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  Libya Africa Health Opinion


Ten Post-11/9 Great Myths about Hookah (Shisha, Narghile) Smoking & Public Health

Posted: 2012-05-14
From: Mathaba
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How Geo-``politically-Correct`` Biased Science Generates Fictitious ``Civilisation Clashes`` in the World. Photo: Cherished memories. Damascus, Syria, with love...


Table of Contents:

Introduction

The Ten Myths:

  • Myth 1: Hookah (Shisha, Narghile) or ««Waterpipe»» Are Similar Objects
  • Myth 2: Hookah (Shisha, Narghile) Scientific Research Started Off in 2002
  • Myth 3: Hookah (Shisha, Narghile) Does Not Filter Out Toxins and Equals 100 Cigarettes (at least)
  • Myth 4: Hookah (Shisha, Narghile) Smoking Causes “Nicotine Addiction”
  • Myth 5: Hookah (Shisha, Narghile) Appeared for the First Time in India, Year 1605
  • Myth 6: Hookah (Shisha, Narghile) Second-Hand Smoke is Highly Hazardous
  • Myth 7: Hookah (Shisha, Narghile) Hazards Suggest Responsibility-to-Protect “Ethnic Communities”
  • Myth 8: Hookah (Shisha, Narghile) Is Not Kosher or Halal (is Haram) in Judaism and Islam
  • Myth 9: Hookah (Shisha, Narghile) Research is a Peacemaking Activity
  • Myth 10: Hookah (Shisha, Narghile) Smoking is Socially Incorrect

Conclusions

Bibliographical References

 ******************

Introduction

Tobacco smoking is injurious to health although not all forms of smoking (cigarette, cigar, dry pipe, hookah, shisha, narghile, bidis, moist snuff, etc.) entail the same risks. This point of utmost importance has been highlighted in a long series of peer-reviewed scientific publications [1][2]. In the wake of September 11, 2001, and for untold reasons, the growingly popular hookah (narghile, shisha) was suddenly viewed as an “Oriental” threat to the “West” (particularly the youth in the USA). For one decade now, research on this form of smoking has been monopolised by anti-smoking groups. The situation would have resulted somewhat normal if, leaving aside the question of the usurped exclusivity of research, these groups had not been funded, directly or indirectly (through “public health”, cancer, lung, associations, the World Health Organisation (WHO) and its satellites, etc.) by pharmaceutical companies (abbreviated, for the sake of convenience, “Big Pharma”).

This industry is worldwide known for selling nicotine “replacement” products (patches, gums, inhalers, etc.) and therapies, and also medicines such as Bupropion, Chantix, etc. (interview on world tobacco policy (WTP)). Big Pharma is traditionally presented as the rival of Big Tobacco (the cigarette industry). However, for both, hookah has become an embarrassing “Oriental” outsider (Ex-Knol online paper). For being the pre-Columbian tobacco harm reduction technique, hookah (shisha, narghile, etc.) has not posed any particular health problem for centuries, as acknowledged by the greatest tobacco and cancer researchers of the world before year 2002 [1][3]. Amazingly, it actually began to pose “problems” after that year (i.e., in the wake of Sep 11, 2011). The response to the question “Why after year 2002” was addressed in previous publications [4](SciTopic on global epidemic).

As in international mobilisations against viruses (hookah was eventually described as a “global epidemic”)[5](SciTopic glob. epid.), ««waterpipe»» anti-smoking emergency centres were immediately set up according to a classical containment strategy. A core research triangle would connect Syria, Lebanon and Egypt and be directly monitored from US-Headquarters located at Memphis University, Commonwealth University (Virginia) and Georgetown University [6].

War!

The first suspect point which immediately drew the interest of some observers was that the corresponding centres –- namely the US-“Syrian Centre for Tobacco Studies” (US-SCTS); the US-American University of Beirut centre (US-AUB) and the US-Egyptian centre (US-ESPRI)-- were focussing their attention on ««waterpipe»» smoking and not cigarette use. Yet, the prevalence of the latter in the corresponding part of the Middle East is much more important... In this respect, the logo of the US-SCTS is clear (image): it represents a narghile bowl (as the symbol of the targeted practice) and not the burning tip of a cigarette...

These centres have been continuously funded by such organisations as the US Fogarty International Centre, the US National Institute of Cancer, etc.) to up to $10 million: in particular $3 million for the US-AUB for ««waterpipe»» antismoking studies hyping the risks of hookah use.

They have produced the materials (dozens of ««waterpipe»»-labelled/coded publications) that were expected by the other conduits of the chain: i.e. the mainstream media (BBC shisha madness story) so that the latter can psychologically prepare (by stifling any dissenting views and avoiding any open scientific debate) the broad public to accept so-called bans on indoor or outdoor smoking prepared in a further stage by legislators (Utah Clean Air Act & response)(ABC: Government Crack Down on Hookah Lounges).

The WHO flawed report on ""waterpipe"" smoking

Unfortunately for them, such an idealistic plan went wrong... In spite of one decade of continuous vehement and sometimes violent anti-hookah “public health” campaigns warning against the “global epidemic” (SciTopic/glob. epid.) –with forceful slogans such as “1 hookah is equivalent to 100 cigarettes” (and sometimes 200, 400, 900...)[7], more and more people across the world (and in the “West” in particular) have been indulging in hookah smoking... No self-critique or apology was published, perhaps because the 100 cigarette-equivalence was claimed to be supported by a WHO (World Health Organisation) “study” which proved to be, not a “study” but a mere flawed report stained with a long series of serious scientific errors. In particular, the two first sentences of the reports contain a misquotation and an error [8]... Nobody, inside the WHO or its satellites, suggested to clarify the “100” figure until the truth came out and eventually became understood and claimed by the public at large. Yet, the so round equivalence is regularly recycled in the mainstream media for its known psychosocial effects (repeating a lie one thousand times can make it a truth...). Similar methods are used to prepare populations to accept totally illegal wars as the most recent and widest one against the Libyan Jamahiriya shows (e.g. Pr Charvin).

Interestingly, the series of lies in the ABC News story (by Thomas Eissenberg, chief author of the WHO flawed report [8], and chief investigator of the US-Syrian ««waterpipe»» anti-smoking centre, on the one hand, and, on the other, by Jack Henningfield, peer-reviewer of the WHO flawed report [8] and senior leader at Pinney Associates, a Big Pharma company) was published in June 2011 while Libya was the target of continuous bombing (Government crack down on hookah lounges).

Big Pharma funded anti-smoking events

The coming back hysteria about hookah smoking can be explained by the unexpected delay in the implementation of the world agenda for banning all forms of tobacco smoking. The delay is actually due to resistance movements questioning the so-called scientific evidence justifying the bans (e.g. Utah prohibition). The global plan, designed within the WHO and Big Pharma cartels, poses that mankind must head (ideally in the medium term) towards a “tobacco free” world with not a single spot left on Earth for smoking (interview on WTP)[9][10].

Another aspect of post-modern totalitarianism: the nightmare of "public health"

In these conditions, one can easily understand how the unexpected re-emergence (from Africa, Asia and remote times, and not from any modern communication or advertising agency in charge of designing short-lived fashions or gadgets) of hookah smoking has become the “pet hate”, “whipping boy” of the anti-smoking leagues (emanations, for many of them, of the puritan sections inside the US society).

