-Communiqué-
Little Red Riding Hood’s Narghile
[Le narguilé du Petit
Chaperon Rouge : French]
[Caperucita Roja y Su
Narguile : Spanish]
A Pleasure Among Friends: How Narghile (““waterpipe””) Smoking…
Keeps Researchers in Wonderland, Obsessing all Prohibitionists
of the World and Has Come to Be their Bête Noire…
by Kamal Chaouachi (2 April
2008)
“Once upon a time there was a dear little girl who was loved by every
one who looked at her, but most of all by her grandmother, and there was
nothing that she would not have given to the child. Once she gave her a little
cap of red velvet, which suited her so well that she would never wear anything
else. So she was always called Little Red Riding Hood. One day her mother said
to her, "Come, Little Red Riding Hood, here is a piece of cake and a
bottle of wine. Take them to your grandmother, she is ill and weak, and they
will do her good [...]” (Little Red Riding Hood,
The Grimm Brothers)
« Il était une fois une
adorable petite fille que tout le monde aimait rien qu’à la voir, et plus que
tous, sa grand-mère, qui ne savait que faire ni que donner comme cadeaux à
l’enfant. Une fois, elle lui donna un petit chaperon de velours rouge et la
fillette le trouva si joli, il lui allait si bien, qu’elle ne voulut plus
porter autre chose et qu’on ne l’appela plus que le Petit Chaperon rouge. Un
jour, sa mère lui dit : - Tiens, Petit Chaperon rouge, voici un morceau de galette
et une bouteille de vin : tu iras les porter à ta grand-mère ; elle est malade
et affaiblie, et elle va bien se régaler. »
SUBJECT: A
critical analysis of a story written by the joint US-Syrian Center for Tobacco Studies [1]. Authored by Fouad HAMMAL, Jeremiah MOCK, Kenneth WARD, Thomas EISSENBERG,
Wasim MAZIAK. Title: “A pleasure among friends: how narghile (waterpipe)
smoking differs from cigarette smoking in Syria”. Supposedly
“peer-reviewed” and published in the Tobacco
Control journal . FUNDING: “US Public
Health Service Grants TW05962, TW07233 and Initiative for Cardiovascular Health
Research in the Developing Countries (IC-Health)” [The latter is funded by
the Rockfeller Foundation, the World Bank and WHO… Most of its member
organisations are of US obedience].
__________
First off, there will be no need to introduce the actors of the joint US-Syrian Center for Tobacco Studies . The newcomer for some of
the readers will be Jeremiah MOCK. This researcher is affiliated with the University
of California at San Francisco, the “think tank” of the world anti-tobacco
movement working for smoking bans in homes, gardens, streets, cars, etc.,
according to the WHO (World Health Organisation) Tobacco-Free
Earth agenda. Hookah
“passive smoking” may just have been invented there. However, Dr MOCK once
co-authored a paper by the same team in which Middle East women are made
responsible for the hookah (narghile, shisha) “epidemic”…
>The WOLF (who, after he devoured the
GRANDMOTHER, “put on her clothes, dressed himself in her cap, laid himself in
bed and drew the curtains…”) said to LITTLE RED RIDING HOOD: “There is growing evidence that waterpipe
smokers have many of the adverse health effects seen in cigarette smokers,
including pulmonary disease, lung cancer, coronary heart disease, and adverse
birth outcomes."
>LITTLE RED RIDING HOOD immediately replied: “Growing Evidence” or
growing pseudo-science and confusion [2] ?
> “Oh, don’t be cheeky!”, said the WOLF.
>Unflinching, LITTLE RED RIDING HOOD resumed: My general comment will be a quotation:
"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." (Pr C.V.P.: “Who's Telling the Truth ?”)
And my particular comment will be on lung
cancer because the pseudo-scientific results about other diseases have
already been addressed in the past. The Indian referred to study (by
Gupta and colleagues) is absolutely not reliable for many reasons given in previous publications .
As for the Chinese reference (by Lubin et al), and about which the US-Syrian Center for Tobacco Studies has already published very serious errors in the same
supposedly « peer-reviewed » Tobacco
Control journal [3], it is all the more ludicrous that the Chinese water
pipe is a tiny device used with a Lilliputian bowl of tobacco and no charcoal !
