Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences. International Journal of Environmental Research and Public Health. 2009; 6(2):798-843.
“-[ADDENDUM 2 mar 2010] After the claims about the supposedly high hazards of hookah Environmental Tobacco smoke. have been clarified, findings from antismoking researchers funded by powerful lobbies have been published. However, they were actually based on methodological tricks”. For more details, go to relevant KNOL (piece of KNOwLedge).
[COPY, with permission from the author]
-Communiqué-
Seven Thousand Billions of
Ultra Fine Smoke Particles
in a Single Hookah (Narghile,
Shisha) Session
and Yet its Users are Still
Alive…
[French: Sept
mille milliards de particules ultra-fines pour une seule séance
de narguilé (chicha) et ses fumeurs sont toujours là, en vie…]
includes : “Shocking Unsubstantiated
Neo-Orientalist Statement on Lung Function
Discrimination (Middle East vs.
European Hookah Smokers)
Published in the ‘Tobacco Control’
Journal”
by Kamal C. (Paris, 01 Dec 2007)
What this paper adds:
Ø
Banning of hookah smoking machines should
become a top priority for public health;
Ø
Forbiddance of ludicrous anthropometrical
statements should become part of national edicts regarding smoke-free places;
Ø The collapse of the peer-review system in relation with hookah studies
is confirmed;
Ø
1 Cigarette roughly Equals 3 (unshared) Hookahs
(regarding Ultra Fine Particles concentration and for
Ø
1 Cigarette roughly Equals 13 (unshared) Hookahs (regarding Carbon Monoxide yields and for
Ø Hookah has not proved, to date, to be MORE dangerous than cigarettes.
A “research paper”
entitled “Ultrafine particle emissions from waterpipes”, authored by Drs MONN,
KINDLER, MEILE and BRANDLI (Switzerland), was recently published in the
“Tobacco Control” journal [1]. It reports a new experience mainly based
on a smoking machine supposed to reflect “real” hookah (narghile, shisha)
smoking. To start with and despite all existing critiques on the subject, only
8 grams of tobamel/mu‘assel (the tobacco-molasses based mixture) were used in a
50 minute (machine) smoking “session” [2]. This is a first serious
methodological error. While the laboratory experience refers to exactly the
same smoking product used in a similar system in Lebanon (Shihadeh et al.), the
authors surprisingly acknowledge: “Some important differences in the
breathing patterns of waterpipe smokers between smokers in the Middle East and
in our study were found. In the study from Shidadeh et al the tidal
volume of smokers was 0.53 litres, the duration was 2.6 seconds and the
interval between breaths was 17 seconds.6 In our study the volume was 1 litre,
the duration 5 seconds and the interval between breaths was 25 seconds (see
table 1).”
Such a statement was published in
the Tobacco Control journal and was supposedly “peer-reviewed” and screened by
teams of world top experts. However, it is nothing but ludicrous
pseudo-scientific anthropometrics. For a given product and a same
configuration, all hookah users of the world smoke the same way. Consequently,
the authors have presented not less than a mere artefact generated by the use
of the smoking machines themselves. They eventually believed that their smoking
machines were an image of real human hookah smoking… The fact that data
collection through smoking topographies in Lebanon and Switzerland gave so
striking differences means that the methodology is wrong. For many years now, I
have been warning against the use of such artificial means which have already
generated a great world confusion [2].
On the occasion of the “World No
Tobacco Day” (2006), a book written by Bertrand
DAUTZENBERG (President of French OFT) and Jean-Yves NAU (journalist from Le
Monde) and containing the same “finding” was released in France. The
related message was largely an shamelessly disseminated and echoed in the media
of that country. Together with other numerous other errors, I showed that this
book was the greatest fraud in the history of tobacco research, apart from its
intellectual piracy aspects [3].
Of course, Dr MONNIN and his
colleagues are neither directly responsible for using a smoking machine nor for
inferring from its use anthropometrical nonsense reminiscent of other glorious
19th Century “scientific” theories (on human races and so on)... The
AUB (the US-American University of Beirut) is certainly responsible for this
situation.
