Critique of a New Erroneous and Flawed Study on


“Characteristics of U.S. waterpipe users”

by Kenneth WARD, Thomas EISSENBERG, Jennifer N GRAY JN, Vidya



published in the

Nicotine and Tobacco Research Journal

by Kamal Chaouachi (Paris, 15 Dec. 2007)


"Even if you cannot understand every point of an argument or verify the factual claims being made, you can usually recognize when someone is directly challenging their opponents' key points. Similarly, you can recognize when someone seems to be completely ignoring challenges to their position. Almost always, the side that is responding to challenges is telling the truth and knows what they are talking about, while the side  that just repeats themselves and talks around the argument is wrong." (Professor C.V.P.: “Who's Telling the Truth ?”) 



Ø       Repeated Scientific Misconduct in Relation with Lung Cancer and Hookah Smoking

Ø       From Internet Piracy to Self-Plagiarism and Fabrication of Bibliographical Sources

Ø       Biased Questionnaires and Silly Questions

Ø       “Cigarette Smoking as a Gateway to Hookah Smoking” is the real problem

Ø       From ““Waterpipe”” Fixation to Fallacies, Fallacism and Religious Obsession

Ø       Undeclared Competing Interests

As I have received no echo for a recent offer aiming at putting an end to the growing world confusion surrounding hookah smoking, I feel I have no reason to stop publishing communiqués on pouring erroneous and flawed studies on ““waterpipe”” smoking. I can see that the authors of the latter have at least begun to realise that the tobacco-molasses based mixture is not burnt but heated… However, they still use the functionalist, reductionist and nominalist ““waterpipe”” neo-word. I have also heard that some of them have discontinued the use of smoking machines. Is this enough ? Obviously not. Ugly censorship is still prevalent and flaws too frequent as I will show now with the new paper by Kenneth WARD and his colleagues of the joint US-Syrian Center for Tobacco Studies . This document was published in the “prestigious” and supposedly “peer-reviewed” Nicotine and Tobacco Research journal [1].

Repeated Scientific Misconduct in relation with Lung Cancer and Hookah Smoking

The sections on Health are completely biased and now “enriched” with new bibliographical references the existence of which was revealed to them in my censored publications (particularly the Tetralogy on Hookah and Health)…

ERROR OR VOLUNTARY LIE: « Waterpipe use likely increases the risk of bronchogenic carcinoma (Nafae, Misra, Dhar, & Shah, 1973), as well as lung (Gupta et al., 2001; Rakower & Fatal, 1962), oral (El-Hakim & Uthman, 1999), and bladder (Bedwani et al., 1997; Roohullah, Nusrat, Hamdani, Burdy, & Khurshid, 2001) cancers. [1]

Let us recall that the team led by Wasim MAZIAK had already published the same error in a seriously flawed review [2]. This statement has been cited again and again because few researchers in this field think with their brain and most of them just parrot and certainly not read the papers their cite as it happened most recently [3].

The above list of cited references is so long that I would need an entire book to show how the related statements are wrong. I will focus on only one: RAKOWER and FATAL’ study. Kenneth WARD and his colleagues credit the authors of that study with exactly the opposite of what they reported about narghile and lung cancer [4]. The two famous scientists actually noted that: “there [was] an eightfold difference between the lowest lung cancer mortality rate for the immigrants [Jews] from Yemen [a majority of them being hookah smokers] and the highest for the immigrants from Europe [50% were smokers and most of them were cigarette users].” This strange fact led them to analyse the tar filtering properties of narghile (results: 84mg for 10g of tobacco ; 161mg without water in the vase).  In the same field, we have just published a study which tends to shed more light on RAKOWER and FATAL’s findings [5].

From Internet Piracy to Self-Plagiarism and Fabrication of Bibliographical Sources

Kenneth WARD and his colleagues lure the reader who is led to believe that the origins of narghile smoking and the causes behind its growing popularity were actually established by their own team or their friends. The scheme is based on the vicious circle principle. They cite their own (or friends’) previous publications: the wrong scenario by Rastam et al [6]; the erroneous and ludicrous biased and anecdotic one-page stories by Kandela (“Narghile Smoking Keeps ““Waterpipe”” Researchers in Wonderland)[7] and the full-of-serious-errors WHO (World Health Organisation) expert report, the first ever published by this United Nations agency [6]. In other words, laundering of pseudo-science.