Furthermore, hookah is geo-“politically-incorrect”: either for advocates of the New World Order or its so-called “opponents” (in particular pseudo-“libertarians”) who are unconsciously defending the same values. The reasons are many:

1-unlike cigarettes, hookah (because of its size) is very ““visible”” and easily ““noticeable”” with its huge clouds of aromatic smoke...;

Colonialism yesterday and peace pipe (Egypt)

2-hookah is not “white” as cigarettes and was even viewed as a “legac[y] of colonialism”(sic) by the US-American University of Beirut co-author of the WHO flawed report [7]. Given the history of Lebanon, the USA were this way cleaned since “colonialism” could not be but... European. Therefore, here is a WHO expert stating that European colonialism would be the cause of the hookah global epidemic... This may be seen either as a mere joke or a serious neo-orientalist blunder [11][12]...

3-Hookah has also been associated with... ““terrorism””... As a Saudi Arabian columnist rightly points out: (free transl. from Arabic: […] I do not exclude the fact that one day a Western scientific or academic section will publish a study showing that shisha smoking causes diarrhoea,

Ja'far 'Abbas, Al-Watan (Arabia), 29 Sept 2003

rheumatism and even widens the ozone gap… More, I even suspect that the Bush clan will eventually establish that that the tabamel [moassel, the tobacco (or no-tobacco)-molasses based smoking mixture for the hookah] contains terrorist genes and that the shisha, in the end, is nothing more than a booby-trap pipe bomb... This would be the ideal pretext for an invasion of Lebanon and Syria, known to be famous producers of shishas and their accessories! [13].

Colonialism today and peace pipe (Iraq)

Consequently, perhaps people like State Senator Brian Boquist (R-Dallas, USA) have understood the whole issue... This politico is said to “teach soldiers bound for the Middle East that hookah smoking is a ritual bringing together warring factions”(Statesman article, 26 Feb 2012).

4-From a political anthropology point of view, hookah smokers seem to be very provocative while doing nothing than sitting and chatting.... They actually give a very bad example in today’s world: talking to each other instead of watching TV and commercials, and drinking tea instead of getting liquored up. This is a very libertarian attitude reminiscent of Karl Marx’ son-in-law, Paul Lafargue, who wrote a book titled The Right to Laziness (orig. “Le Droit à La Paresse”).

Bombing a wedding party in Al-Qaim (Syrian border), Iraq, May 2004

Hookah has indeed got a communistic libertarian dimension because the alternative values it suggests are play, conversation and idleness. In sum, hookah is also seen as a threat to the New World Order. Indeed, through history, authoritarian governments in the Middle East used to send police eavesdroppers to narghile cafes.

These times may come back again under other pretexts (a Patriot Act, for example)...

On the occasion of the 2012 release of a book scanning the full spectrum of the world hookah scene [14](brochure in English), we review below 10 great recent prevalent myths which emerged after September 9, 2011...

2012 release of the book (includes the full critique of the WHO flawed report)

Myth 1: Hookah (Shisha, Narghile) or ««Waterpipe»» Are Similar Objects

This is the one of the greatest frauds and fatal methodological errors in the so-called research undertaken since 2002. It implies that all water pipes of the world, in spite of their striking diversity, produce the same smoke and induce the same health effects. The very ««waterpipe»» “notion” proved to be a confusionist neologism, actually designed for a paradigmatic purpose, and also and above all a nominalism. Lumping together all water pipes of the world (the Pakistani or Indian hookah, the Tunisian or Libyan Shisha, the Egyptian Goza, the Yemeni Mada’a or the Lebanese or Syrian Arghile and even the tiny Chinese water pipes) under a same object and “concept” dubbed ««waterpipe»» (particularly in the form of the one-word neologism - but this is also true for the dashed form) has resulted in a catastrophe for research on tobacco smoking and a waste of millions of dollars... This point has been highlighted in many peer-reviewed scientific articles. Many researchers (including authors of “systematic reviews”) have actually fallen in that epistemological trap [15][16]. Anyone typing ««waterpipe»» (in one word) at PubMed US central database can get an idea of the related “production and its meaning (PubMed).

A sound approach to the study of smoking through water pipes in the world entails a clear distinction between the different artefacts, smoking products (moassel/tabamel, tumbak, jurak, etc.), smoking behaviour, working temperatures, etc. Lazy unethical scientists do not like complex objects so they squarely decide to short-circuit complexity through the arbitrary use of a word like ««waterpipe»» supposed to reflect a universal entity (reductionist attitude). Moreover, such an entry cannot be found in any English, Urdu, Hebrew, Persian, Hindi, Arabic, Turkish dictionary... This has represented the major bias in research since 2002. As a result, many readers of this ««waterpipe»» literature (most doctors of the world are naive in this respect) believe that the findings of the corresponding studies are universal. This is a great fraud. Further to our critiques, the faulty researchers are still using the same word (in a clear intent to save their face) but systematically note somewhere in their publications that ««waterpipe»» covers hookah (shisha, narghile), as if it were a mere question of vocabulary... It is not.

Myth 2: Hookah (Shisha, Narghile) Scientific Research Started Off in 2002

 “No research into hookah use existed before 2002, according to Wasim Maziak, director of the Syrian Center for Tobacco Studies in the Middle East. But his center alone has been involved in 50 scientific reports about argileh, the fruity, fragrant tobacco used in hookah pipes.”

Wasim Maziak, Head of US-SCTS, handling his "Quality" Awards from a Gulf State

This is an official blatant lie announced in the media by one of the main authors of the WHO flawed report (Detroit News, 14 Aug 2009)[17]. Research on hookah actually began at the dawn of the 17th century (1622 to be exact). Although it has sometimes stayed dormant over centuries (likely because there have not been “public health” alerts in relation to hookahs...), it gave birth to the most valuable independent (from both Big Pharma and Big Tobacco) studies from the 40ties onwards until the end of the 20th century. The 2002 date actually coincides with the inception of... the US-Syrian ««waterpipe»» antismoking centre; what the naive reader of the Detroit News certainly ignored... These facts were clarified in a peer-reviewed article and an online analysis [4](SciTopic/global epid.).

Myth 3: Hookah (Shisha, Narghile) Does Not Filter Out Toxins and Equals 100 Cigarettes (at least)

This myth could actually be subdivided into 10 sub-myths as e.g.: “cigarette smoke and hookah smoke are chemically identical”(The Guardian)[18]; “hookah smoke contains 36 times more “tar” than a cigarette”; “the water does not filter out toxic chemicals”; “thermodynamic processes are the same (tobacco is burnt as in cigarettes)”; etc.  However, we will limit ourselves to a broad review of cross-issues.

Dr Sanghvi, a renowned cancer specialist from India, early performed a chemical analysis (tar, nicotine...) of hookah smoke and concluded that “[the] results were comparable to those for some of the mildest cigarettes on the world market and show the efficiency of water as a filter”[19]. The hookah water filtration rate (that would be nearing zero according to the antismoking literature and its media...) was officially established in 1991 by Saudi pharmacologists and chemists in a pioneering English peer-reviewed scientific publication which was dismissed, with many others, in the WHO flawed report (actually prepared under US prohibitionist pseudo-scientific guidance). The Middle East researchers found that the shisha water-filtration average rate was 38% [2]. This is for the role of water only since the hookah filtering effect is not limited to the liquid only as many believe [1].

