-Communiqué-
The Cochrane 2007 Review Masquerade
on ““Waterpipe”” Smoking Cessation
(by Wasim MAZIAK, Kenneth WARD
and Thomas EISSENBERG),
its By-Products and the
Suspect Unbalanced Focus on
““Waterpipe”” Smoking vs.
Cigarette Smoking
by Dr Kamal T.C.
(Paris, 29 October 2007)
"I'm
gonna take two weeks, gonna have a fine vacation; I'm gonna take my problems to
the United Nations [...] Sometimes I wonder
what I'm a gonna do; But there ain't no cure for the summertime blues" (Eddie Cochran, rock’n’roll singer of the fifties, Summertime Blues)[ Listen and Watch online HERE: extra material added 30 Oct]
"The
Cochrane Library contains high-quality, independent evidence to inform
healthcare decision-making. It includes reliable evidence from Cochrane and
other systematic reviews, clinical trials, and more. Cochrane reviews bring you
the combined results of the world’s best medical research studies, and are
recognised as the gold standard in evidence-based health care." [[1]]
The main co-authors of the WHO
report on “waterpipe tobacco smoking”[[2]]
have recently published a new review entitled “Interventions for waterpipe
smoking cessation” [[3]].
They state that such a document aimed at considering “randomized controlled
trials, quasi-randomized controlled trials or cluster-randomized controlled
trials”. As expected, the authors found no references in the world
literature. Nonetheless, this review has been published as it is, probably as
an announcement and certainly for advertising purposes (artificial “impact
factor” rising) . There is a “Discussion” section with sub-sections such as
“spread of use”, “usage and gender”, “perceived risks”, “health effects”,
“attitudes and behaviour related to waterpipe cessation”, “dependence, and a
“Conclusion” broken down in two parts: “implications for practice” and
“implications for research”. As for the bibliographical references, they are
said to have been “compiled from conducting an earlier exhaustive review
of the literature on waterpipe smoking (Maziak 2004)”. In fact, and as
all careful researchers know, this “exhaustive” review -on which the erroneous
WHO report is based-, was far from being exhaustive simply because its authors
(the same as those of the present review) dismissed, and on purpose, world key
relevant references [[4]].
Amazingly, this time, there is no section nor any word about the origins of the
hookah while almost each of the numerous previous publications of the same team
has been insisting on this point and particularly on the Indian origin.
Conscientious researchers will remind that such a repeated and definitive
“peer-reviewed” statement was “supported” by strong “peer-reviewed” references,
like Kandela’s papers for instance [[5]].
The sudden eclipse of this “topic” may be due to the fact that the WHO expert
report contained two related serious errors in its very two first sentences [[6]].
Anyway, I will not discuss here the
substance of this new “review” and its numerous scientific flaws and serious
errors but rather focus, for the time being, on its form.
CONFLICT OF INTEREST. Strangely enough, the "Potential
conflict of interest" section states: "The authors are
conducting a trial of smoking cessation for waterpipe users, and plan to
include their findings in future updates of this review." In view of this, I immediately wrote (26 Oct. 2007)
to the Cochrane Collaboration Secretariat to demand clarification:
From the viewpoint of the Cochrane code of conduct, this is an
unacceptable answer. Even if it is still empty of some data, the above
document actually contains a so-called "review" of the
"existing" or "previously "reviewed" and
"peer-reviewed" "literature" on the subject:
"waterpipe" smoking. Consequently, the question is: what were the
potential authors' conflicts of interest when these data were
"collected", "analysed" and "meta-analysed"? Particularly,
I would like you to ask the third co-author to clarify his relation with Plowshare Inc. and Sention Inc., two
industrial firms to whom he has apparently been paid as a consultant although
he has not declared these facts in most of his publications. The Secretary
kindly replied to me on the same day: “Thank
you for your message. I have forwarded it to the Co-ordinators of the Cochrane
Tobacco Addiction Review Group, under whose auspices the review was produced,
and they, or else the Group's Co-ordinating Editor, or the authors
themselves will respond to you directly.”
I had a quick look at the Cochrane Tobacco Addiction Review Group site [[7]]
and there I saw that one of its editors is the co-author of a famous
editorial about “conflicts of interests” [[8]][[9]]. In these conditions, I
concluded that I cannot expect a great
support from the above organisation.
