An Anthology of Serious though Widespread Errors in the ““Waterpipe”” (Hookah, Shisha, Narghile) Mainstream Biomedical Literature

Tobacco is Dangerous. However, parotting in this field of research has been detrimental to public health



This anthology refers to serious errors officially published, in general, in international peer-reviewed biomedical journals. Electronic links are provided in each case so the reader can check by her/himself. This is (as of October 2009) a preliminary draft representing only the “top of the iceberg”. It will be updated as the work proceeds. Please return.

Broad Framework References:
[1] COPE, the Committee on Publication Ethics.“A code of conduct for editors of biomedical journals”, “a suggested code of conduct for editors to guide them towards being fair to authors, researchers, and readers”:

[2] WMA (World Medical Association).

Ethical Principles for Medical Research Involving Human Subjects.Adopted by WMA GA 18th GA (General Assembly), Helsinki (Finland), June 1964. Further amended until the 52nd WMA GA (Edinburgh, Scotland, Oct 2000). Clarification on Paragraph 29 added by WMA GA (Washington, 2002) and other on Paragraph 30 by WMA GA (Tokyo, 2004)

[3] ICMJE.

Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication.Updated Oct. 2007:

[4] World Association of Medical Editors (WAME).

Publication Ethics Policies for Medical Journals.


Elsevier Publishing Ethics Resource Kit (PERK):


Elsevier and Plagiarism:


This introduction will also be a conclusion. It appears that most of the researchers (there was no problem with those of the past decades) do not -or just mean not to- read the papers they cite [1]. We name “parotting” such a behaviour so alien and destructive to scientific research.

Most of the papers listed in this page for their serious errors were produced by individuals who boast of doing “model” and “excellence” research [

2]. We leave the readers form their own opinions.


1]Muir Hazel.Scientists Don’t Read the Papers They Cite.New Scientist 2002 (14 Dec).[2] Maziak W, Ward KD, Eissenberg T, Klesges RC, Keil U.The [US-] Syrian Center for Tobacco Studies: a model of international partnership for the creation of sustainable research capacity in developing countries.Promot Educ. 2004;11(2):93-7, 116, 134.

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”
(Arthur Schopenhauer)[1]

[1] Recently and relevantly cited by Vaccine Resistance Movement (Oct 28, 2009)


1 to 7. COMING SOON…


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8. “BLACK” IS “WHITE” (Maziak et al, 2004; Ward et al, 2007)

Rakower and Fatal’ historic study [

1] has been sometimes cited in the available literature to support the statement that narghile smoking causes lung cancer [2][3] ,i.e.the opposite finding reached by its authors.

This huge error was published in the antismoking

Tobacco ControlandNicotine and Tobacco Researchjournals and repeated by dozens of parroting researchers in several “respectable” “peer-reviewed” journals of the world.

David Balfour, the Editor in Chief of the second journal, refused to publish a correction in accordance with their “sweep it under the carpet” policy.

[1] Rakower J, Fatal B: Study of Narghile Smoking in Relation to Cancer of the Lung. Br J Cancer 1962; 16:1-6.

[2] Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tobacco Control 2004; 13: 327-333.

[3] Ward KD, Eissenberg T, Gray JN, Srinivas V, Wilson N, Maziak W: Characteristics of U.S. waterpipe users: A preliminary report. Nicotine Tob Res. 2007 Dec;9(12):1339-1346.

9. “BLACK” IS “WHITE” (Primack et al. 2009; Maziak et al. 2004 : about Bladder Cancer)

In their paper on “water pipe” and cigarette smoking, Primack et al cite, among authors, an Egyptian study (Bedwani et al.) to support the existence of a link of the first mode of smoking to cancer [1][2]. This is not exact as the authors of the very study clearly emphasised that:

“it is more important, and more original, that our data did not find users of products other than cigarettes (i.e., water pipe and hashish) to be at elevated risk, after allowance for cigarette smoking “.

