Dr Kamal Chaaouachi (pronounced "sha-wa-shi"). Tobacco researcher and consultant, mainly from a medical anthropology perspective. Native of Tunisia-Middle East. Teaches the hookah science (what sound science says about hookah) to French doctors (University of Paris XI-XII). Scientific collaborator of various research centres in Asia, Africa and Europe. Biographical Profile. Photo & Interview (on world tobacco policy). Click to get this page translated into : Arabic ; Spanish ; French.
SUMMARY OF RESEARCH (author or co-author) : > Two transdisciplinary research Books: (1) “Tout savoir sur le narguile –societe, histoire, culture et sante” [Everything about hookahs: societies, culture, history ; health] (Paris, Maisonneuve et Larose, 1997, 256 pages); (2) "Le narguile" (Paris, L’Harmattan, 261 pages). > First world studies on: Hookah Smoking and Cancer aetiology [2008]; its Radiological Hazards [2008] and its ETS (Environmental Tobacco Smoke) (Passive Smoke) [2009] including Public Health recommendations; the methodological critique of the WHO flawed expert report on "“waterpipe"" smoking [2006] prepared 20 WHO top tobacco experts. > First measurements of alveolar and ambient CO (Carbon Monoxide) in hookah lounges in 1998. Issued the first Public Health recommendations in this respect (Alcoologie 1999). > First technical and critical comprehensive reviews (1998, 2000, 2004, 2005-6) on this issue: Tetralogy on hookah and health . > Methodological critique (2009) of the WHO and US American University of Beirut’s Flawed Narghile Smoking Machine (behind the global confusion : e.g. above-mentioned WHO flawed report and, more recently : one 30-minute hookah session = up to 450 cigarettes...)[BBC story] and its smoking topography. Plagiarism : In France, an extensive part of this work was plagiarised in the form of a “"book"” titled "Tout ce que vous ne savez pas sur la chicha" (Editions MARGAUX-ORANGE). Its "authors" are Bertrand Dautzenberg, president of OFT (Office Français du Tabagisme), the French top national antismoking authority, and Jean-Yves Nau, columnist with Le Monde national newspaper and collaborator of Revue Médicale Suisse ( type “nau jy” here). The above publisher (Stéphane Arbouze, Dir. Editions MARGAUX-ORANGE, whose products are financially supported by the great names of the Pharmaceutical Industry [browse its site]) defends such a practice and two "peer-reviewed" articles (Prignot et al. in International Journal of Tuberculosis and Lung Disease; Becquemin et al. in Revue des Maladies Respiratoires) have openly cited this great fraud. Evidence here : Letter published in a peer-reviewed biomedical journal (English and Italian) and comparative table there. Funding: zero vs. $ 10 MILLION for antismoking research backed by the pharmaceutical industry (nicotine patches, gums, Chantix, etc.). The marketing label of the latter is easy identifiable: ““waterpipe””.
Abstract: ****************************AIM Much has been written about the toxicity of narghile (hookah, shisha) smoke. However, it is seldom mentioned that narghile smoke is actually far less complex than that of cigarettes. In spite of being a much simpler object to research, there has been a world of avoidable and preventable confusion due, to a great extent, to the inappropriate use of the narghile smoking machine designed at the US-American University of Beirut that now is considered to be âstandardisedâ. This machine has allowed the claims of high yields of tar, CO, PAH, heavy metals and, lastly, volatile aldehydes. Consequently, any public health intervention against narghile (hookah, shisha) use requires a long overdue critique of this machine on which a large amount of the peer-reviewed âwaterpipeâ literature uncritically relies. Public health policy makers should be aware of the unprecedented degree of confusion in this field.
************************** METHODS: The analysis is twofold. On one hand, the classical FTC (Federal Trade Commission) regime applied to cigarette testing (and behind the official figures printed on cigarette packs) is presented, whereby it is recalled that a 35-ml puff is drawn each minute for only a few minutes. On the other hand, a discussion follows about the relevancy of the narghile smoking machine based on averaging a complex human and social activity to a puff relentlessly drawn every 17 s over a full hour, with, marginally, the heating source (coal) in the same position over the smoking mixture (contrary to common practice). It is assumed that such stress-strain conditions result in abnormal perturbations in the chemical reactions at stake. The case of aldehyde generation is taken as an example.