CHALLLENGE. I challenge all ““waterpipe””
experts of Tobacco Control, Nicotine and Tobacco Research (including
their teams of peer-reviewers), Globalink, WHO (World Health Organisation) TFI
(Tobacco Free Initiative), WHO TobReg (Study Group for Tobacco Regulation) and
all their followers anywhere in the world, to produce the least evidence that
Middle Easterners’ and Europeans’ lungs react differently to hookah smoke
stimuli. If they are unable to do so, then they owe an apology to all Middle
Easterners of the world: from East to West. That they stain the credibility of
public health or science is one thing. That they publish ludicrous
pseudo-scientific statements on people is another one.
LIE. The
new Swiss paper states: “Shihadeh et al assessed the chemical
composition of waterpipe particles for the first time.” This is a blatant lie. This is the message
““waterpipe”” experts have been trying to hammer in people’s minds in order to
make them accept the idea that smoking machines are the best way to do science
in this field. I have also noted that in the Cochrane Review, all of Shihadeh’s
five publications are cited [4]. In fact, early decades before,
researchers had analysed key elements of hookah smoke. Besides, many hookah
users now know that particle emissions depend on many factors that will not be
detailed now in this communiqué.
FINDINGS.
On one hand, it has been given
for granted in scientific journals, the biomedical press and the mass media
that 1 hookah would equal 100 cigarettes, wouldn’t it? On the other, and as
many hookah are aware of, a single cigarette often equals several hookahs on a
toxicological level, doesn’t it ? Let us see now thanks to the figures
provided in Monn et al.’ study. There would be 74.4 billions (109)
of UFP (ultrafine particles the size of which ranges from 0.02 to 1µm) for one
1000 ml ““waterpipe””™ (machine) “breath” (i.e. a puff) and 9.24 billions of
UFP¨for a single 45 ml cigarette “breath” (id.).
From the above, we infer that for a
reference volume of 500 ml, a single cigarette actually delivers 9.24 x
(500/45)=9.24 x 11.1 = 102.6 billions of UFP. For the same volume, a hookah
actually delivers 74.4 x (500/1000)=37.2 billions of UFP. Noting that one
machine-smoked cigarette produces about 500 ml, that is 11 puffs of 45 ml, we
therefore conclude that 1 cigarette equals 102.6/37.2= 2.76 hookah
> 1 Cigarette roughly Equals 3
(unshared) Hookahs (regarding Ultra Fine Particles concentration and for
As for CO (Carbon Monoxide), we
have: 1.79 mg for a 1000 ml hookah (machine) puff and 1.06 mg for a 45 ml
cigarette puff. If we do the same calculation, then, for a common reference
volume of 500 ml, a cigarette actually delivers 1.06 x (500/45)=1.06 x
11.1=11.76 mg of CO. For the same volume, a hookah actually delivers 1.79 x
(500/1000)= 0.89 mg. Noting that one machine-smoked cigarette produces about
500 ml, that is 11 puffs of 45 ml, we therefore conclude that 1 cigarette
equals 11.76/0.89= 13.21 hookah
> 1 Cigarette roughly Equals 13
(unshared) Hookahs (regarding Carbon Monoxide yields and for
Of course, this kind of equation may
change, tremendously sometimes, according to the considered (toxic) substances.
This is why I have never paid too much attention to comparisons that most often
prove to be un-scientific. Only comparable things can be compared. I am not a
fearmonger but a scientist interested in public health.
Also, I forgot to say that for a
100-puff “session”, the number of UFP would be:
74.4 billions x 100 = 7,440 billions.
>> Seven Thousand Billions of Ultra Fine smoke Particles in a
Single Hookah (Narghile, Shisha) Session and Yet their Users are Still Alive…
By the way, what are these particles made of ? I will have the
opportunity to address this question in a further communiqué.