How it works (the “technique”). Just cite in a study of this year (2007) a past publication (authored by you or your friends) speculating on the remote origins of the artefact and the causes behind the world hookah phenomenon. Most people will not remember that such publications were based to some extent on data collected and pirated on the internet and that the real source was never cited on purpose by the joint US-Syrian Center for Tobacco Studies team because of the world embargo on early writings [8]. Consequently, such scientific misconduct can also be described as a form of internet piracy.

Biased Questionnaires and Silly Questions

Below are a few examples of biased questions [1]. Please note that the capital letters are to be found in the printed version of the publication:

·          “How do you compare the HEALTH EFFECTS of smoking tobacco using a waterpipe vs. smoking cigarettes?”

·          ”How do you compare the NICOTINE in the smoke from a waterpipe with the nicotine in the smoke from a cigarette?”

·         “If a cigarette smoker switched from cigarettes to waterpipe, how much would they reduce their health risks associated with using tobacco products?”

If the ““waterpipe”” world “top” “experts” themselves were unable to establish such supposed HEALTH effects [6], what did they expect from volunteers paid US $ 20 to answer such a biased and ludicrous question ? The same applies for the one related to switching from cigarettes to ““waterpipe””.  As for “NICOTINE”, it is also a biased question because it is given as granted that everybody is capable of “feeling” the effect of nicotine. In the context of hookah smoking, this is nonsense just as talking of “nicotine dependence” is completely ludicrous.  And we should call such attitudes and intentions by “experts” ,  science, “peer-reviewed” science ?

Hookah as a “Gateway to Cigarette Smoking” ?

First, the insistence on this theme leads me to think that there may be tremendous financial interests at stake behind. In any case, what I do know is that the reverse is true: Cigarette smoking is an excellent gateway to all forms of smoking: from cigar to hookah. Therefore, the aim is apparently to find a “scapegoat” for the failure of their fear-based strategies aiming at curbing cigarette use among youth.

From ““Waterpipe”” Fixation to Fallacies, Fallacism and Religious Obsession

While the vast majority of “volunteers” of their survey reported being Christian or “other or nonreligious”, the authors insist by two times on the proportion of Muslim and Hindu backgrounds. This trend is not new within the Anti-Tobacco movement. So, the reader is invited to refer to a joint communiqué on a Fallacist statement by Pascal DIETHELM [9]. Sometimes we may wonder: As if Iraq were not enough, here comes the ““Waterpipe”” Mass Destruction Weapon from the Middle East…[10]

Because of such an obsession, we can read in the daily press, as a famous resource on the internet relevantly highlighted: “Health officials hope that spreading that message among water pipe users in the Arab American communities will help discourage other users too. That includes members of the military returning from Iraq, Wenrich said. Some are bringing back arghiles from the Arabic country and adding to the water pipe's popularity. "It is culturally related, but becoming more mainstream," she said.” [11].

For more than a decade now, we have established that the narghile practice is egalitarian from all viewpoints: gender, religion, social, generations [8]. Therefore, their failure is a backlash of censorship and certainly not the last one….

Undeclared Competing Interests

Thomas EISSENBERG, one of the leading collaborators of this new study, is also author or co-author of a number of papers published in the same Nicotine and Tobacco Research journal [12-17]. He describes in them how he has made use of a smoking topography system called CReSS [Clinical Research Support System]. This had direct orientations and consequences on his group’s publications on hookah smoking. The truth is that he has personally contributed to its development, through direct funding, at least in 2001, from Plowshare Technologies, Inc., an industrial firm. However, he did not declare these competing interests in any of these publications. According to the his affiliated university, he was awarded in 2004 "a $2.2 million, five-year grant from the National Cancer Institute to develop a model for testing the purported benefits of potential reduced-exposure products for cigarette smokers and smokeless tobacco users "[17]. The same source adds that his laboratory “has been developing methods to assess the effects on smokers of the new products, using a data-collection system developed and marketed by Plowshare Technologies, Inc., of Baltimore, MD, (www.plowshare.com)”. Thomas EISSENBERG has in fact worked on the corresponding system sponsored by the above industrial firm at least in 2001.