**************************** RESULTS: The narghile smoking machine was modelled after the one for cigarettes, which not only is an inappropriate reference, but also is totally irrelevant for a kind of tobacco use that is different from all points of view. The narghile smoking machine and its underlying smoking topography represent a biased toxicological model of the related practice. Human-centered alternatives are presented.
**************************** CONCLUSIONS: Against the background of a public health epidemic, a recommended research avenue is to focus on biological measurements of human subjects (urinary carcinogens, chemical or biological markers) carried out in a natural environment in realistic conditions and coupled with a puff-by-puff smoke analysis.
Abstract: "In their interesting and original study, El-Setouhy and colleagues faced the unexpected counterintuitive finding that no associations were found between micronuclei and tobacco smoke exposure (duration and dose) or even addiction [...]"
Notes: A good academic example of the tragic consequences of using the """waterpipe""" scientific nominalism.
Abstract: [A Tribute to Gian Turci] This paper reviews the present knowledge about the nature of hookah (narghile, shisha) ETS and, in the light of the controversy over the actual health effects of cigarette ETS, concludes that the former should not be hyperbolised in an unscientific way as, unfortunately, a WHO report suggests.
Notes: "Hookah (narghile, shisha) smoking is seen as a global tobacco epidemic and there is definitely a lack of sound studies on the hazards related to its active smoking [1]. Amazingly, and as if hookah and cigarette smoking were similar, more and more biomedical publications report hazards related to its ETS (environmental tobacco smoke). Not only is the model of cigarette smoking irrelevant but [...]"
Abstract: Aim This comment is based on a critical review of a study on blood pressure and heart rate in shisha (narghile, hookah) smokers in Jordan.
Subjects and methods The study was analysed against the most recent literature on this issue, in general, and against peer-reviewed biomedical publications from the Middle East, in particular.
Results Several errors and misquotations were found in the study under scrutiny. Most of them stem from misrepresentations related to the chemistry of shisha smoke, the anthropology and geography of its use, and the relevance of the literature cited by the authors (vs. the non-cited one), both from a quality and quantity viewpoint.
Conclusion A clarification is made about all these points of utmost importance and will hopefully help a new generation of researchers avoid wading too far in this field. Against the background of a world epidemic, public health interventions will gain credibility and performance.
Abstract: Hookah (narghile, shisha, âwater-pipeâ) smoking is now seen by public health officials as a global tobacco epidemic. Cigarette Environmental Tobacco Smoke (ETS) is classically understood as a combination of Side-Stream Smoke (SSS) and Exhaled Main-Stream Smoke (EMSS), both diluted and aged. Some of the corresponding cigarette studies have served as the scientific basis for stringent legislation on indoor smoking across the world. Interestingly, one of the distinctive traits of the hookah device is that it generates almost no SSS. Indeed, its ETS is made up almost exclusively by the smoke exhaled by the smoker (EMSS), i.e. which has been filtered by the hookah at the level of the bowl, inside the water, along the hose and then by the smokerâs respiratory tract itself. The present paper reviews the sparse and scattered scientific evidence available about hookah EMSS and the corresponding inferences that can be drawn from the composition of cigarette EMSS. The reviewed literature shows that most of hookah ETS is made up of EMSS and that the latter qualitatively differs from MSS. Keeping in mind that the first victim of passive smoking is the active smoker her/himself, the toxicity of hookah ETS for non-smokers should not be overestimated and hyped in an unscientific way.
Abstract: The article refers to the following materials:
[*][*][*][*][*][*]Rodrigues AA. To convince and to inform: ethical issues in public health campaigns. J Bras Pneumol. 2009 Apr;35(4):396-7.
http://www.jornaldepneumologia.com.br/english/artigo_detalhes.asp?id=1352
[*][*][*][*][*][*]http://www.jornaldepneumologia.com.br/PDFenglish/2009_35_4_16_english.pdf
[*][*][*][*][*][*] Viegas CAA. Authorâs reply. J Bras Pneumol. 2009 Apr;35(4):397-8.
http://www.jornaldepneumologia.com.br/english/artigo_detalhes.asp?id=1353
[*][*][*][*][*][*]http://www.jornaldepneumologia.com.br/PDFenglish/2009_35_4_17_english.pdf
[*][*][*][*][*][*]Viegas CAA. Noncigarette forms of tobacco use. J Bras Pneumol. 2008 Dec;34(12):1069-73.
http://www.jornaldepneumologia.com.br/english/edicoesanteriores_exibe.asp?volume=34&edicao=12
[*][*][*][*][*][*]http://www.jornaldepneumologia.com.br/PDFenglish/2008_34_12_13_english.pdf
[*][*][*][*][*][*]Kandela P. Nargile smoking keeps Arabs in Wonderland. The Lancet 2000 ; 356 (9236):1175.