NEW “EFFICIENT” “PEER-REVIEW”
TECHNIQUES. The
“Acknowledgements” section of MAZIAK et al’s review states: “We would like
to thank Alan Shihadeh and Mirjana Djordjevic for reading and commenting on
earlier drafts of this review”. Interestingly, Alan SHIHADEH is co-author
of the erroneous WHO expert report and author of supposedly peer-reviewed
studies whose blatant methodological bias have remained uncommented by the
research community for years [[10]][[11]].
Mirjana DJORDEVIC is a member of TobReg, the WHO Study Group who
“peer-reviewed” the WHO expert report. Further to the numerous and serious
errors I detected in that document, I may now understand that this new review
has not been only “peer-reviewed” but also, as Drs DYBING
(Chairman, TobReg) and Dr HENNINGFIELD (TobReg member) have stated: “subject
to multiple layers of review and verification” [[12]]. A
logical question could be: is this, at last, and after so many intents, a
guarantee of sound science in the field of “waterpipe tobacco smoking” ? I am
afraid it is not. Future will show us soon.
FUNDING
AND ITS SUSPECT PRIORITY. The “Sources of support” section of the review states that the funding
comes from: “US Public Health Service Grants TW05962, TW07233 and Initiative
for Cardiovascular Health Research in the Developing Countries (IC-Health)
USA”. Noteworthy is the fact that Fogarty International (USA)’s funding of
the joint US-Syrian Center for Tobacco Studies [[13]]
was recently renewed for a second period of five years (i.e., if I mistake not,
something like 2 other millions of dollars). In the same time, a salvo of new
studies led by scientists working and meeting within the Society on Nicotine
and Tobacco Research forums was also fired. Most of these studies are to be
published in Nicotine and Tobacco Research or, alternatively, in the
other hegemonic journal: Tobacco Control. The great advantage is that
most of the “peer-reviewers” of these journals are anti-tobacco activists
belonging to the same ideological family. As John Polito would say: "What I do know is that science, not financial
interests, should be defining terms and writing rules, and that peer-review and oversight is in need of more
than a band-aid"[[14]].
Many independent researchers know
that it is impossible to get a paper with non-conformist views, or even a mere
critique in form of a Letter to the Editor, published in these
monopolistic “reference” journals. Since all papers are supposed to be
“peer-reviewed”, there cannot be any discussion on the substance… Critical
scientists are quickly identified by the staff of these journals thanks to
their network of active editors, regional advisors, reviewers, etc. Besides,
most of them are members of the Globalink network of anti-tobacco activists [[15]].
Pre-accepted studies systematically bear the ““waterpipe”” label which is, from
a sociological viewpoint, a code. On this anti-scientific nominalist and
confusionist ““waterpipe””, notion, please refer to my Letter to Dr Margaret
Chan, Dir-Gal WHO, and to one of my last publications [[16]][[17]].
Now, let me cite a few of the current
by-products of the Cochrane review:
Ø
Neergaard J, Singh P, Job J, Montgomery S.
Waterpipe smoking and nicotine exposure: A review of the current evidence.
Nicotine Tob Res. 2007 Oct;9(10):987-94.
Ø
Ward KD, Eissenberg T, Gray J, Srinivas V,
Wilson N, Maziak W. Characteristics of American waterpipe users: a preliminary
report. Nicotine & Tobacco Research 2007 (in press).
Ø
Maziak W, Rastam S, Ibrahim I, Ward KD,
Eissenberg T. Waterpipe associated particulate matter emissions. Nicotine &
Tobacco Research 2007 (in press).
Ø
Smith-Simone SY, Maziak W, Ward KD, Eissenberg
T. Waterpipe tobacco smoking: knowledge, attitudes, beliefs and behavior in two
U.S. samples. 2007 Nicotine & Tobacco Research;(in press).