AS A BEGINNING FOR A CONCLUSION
This study from Switzerland, the
land of chocolate, was also announced in the media by Pascal DIETHELM (a member
of the Governing Board of the French CNCT, the Comité National Contre le Tabagisme)
and a group of organisations [5]. Pascal DIETHELM has cited the
erroneous WHO report on hookah smoking which disparagingly misrepresent
families and life in the whole Arab world by officially stating that children
smoke the hookah with their parents [6]. However, the above reporter
went as far as writing that 12 year old children and even kids under that age,
are allowed to smoke the narghile in the very home of their parents because the
latter would rather see them using the bubbling contraption instead of
cigarettes... A contextual analysis of such propaganda revealed that this was
mere Fallacist stuff for fear-arousing media because the referred to families
are of immigrant origins [7]. In this respect, the infamous
though popular Sacred Narghile site awarded th author the rare Golden Stupidity
Palm for his statement, recalled here: « Pire
encore, de
nombreux parents, en toute innocence, permettent à leurs enfants, parfois de très jeunes adolescents de 12 ans ou
moins, de se réunir en groupe avec des amis dans le logement
familial pour fumer le narguilé, alors qu'ils
n'accepteraient pas que ceux-ci fument des cigarettes ».
I have heard that recently in
France, two famous scholars have issued a call in which they warn against fatal
trends in alcohol and tobacco policies. I found their analysis so interesting
that I decided to copy it on a listing of personal communiqués I am preparing [8].
Certainly, as they say, hell is paved with good intentions.
Finally, I would like to point out
that I am not impressed by the recent ““waterpipe”” studies blitzkrieg. Bad
study + bad study + … + bad study = mass bad studies, isn’t it ? I have
called for collaboration for ages. As my first concern is public health, I have
made several offers which were even lifelines in view of the catastrophic
situation. The last one, about a Meta Peer Reviewer position with WHO can be
found here.: http://kamcha.googlepages.com/home . In view of the asymmetric war imposed to
me and the silly opposition between anti-hookah’s and pro’s, this is all I can
do and the proposal is still open. Take it or leave it. If they want a One
Hundred Years’ War, I will be standing behind the scientific barricades and
they may be assured that I will not know Jeanne d’Arc’s fate. If several
erroneous public health reports (including two from WHO) have been debunked,
and if they want more intense exposure, much good may it do them. They are
free.
Researcher and
Consultant in Tobacco Control (Paris)
http://PublicationsList.org/kamal.chaouachi
_____________
References:
[1] Monn C, Kindler P, Meile A, Brandli O.
Ultrafine particle emissions from waterpipes. Tob Control 2007;16: 390-3.
http://tobaccocontrol.bmj.com/cgi/content/abstract/16/6/390?etoc
[2] 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. TheScientificWorldJOURNAL:
TSW Holistic Health &Medicine 207 (7): 1691–6. DOI 10.1100/tsw.2007.255.
[3] Chaouachi K. Tout ce que vous
ne pouviez pas savoir sur le livre de Bertrand DAUTZENBERG et Jean-Yves NAU : «
Tout ce que vous ne savez pas sur la chicha ». Paris, 8 June
2007.
http://docs.google.com/View?docid=dgbz283m_78gkhthv
[4] Chaouachi K. 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. Paris, 29 Oct
2007.
http://docs.google.com/Doc?id=dgbz283m_110kvmzdt
[5]
Diethelm P. « Narguilé : attention, danger!» (May
2007) http://www.oxygeneve.ch/dossier.php?id=67 (accessed June 29, 2007). Campaign” prepared by: OxyRomandie ;
CIPRET-Genève ; UICC ; Département de l'économie et de la santé de
Genève and Organisation mondiale de la santé (World Health Organization)
[6] 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
[7] Chaouachi K. Communiqué (in collaboration with The
Sacred Narghile site): La rage et l’orgueil contre... le narguilé. Paris, 29 June 2007. Available via the above the above site.
[8]
Appel à réagir du 19 novembre 2007: Alcool, tabac. Gare au pavé de l'ours. Hygiénisme moral, puritanisme d'Etat, ou
lobbies industriels ? Copy: http://narghilecommuniques.googlepages.com/Alcool_Tabac_Grands_Sages_Tabacologi.htm
________