Abstract: In their review on water pipe smoking, Watad et al. (2009) credit Rakower & Fatal (1962) for stating that "plasma carboxyhaemoglobin was significantly higher for WP [water pipe] smokers when compared to nonsmokers and cigarette smokers". This is a first misquotation. In another instance, the same authors are credited for stating that "jurak or ajami are cruder forms of measselâ. Once again, this is not exact.
Bedwani et al. (1997) are cited in connection with a âsignificantly increased riskâ of bladder cancer among water pipe smokers compared to non-smokersâ. This is another misquotation as the Egyptian authors clearly emphasised that "it is more important, and more original, that our data did not find users of products other than cigarettes (i.e., water pipe and hashish) to be at elevated risk, after allowance for cigarette smoking". Watad et al. might not be responsible for this error as it was published in a previous review by Maziak et al (2004). However, they should have been more critical in their review of the literature as a last example -that of Yadav & Thakur (2000), unduly cited for "complication rates during pregnancyâ- shows.
<b>References:</b>
Bedwani, R., El-Khwsky, F., Regnanathan, E., Braga, C., Abu Seif, H., Abul Azmm, T. et al. (1997). Epidemiology of bladder cancer in Alexandria, Egypt: Tobacco smoking. International Journal of Cancer, 73, 64â67.
Maziak, W., Ward, K.D., Afifi Soweid, R.A., Eissenberg, T. (2004). Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tobacco Control 13, 327-333.
Rakower, J., Fatal, B. (1962). Study of narghile smoking in relation to cancer of the lung. British Journal of Cancer, 16, 1â6.
Watad, W., Sukhera, J., Shushan, S., Kazlak, M., Skinner, H.A., Alnueirat, A.A., Roth, Y. (2009). Water Pipe Smoking: Effects, Attitudes and Directions. Journal of Smoking Cessation, 4, 18-25.
Yadav, J., & Thakur, S. (2000). Genetic risk assessment in hookah smokers. Cytobios, 101(397), 101â113.
Abstract: NOTE : This Letter to the Editor took almost one year to get published and confusion (passive/active smoking) has now reached hight levels further to Dr Mirahmadizadeh and Dr Nakhaee's response. Consequently, it was decide, in order to spare time, to expedite the matter by addressing their arguments in the form of a KNOL [1].
Notes: [1] Chaouachi K. Pregnant Women in Iran and Environmental Tobacco Smoke:Exposing Animals to Hookah MainStream Smoke is Not Measuring Human Passive Smoking [Internet]. Version 8. Knol. 2009 Oct 2. #################################################
http://knol.google.com/k/kamal-chaouachi/pregnant-women-in-iran-and/534k6mvefph/5?hd=ns#
Abstract: Narghile (hookah, shisha, goza, "water-pipe") smoking has become fashionable worldwide. Its tobacco pastes, known as moassel and jurak, are not standardized and generally contain about 30-50% (sometimes more) tobacco, molasses/juice of sugarcane, various spices and dried fruits (particularly in jurak) and, in the case of moassel, glycerol and flavoring essences. Tobacco contains minute amounts of radiotoxic elements such as (210)Pb, (210)Po and uranium, which are inhaled via smoking. Only very few data have been published on the concentrations of natural radionuclides in narghile tobacco mixtures. Consequently, the aim of this study was to draw first conclusions on the potential hazards of radioactivity in moassel tobacco in relation to narghile smoking. The results indicate the existence of a wide range in the radioactivity contents where the average (range) activity concentrations of (238)U, (234)Th (226)Ra, (210)Pb, (210)Po, (232)Th and (40)K, in Bq/kg dry weight were 55 (19-93), 11 (3-23), 3 (1.2-8), 14 (3-29), 13 (7-32), 7 (4-10) and 719 (437-1044)Bq/kg dry weight, respectively. The average concentrations of natural radionuclides in moassel tobacco pastes are comparable to their concentration in Greek cigarettes and tobacco leaves, and lower than that of Brazilian tobacco leaves. The distribution pattern of these radionuclides after smoking, between smoke, ash and filter, is unknown, except for (210)Po during cigarette smoking and from one existing study during moassel smoking. Radiological dose assessment due to intake of natural radionuclides was calculated and the possible radio-toxicity of the measured radionuclides is briefly discussed.
