following statements:  “Current WP smoking was defined as smoking at least one WP per month, while current cigarette smoking was defined as smoking at least one cigarette per day”or: “Moreover, questions on normative beliefs were taken from a study performed on cigarette smokers”[2]…

Above all, please have a look at Table 1 and see, among the methodologically flawed items, how some of them are just ludicrous and fuelling confusion, reflecting a blatant misrepresentation of the background society and culture:  “Are you ready not to eat in exchange for a waterpipe?” or: “Smokes waterpipe to please others”…

As previously said, it is now clear that a new mantra had to replace the long-lived hoax about the MEPP (1 hookah equals 100 cigarettes) now officially abandoned [8][9]. According to it, there would now be a (new…) “current consensus” (sic) that “shisha smoking is likely to carry some of the same health risks as smoking cigarettes” (sic)…Of course, it is even more unscientific as the previous one… and the ««waterpipe»» ««dependence»» myth would play the same patching-up function [10][11][12]…

Finally, the reader is invited to consider the renewed global confusion when such a tool, designed to measure the purported ««waterpipe»» ««dependence»» in such methodological conditions, is exported to other countries [13]….

Bibliographical references:

[1] “««Waterpipe»» Addiction”: one of the Greatest Fallacies in Tobacco Research. 05 Sept 2013

[2] Kareem Shaheen. Scientists call for fighting nargileh ‘epidemic’. Nov. 02, 2013.

[3] First Prohibitionist International Conference on ««Waterpipe»» (Emirates, 20-23 Oct 2013). To Celebrate One Decade of Big Pharma Pseudo-Science on the Middle East Peace Pipe. 05 Sep 2013

[4] Open Letter to Wasim Maziak, Syrian Political Opponent and Head of the US-Syrian «Research» Centre in Aleppo (US-SCTS) [Lettre ouverte à Wasim Maziak, opposant politique syrien et directeur du centre « de recherche » USA-Syrie à Alep (US-SCTS)]. Tunisie-Secret, 7 Sep 2013

[5] Salameh P, Waked M, Aoun Z. Waterpipe smoking: Construction and validation of the Lebanon Waterpipe Dependence Scale (LWDS-11). Nicotine Tob Res. 2008 Jan;10(1):149-58.

[6] Salameh P, Salamé J, Waked M, Barbour B, Zeidan N, Baldi I. Waterpipe dependence in university students and effect of normative beliefs: a cross-sectional study. BMJ Open. 2014; 4:e004378.

[7] Molimard R. Fagerström Finds His Way To Damascus (trad. Iro Cyr) [Fagerström trouve son chemin de Damas]. 26 Nov. 2011

[8] Long-Lived Hoax about Middle East Peace Pipe (1 Hookah Equals 100 Cigarettes) Officially Abandoned. 24 Nov 2013.

[9] Jawad M, Bakir AM, Ali M, Jawad J, Akl EA. Key health themes and reporting of numerical cigarette–waterpipe equivalence in online news articles reporting on waterpipe tobacco smoking: a content analysis. Tob. Control. published 18 July 2013, 10.1136/tobaccocontrol-2013-050981

[10] Patched Up Pseudoscience & Plagiarism on Behalf of UK Researchers (Olivia Maynard et al.) in Big Pharma Supported Journal. 29 Oct 2013

[11] “Plagiarism: the act of presenting another’s works or ideas as your own” (image)

“Plagiarism is globally recognised as a serious academic offence” (The Lancet)

[12] Maynard OM, Gage SH, Munafo MR. Are waterpipe users tobacco-dependent ? Addiction. 2013 Nov;108(11):1886-7. doi: 10.1111/add.12317.

[13] Primack BA, Khabour OF, Alzoubi KH, Switzer GE, Shensa A, Carroll MV, Azab M, Eissenberg T. The LWDS-10J: Reliability and Validity of the Lebanon Waterpipe Dependence Scale Among University Students in Jordan. Nicotine Tob Res. 2014 Feb 26.

More on the issue and more to come:

[14] Entrevue avec le Dr Dussart: « La dépendance au narguilé est une mystification »

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