Is it scientific to claim, in one way or another, that hookah smoke contains the same 4,000 (in fact 5,000 have been identified so far) chemicals ?

The same scientists concluded that with only 142 compounds detected in the smoke generated by a pipe filled with Jurak (a mixture of 15% of tobacco leaves and 47% carbohydrates (glucose)), shisha smoke is actually far less complex than cigarette smoke since around 5,000 substances have identified so far in the latter. This is obviously due to the much lower temperatures to which the tobacco-molasses mixture (moassel/tabamel) is subjected: actually hundreds of degrees below that of cigarettes [2].

[GLYCEROL] Quite interestingly, and once again in striking contrast with regular cigarettes, a great part (80% and more) of hookah smoke (prepared with flavoured moassel) is made up of water and glycerol (biologically inactive substances)[3]. All these hard facts explain why hookah smokers can puff more abundantly and for longer periods of time than cigarette users. The top tobacco experts who “peer-reviewed” the WHO flawed report [8], have finally acknowledged the above facts we have put forward in every occasion for almost one decade: “Only recently experts [not the ««waterpipe»» antismoking ones of course...] have acknowledged that "WP [““waterpipe””] smoking is so different from cigarette smoking that data on smoke composition and toxicity cannot be extrapolated from one to the other”[20].

Then, apart from unethically sending to the bin key studies (bibliographic bias, publication bias) and “sweeping under the carpet” a lot of hard facts (scientific misconduct), there are two main tricks ««waterpipe»»  antismoking researchers have been using in order to deceive doctors and parents around the world.

-Trick 1. Toxicological comparisons are systematically made between an average hookah smoking session (about one hour, that is 60 minutes) with one-cigarette (consumed in about 5 minutes). The raw arithmetic is then sent this way to the mainstream media. However, an important fact which is silenced on purpose is that the common hookah user in the “West” smokes on average 2 to 3 pipes a week (according to epidemiological antismoking studies)... so that the inhalation of chemicals is also highly diluted.... by the time factor... Even in the worst case (one hookah a day), the comparison with a one-or-two pack(s) a day cigarette smoker would show that the latter is dozens of times much more exposed to hazardous chemicals than the former.

This said, even comparing on such biased bases, the mean blood nicotine level among hookah smokers sitting for a 45 min session was found (by ««waterpipe»» antismoking researchers themselves) to be lower than among cigarette users after having smoked a single cigarette (for about 5 min). After correction (pharmacokinetics model), nicotine exposure to hookah smoke would be 1.7 times that of a single cigarette user [21]. In sum, 1 hookah smoking session would expose the user to the nicotine equivalent of 1 to 2 cigarettes at the most [22]... Furthermore, the example cited about nicotine is also relevant to the analysis of many other toxic chemicals such as nitrosamines and polycyclic aromatic hydrocarbons. What makes ««waterpipe»» antismoking researchers embarrassed is that even the biological markers of these last products are generally found in very much lower quantities in shisha users than among cigarette smokers and this, in their own experiments and studies [23]...

Shisha smoking machine set with a 17s inter-puff time. Golden rule: the greater the puffing frequency is, the higher the "tar" level. A 60 s or 120 s interval between two puffs would make this level drop several-fold

-Trick 2. The second trick is that the figures of toxic substances advertised –and never questioned (censorship)- in the mainstream media are those produced by a smoking machine supposed to mimic human hookah smoking. One periodic puff is relentlessly drawn every 17s over one full hour with all the methodological biases this implies [24]. For instance, reducing (always ruled for clear reasons...), even for a few minutes (therefore supposing a hookah smoker is not a robot and stops puffing from time to time because talking with his fiancée, his mother over the phone or drinking a cup of mint tea, ...) the time between two machine-generated puffs, immediately translates into a dramatic drop of tar content [2][24].

This is why all measurements of toxic emissions are always performed at such an artificially high puffing frequency. There is a question we are asking to all tobacco researchers of the world. Since the use of cigarette-smoking machines (5 to 7 minutes only with one puff drawn every minute) has been continuously criticised (from 1967 exactly to date) by the most renowned tobacco scientists of the world, for distorting the reality of human smoking, how come the recently designed hookah smoking machine (based on a 17s inter-puff time; i.e. about 3 puffs per minute over one full hour, i.e. 60 min) has remained uncommented [25]?

The amazing silence has a clear explanation: fear. Biomedical researchers are afraid of confronting a totalitarian system known to silence dissenting views, stifling debate through direct interventions on Editors-in-Chief, and imposing censorship. For researchers from Asia and Africa, there is also the highly sensitive neo-orientalist aspects of the issue [11][12]. The USA are involved in the funding of many Middle East research teams and the reasons are not necessarily humanitarian, philanthropic or related to the “public health” of the local populations as in the case of the war on ««waterpipe»» smoking. Who, among the community of Middle East researchers, would openly dare criticise such an institution as the imperial US-American University of Beirut?

Benzo-a-pyrene

Evidence for the abuse of smoking machines in studies motivated by political objectives (laws banning hookah smoking) is given, for example, by a German team whose members have recently found levels of benzo[a]pyrene (a powerful carcinogenous polycyclic aromatic hydrocarbon) 20 times lower than their colleagues of the US-American Lebanese University. Yet, the experimental protocol in both studies was based on the use of a shisha smoking machine set with the same parameters (inter-puff time, notably)[26][27].

A warning about “tar”.  Comparing cigarette tar and hookah tar (at least the way this has been done since 2002) is totally unscientific. For long years, until our critiques became recognised as cogent [20], it was barely stated in biomedical publications that both are completely different from each other. However, and this is another trick, the advertised figures for tar actually include a high proportion of glycerol (among other humectants)[2][8]. The inventors of the electronic cigarette (as well as of a previous harm reduction cigarette named Eclipse), which have been introduced in the world market over the last two decades, directly draw their inspiration from the hookah system [8]. One example of the extremely different chemical composition is that nitrosamines (which are perhaps the most hazardous compounds in tar), are either absent or found in much lower quantities in hookah smoke (vs. cigarette smoke).

A warning about the charcoal. Another played down fact of utmost importance (as far as public health consequences are concerned) is that 90 to 95% of the toxicity of hookah smoke (not the hyped one described in the cumulating pseudo-scientific literature and scaremongering mainstream media) comes from the charcoal used to heat the smoking mixture. This fact (the debunking per se of another myth) is a direct conclusion of the studies led by the early previously mentioned Saudi independent researchers [2]. In recent laboratory experiments involving the use of ICMS-MS (Inductively Coupled Plasma Mass Spectrometer), we have measured the concentrations of heavy metals (highly carcinogenic) in moassel pastes and compared them with other tobacco or tobacco-derived products. Results show that the heavy metals are much more abundant in cigarette tobacco than in shisha moassel. We have therefore confirmed previous results by the same above-mentioned Saudi researcher [28]. Consequently, heavy metals very likely come from the charcoal (and/or the metal covering of the pipe) as we emphasised one decade ago. From there, the early design of a harm reduction charcoal-free (electric or gas powered) was the most relevant response to public health concerns [29]. Instead of educating people on how not to misuse charcoal in order to avoid carbon monoxide intoxications (as with barbecues), WHO anti ««waterpipe»» researchers have, for one decade, literally censored any statement mentioning the need for a proper ventilation (i.e. harm reduction). They have focussed on eradication-only take home messages: Quit right now! More than scientific misconduct, this actually qualifies for a public health crime.