Abstract: EXCERPTS **************
âI was very surprised by the admonishing tone of Dr Maziakâs criticism of Carroll et al. study in Issue 5 of Vol. 32. After careful evaluation, I found the latter article excellent all the more that it involved a large sample, made a clear division of groups, and was the first to report the prevalence of hookah (shisha, narghile) smoking in an Australian population.â **************
ââPublic healthâ does not belong to any group or individual in particular. It is public and should remain a public concern as its names clearly show, even when the matter deals with such a hot topic as tobacco and âwaterpipeâ smoking. It is sad to see how Carroll et al. were led to justify their âunexpectedâ finding by adding: âthis may not be reflected in other regional or population settingsâ. They did not have to, [â¦]â
**************
"Concerning health aspects, it must be understood that hookah smoke is actually far less complex than cigarette smoke. For the first time in 1991, 142 compounds were detected in its smoke with a filtration rate of 38%. This figure is to be compared to the 4,700 substances that have been identified so far in cigarette smoke."
**************
âFinally, did we need eight years of international research and half hundred of âwaterpipeâ studies to establish that âthe waterpipe is mainly an intermittent tobacco use methodâ, or was this fact already established by four centuries of literature, including early scientific studies, and not to mention common sense? What are scientific reviews made for?"
Notes: A pedagogicl example of the tragic consequences of using the """waterpipe""" scientific nominalism.
Notes: Dr Kamal T. Chaouachi
Researcher and Consultant in Tobacco Control (Paris)
http://PublicationsList.org/kamal.chaouachi
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References
[1] Khoury A, Hanan HS, Hamade H, Meqdade M. Characteristics of bacteria in smoking tube of water pipe (Narghile). Eur Respir J 2006; 28: Suppl. 50, 466s.
[2] Kamel M, Elyes H, Sophia B, Raya S, Abdellatif C. Pulmonary tuberculosis in narghile (Ng) lighters. Eur Respir J 2002; 20: Suppl. 38, 555s.
[3] Meleigy M. Waterpipe and communicable diseases link, says WHO. The Lancet/Infections 2007 (July); Vol 7; issue 7:448. http://infection.thelancet.com
[4] Chaouachi K. A Critique of the WHO's TobReg "Advisory Note" entitled: "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulatorsâ. Journal of Negative Results in Biomedicine 2006 (17 Nov); 5:17. http://www.jnrbm.com/content/5/1/17
[5] Steentoft J, Wittendorf J, Andersen JR. Tuberculosis and water pipes as source of infection in Storstroem County, Denmark. Ugeskr Laeger 2006 (Feb 27);168(9):904-7.
Abstract: Critical comment on: Tamim H, Yunis KA, Chemaitelly H, Alameh M, Nassar AH; National Collaborative Perinatal Neonatal Network Beirut, Lebanon. Effect of narghile and cigarette smoking on newborn birthweight. BJOG. 2008 Jan;115(1):91-7.
Abstract: Many biomedical studies of the past seven years have failed in giving a sound picture of what hookah (shisha, narghile, goza) smoke and smoking are. The reasons are many: from the widespread use of a confusing neologism (âwaterpipeâ) instead of the few clear and natural words used for centuries by indigenous and non-indigenous people in their real life, to the use of artificial smoking (machines) instead of relying on quantitative and qualitative analysis of toxicants directly performed on real hookah smokers.
Notes: ###################################################################################
IMPORTANT NOTE: ONLINE (pdf file) with the kind permission (5 Oct 2008) of the Editor of the Journal. Please acknowledge by citing exlclusively as follows:
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 2007 (7): 1691â6.
DOI 10.1100/tsw.2007.255.
Abstract: BACKGROUND: Hookah (narghile, shisha) smoking is growing worldwide and particularly in France. The main reasons for this are: first, the arrival on the market of new highly flavored tobacco-based mixtures; second, a new type of charcoal used as a quick heating source; third, the pleasure to experiment with an exotic orientalist practice or the desire to return to the corresponding tradition; fourth, the belief that water filtration would lower the risk of smoking. METHODS AND RESULTS: Long-term epidemiological data on complications are scarce. Little is known about qualitative and quantitative transformations occurring when hookah is smoked (in particular regarding carcinogenic agents). Such information will be difficult to collect due to the lack of standardization for this mode of tobacco use. The only current consensus on this issue is that a significant amount of carbon monoxide is produced by the charcoal used to heat and distil the tobacco-molasses mixture. Apart from direct inhalation, concentrations measured in some fashionable hookah lounges and bars are particularly high. Moreover, the additives contained in the widely used quick-lighting charcoals and their harmlessness remain unknown. CONCLUSION: This study sets out the available scientific knowledge regarding the real medical consequences related to the growing use of hookah and focuses on the best known and urgent issue, i.e. concern related to carbon monoxide intoxication in a very peculiar context.