How come, in these conditions, researchers worthy of this name can compare it
with the Middle Eastern shisha ? These comparisons actually die hard because
these people have been making use of the
clannish ““waterpipe”” nominalism which implies that all ““waterpipes””
of the world are the same. Any hookah (narghile, shisha) user knows that this
is a childish functionalism (the almost uniquely distinctive feature of a
hookah would be water) and unscientific reductionism…
What is more, GRANDMOTHER, is that Lubin et al’s study (entitled “Risk
of lung cancer among cigarette and pipe smokers in southern China”; 1992)
concluded that [water] “pipe smoking may be less deleterious than cigarette
smoking. The reasons for this are unclear, but may be due to the filtration
action of the water bath or to less vigorous inhalation of pipe smoke”[3].
Another never cited researcher (voluntary publication bias) is WD
Hazelton (lead author of: “Analysis of a Historical Cohort of Chinese Tin
Miners with Arsenic, Radon, Cigarette Smoke, and Pipe Smoke…”; 2001) who
concluded that “Smoking a bamboo waterpipe or a Chinese long-stem pipe
appears to confer less risk than cigarette use, given equivalent tobacco
consumption”. The reason would be that “The arsenic-tobacco interaction
also appears to be very important”, a point that previous studies, in the
same country (China) did not take into due consideration [3]. In fact, and to
close this section, a recent study on hookah smoking and cancer states: “A
comprehensive review of the world literature shows that at least a dozen
studies refers to a weak relation between lung cancer and hookah smoking”[4].
>The WOLF said to LITTLE RED RIDING HOOD: “Narghile smokers generally started in their 20s
and found that smoking narghile fostered a sense of togetherness and cultural
identity, while cigarette smokers started in their early teens, males having
started to becoming a ‘‘real man’’”.
>LITTLE RED RIDING HOOD replied:
But this is in contradiction with the WHO Erroneous report on
““waterpipe”” tobacco smoking” which states that it is not uncommon to see
children smoking the narghile with their parents in the Arab world...
>The WOLF said TO LITTLE RED RIDING HOOD: "The history of the narghile in Syria
remains murky”.
> to what LITTLE RED RIDING HOOD could not
help from pointing out:
Oh but for 6 years now, the official history of narghile that emerged from
dozens of “studies” published by “experts” in supposedly “peer-reviewed”
biomedical journals, was that the origins of the artefact (““waterpipe””) and
the practice were both Indian. The WHO
Erroneous report on ““waterpipe”” tobacco smoking” prepared, among others,
by the chief researchers of the US-Syrian Center for Tobacco Studies (Thomas EISSENBERG, Kennneth WARD, and the
undeclared author Wasim MAZIAK, director of that centre) and Alan SHIHADEH (US-American University of Beirut) is insistent and take a firm stand on this in its
two first sentences !
Besides, GRANDMOTHER, I can see that for the first time in 6
years of publications in the biomedical press, you use the word “Narghile”
instead of the usual ““waterpipe””
and that you zealously went even as far as changing the title of the WHO Erroneous report on
““waterpipe”” tobacco smoking” that you cite in your story and call it:
“Narghile tobacco smoking” (instead of “waterpipe tobacco smoking”)!
I can see two major reasons for this funny
situation. First, it would not have been very professional, in a story supposed to
have an “anthropological” side, to use a “word” (““waterpipe””) that the local
people do not use in their daily life [5]. I read somewhere that it would have been funny to imagine a naïve
anthropologist asking smokers in a Syrian coffee-house: What about your “galyûn
bi-l-mâ‘” practice, the literal translation of the ““waterpipe”” neologism ! Not to mention the related problems with the made-in-the-USA
questionnaires blindly imported and translated into Arabic…[6]
The truth is that ““waterpipe””, is a “word” not found in dictionaries
and inexistent in key languages such as Hindi, Urdu, Turkish, Arabic, Hebrew,
Persian, etc. or even in scientific English. In contrast, “hookah” and
“narghile” can be found in dictionaries and “shisha” has been widely used for
ages in the Arab world. Therefore,
the use of such a word for all situations, in space and time, is
methodologically wrong because the pipe and the smoking products are not the
same from one country to the other, from one community to the other, etc. As a
simple example, the shisha smoked today by young people in the USA is used with
a flavoured tobacco [or no-tobacco]-molasses based mixture called
tobamel (tobacco plus “mel” for “honey” in Latin) or
mu‘essel (i.e. “honeyed”, in Arabic) in Arab countries. Now, this product is completely different from the pure moistened
tobacco (called tutun) smoked in a madâ‘a by the Yemeni Jews described by
Rakower and Fatal in their famous study. Consequently, extrapolation of
findings between both above cases is not appropriate. Unfortunately, this has
been done and resulted in frequent bias. As a conclusion, the word “waterpipe”
should be avoided in studies unless extreme and quick simplification is needed.