All the above-mentioned censored hard facts translate into health effects; first of all according to the “the dose is the poison” medical principle. The greater the number of toxic chemicals is, the greater the negative effect on health. For instance hookah smoke cytotoxicity (toxicity of smoke on cells) has been studied over the past decades by independent (from Big Pharma and Big Tobacco) researchers [2]. The same goes for cancer with the first aetiological studies carried out by Pakistanis doctors on heavy hookah users who have been smoking, for decades, huge amounts of tobacco [1].

To close this chapter, let us point out that hookah smoke is far from being pure air. So, users (always preferred as recreational) should take care with the charcoal since the levels of inhaled carbon monoxide generally measured among hookah smokers are higher than among cigarette users.

PS: please consider the recent ludicrous pseudo-scientific Byzantine discussion on a “prestigious” medical forum. It involved proponents of a mere-arithmetic “100-cigarette” equivalent and “revisionists” drawing a not less anti-scientific “10-cigarette” parallel (Royal College/British Journal of General Practice)(comments dated 09 Feb & 23 Apr 2012). The reader will appreciate how, thanks to smart language (British English...) known for its understatement characteristics and “moderation” rules, scientific blunders as big as “1 hookah equals 100 cigarettes” (and now 10 cigarettes) are laundered and piped into the so-called “peer-reviewed” biomedical press.

Myth 4: Hookah (Shisha, Narghile) Smoking Causes “Nicotine Addiction”

Nicotine

First of all, it must be clear that nicotine is not carcinogenous 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) mais aussi ludique (Johan Huizinga), artistique et libertaire (Guy Debord)»[14].

Myth 5: Hookah (Shisha, Narghile) Appeared for the First Time in India, Year 1605

Early African water pipe (antelope horn)

“Official” History serves political objectives as this happens every time conquerors impose their interpretation of events and leave it unquestionable for long periods of time (by having recourse to new laws if necessary). The WHO flawed report begins with a misquotation and an error... related to the origins of the hookah whereby its authors endeavoured to “fix” it in India, year 1605 [8]. The authors quote an anecdote according to which a physician to the Indian Court would have invented a way to make tobacco less harmful to the Emperor by making its smoke pass through water. The direct inference of the WHO report –frequently echoed in the mainstream media- is that the “myth of the harmless hookah” would be “as old as its invention”[8].

The objectives are threefold:

1. The trickily timed (1605) anecdote is used in a political way as in Myth 2 about the “official” date (2002) for the inception of research on hookah smoking (i.e. ««waterpipe»» antismoking publications)[17]. Year Zero, Ground Zero...

2. The dismissal of a great amount of scientific evidence, showing that hookah smoking is a tobacco harm reduction technique, would therefore be “justified”[2][8][19];

3. Hookah users are persuaded that what they have been intimately experimenting (particularly the sensory difference between cigarette smoke and hookah smoke) is mere Maya (illusion). For this reason, the debunking of Myth 3 (about the filtering effect of hookah) was necessary.

Shirazi, the first ever poem on smoking. It is Iranian and it is a poem of love...

Fortunately, archaeological, anthropological and literary independent research shows that hookah has even a more remote origin [8][14]; perhaps going thousands of years back [36]. In particular, the first poem on smoking was written as early as 1535. It is Iranian and it is a poem of love in which its author, Shirazi, is ravished by the scene of her beloved smoking the Qalyan (one of the local Iranian water pipes) [14][36][37]:

“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...”

Myth 6: Hookah (Shisha, Narghile) Second-Hand Smoke is Highly Hazardous

Official fake poster of the French antismoking campaign

The issue behind this myth is the last stronghold of antismoking researchers and Big Pharma lobbies within the WHO. Since they have not found any sufficient levels of toxic substances in hookah mainstream smoke (the one absorbed by the smoker) to justify all-out bans, they have raised, as in fake social “revolutions”, the “Responsability to Protect” civilians... non-smoking civilians... from hookah smoke (interview). Unfortunately for them (and “paradoxically” for some), hookah, unlike cigarettes, does generate almost no side-stream smoke (the most toxic one in cigarette because it is hot and not filtered by the smoker’s lungs). In view of this new peculiarity, antismoking groups have virtually invented hookah side-stream smoke. An official campaign in France (World No Tobacco Day 2006), approved by the Ministry of Health featured a hookah emitting huge clouds of smoke. This is an official scientific hoax on which 99% of tobacco researchers of the world kept silent by fear of retaliation should they speak out.

Cigarette sidestream smoke is chemically different (hotter and more toxic) from mainstream smoke (filtered by the smoker's lungs). By comparison hookah (narghile, shisha) generates almost no side-stream smoke

A detailed analysis of the potential hazards related to hookah side-stream smoke hazards was published in a peer-reviewed scientific journal [2]. Antismoking activists within Globalink (of which the heads of the US-Syrian, US-Lebanese and US-Egyptian ««waterpipe»» antismoking centres are members of (Ex-Knol online  paper)[38], have actually pressured the journal in an intent to block the publication. However, the Editor-in-Chief saw that its scientific merit was unquestionable and maintained his previously taken decision to publish it [2].  Immediately, the $3 million funded US-American University of Beirut team prepared a biased study in response to a so-called “controversy”(sic) whose authors were never named (i.e. we)... Thanks to a biased setup of the pipe, the production of toxic substances supposedly due to hookah side-stream smoke was artificially blown up [39].

In our turn, we prepared a response exposing the methodological tricks. It was sent to the corresponding journal (Atmospheric Environment). We still believed corruption had not reached the latter. We were deceived as in another case involving the same US-American University of Beirut team whose members have actually lied to the Editor-in-Chief of the Inhalation Toxicology journal in order to make him change his mind after he had thoughtfully and independently taken a positive decision regarding a manuscript of ours (details). The possibility of a sound scientific debate was therefore stifled and we eventually published our detailed response in the Libyan Journal of Medicine, an independent peer-rewiewed medical journal indexed with PubMed [25]. By choosing such a journal (before the war against the Libyan Jamahiriya), we were assured that our dissenting views would not be censored by the US prohibitionists now in total(itarian) ideological control of most scientific journals of the world when it comes to tobacco issues in general and, more sensitively, hookah in particular.

Eventually, we realised that the above-mentioned Atmospheric Environment journal (which published the biased study on hookah side-stream smoke and whose pressured Editors rejected with no scientific explanation our critiques), was actually hosted by the same institution (University of East-Anglia) involved in the Climate Change scandal dubbed “Climategate”. Considering that the surprising unethical practices (censoring of dissenting views clearly reflected in official emails hacked by activists) were exactly the same we faced, we decided not to waste time in sterile diplomatic discussions with liars and publish “for History” and “future generations” an online modest paper titled “Waterpipegate & Climategate” (Ex-Knol online paper).