Let us have a look at the original table in the Egyptian study : Interestingly, this serious error was also published in a previous review by Maziak et al [3]. ____________ [1] Primack BA, Fertman CI, Rice KR, Adachi-Mejia AM, Fine, MJ. Waterpipe and Cigarette Smoking Among College Athletes in the United States . J Adol Health 2009; 1–7. [2] Bedwani R, El-Khwsky F, Renganathan E, Braga C, Abu Seif HH, Abul Azm T, Zaki A, Franceschi S, Boffetta P, La Vecchia C. Epidemiology of bladder cancer in Alexandria, Egypt: tobacco smoking. Int J Cancer. 1997 Sep 26;73(1):64-7. [3] Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tobacco Control 2004; 13: 327-333 [

note: served as the main basis for the WHO flawed report ]. Note:“Dr. Primack is supported with funding from the Robert Wood Johnson Foundation, the National Cancer Institute and the Maurice Falk Foundation.”*********************************

10. “BLACK IS WHITE” (Giulani et al, 2008)

A lie
about our historic study on hookah smoking and cancer [1] was published in the American Journal of Preventive Medicine: “the small, but increasing, body of literature on water-pipe smoking demonstrates similar and, in some cases, greater detrimental health effects than cigarette smoking[2]. Kevin Patrick, Editor-in-Chief of the Am J Prev Med, refused (20 Mar 2009) to publish a correction in accordance with their “sweep it under the carpet” policy.

[1] 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)

[2] Giuliani KK, Mire OA, Jama S, Dubois DK, Pryce D, Fahia S, Ehrlich LC. Tobacco use and cessation among Somalis in Minnesota. Am J Prev Med. 2008 (Dec);35(6 Suppl):S457-62.


12a. COMPARING APPLES with ORANGES (Neergaard et al., 2007 “Metanalysis”)

Neergaard et al conclude from a flawed metaanalysis that blood nicotine of a daily ““waterpipe”” user would be similar to that of an individual who smokes 10 cigarettes per day [


In a recent publication on shisha (hookah, narghile) radioactivity [

2], the authors warned that Neergaard et al’ “metaanalysis” has actually fuelled a wide confusion in the world [3] . The first reason is very simple as the studies pooled by Neergaard et al for data extraction and compilation actually come from India, Lebanon, Koweit, countries in which the smoking mixtures used in the local water pipes –and analysed in the selected studies- was tumbak and jurak. This is where the main bias lies as the latter are actually products known by specialists to be much stronger in nicotine than moassel/tobamel (and whose related smoking patterns are also completely different), the one actually used in the USA and Europe these days. Neergaard et al believed (as many other researchers have unfortunately done (because of the “”waterpipe”” nominalism) that the pipes and the smoking mixtures were the same in each of the diverse geographical contexts.

The main rule for conducting a metaanalysis is that you cannot compare apples with oranges and that you need to separate the sheep from the goats.


[1] Neergaard J, Singh P, Job J, Montgomery S. Waterpipe smoking and nicotine exposure: a review of the current evidence. Nicotine Tob Res. 2007;9(10):987–94

[2] 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.

[3] Primack BA, Walsh M, Bryce C, Eissenberg T. Water-Pipe Tobacco Smoking Among Middle and High School Students in Arizona. Pediatrics. 2009; 123:e282-e288.

12b. COMPARING APPLES with ORANGES (Akl et al., 2010 “Systematic Review”)

[*] 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

[Elie Akl et al’s biased flow chart]

The antismoking researchers dismissed (details given in their “eligibility criteria”) the most relevant studies when they did not find a sufficient cancer risk… Amazingly, they mostly relied on studies led in China based on water pipes working with NO charcoal and in which tobacco is BURNT as in cigarettes, contrary to what the authors believed… This point is certainly not a detail because the chemistry of smoke is completely different and, as a consequence, the potential health effects…” See the related Knol about a “Systematic Review” (on cancer studies in particular) by Elie Akl et al. (University of New York at Buffalo),published in the International Journal of Epidemiology.



