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[ UPDATE: 15 Mar 2008. COMMUNIQUE: The Erroneous and Biased Cochrane Review on “waterpipe smoking cessation”. Cochrane’s Editorial Decision  and the Necessary Final Comments ]



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]]


[ ]



[[1]] The Cochrane Library:

[[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.

[[3]] Maziak W, Ward K, Eissenberg T. Interventions for waterpipe smoking cessation. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005549.

[[4]] Chaouachi K. A Critique of the WHO’s TobReg “Advisory Note” […], op. cit.

[[5]] Kandela P. Narghile smoking keeps Waterpipe Researchers in Wonderland. The Lancet 2000; 356 (9236): 1175.

[[6]] Chaouachi K. A Critique of the WHO’s TobReg “Advisory Note” […], op. cit.

[[7]] The Cochrane Tobacco Addiction Review Group:

[[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.

[[9]] West R.: Theory of Addiction. Addiction Press/Blackwell Publishing Ltd, Oxford, 2006.

[[10]] Chaouachi K. A Critique of the WHO’s TobReg “Advisory Note” […], op. cit.

[[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)

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).

[[13]] US-Syrian Center for Tobacco Studies:

[[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:

[[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):

[[17]] Chaouachi K. The narghile (hookah, shisha, goza) epidemic […], op. cit.

[[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: (Aug. 2004)

[[20]] Chaouachi K. A Critique of the WHO’s TobReg “Advisory Note” […], op. cit.

[[21]] Chaouachi K. Letter to Dr Margaret CHAN, Director-Gal of WHO  […], op. cit..

[[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.


(**) Marks J. Drug Misuse and Social Cost. Br J Hosp Med. 1994 Jul 13-Aug 16;52(2-3):65, 67.



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)