In theory (and based on imported pseudo-science from the US), this man could be fined: not for reading the Ath-Thawra newspaper (meaning “Revolution”..., the nationalist historic movement, not the ““Arab Spring”” imported thing...) but for smoking indoors. Please note, however, how well ventilated are Middle East cafes...

As we said somewhere, tobacco being injurious for health, the Syrian government was certainly right to recently ban smoking in certain public places. The corresponding decree was relevant in many instances (taxis, public transportation, shared offices, etc.). However, and because it was directly inspired by the US-SCTS ««waterpipe»» antismoking centre, it did not distinguish, on purpose, between non-ventilated, poorly and well-ventilated public areas (Ex-Knol online paper). The case of Syrian coffee houses, as described in anthropological accounts, was therefore a striking example for the inconsistency of the ban and posed the question of the scientific integrity of the data provided by the Globalink US-Syrian activists who touted it [2][38].

More, during their briefing by antismoking activists, the Syrian authorities were provided with data on “working examples” from the world. As in many other cases, the operation had been a mere importation of so-called “Western” “evidence” justifying an immediate ban in public hospitalities. As far as Europe is concerned, not only the French ban on hookah smoking was, from the outset, a scientific fraud but, on a wider continental level, it was also based on a manipulation of official statistics [40](debunking critique by French top tobacco authority).

If the Syrian decree has now been “alleviated” and is more “tolerant”, it is a good thing for the preservation of the social, cultural, economical and even political tissue of Syria, particularly against the background of threats against its territorial integrity and independence. As for the Lebanese ban, it is a good example of US interventionism in the name of a supranational convention (FCTC: Framework Convention on Tobacco Control) itself a product of the prohibition proponents (Ex-Knol online paper)...

Based on their own anthropological medical findings, Iranians have realised that a ban on their local water pipes was contrary to common sense; hence, their repeated U-Turn decisions to lift previous bans (article). Or, perhaps, thanks to some mysterious “domino effect”, Iran public health authorities have decided to adopt the tolerance displayed by the Syrian government. This is even more promising that the world has seen a lot of ««waterpipe»» antismoking research led in Iran over the past few years -and directly inspired by the US example (Ex-Knol online paper).

Finally, we should also mention a German unethical study in which human guinea pigs were actually smoked out by the researchers. This dangerous, unrealistic and biased experiment was debunked in time [41].

Myth 7: Hookah (Shisha, Narghile) Hazards Suggest Responsibility-to-Protect “Ethnic Communities”

In 2007, ASH (Action on Smoking & Health) led an interview with the heads of the three US ««waterpipe»» antismoking centres in the Middle East (Lebanon, Egypt, Syria) in their capacity as authors of the WHO flawed report [8]. The objective was to get their supposedly “authoritative” support for a planned ban in the United Kingdom (targeting in particular the numerous shisha lounges there). Although none of the invited researchers was living, working or native of that country, their message was clear: “excluding “shisha bars” when England goes smokefree on July 1 could worsen the grave inequalities in health that already affect ethnic minorities” [7].

Such a “disinterested” invitation was bluntly rejected by the owners of shisha lounges who resisted assaults on their liberties and business. Interestingly, they have not seen a worsening of “the grave inequalities in health “due to their activity... in spite of what the BBC reported a few years later: “In March, the BBC published a news story claiming that GPs in Leicester "are seeing an increase in teenagers with health problems linked to shisha pipe smoking". But Leicester PCT [Primary Care Centre] now says the story was erroneous; while it maintains the number of teenagers in the city smoking shisha is on the rise, it says GPs have not confirmed an increase in treating patients with health problems caused directly by shisha.” (The Guardian)[18]. The BBC never apologised, as most mainstream media (Al-Jazeera, etc.) do, believing that they are not answerable for what they publish and that they stand above all ethics and laws (interview).

It does not matter if the 100 (sometimes rising two-fold and even nine-fold)-cigarette equivalent comparison –that many hookah users of the world may have read or heard somewhere, is antiscientific or not because its very function was to psychologically prepare the “opinion” at large to accept assaults on civil liberties in the  name of the “protection” of innocents (ABC News: Government Crack Down). Here, the “innocents” are either the poor “ethnic minorities” for whom the WHO ««waterpipe»» antismoking experts have been weeping on or the non–smoking civilian populations inside the Oriental hookah lounges... Let us note here that antismoking media advocates systematically discard the argument that such places are actually patronised by people who wilfully decide to frequent them for the only purpose of smoking hookah...

An interesting parallel is that the 6,000 (victims) figure (used during the last war against the Libyan Jamahiriya) was also the same as the one (deaths purportedly due to "passive smoking") used in an official report of the European Commission to justify bans on cafes on a continental scale. As said previously, the statistics had been twisted for this purpose (interview). Finally, it is worth pointing out that in view of the “unexpected” “stubborn” facts related to hookah (efficient filtering of tobacco smoke, recreational use, no significant side-stream smoke, no addiction, etc.), ««waterpipe»» antismoking activists have even raised the question of smell... Apparently, they wish to ““regulate”” (this word is more and more frequent in the pouring literature and is actually a “fig leaf” for “prohibition”) smell but is this very rational? Furthermore, as “tobacco control” activists, does the “regulation of either charcoal (used for heating the hookah) or “smell” logically fall within their competences?...

Myth 8: Hookah (Shisha, Narghile) Is Not Kosher (Haram) in Judaism and Islam

Divine commandment: Seek (good sound) science from the cradle to the crave...

Some Muslim observers have objected that fatwas banning the use of hookah have been issued in the recent past. Certainly though few people know how these religious rulings were taken. Quickly said, the corresponding scholars have been briefed by pseudo-scientific reports and took their decisions in violation of the Prophet’s commandment that the true believer should seek science from the cradle to the grave (Utlubu ‘l-‘ilma min al-mahdi ila-l lahdi). Of course, it could not be “bad science” but “good science”, i.e. unbiased solid science (SciTopic on Hookah Mystique). The direct epistemological consequence is that researchers (particularly those working on Muslim societies) should just stick to this simple universal precept. Even atheist researchers will accept such an invitation because it is as obvious as logical. Therefore, the central question is: why research on tobacco smoking should appear as an exception to this principle; because a handful of “Western” millenarists would have transformed “tobacco control” into a religious movement (online article)?

Religious leaders, and particularly authors of fatwas, have obviously been duped by tobacco prohibition activists seeking moral support and “guarantee” (here the one, so important, of Islam) for their global agenda of a “tobacco free world”. A parallel with the recent war against the Libyan Jamahiriya shows how a fatwa was also issued by a so-called sheikh on Al-Jazeera Channel. The process was exactly the same. The man aired a criminal fatwa which was supported, not by official reports from independent international commissions or organisations but media news and particularly Al-Jazeera’s ones...

Islam does not “forbid” behaviours if there is no solid evidence suggesting the need for interference or ruling. As a consequence, hookah smoking is not haram [42]. Furthermore, one famous verse of the Holy Quran is Let There Be No Compulsion in Religion (« Lâ ikrâha fî-d-dîn »)( II, 255). Islam is a so tolerant religion that Western “tobacco control” activists are puzzled when considering how their campaigns are difficult to implement in the corresponding countries. An historic example of this tolerance is given by Sinan Mimar, the great Ottoman architect of the 16th century, who used to smoke the narghile inside the magnificent mosques he was building. When asked, one day, by the Sultan why he was doing this, he said that he was testing the holy buildings for their acoustic quality thanks to the typical bubbling sound emitted by the pipe...