Since contemporaneous hookah smoking bridges between continents and languages,
the selection of the right vocabulary remains of utmost important, particularly
in questionnaires. Hanna’ study is a model in this field [7].
The two hegemonic journals in the field of
tobacco issues (Tobacco
Control and Nicotine and Tobacco Research impose to
authors, for obvious purposes, the use of this clannish unscientific nominalist
and reductionist neologism.
>The WOLF SAID TO LITTLE RED RIDING HOOD: “Although there have been social changes in Syria in
recent years, Syrian society remains conservative and closed. Health generally,
and tobacco use in particular, can be sensitive topics.”
>Oh, said LITTLE RED RIDING HOOD: This is mere hypocrisy. You have kept silent
on the health horror scene in the neighbouring country and I gather this is
because of the funding source of your “studies”… Look at this: What Taboo Research
Areas in Middle East Health ? (BMJ 2006 (1 Dec). A critical analysis of:
Maziak W. Health in the Middle East. BMJ 2006;333;815-816).
>The WOLF said to LITTLE RED RIDING HOOD: "However, Syrians are known to have used
narghile for many generations, if not centuries" and added “In Syria, we estimate that 20% of
men and 5% of women smoke narghile regularly”.
>LITTLE RED RIDING HOOD naively wondered: So, tell me, GRANDMOTHER, why three
international research centres have officially been appointed for fighting its
use, only after “centuries” (the US-Syrian Center for Tobacco Studies , one in Egypt and the US-American University of Beirut) ? Also, I have seen that the funding of the former was renewed for a second period of five years
(representing if I mistake not, something like, at least, 2 other millions of
dollars). Neegaard et al. emphasise that: “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).”[8];
Therefore and despite the repeated denegation by Wasim MAZIAK, Thomas
EISSENBERG and Kenneth WARD over the past years, the primary objective of the
profusion of 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, it was
noted 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… (Globalink,
Aug. 2004)…
>The WOLF said to LITTLE RED RIDING HOOD: “We found that narghile smokers considered narghile to be a cultural
feature of life in Aleppo, in much the same way that hummus and tabuleh are
served in social gatherings and quintessentially part of Syrian culture”.
>LITTLE RED RIDING HOOD replied to the WOLF: May I suggest to also ban Hummus and Tabuleh…
>The WOLF said
to LITTLE RED RIDING HOOD: “We
started this study with ‘‘explorer’s eyes’’ and without being driven by an a
priori hypothesis.”
>LITTLE RED RIDING HOOD suddenly realised that her GRANDMOTHER was LYING.
She said in a provocative way: 7 years of “studies
claiming that 1 narghile equals 200 to 40 cigarettes and without paying the
least attention to the context and now you pretend to be a professional
socio-cultural anthropologist…
Grandmother, what a terrible big mouth you have !
Kamal Chaouachi (kamchaAgmail.com)
-Story teller, poet and novelist: http://PublicationsList.org/kamal.chaouachi
-Author
of a previous tale: [Ali Baba’s Narghile and the 40 Flying Cigarettes] Le narguilé d’Ali Baba
et les 40 cigarettes volantes. 1 June
2006.
_________
References:
[1] Hammal F, Mock J, Ward KD, Eissenberg
T, Maziak W. A pleasure among friends: how narghile (waterpipe) smoking differs
from cigarette smoking in Syria. Tob Control. 2008 Apr;17(2):e3.
[2] Chaouachi K. Shisha confusion. British
Dental Journal 2007 (22 Dec); 203 (12):669-70.
doi:10.1038/bdj.2007.1124
[3] Chaouachi K. Serious Errors in this Study. Tobacco Control 2004 (2 Dec.). A critical analysis of the following study:
Maziak W, WARD KD, AFIFI-SOWEID RA, and EISSENBERG T. Tobacco smoking using a
waterpipe: a re-emerging strain in a global epidemic. Tobacco Control 2004; 13: 327-333. http://tc.bmjjournals.com/cgi/eletters/13/4/327
http://docs.google.com/View?docid=dgbz283m_83fdtkjd
See also reply to Proxy’s intervention (by “Matthew P Gelfand,
Undergraduate Student Brown University”) in the Pediatrics journal:
http://pediatrics.aappublications.org/cgi/eletters/116/1/e113#7836
[4] Carcinoembryonic
antigen (CEA) levels in hookah smokers, cigarette smokers and non-smokers.
J Pak Med Assoc 2007;57(12):595-9.