Abstract: ################################################################################################# OBJECTIVE : To find CEA levels in smokers of different categories (hookah smokers, cigarette smokers smoking different brands of cigarettes and different number of cigarettes per day) and to correlate CEA levels with type and rate of smoking. #################################################################################################
METHODS : A total of 122 cigarette smokers (115 men and 7 women) and 14 hookah smokers (all men) with age ranging from 16-80 years were studied. CEA levels were also measured in 36 non-smokers who served as controls. Enhanced chemilumiscent immunometeric technique was applied to measure CEA levels in our subjects. #################################################################################################
RESULTS : The mean CEA levels of cigarette smokers were compared with the mean CEA levels observed in
hookah smokers (7.16 ±10.4 ng/ml) and non-smokers (2.15 ± 0.68 ng/ml). The mean value of CEA level observed in cigarette smokers, 9.19 ± 14.9 ng/ml (n=122) was significantly higher than the levels in non-smokers and hookah smokers (p<0.0067). It was also observed that CEA levels increased with the number of cigarettes smoked per day. The highest levels were observed in smokers who smoke more than 31 cigarettes per day. The smokers that use relatively cheaper brands of cigarettes had higher levels of CEA compared to those who use high quality brands. #################################################################################################
CONCLUSION: It was concluded that the brands of cigarettes (which were ranked on the basis of price) and the rate of smoking both play an important role in raising the CEA levels. Further the common belief that hookah also called narghile or shisha is a relatively safe mode of smoking is not completely correct; a significant proportion of hookah smokers have high levels of CEA although mean levels of hookah smokers were low compared to cigarette smokers (JPMA 57:595;2007).
Notes: #################################################################################################
IMPORTANT NOTE#####################
For some reason, we were unable to respond to Dr Maziak's Letter to the Editor of JPMA about our first study on CarcinoEmbryonic Antigen (CEA) levels in hookah and cigarette smokers [1]. However, we wish to inform readers that the related concerns have been exhaustively addressed in the online Comments section of the Harm Reduction Journal which has published our second study on the same topic [2].
#################################################################################################
Dr Kamal Chaouachi #################################################################################################
[1] Maziak W. Carcinoembryonic antigen (CEA) levels in hookah smokers, cigarette smokers and non-smokers--a comment. J Pak Med Assoc. 2008 Mar;58(3):155. #################################################################################################
[2] Sajid KM, Chaouachi K, Mahmood R. Hookah smoking and cancer. Carcinoembryonic Antigen (CEA) levels in exclusive/ever hookah smokers. Harm Reduction Journal 2008 24 May;5(19).
http://www.harmreductionjournal.com/content/5/1/19
Abstract: This paper is the last one of a Tetralogy on Narghile (Hookah, Shisha) and Health worked out within a transdisciplinary socio-anthropological and biomedical framework. 15 reasons are outlined to help understand the corresponding sudden world craze. The article analyses the relationship with the world tobacco industry, the relevance of comparisons with cigarettes, the use by women and the issue of environmental smoke. The most recent epidemiological studies are reviewed as well as findings and hints at research regarding the peculiar dependence associated this practice. This publication also gives the keys for an intelligent preventive approach respecting the local socio-cultural context in which it deeply takes its roots. Clarification is made about alcohol and cannabis related use. Lastly, harm reduction measures and key-messages are given for tobacco prevention activists.
Abstract: The narghile (hookah, shisha, âwaterpipeâ) is a key element of everyday's life in the Middle East. Its ethnographic, folkloric and anthropological dimensions are analysed in relation to its traditional settings and particularly the Oriental coffee-houses. Then, we try to understand the long silence of social sciences regarding this ancient and common practice, from both the Northern and Southern sides of the Mediterranean. With Pierre Bourdieu, we ask: who decides what is important or relevant in social sciences; in other words, which theme deserves attention? With a few researchers, we agree that not all the social sciences corpus of the colonial times must be considered historical garbage. As our bibliographical sources were extremely scarce, we realised that a few valid and usable elements could be picked out of that huge production, particularly in the ethnographic field.