Finally, another related myth is that the Prophet of Islam would be a hookah smoker [43]... A response to what was in fact a xenophobic joke however published in the “prestigious” British Medical Journal..., was censored, with no given reason by the Editors. Once again, such an incident exemplifies aspects of the unsuspected totalitarianism the hookah issue exposes every day (Ex-Knol online article).

Myth 9: Hookah (Shisha, Narghile) Research is a Peacemaking Activity

Periodic hysteria in the media and all-out attacks based on pseudo-scientific studies have actually fuelled a great deal of xenophobia in the world. This is very easy to understand when considering the conclusions the targeted average (wo)man in the street :

-“Their” fathers teach “their” children how to smoke the hookah (WHO flawed report on ««waterpipe»» smoking)[8]. This led a Globalink activist [38] in Switzerland to stress that numerous parents in that country (obviously immigrants and likely from the “Great Middle East”) allow their children, sometimes aged less than 12 years, to gather at home and smoke hookah in group (Original: « […] de nombreux parents, […] parfois de très jeunes adolescents de 12 ans ou moins […] dans le logement familial […]”(On “Denialism”).

A common female smoker in Iran

-Many ludicrous statements have also been published about women. In the WHO flawed report in particular [8], and in a great span of the antismoking literature in general, one can read that hookah smoking is a male activity. The reverse is true. In countries such as Iran, Yemen, Lebanon and others, women are even known to smoke hookah more than men...

Neo-orientalism. Headline reads: "Moslem World - Women Do Assert Themselves...

"Most recently, a team from the US-American University of Beirut has prepared a pseudo-anthropological publication portraying, by some aspects, Arab hookah smoking women as whores... The naively neo-orientalist idea is that this could represent a way to deter them from such an activity... A few years ago, a neo-orientalist journal named Le Courrier International published a front page depicting a fabricated early ““Arab Spring””-like photograph selling the “liberation” of Arab women thanks to cigarettes. Once again, and on one hand, how was cigarette dependence going to liberate anybody? On the other, all sociological studies show that more and more Arab women have found in shisha smoking (therefore, a traditional habit) a way chill out with friends...

-“They” pollute the "West" with these huge amounts of highly toxic smoke [7]...

-Recycling the WHO flawed report in an interview with the Editor-in-Chief of the Addiction journal (UK), a health facility recently stated that « even without the support of science, WHO has come to the conclusion that hookah, in general, is more dangerous than smoking cigarettes” (Riordan Clinic)...What does this mean ?

-In the greatest world fraud in tobacco research, the Head of the Office Français du Tabagisme (OFT) even revealed anthropometric pseudo-scientific “findings” about smokers in the Arab world. The latter  would not be “equipped" with the same lungs as in Europe [44]...

Myth 10: Hookah (Shisha, Narghile) Smoking Is Socially Incorrect

In theory, these peaceful people could have been fined for not abiding by the nationwide smoking ban in France... (decree dated 02 Jan 2008). From the revue des buralistes (28 Jan 2008).

Instead of studying the ethnography of talk during a hookah session (something seen as “magic” for many users), and thus considering the overall potential benefits in terms of social cohesion [14], ««waterpipe»» antismoking researchers have, for one decade now, warning against that devilish suction hose which, going from mouth to mouth, would catalyse the spread of tuberculosis... Fans of “clash of civilisations” theories actually hate the hookah because more and more people around the world (and US teenagers in particular), are discovering in their own lands social virtues their fathers have lost. These can be summarised by three examples from Iran, the Libyan Jamahiriya and Syria:

-an early report from Iran, by the National Geographic Magazine (1921): «[...] The tea-house is the democratic Persian’s political and social club, a splendid institution for which we have no adequate equivalent in America ... anything from an adobe hut with a few crude benches to the glorified cafés... it always possesses those unfailing essentials, a big brass Russian samovar, an adequate collection of little tea-glasses, bright-colored saucers, and filigree spoons, a bubbling hubble-bubble or two for public use, and a genial atmosphere of camaraderie [...]» [45].

Cherished memories. Tripoli, Libyan Jamahiriya, with love... A traditional cafe. Note: the flag at half-mast, stuck into the spout of the standing hookah (instead of the suction hose), was of green colour if our memory is not letting us down...

-a more recent report from Tripoli, Libyan Jamahiriya, Green Square 1992: “At night fall, a walk around the part of the capital awash in the orange glow of magnificent street lamps, was a constant temptation to linger awhile in a good-natured atmosphere. Under tall palm trees, right in the middle of a colourful crowd of young men and women, of whole families and old men, the waiters of an open air restaurant could be seen rushing between the crowded tables and the kitchen. After the meal, those who ordered a hookah that was already set up at their table would be provided with a kursy (pipe bowl, in clay or in metal, depending on whether the hookah was an arguila or a shisha) full of apple-flavoured mo'essel (tobacco aromatised with molasses). Sometimes, the waiter would alternate this with the distribution of new live embers for burning the tobacco [...]”(Universita del Mediterraneo, Rome, 1997, n° 5).

-A poem inspired by a garden scene in Aleppo, Syria (Lamartine, 1832) :

Gaza, Palestine. The open-air city-wide jail. Shisha smokers there mocking unscientific imported "public health” warnings, say: “We will more likely die in an Israeli raid!...”

« Quand, ta main approchant de tes lèvres mi-closes

Le tuyau de jasmin vêtu d’or effilé,

Ta bouche, en aspirant le doux parfum des roses,

Fait murmurer l’eau tiède au fond du narguilé; [...]

De mon cœur attiédi la harpe est seule aimée.

Mais combien à seize ans j’aurais donné de vers

Pour un de ces flocons d’odorante fumée

Que ta lèvre distraite exhale dans les airs [...] »

Conclusions

Scientific research can be led just as wars are waged today. The debunking of the ten above myths also provides evidence (symbolic evidence here) for the “clash of civilisations” fallacy. Big Pharma (quit smoking aids) and Big Tobacco (cigarettes) share a common interest in getting rid of recreational non-addictive popular tobacco use methods, particularly when they come from Asia and Africa.  The key points to consider in order to understand the recent global “public health” hysteria about hookah (narghile, shisha) smoking and what is at stake behind, can take the form of the following questions:

-Who funds whom? For instance, while it is clear for many observers why and how Big Pharma funds antismoking studies, it is less common and perhaps paradoxical to admit that ««waterpipe»» antismoking teams (the US-American University of Beirut, chiefly, but also the US-Syrian team) have received undisclosed funding from... the Tobacco Industry itself...

Hookah users will immediately understand the motives. Because of the absence of addiction (see Myth 4), hookah is seen, in the new global market, as a competitor from Asia and Africa (Ex-Knol online paper). When tipped, a tobacco control researcher at Boston University has reacted to this scandal in an article titled: “Six Articles on Health Effects of Hookah Use Fail to Mention that Research Sponsor Was Directed by a Tobacco Industry Executive”. Indeed, the number (though underestimated) is high and no apology was issued because these people (just as conquerors in today’s totalitarian wars) believe they are above ethics and laws.