[5] Al-Belasy F. The Issue of Nomenclature: In Reply (18
June). E-Letter to the Editor about: Ward KD, Eissenberg T, Rastam S, Asfar T,
Mzayek F, Fouad MF, Hammal F,Mock J, Maziak W. The tobacco epidemic in Syria.
Tobacco Control 15: 24-29; 2006.
http://tobaccocontrol.bmj.com/cgi/eletters/15/suppl_1/i24#576
[6] E-Letter to the Editor: Syria, Lebanon, Tobacco Research in General and
Narghile (Hookah, Shisha) Smoking in Particular.
Tobacco Control 2006 (8 June). A critical analysis of the following study: Ward KD, Eissenberg T, Rastam S, Asfar T,Mzayek
F, Fouad MF, Hammal F,Mock J, Maziak W. The tobacco epidemic in Syria. Tobacco Control 2006;15;24-29.
http://tobaccocontrol.bmj.com/cgi/eletters/15/suppl_1/i24#544
[7] 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.
[8] 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.
_____________________
Other cited electronic links
http://www.scts-sy.org/en/home.php
http://www.who.int/tobacco/resources/publications/wntd/2007/en/index.html
http://tobaccocontrol.bmj.com/cgi/content/abstract/17/2/e3
http://docs.google.com/Doc?id=dgbz283m_133dkdj5265
http://jpma.org.pk//Misc/PDFDownload.aspx?Download=true&ArticleID=1260
http://www.bmj.com/cgi/eletters/333/7573/815#150477
http://docs.google.com/Doc?id=dgbz283m_113c48b5j
________
ANNEX for those who want to know more:
By the times a kind of collaboration was still
envisaged, Dr MAZIAK asked the author to provide him with an input for the
publication commented above. The following contribution was sent to him on the 24th of Aug 2006. Read it and try to understand by yourself
what is wrong and why it has been rejected:
Qualitative research focussing
exclusively on narghile smoking was carried on in several countries of the
Middle East and particularly in Yemen as early as 1997 as part of a
comprehensive transdisciplinary approach covering both the
socio-anthropological and biomedical dimensions of the narghile practice
(Chaouachi 2000). Several interviews were conducted and reflected various
themes: from knowledge, attitudes, and practices according to gender and age,
to the complex religious ethos and the interrelation with alcohol, qat,
cannabis and cigarettes. Similarities and differences between narghile and
cigarette smoking were recently highlighted (Poland 2006). Narghile dependence
was found to have peculiar dimensions: e.g. a related abstinence period closer
to the half-life of cotinine, not nicotine. This work contained recommendations
for immediate public health action regarding, first, carbon monoxide
intoxication. Then, interference in quitting (ex-)cigarettes smokers and the
consequent relapse were analysed in the light of the anthropological biomedical
representation at the heart this approach. “Self-medication” was shown to be
illusory because of nicotine and other substances physiological compensation.
Another major finding of this work was the necessity to take into account the
remote and recent career and profile of volunteers in any study. Furthermore,
the assumption that whether or not narghile use could be a gateway to cigarette
smoking was also tested (Chaouachi 2000). Finally, the difficulty to work on a
product of the material culture of the Middle East region in a post-orientalist
context was highlighted (Chaouachi 2006).
-Chaouachi K (2000). Le narguilé : analyse
socio-anthropologique. Culture, convivialité, histoire et tabacologie d’un mode
d’usage populaire du tabac. Transdisciplinary doctoral thesis, Université Paris X (France), 420
pages. [Engl.: "Narghile (hookah): a Socio-Anthropological
Analysis. Culture, Conviviality, History and Tobaccology of a Popular Tobacco Use Mode”].
-Poland B, Frohlich K, Haines RJ, Mykhalovskiy
E, Rock M. Sparks R (2006) The social context of smoking: the next frontier
in tobacco control? Tobacco Control;15:59-63. E-Letter Apr. 1, 2006.
-Chaouachi K (2006). Culture
matérielle et orientalisme. L’exemple d’une recherche socio-anthropologique sur
le narguilé. Arabica, tome LIII,2, 177-209. Koninklijke Brill NV (Leiden). [Eng.:
Material Culture and Orientalism. The Example of a
Socio-Anthropological Research on Narghile] www.ingentaconnect.com/content/brill/arab/2006/00000053/00000002/art00003
___________
Technical Note : because it contains several electronic links to online documents, this
communiqué is also made available at:
http://docs.google.com/Doc?id=dgbz283m_134f4zvz4gn