Indeed, literature, poetry and painting actually made up for the long silence of social sciences regarding the narghile. Consequently, the present world sudden craze for hookah smoking can be construed as a backlash effect and even a bad joke played to the official representatives of the corresponding disciplines. Now that hookah lounges are popping up everywhere in the world, what will they say? That they did not know or that there were more "serious" themes to be studied: religion, sex, power, conflicts, identity, etc.?
The narghile practice and its revival show how an ancient popular culture now challenges the dominant and global one. Contrary to some quick analysis, the underlying identity feature is not so important. In fact, the unexpected phenomenon poses the question of cultural transfer and, beyond, the question of culture itself.
The critique of orientalism by Edward Said actually touched off an epistemological revolution in the field of social and human sciences. We develop further an analysis begun in a doctoral thesis about the relation between material culture and orientalist representations. However, beyond the classic orientalist vision of the past, a new question emerges: that of neo-orientalism. On a practical level, this concept refers to the development of hookah lounges all over the world (about one thousand in a country like France and more or less the same figure for the USA). Amazingly, people patronise these places for the narghile experience. In these conditions, the owners of these establishments, most of them of Middle Eastern origin, actually began to sell an orientalist "service" or "product" (Arabian Nights decor, exotic food, drinks, music and narghiles) to both "Westerners" and "Easterners" living in the West. Even in the Middle East, a kind of neo-orientalism is sold to the Orientals themselves.
On a theoretical level, and because hookah smoking is now considered a world epidemic and a global threat, US-funded research centres were set up in key countries of the Middle East to try to contain the damage caused to the world by this new virus. Biomedical studies on this epidemic have been published on almost a monthly basis over the last three years. In this context, Edward Saïd's criticism is, once again, highly relevant because Oriental researchers are involved in this last process.
Abstract: Hookah (Narghile), its practice, the past and present research on it and the corresponding methodological problems have been set out in Tabaccologia 1/2005. In issue 3/2005, its pharmaco-physiological aspects (nicotine, tar, CO, polycyclic aromatic hydrocarbons, heavy metals) were given a detailed description. Here, the health aspects and related pathologies will be reviewed: tumors, lung pathologies, cardio-vascular risks and others. Beyond, the last issue will be sealed with the presentation and analysis of issues in connection with dependence, public health and prevention concerns.
Conclusion : this paper calls on the international community to respond urgently to a fourfold world public health emergency.
Abstract: BACKGROUND AND AIM: The World Health Organisation Study Group on Tobacco Product Regulation (TobReg) has issued in 2005 an "Advisory Note" entitled: "Waterpipe Tobacco Smoking: Health Effects, Research Needs and Recommended Actions by Regulators". "Waterpipe" smoking is now considered a global public health threat and the corresponding artefact is actually known in the world under three main terms: hookah, narghile and shisha. This important report, the first ever prepared by WHO on the subject, poses two major problems. On one hand, its bibliographical references dismiss world chief relevant studies. On the other, it contains a certain number of errors of many orders: biomedical, sociological, anthropological and historical. The purpose of the present study is to highlight, one by one, where these weaknesses and errors lie and show how this official report can be considerably improved. RESULTS: We realise that widely advertised early anthropological studies were not taken into consideration whereas they shed a substantial light on this peculiar form of smoking and help understanding its high complexity. As for concrete errors to be found in this report, they deal with the chemistry of smoke, health-related effects, smoking patterns, description and history of the artefact and its use, gender and underage use aspects, prevention and research needs in this field. CONCLUSION: The scientific credibility of an international expert report may be at stake if its recommendations do not rely on sound objective research findings and a comprehensive review of the existing literature. The critical comments in this study will certainly help improve the present WHO report.
Notes: SEE ALSO: 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.âs 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
SEE ALSO: Chaouachi K. Comment entitled: In Reply to Drs Eissenberg, Maziak, Shihadeh and Ward. Submitted to JNRBM (Journal of Negative Results in Biomedicine) on 26 Aug 2007. Unpublished to date (probably because it was deemed redundant by the Editors).
SEE ALSO: Letter to Dr Margaret CHAN, Director-Gal of WHO (World Health Organisation) to demand the dissolution (winding up) of WHO TobReg: http://docs.google.com/View?docid=dgbz283m_106vf22zw (07 Sept 2007).