Here, I would like to draw the
attention of the reader to the funding sources of all these new publications
because most of the involved US Public Health Authorities have succeeded,
thanks to their notable influence on WHO, in making of hookah (narghile,
shisha, “”waterpipe””) smoking the Tobacco Threat of the 21st
Century. As NEEGAARD et al. emphasises: “Tobacco research centers, with
waterpipe research as one of their primary objectives, have been
established recently in Egypt (Egyptian Smoking Prevention Research Institute)
and Syria (Syrian Center for Tobacco Studies).”[[18]]
Therefore and despite the repeated denegation by Wasim Maziak, Thomas Eissenberg and Kenneth Ward over the past years, the primary objective of these studies is actually ““waterpipe””, a priority all the more suspect that the prevalence ratio between cigarette and ““waterpipe”” smoking is at least 1 to 3 in the Middle East and much lower elsewhere in the world… This priority is all the more shady that almost no study has been conducted on cigarette smoking, specifically, by the joint US-Syrian Centre over the past five years. And to top it, I can now remember that Thomas Eissenberg once defended the Thai Ban on hookah smoking by declaring that cigarettes are sort of part of our (Western) culture and therefore, there would be nothing "radical" we can do to change the present order of things…[[19]]
All the erroneous, biased or
low-quality (Who were the “peer-reviewers” indeed ?) studies that have been
pouring over the past years and these days are funded by US agencies and public
health authorities such as Fogarty Centre, NIH, PHS, Robert Wood Johnson
Foundation, etc. I have also heard that the FAMRI (Flight Attendant Medical
Research Institute) is also financing studies on ““waterpipe””. Since I have
also read, for the first time, the word “Bupropion” in the Cochrane review,
I must say that I am very sceptical when contemplating two facts. On one hand,
the so-called “experts” know absolutely nothing of the peculiarities of hookah
dependence (when it happens). On the other, the odd hookah, in the eyes of the
Pharmaceutical Industry, might be a serious bubbling rival for the cigarette.
What if crowds of cigarette smokers or potential cigarette smokers (because
cigarettes are a gateway to hookah smoking and the reverse may not be true)
suddenly flock to hookah use ? Were not indoor smoking bans and heavy
anti-smoking advertising expected to induce rises in sales of Nicotine Replacement
Therapies products (patches, gums, etc.) ? In any case and with a view at
cessation, these products are not adapted for hookah smoking. Human methods
like Allen Carr’s or others based on hypnotherapy are certainly more promising
because their object is not “nicotine” but the psychological dimension of
smoking; in other words, the obscure desire. So, I fear the Pharmaceutical
Industry may be playing an important hidden role in this battlefield. It might
be behind most of the publications targeting ““waterpipe-as-the-priority”” and
their funding. Future will tell us soon.
CONCLUSION. This new “provisional” “gold
standard” (sic) review is in fact a remake of the erroneous WHO report [[20]].
Its authors and structure are the same. The cited and dismissed authors are the
same, so this represents another breach in the ethics of science in general and
of biomedical edition in particular. In my last Letter to Dir. Gal WHO [[21]],
I had shown that Wasim MAZIAK’s de facto co-autorship of the WHO report had
been camouflaged by him and his colleagues (Thomas EISSENBERG, Kenneth WARD and
Alan SHIHADEH), and that this qualifies for serious scientific misconduct. In
the new “review”, the numerous errors to be found in the WHO report have been
camouflaged so that the corresponding erroneous studies could be cited again,
in other words, recycled. In the world of the Mafia, this operation is called
“money laundering”. Le me call it in the present case: “Pseudo-science
laundering”.
Dr Kamal T.Chaouachi
Researcher and Consultant
in Tobacco Control (Paris) [[22]]
(kamchaAgmail.com)
[ http://publicationslist.org/kamal.chaouachi ]
[[2]] 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; 5:17. http://www.jnrbm.com/content/5/1/17
[[3]] Maziak W, Ward K, Eissenberg T. Interventions for
waterpipe smoking cessation. Cochrane Database Syst Rev. 2007 Oct
17;(4):CD005549.
[[5]] Kandela P. Narghile smoking keeps Waterpipe
Researchers in Wonderland. The Lancet 2000; 356 (9236): 1175.
[[7]] The Cochrane Tobacco Addiction Review Group: http://www.primarycare.ox.ac.uk/research/cochrane
[[8]] Edwards
G, Babor TF, Hall W, West R. Another mirror shattered? Tobacco industry
involvement suspected in a book which claims that nicotine is not addictive.
Addiction. 2002 (Jan);97(1):1-5.