The recipient of the financial support from the “generous” “unexpected” sponsor is described in an official document from the US-American University of Beirut. One can see that from an early date, the plan was to “translate” “research” findings into world prohibitionist “policy”. One can also read how the WHO flawed report [8] aimed to be “against narghile smoking”(sic) and how the chairman of the Study Group within WHO to be appointed for that cause was selected from the US-American University of Beirut itself... In other words, the main co-author of the WHO flawed report (Alan Shihadeh) was the colleague of that chairman (Ghazi Zaatari) from the same US-American University of Beirut... Is this an “Oriental” exception or a democratic model for the preparation of all reports within the World Health Organisation and similar UN agencies?

"The AUB-TCRG was established informally in 1999 through a grant from the International Development Research Center-Research for International Tobacco Control (IDRC-RITC)."

Thanks to “generous” funding, the “untouchable” (*) US-American University of Beirut has been the spearhead of the ««waterpipe»» antismoking global hysteria. However, some researchers dared “touch” it to expose how its so-called scientific activities in relation with a commonplace material artefact are on the same wavelength as those of the “Great Middle East”project. (*)note: "untouchable" perhaps because some high-ranking officials in Lebanon, Syria and even Iran have studied there...

"The AUB TCRG’s portfolio speaks for itself in terms of research methods and results. The focus on the narghile as a type of tobacco consumption has provided a niche of expertise. The impact of this expertise is evident through the publication of an IDRC monograph on results of the epidemiologic research, significant contribution of the research to the WHO advisory Note against narghile smoking, active participation of members of the group in the second and third WHO FCTC Conference of Parties meeting, and the appointment of a member of the group as the Chairman of the Study Group on Tobacco Product Regulation (TobReg) of the WHO Tobacco Free Initiative."(source)(alternate link)[46]

-Why studies with negative results (i.e. unexpected results for ««waterpipe»» antismoking activists) led in Asia and Africa and published in English in peer-reviewed journals have been officially dismissed?

-Why are research centres in charge of fighting the world ««waterpipe»» “global epidemic” all funded by US sources and managed from the USA?

-Why has there been, for so long, such an amazing consensus of ""all"" researchers and media of the world ?

-Why, in all mainstream media stories, the interviewed experts always belong to the same camp (for instance the Globalink family as in the ABC News story (Government Crack Down)(Ex-Knol online  paper)[38])? Then, why are their “hard facts” and so-called “findings” of “scientific” “research” systematically balanced with the opinion of the (wo)man in the street (always a hookah lounge owner or patron...), never with the views of another expert opposing the official myths about hookah smoking?

-Indeed, what is wrong with this kind of "research"? Whom are they at war with?

In any case, the public health bottom line message is that findings from scientific research over four centuries show that hookah (shisha, narghile) smoke is much less toxic than cigarette smoke. If you are a (regular) smoker of this kind of pipe, beware of how you use the charcoal however (as you would do with a barbecue). Keep in mind that if hookah is less harmful, this does not mean that it is harmless (antismoking researchers do not distinguish on purpose, between these two notions).

 

Bibliographical References

(academic/peer-reviewed, except: 7, 13, 17, 18, 46):

[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). Doi:10.1186/1477-7517-5-19

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2438352/

[2] Chaouachi K. 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.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=19440416

[3] 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 2009 (online: 24 Dec).

http://dx.doi.org/10.1016/j.mehy.2009.11.036

[4] Chaouachi K. Prevention and sporadic carbon monoxide poisoning related to shisha (hookah, narghile) tobacco smoking. J Emerg Med. 2010 (Feb 2)[Epub ahead of print] . doi:10.1016/j.jemermed.2009.11.027 http://dx.doi.org/10.1016/j.jemermed.2009.11.027

[5] Maziak W. The Global Epidemic of Waterpipe Smoking. Addictive Behaviors 2010 (August)

http:/dx.doi.org/10.1016/j.addbeh.2010.08.030

[6] Chaouachi K. Hookah (narghile, shisha). An Epidemic from Egypt ? [Le narguilé (chicha, hookah) : une épidémie venue d’Egypte ?]. In: Figures de la santé. Passé, présent, avenir. CEDEJ (Centre d’études et de documentation économiques, juridiques et sociales)/CNRS, Le Caire (Egypte),  2007, pages 247-267.

http://ema.revues.org/index1776.html

[7] 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, respectively heads of the US-“Syrian Centre for Tobacco Studies” and US-American University of Beirut centre] 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”.

http://www.newash.org.uk/ash_4q8eg0ft.htm

[8] 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 Biomedicine 2006 (17 Nov); 5:17. Doi:10.1186/1477-5751-5-17 [The WHO report was prepared by Alan Shihadeh (US-American University of Beirut), Thomas Eissenberg (US-“Syrian Centre for Tobacco Studies”) and Wasim Maziak (idem) and requested and peer-reviewed by (chiefly): Jack Henningfield (senior leader at Pinney Associates, pharmaceutical company) and Ghazi Zaatari (US-American University of Beirut)]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664583/

[9] Chapman S. Global perspective on tobacco control. Part II. The future of tobacco control: making smoking history? Int J Tuberc Lung Dis. 2008 Jan;12(1):8-12.

http://www.ncbi.nlm.nih.gov/pubmed/18173870?...

[10] Ben Youdan. Smokefree parks in New Zealand: an important step towards the goal of a smokefree New Zealand in 2020. Journal of the New Zealand Medical Association, 29-January-2010, Vol 123 No 1308.

http://www.nzma.org.nz/journal/

[11] Saïd Edward : L’orientalisme: L’Orient créé par l’Occident (orig. : Orientalism, 1978), trad. fr. par Catherine Malamud), Paris, Seuil, 1980. See also Culture and Imperialism, Vintage Books, 1994 and speech at York University (Toronto, 10 Feb 1993)

http://www.zmag.org/zmag/articles/barsaid.htm

[12] Chaouachi K. [Material Culture and Orientalism. The Example of a Socio-Anthropological Research on Narghile]. Arabica 2006, LIII;2: 177-209 [Published by Koninklijke Brill NV, Leiden, The Netherlands]

http://www.ingentaconnect.com/content/brill/arab/2006/00000053/00000002/art00003

[13] Ja‘far ‘Abbâs, “’Ahîran gazawnâhum”, Al-Watan (Arabia), 29 Sept 2003. Cited, pp. 187-8 in “Tout savoir sur le narguilé”

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http://www.editions-harmattan.fr/index.asp?navig=catalogue&obj=livre&no=37021

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http://www.ncbi.nlm.nih.gov/pubmed/20671057

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http://chestjournal.chestpubs.org/content/139/5/1250.full

[17] Kozlowski, Kim. Michigan health leaders target growing hookah use. The Detroit News 2009 (Friday, Aug 14)

http://detnews.com/article/20090814/LIFESTYLE03/908140351/1409/METRO/Mich.-health-leaders-target-growing-hookah-use (original link now broken; alternate link: http://tinyurl.com/cnrt8x3)

[18] The Guardian. Smoking shisha: how bad is it for you? It is growing in popularity but some experts say a single shisha session is the same as smoking 200 cigarettes. By Huma Qureshi, 22 Aug 2011

http://www.guardian.co.uk/society/2011/aug/22/shisha-smoking-how-bad-is-it

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http://www.mendeley.com/research/nicotine-content-and-delivery-across-tobacco-products/