No further comment.


Dr Kamal T. Chaouachi

Researcher and Consultant in Tobacco Control (Paris)

http://PublicationsList.org/kamal.chaouachi (kamchaAgmail.com)



[1] Ward KD, Eissenberg T, Gray JN, Srinivas V, Wilson N, Maziak W. Characteristics of U.S. waterpipe users: A preliminary report. Nicotine Tob Res. 2007 Dec;9(12):1339-46.

[2] Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T. Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tobacco Control 2004; 13: 327-333.

[3] Chaouachi K. Shisha confusion. BDJ 2007 (22 Dec); 203 (12):669-70.

[4] Rakower J, Fatal B. Study of Narghile Smoking in Relation to Cancer of the Lung. Br J Cancer 1962 (Mar);16:1-6.

[5] Sajid KM, Parveen R, Durr-e-Sabih, Chaouachi K, Naeem A, Mahmood R, Shamim R. Carcinoembryonic antigen (CEA) levels in hookah smokers, cigarette smokers and non-smokers. J Pak Med Assoc 2007;57(12):595-9.

[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.


[7] Chaouachi K. eLetter to the Editor: “Measuring Real Exposure to Narghile (Hookah, Shisha) Smoke and Other Concerns Related to Public Health”. European Journal of Public Health 2006 (Jul 2). A critical analysis of  Tamim H, Akkary G, El-Zein A, El-Roueiheb Z, El-Chemaly S. Exposure of pre-school children to passive cigarette and narghile smoke in Beirut. European Journal of Public Health 2006 (May 4): 4 pages.


[8] Chaouachi K. Early censored studies: http://PublicationsList.org/kamal.chaouachi

[9] Communiqué dated 29 June 2007 (in collaboration with The Sacred Narghile site): « La rage et l’orgueil contre... le narguilé ». Available via the above the above site. Une critique de l’article de Pascal Diethelm : « Narguilé : attention, danger!» (May 2007)  http://www.oxygeneve.ch/dossier.php?id=67 (accessed June 29, 2007) pour une  campagne préparée par:  OxyRomandie ;  CIPRET-Genève ; UICC ; Département de l'économie et de la santé de Genève et l’Organisation mondiale de la santé. (*)

[10] Mokdad AH, Warren CW. As if cigarettes were not enough, here comes narghile. A commentary on an article by Yunis et al. in IJPH 52/4.

[11] Wlazelek A. “Caution: Don't go near the water pipe. Health officials voice concern over misperceptions that smoking a hookah is less dangerous than other methods”. Los Angeles Times 2007 (18 Nov).

[12] Breland, A.B., Buchhalter, A.R., Evans, S.E., and Eissenberg, T. (2002) Evaluating acute effects of potential reduced exposure products for smokers: clinical laboratory methodology. Nicotine & Tobacco Research. 4 (Suppl 2), S131-S140.

[13] Buchhalter A.R., Schrinel, L., and Eissenberg, T. (2001) Withdrawal Suppressing Effects of a Novel Smoking System: Comparison with Own Brand, Not Own Brand, and Denicotinized Cigarettes. Nicotine & Tobacco Research. 3, 111-118.

[14] Buchhalter, A.R. and Eissenberg, T. (2000). Preliminary evaluation of a novel smoking system: effects on subjective and physiological measures and on smoking behavior. Nicotine & Tobacco Research. 2, 39-43.

[15] Eissenberg, T., Adams, C., Riggins, E.C.R. III, and Likness, M. (1999). Smoker' sex and the effects of tobacco cigarettes: subject-rated and physiological measures. Nicotine & Tobacco Research. 1, 317-324.

[16] Breland, A.B., Kleykamp, B.A., and Eissenberg, T. (2006) Clinical laboratory evaluation of potential reduced exposure products for smokers. Nicotine & Tobacco Research, 8, 727-738.

[17] VCU (Virginia Commonwealth University) News Centre. VCU reseacher wins NCI grant for tobacco research 2004 (16 Feb) http://www.news.vcu.edu/news.aspx?v=detail&nid=186  (accessed 4 Nov 2007)




(*) « 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. »




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