WHO flawed report on “”waterpipe””” tobacco smoking

Mainly based on the following paper: Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tobacco Control 2004; 13: 327-333 [itself containing many serious errors reported in this anthology]


coming soon…]


14. Fraudulent COCHRANE Review on “”Waterpipe”” Smoking (Maziak, Ward, Eissenberg, 2007)


*] Maziak W, Ward K, Eissenberg T. Interventions for waterpipe smoking cessation. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005549. Note: peer-reviewed by Alan Shihadeh (US-American University of Beirut) and Mirjana Dordjevic (member of WHO TobReg), respectively co-author and peer-reviewer of the WHO flawed report

[Details : upcoming]


15.“4,000 other [chemical] substances”in Shisha Smoke (Dautzenberg et al., 2007)

Pioneering independent experts have identified only but a few hundred of chemical in shisha smoke. However, for the antismoking authors of this international pan-European brochure, this is not possible. Shisha smoke must be similar or worst than cigarette smoke (4,000 compounds identified so far)…

[*] OFT (Office Français du Tabagisme, presidé par Bertrand Dautzenberg)[French Top National Antismoking Agency]. International Brochure about Shisha. Available from the site of the European Smoke-Free Hospitals and Health Services: Also available in French


16. Mistaking Study on Shish’ Kebab [Grilled Meat] CO for One on Shisha (Dautzenberg & Nau, 2007)

Two French shisha experts (Bertrand Dautzenberg, president of OFT, the national antismoking agency, and Jean-Yves Nau, a medical journalist with Le Monde national newspaper) have published in May 2007 a 144 page “book” on the great hazards posed by hookah smoking, and particularly passive smoking. This “book” aimed to be the hookah “scientific basis” for the French Ministry of Health. The latter enacted a decree (similar to the Syrian one) making no distinction between hospitality venues and other public places, not to mention between tobacco forms (cigarette, cigar, narghile, etc.).

Such a “book” not only proved to be

the greatest fraud in the history of tobacco research(with errors on almost every page)[among others, page 23, the same error as above about the number of chemicals] but alsoa high form of plagiarism.The publisher ( Stéphane Arbouze, Dir. Editions MARGAUX-ORANGE, whose products are financially supported by the the great names of the Pharmaceutical Industry [have a look at its site) defends such a practice in accordance with their “sweep it under the carpet” policy. These facts have been published in a peer-reviewed biomedical journal [1]. Further to all these revelations, the French hookah lounges kept working in spite of the unscientific decree.

[1] Chaouachi K. An Open Letter against Plagiarism and Plagiarists. Tabaccologia 2009; 1: 46-7 [English version]


17. International Cancer Specialists Cite Plagiarised Material (Prignot et al, 2008)

A “review” full of serious errors [

1]. It cites, among others, the “book” (plagiarim) by Bertrand Dautzenberg and Jean-Yves Nau [2]. Moira Chan-Yeung, Editor-in-Chief of the International Journal of Tuberculosis and Lung Disease, refused (7 Oct 2008) to publish a correction in accordance with their “sweep it under the carpet” policy.

[1] Prignot JJ, Sasco AJ, Poulet E, Gupta PC, Aditama TY. Alternative forms of tobacco use. Int J Tuberc Lung Dis. 2008 Jul;12(7):718-27.

[2] Chaouachi K. An Open Letter against Plagiarism and Plagiarists. Tabaccologia 2009; 1: 46-7 [English version]


18. Almost plagiarism, once again…(Jacot-Sadowski and Cornuz, 2009)

but only tasteless parroting of widespread errors (among them, still stating that tobacco is burning…). Published in the

Revue Médiale Suisse[1].Interestingly,Jean-Yves Nau, co-plagiarist with Bertrand Dautzenberg [2], has been a collaborator of this journal for many years. Type “Nau JY” in PubMed and you will see the more than 500 indexed articles published this researcher [3]. Perhaps Jean-Yves Nau is the most prolific Medline-indexed antismoking writer in the world, far ahead of someone like Simon Chapman, ex-Editor-in-chief of the antismoking “Tobacco Control” journal and Globalink Big Boss.

[1] Jacot Sadowski I, Cornuz J. [New modes of tobacco and nicotine use] Rev Med Suisse. 2009; 5: 1457.

[2] Chaouachi K. An Open Letter against Plagiarism and Plagiarists. Tabaccologia 2009; 1: 46-7 [English version]

[3] PubMed Medline:


19. US-American of Beirut Biased Smoking Machines (Shihadeh et al, 2003-2009)

The US-American University of Beirut is funded to up to around $ 3 million (US public money)

[*] Daher N, Saleh R, Jaroudia E, Sheheitlia H, Badra T, Sepetdjian E, Al-Rashidi M, Saliba N, Shihadeh A. Comparison of carcinogen, carbon monoxide, and ultrafine particle emissions from narghile waterpipe and cigarette smoking: Sidestream smoke measurements and assessment of second-hand smoke emission factors. Atmospheric Environment 2009 (9 Oct); doi:10.1016/j.atmosenv.2009.10.004

[*] Sepetdjian E, Shihadeh A, Saliba NA. Measurement of 16 polycyclic aromatic hydrocarbons in narghile waterpipe tobacco smoke. Food Chem Toxicol 2008 May;46(5):1582-90.