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http://www.ajpm-online.net/article/S0749-3797%2809%2900583-2/abstract

[22] Chaouachi K. Hookah (shisha, narghile) smoking, cancer and the need for a critical medical anthropology]. Rev Pneumol Clin. 2011 Apr;67(2):124-6. Epub 2010 Oct 27. French.

http://www.ncbi.nlm.nih.gov/pubmed/21497730

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http://cebp.aacrjournals.org/content/early/2011/09/07/1055-9965.EPI-11-0545.abstract?sid=705d7e2

[24] Chaouachi K. Public health intervention for narghile (hookah, shisha) use requires a radical critique of the related ‘‘standardised’’ smoking machine. J Public Health 2009;18(1):69–73. Doi: 10.1007/s10389-009-0272-7 [Springer Berlin/Heidelberg].

http://www.springerlink.com/content/58352477706011t0/

[25] Chaouachi K. Assessment of narghile (shisha, hookah) smokers’ actual exposure to toxic chemicals requires further sound studies. Libyan Journal of Medicine 2011, 6: 5934. 5 pages. Published Online 11 May 2011. Doi:10.3402/ljm.v5i0.5934

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094468

[26] Schubert J, Hahn J, Dettbarn G, Seidel A, Luch A, Schulz TG. Mainstream smoke of the waterpipe: Does this environmental matrix reveal as significant source of toxic compounds? Toxicol Lett. 2011; 205:279-84.

http://www.ncbi.nlm.nih.gov/pubmed/21712083

[27] Gattavecchia E, McClure L, Chaouachi K, Carano M, Zaga V. Benzopyrene and Tobacco Smoke [Benzopirene e fumo di tabacco]. Tabaccologia 2010;3:32-6

http://www.tabaccologia.it/filedirectory/PDF/Tabaccologia03-10.pdf (8.65 Mb)

[28] Khater AE, Amr M, Chaouachi K. Uranium and Heavy Metals in Narghile (Shisha, Hookah) Moassel. Session on Environmental Radioactivity. Poster 11-P-18. The Third Asian and Oceanic Congress on Radiation Protection. IRPA (International Radiation Protection Association). Tokyo (Japan), 2010 (25 May).

http://www.aocrp-3.org/p_environ.html

[29] Patent 2005: "Narguile a allumage simplifie" [Narghile with simplified ignition]. Appl. EP20050291196. Filed 3 June. Published 14 Dec).

[30] Fagerström KO. Determinants of Tobacco Use and Renaming the FTND to the Fagerström Test for Cigarette Dependence. Nicotine & Tobacco Research (Oct 24, 2011)

http://ntr.oxfordjournals.org/content/14/1/75.short

[31] Fagerström KO. Tobacco or Nicotine Dependence ? Tabaccologia 2003;1:6

http://www.tabaccologia.org/PDF/1_2003/3_1_2003.pdf

[32] Auf RA, Radwan GN, Loffredo CA, El Setouhy M, Israel E, Mohamed MK. Assessment of tobacco dependence in waterpipe smokers in Egypt.Int J Tuberc Lung Dis. 2012 Jan;16(1):132-7.

http://www.ingentaconnect.com/content/iuatld/ijtld/2012/00000016/00000001/art00024

[33] Rastam S, Eissenberg T, Ibrahim I, Ward KD, Khalil R, Maziak W. Comparative analysis of waterpipe and cigarette suppression of abstinence and craving symptoms. Addict Behav. 2011 May;36(5):555-9. Epub 2011 Jan 20.

http://www.ncbi.nlm.nih.gov/pubmed/21316156

[34] Carroll T, Poder N, Perusco A. Is concern about water pipe smoking warranted? Aust N Z J Public Health. 2008;32(2):181-2.

http://www3.interscience.wiley.com/journal/121559909/abstract

[35] Richard Hébert. What's new in Nicotine & Tobacco Research? "Waterpipes are addictive, too". Nicotine & Tobacco Research 2009 11(7):773-8. Doi:10.1093/ntr/ntp116

http://ntr.oxfordjournals.org/cgi/content/extract/11/7/773

[36] Chaouachi K. et al. Pre-Columbian Tobacco Smoking Mummies? A Critical Review of the Evidence in the Light of Most Recent Tobaccological & Anthropological Findings. Tabaccologia, in press, 2012, 15 pages [article in English].

http://www.tabaccologia.it

[37] Floor W. The Art of Smoking in Iran and Other Uses of Tobacco. Iranian Studies 2002; 35 : 47-85.

[38] Globalink. The world antismoking Globalink network sponsored by the pharmaceutical industry (Pfizer in particular) counts some 6,000 members working with : ministries of health; antismoking NGOs; the World Health Organisation and its relevant bodies (TobReg, the Study Group for the Regulation of Tobacco Products; the “Tobacco Free Initiative”; the regional bureaux; etc.); the Cochrane Review Tobacco Addiction Group; etc. Globalink also maintains strong links with the main antismoking journals: “Tobacco Control” most importantly; “Nicotine and Tobacco Research”; “Addiction”; some US biomedical journals which regularly publish articles on tobacco issues, etc.

http://www.globalink.org (intranet)

[39] Daher N, Saleh R, Jaroudi E, Sheheitli H, Badr 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 2010; 44(1): 8-14.

http://dx.doi.org/10.1016/j.atmosenv.2009.10.004

[40] The Smoke Free Partnership [financed by and prepared for the European Respiratory Society, INCa (Institut National du Cancer), Cancer Research UK, European Heart Network]. Report “Lifting the smokescreen - 10 reasons for a smokefree Europe”. 2006. 146 pages. ISBN 1-904097-56-1

http://www.smokefreepartnership.eu/Lifting-the-smokescreen-10-reasons

[41] 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. Doi:10.1016/j.fct.2010.01.020

http://dx.doi.org/10.1016/j.fct.2010.01.020

[42] Pulera N, Chaouachi K. Prevenzione dei danni da fumo di tabacco: un ruolo per l’islam? Tabaccologia 2007;1:20-21

http://www.tabaccologia.org/PDF/1_2007/4_12007.pdf

[43] Liam Farrell. The prophet of nudge. British Medical Journal 2011; 342:d1448 doi: 10.1136/bmj.d1448 (Published 10 March 2011)

http://www.bmj.com/content/342/bmj.d1448

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

http://www.tabaccologia.org/PDF/1_2009/19_1_2009.pdf

[45] Bird FL. Modern Persia and its Capital - The National Geographic Magazine, 1921; 39/4:383-6, 1921. Quoted (page 105, footnote 191 out of 387 footnote) in: Chaouachi K [Anthropology of Narghile: Its Use and Soft Drugs], Paris, 1997, L'Harmattan, 262 pages.

[46] US-American University (US-AUB). US-AUB Tobacco Control Research Group. With Issam Fares Institute (05 Mar 2011)

http://www.aub.edu.lb/ifi/public_policy/rapp/rapp_research/Documents/economics_of_tobacco_lebanon/Short_Bios/Short_Bios.pdf (altern: http://docs.google.com/open?id=0B2iXoxgyuf9lQm5QeUtYTHM1ZGM)



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