Abstract: A first review of relevant medical and pharmacological studies was carried on by the author within the framework of a doctoral research encompassing all aspects - socio-anthropological, historical and tobaccological - of narghile (hookah, waterpipe) use. Further to the revival of its use in the Middle East in the 80s and 90s, the use of narghile has now become a globalised habit in the wake of which new studies appeared. However, in most cases, the corresponding results cannot be relevantly exploited because very often one cannot clarify if the committed volunteers were exclusive narghile smokers, ex-consumers of cigarettes having one day stopped smoking or yet having substituted for it the narghile practice. Indeed, as pointed out by several researchers in Turkey, narghile smokers, particularly those who are dependent, belong to this last category. In addition, we note that, unfortunately, the very large majority of studies systematically gloss over important research works of sociological, ethnological and anthropological nature. Most of the time, such a negative attitude leads to ill-considered and even wrong or absurd interpretations. Notwithstanding, the mentioned disciplines, by embracing the vast field of knowledge, practices and human representations, form, in this very case, an essential and heuristic tool allowing the approach of an object and a practice both known as highly "exotic" and complex.
Conclusion: in our opinion, it is now necessary to study the effects of narghile on exclusive smokers, not having indulged during their past career neither in the use of cigarettes nor in any other form of tobacco (cigar, pipe, bidi, etc.). Because of the tobaccological peculiarity of its mechanisms (nicotine, cotinine, aromas, important interaction with the socio-cultural context) and thanks to the diverse points of view it offers to the researcher, narghile undoubtedly can help improve our understanding of cigarette dependence. This critical review aims at being a modest contribution to such an objective.
Structure of this 4-part document: The whole review on hookah/narghile is presented through a general introduction followed by 3 main sections. The first one tackles the pharmacological aspects of hookah use. The second one embraces all observed pathologies related to the corresponding practice. Finally, the third and last section poses issues in connection with dependence, public health and prevention concerns.
Abstract: Hookah (Narghile) and its practice have been introduced in the last issue through the methodological problems, the state and evolution of knowledge about it until the most recent research existing in this field. We will now offer a review of its pharmaco-physiological aspects in direct relation to the very peculiarity of this tobacco use mode known to force smoke to go through water. To what extent are nicotine, tar, CO and polycyclic aromatic hydrocarbons, inter alia, affected by this process ?
Besides, does tobacco really burn as in the case of cigarette and what are the consequences? In a further issue, pathologies in relation with the use of this device will be thoroughly reviewed. Finally, the panorama will be closed with the presentation and analysis of issues in connection with dependence, public health and prevention concerns.
Abstract: SEE ALSO http://www.actupparis.org/IMG/pdf/Action_51-2.pdf (pages 12/28 to 15/28). Contains excerpts of the translation into French. John MARKS is introduced to the readers. Noteworthy: Table on Opium use page 15/28.
Abstract: FRENCH: free full-text available online at http://www.cedej.org.eg/article.php3?id_article=838 ########################################
ENGLISH: Title: âNarghile (Shisha, Hookah): A World Epidemic Coming from Egyptâ
The unexpected growing use of the hookah (narghile, shisha) in the world, including in its Middle Eastern âcradleâ, is already called an âepidemicâ by some scientists. The use of prevention and eradication models developed for virus, emergent diseases, drug addiction are definitely irrelevant and results in common methodological errors, misconceptions (regarding dependence, smoking patterns, health, gender, historical and other aspects) and prejudices of orientalism. A transdisciplinary approach seems necessary in order to tackle the various dimensions of this mode of tobacco use because it is deeply rooted in a complex network of closely interrelated social, cultural and health issues in a given human context.
Abstract: Date: 21-26 August, 2005
Location: Istanbul, Turkey
Region: EMRO
Topics: General Bioethics
"The 2005 World Meeting of the International Forum for Social Science and Health (IFSSH) aims to realize a universal platform for reflections and forward-looking discussions in all important areas that fall under the health social science agenda. Marked by the shadow of global terrorism and war, the 21st century has started with significant challenges for socially relevant and policy oriented understandings of health, disease, death and birth. Unprecedented advances in technology and informatics have been accompanied with the relentless burden of poverty and disease. Growing health inequity is accompanied by the emergence of new forms of disease. An interdisciplinary gathering of the experiences and perspectives of social scientists and health specialists is crucial for an assessment of the human condition at the onset of the new millennium. The 2005 World Meeting of the International Forum for Social Sciences and Health (IFSSH) will be held in collaboration with the International Children's Center (ICC), the IVth International Congress of Ethnobotany (ICEB 2005) and a number of sessions will be run jointly with them."