[*] Al Rashidi M, Shihadeh A, Saliba NA. Volatile aldehydes in the mainstream smoke of the narghile waterpipe. Food Chem Toxicol. 2008 Nov;46(11):3546-9.

[*] Shihadeh A, Azar S.

A closed-loop control “playback” smoking machine for generating mainstream smoke aerosols.J Aerosol Med. 2006 (Summer);19(2):137-47.

[*] Shihadeh A, Saleh R. Polycyclic aromatic hydrocarbons, carbon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of the narghile water pipe. Food Chem Toxicol 2005; 43(5): 655-61.

[*] Shihadeh A, Azar S, Antonios C, Haddad A. Towards a topographical model of narghile water-pipe café smoking: a pilot study in a high socioeconomic status neighborhood of Beirut, Lebanon. Pharmacology, Biochemistry and Behavior 2004; 79: 75-82.

[*] Shihadeh A. Investigation of mainstream smoke aerosol of the argileh water pipe. Food Chem Toxicol 2003; 41: 143-52.


Among other critiques: Chaouachi K.

Public health intervention for narghile (hookah, shisha) use requires a radical critique of the related “standardised” smoking machine.Journal of Public Health [Springer Berlin/Heidelberg] 2009; 17(5): 355-xxx. DOI: 10.1007/s10389-009-0272-7


20 to 45. Unsorted shoddy science

[*] Rice VH, Weglicki LS, Templin T, Jamil H, Hammad A. Intervention effects on tobacco use in Arab and non-Arab American adolescents. Addict Behav. 2010 Jan;35(1):46-8. Epub 2009 Aug 21.

[*] Vandemergel X. Haccuria A. Shisha or waterpipe: An emerging public health problem [Chicha ou narguilé, un problème de santé publique émergent]. Louvain Medical 2009 Sep; 128 (7) : 241-5.

[*] Sarrafzadegan N, Toghianifar N, Roohafza H, Siadat Z, Mohammadifard N, O’Loughlin J.Lifestyle-Related Determinants of Hookah and Cigarette Smoking in Iranian Adults. J Community Health. 2009 Oct 29. [Epub ahead of print]. Doi : 10.1007/s10900-009-9186-0

[*] Ray CS. The hookah – the Indian waterpipe. Current Science 2009; 96 (10):1319-23. [*] Cobb C, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe tobacco smoking: an emerging health crisis in the United States. Am J Health Behav. 2010 May-Jun;34(3):275-85. See related knol

and more is coming *********************************

46. MIRAGES are Universal in the Desert of Hookah research

Not only when it comes to unscientifically comparing cigarettes and hookahs:


Narghile smoking keeps researchers in Wonderland. J Bras Pneumol. 2009Aug;35(8):819-20.

but also, and above all, when it comes to hyping and inventing the hazards of

Hookah Environmental TobaccoSmoke (note: already overstated in the case of cigarettes as the greatest experts of the world have shown)

[*] Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences. Int. J. Environ. Res. Public Health 2009; 6(2):798-843.

a great number of waterpipe researchers see mirages (optical illusions) in the desert. Let us see about 4 mirages: in the UK, the USA, France and Switzerland:


47. MIRAGE (OPTICAL ILLUSION) in the UK DESERT (Gatrad et al., 2007)

How UK doctors, who touted the Ban on hookah smoking (Jul 2007) in the British Medical Journal [1]:

“did not realise is that the “large plume of smoke” is actually and exclusively exhaled mainstream smoke,

i.e.aged, water-filtered and respiratory-tract filtered smoke, not side-stream smoke (as with cigarettes). The chemical differences and public health consequences are so immense and this has been established for the first time in a recently published study” [2].


1] Gatrad R, Gatrad A, Sheikh A. Hookah smoking. British Medical Journal 2007 Jul 7;335(7609):20.