[[11]] Chaouachi K. The narghile (hookah, shisha, goza)
epidemic and the need for clearing up confusion and solving problems related
with model building of social situations. TheScientificWorld JOURNAL: TSW
Holistic Health &Medicine 207 (7): 1691–6. DOI 10.1100/tsw.2007.255.
[[12]] Dybing R, Henningfield J. Comment
on critique of WHO report (15 Aug 2007)
http://www.jnrbm.com/content/5/1/17/comments
Chaouachi K. WHO and Peer-Review Standards in Studies on Hookah Smoking. The Lancet Early Online Publication 2007 (29 Oct). In reply to Dr Douglas Bettcher, Dir. WHO/TFI a.i.’s comment: Bettcher D. WHO Response to Use of evidence in WHO recommendations. The Lancet Early Online Publication 2007 (10 Sept).
http://www.thelancet.com/journals/lancet/article/PIIS0140673607606758/comments?totalcomments=1#1305
[[13]] US-Syrian Center for Tobacco Studies: http://www.scts-sy.org/en/home.php
[[14]] Polito J. Rapid Response (18 May 2003) to: Enstrom JE, Kabat GC. Environmental
tobacco smoke and tobacco related mortality in a prospective study of
Californians, 1960-98. BMJ 2003; 326: 1057.
[[15]] Globalink: http://www.globalink.org
[[16]] Chaouachi K. Letter to Dr Margaret CHAN, Director-Gal of WHO (World
Health Organisation) to demand the dissolution (winding up) of WHO TobReg (07 Sept 2007): http://docs.google.com/View?docid=dgbz283m_106vf22zw
[[18]] Neergaard J, Singh P, Job J, Montgomery S. Waterpipe
smoking and nicotine exposure: A review of the current evidence. Nicotine
Tob Res. 2007 Oct;9(10):987-94.
[[19]] Globalink: http://www.globalink.org
(Aug. 2004)
[[22]] CAUTION: Of course, I do not use the “Tobacco
Control” phrase with the meaning of “Tobacco Kontrol”
(“controlling smokers and their suppliers” according to Pierre Lemieux’ cogent
critiques)(*). Instead, I use it with from a diametrical point of view: that of
the broad traditional meaning of “drug control” as in UNDCP (the
ex-United Nations Drug Control Programme) and John Marks’ famous work (**).
This non-conformist physician used to prescribe legally (within the so-called
British System) hard drugs to their users. In my daily practice, this
non-prohibitionist notion means the control over the quality of products
(cigarettes, cigars, etc.) that also implies a systematic decriminalisation of
harm reduction solutions (Eclipse cigarette, Swedish SNUS, No-Carbon Monoxide
hookah, etc.) and, not the least, a rejection of the growing related junk
science that stained the credibility of science and public health.
(*) http://www.pierrelemieux.org/artkontrol.html
(**)
Marks J. Drug Misuse and Social Cost. Br J Hosp Med. 1994 Jul 13-Aug
16;52(2-3):65, 67.
http://docs.google.com/Doc?id=dgbz283m_89ff6p76
http://www.toxibase.org/BaseBiblio/Scripts/Show.bs?bqRef=13079
No competing commercial interests, but
co-inventor on patent application for a No-CO harm reduction hookah. I signed away
my past and future rights (total relinquishment) on this harm reduction patent
by June 15, 2005, i.e. before its commercial exploitation. From that date, I
have not had anymore any relation of any sort with the patent, even if the US
patent still mentions my name on the internet. A legal document was signed on
the same date in presence of a State Attorney in Paris (France).
>> Anecdotes about Reference 1: A “peer-reviewer” of the manuscript of
this critique (totalising between 10,000 and 20,000 visits these days)-
submitted first to the Canadian Journal of Public Health- rejected
it because its English would be poor… A
direct consequence of the numerous errors to be found in the WHO report is
reflected in a peer-reviewed paper published in The Lancet (Infectious
Diseases) where its author quotes from the erroneous WHO report: Meleigy M. Waterpipe and communicable diseases, says WHO.
The Lancet/Infections 2007 (Jul); Vol 7; issue 7:448. The Editors of The Lancet
have acknowledged the existence of this error (correspondence 28 Sept 2007,
available)