Event type: Conference
International focus: Yes
Further information:
Prof. Dr. Akile Gürsoy
IFSSH Secretary General
Congress Chairperson
Head, Anthropology Department
Yeditepe University
Tel: +90 (0216) 578 08 91
GSM: +90 (0532) 457 22 24
E-mail: akile@yeditepe.edu.tr
or ifssh@yeditepe.edu.tr
Website: Congress for Social Sciences and Health
Notes: A comment on:
[*] Islami F, Pourshams A, Nasrollahzadeh D, Kamangar F, Fahimi S, Shakeri R, Abedi-Ardekani B, Merat S, Vahedi H, Semnani S, Abnet CC, Brennan P, Møller H, Saidi F, Dawsey SM, Malekzadeh R, Boffetta P. Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: population based case-control study. BMJ. 2009 Mar 26;338:b929.
http://www.bmj.com/cgi/content/full/338/mar26_2/b929
Notes: A critical comment on :
[1] University of Pittsburgh School of Medicine. Many College Athletes Reject Cigarettes But Smoke Hookah, Pitt Study Finds. Medical News Today 2009 (27 Aug)
http://www.medicalnewstoday.com/articles/161977.php
AND
[2] Primack BA, Fertman CI, Rice KR, Adachi-Mejia AM, Fine, MJ. Waterpipe and Cigarette Smoking Among College Athletes in the United States. J Adol Health 2009; 1â7.
http://dx.doi.org/10.1016/j.jadohealth.2009.05.004
"Dr. Primack is supported with funding from the Robert Wood Johnson Foundation, the National Cancer Institute and the Maurice Falk Foundation."
Abstract: Contains the 4 first critical reviews in sociology, anthropology, history and tobaccology (biomedical aspects) on hookah (narghile, shisha) smoking. For instance, concerning the heating of the smoking product, this document showed that what is chemically taking place inside the bowl of a shisha filled with tobamel (the tobacco [or no-tobacco]-molasses based smoking mixture), and topped with a pierced aluminium foil and some charcoal, is something different from âcombustionâ (a common misstatement put forward by major experts). I showed it was a chemical process more akin to the Maillard Reaction (with a âdistillationâ dimension) than a âcombustionâ.
Notes: The original critical review on biomedical aspects was further updated several times: e.g.:
> Chaouachi K. The medical consequences of narghile (hookah, shisha) use in the world. Rev Epidemiol Sante Publique 2007 (Jun) ; 55(3):165-70 [article in English].
> Tetralogy on Narghile (Hookah, Shisha) and Health published in Tabaccologia, the
official Journal of the Italian Society of Tobaccology:
-Part 1: Presentation (Tabaccologia 2005; 1: 39-47);
-Part 2: Chemistry (Tabaccologia 2005; 3: 27-33);
-Part 3: Diseases (Tabaccologia 2006;1:27-34);
-Part 4: Public Health and Prevention (Tabaccologia 2006;4:29-38).
http://docs.google.com/View?docid=dgbz283m_3cm537w
Abstract: NOTE : A Letter to the Editor about a study published by Dr Mirahmadizadeh and Dr Nakhaee (M&N) took almost one year to get published [1][2]. Unfortunately, confusion (passive/active smoking) has now reached hight levels further to (M&N)'s response [3]. Consequently, it was decided, in order to spare time, to expedite the matter by addressing their arguments in the form of a Knol (piece of knowledge)[4].
Notes: [1] Chaouachi K. Qalyan, Narghile, Shisha and pregnant women's exposure to passive smoking in Iran. Med Princ Pract. 2009;18(5):425.
http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=000226301
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
[2] Mirahmadizadeh A, Nakhaee N. Prevalence of waterpipe smoking among rural pregnant women in Southern Iran. Med Princ Pract. 2008;17(6):435-9.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
[3] Mirahmadizadeh A, Nakhaee N. Reply: Recent Evidence Is Alerting Us to the Critical Importance of Secondhand Water Pipe Smoke. Med Princ Pract. Med Princ Pract. 2009;18(5):425-6.
http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=000226301
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
[4] Chaouachi K. Pregnant Women in Iran and Environmental Tobacco Smoke. Exposing Animals to Hookah MainStream Smoke is Not Measuring Human Passive Smoking. Knol 2009 (3 Oct)
http://knol.google.com/k/kamal-chaouachi/pregnant-women-in-iran-and/534k6mvefph/5#