2] Chaouachi K. [E-Letter] UK Ban on Cigarette and Hookah Smoking : Why Not Call Down the Precautionary Principle ? British Medical Journal 2009 (20 Apr)

We can say that Gatrad et al’s paper contains a “large plume” of errors. In spite of this, this peer-reviewed article has been parotted by numerous researchers and tobacco experts.



See comments and picture at:



See comments and picture at:



Few people noted that Pascal Diethelm, a renown tobacco control activist, took hookah MainStream Smoke (the one inhaled) for Side-Stream Smoke (almost inexistent in the case of hookah)[

1]. However, he published a tribune in the European Journal of Public Health in which he accused those who do not hype the hazards of (cigarette) ETS of being “denialists” (i.e., of something compared to a holocaust). Several independent researchers sent comments to the Editors [3].


1] Diethelm P. Narguilé : attention, danger ! Dossier 07-003 – 2007-05-29.OxyGenève 2007 (May). (accessed 31 Jan 2009)


2] Diethelm, P, McKee, M. Denialism: what is it and how should scientists respond ? Eur J Public Health. 2009; 19:2-4.


3] [E-Letter]: Denialism, Hookah Environmental Tobacco Smoke, and the «Overwhelming Consensus on the Evidence». Eur J Public Health. 2009 (17 Feb). A critique of: Diethelm, P, McKee, M. Denialism: what is it and how should scientists respond? Eur J Public Health. 2009; 19:2-4.


51. MIRAGESin Germany and Lebanon (Fromme et al, 2009; Daher et al, 2009)

[*] Fromme H, Dietrich S, Heitmann D, Dressel H, Diemer J, Schulz T, Jörres RA, Berlin K, Völkel W. Indoor air contamination during a waterpipe (narghile) smoking session. Food Chem Toxicol. 2009 Jul;47(7):1636-41.

[*] Daher N, Saleh R, Jaroudia E, Sheheitlia H, Badra T, Sepetdjian E, Al-Rashidi M, Saliba N, Shihadeh A. Comparison of carcinogen, carbon monoxide, and ultrafine particle emissions from narghile waterpipe and cigarette smoking: Sidestream smoke measurements and assessment of second-hand smoke emission factors. Atmospheric Environment 2009 (9 Oct); doi:10.1016/j.atmosenv.2009.10.004 Source: Fromme et al. 2009 ; Daher et al. 2009. (Chaouachi. Cours Universite Paris XI).

Critiques of the above papers:

[*] Chaouachi K. Hookah (shisha, narghile, “water pipe”) indoor air contamination in German unrealistic experiment. Serious methodological biases and ethical concern. Food Chem Toxicol 2010;48(3):992-5. [Epub ahead of print 25 Jan 2010]. Doi:10.1016/j.fct.2010.01.020

[*] Chaouachi K. Re: Findings on Waterpipe Second Hand Smoke. BMJ 2009 (11 Nov)

52. Another MIRAGE in Lebanon (George Saade et al, 2010)

A critique of this unethical flawed study to be found in the antismoking “Tobacco Control” journal has been published under the form of a Knol titled :

The Lebanese Ban on Smoking in Hospitality Venues(Cafes, etc.):US Interventionism and Prohibition in the Name of the FCTC (Framework Convention on Tobacco Control). Knol. 2010 (Apr 14).


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74. ASPERGILLOSIS patient who did not change the water of his hookah for 2 weeks (Szyper-Kravitz et al., 2001)

In spite of this striking “detail” (the fact that water had not been changed for such a long period), this study was cited over and over again by numerous antismoking tobacco researchers [



1] Szyper-Kravitz M, Lang R, Manor Y and Lahav M. Early invasive pulmonary aspergillosis in a leukemia patient linked to aspergillus contaminated marijuana smoking. Leuk Lymphoma. 2001 Nov-Dec;42(6):1433-7.

Among others and above all


2] Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T.Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic.Tobacco Control 2004; 13: 327-333. [itself cited over and over again]


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142. LEBANESE STUDENTS (Monique Chaaya et al., 2004)

[*] Chaaya M., Roueiheb Z.E., Chemaitelly H., Azar G., Nasr J. and Al-Sahab B. Argileh smoking among university students: A new tobacco epidemic. Nicotine & Tobacco Research. 2004 Jun; 6 (3):457-63.


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[even more :

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