Thursday 21 October 2010

Shisha madness

There was a time when scientific research was presented to reputable journals for peer-review and publication. In the field of tobacco research, however, there is a growing trend towards what Dr Michael Siegel calls "science by press release," which bypasses the scientific journals and delivers findings directly to the media. This has an obvious appeal for some researchers. The media have an insatiable appetite for scare stories and journalists are rarely qualified to ask the appropriate questions.

Science by press release allows fresh 'evidence' to spread worldwide, reaching the public and opinion-formers with immediate effect. By the time any awkward questions have been asked of it, the message has been sent and the media has moved on. An example of this came on 24 August 2009, when the BBC announced the scarcely believable new 'fact' that shisha smoking could be "400 to 450 times more dangerous than having a cigarette."

The news story ('Shisha as harmful as cigarettes') was itself little more than a press release to promote the BBC's Asian Network's radio programme that was broadcast at 6pm the same day. The intention of both the article and the programme was to stoke up fears amongst the predominantly Asian users of shisha pipes (also known as hookahs, nargiles and hubble-bubbles). Both the news story and the radio show were guilty of grossly misrepresenting the known facts.

Misleading statements

The Department of Health research focused entirely on carbon monoxide, with its key finding being that:

It found one session of smoking shisha resulted in carbon monoxide levels at least four to five times higher than the amount produced by one cigarette.

This may be true, but since a 'session' was defined as half an hour's continuous smoking, CO levels were bound to be higher amongst shisha smokers than amongst those who smoked a cigarette for, as the researcher said, "a couple of minutes, five minutes at the most."

The BBC went on to add:

High levels of carbon monoxide can lead to brain damage and unconsciousness.

This, too, is true, but it gives a highly misleading impression. The reader is led to believe that shisha smoking leads to brain damage and unconsciousness without any evidence being presented that this ever actually happens. The reason it does not happen is simple - although "high levels" of CO "can" result in brain damage and even death, the levels found in shisha smokers (and cigarette smokers) are by no means high enough.

Using the same rhetorical trick, I could tell you—with a clear conscience—that your television emits radiation and that high levels of radiation can cause cancer and childhood leukemia. Both statements are true, but by following one with the other I would be giving the unwary reader the false impression that televisions cause cancer.

Questionable research

Similar examples of sleight of hand could be found in the radio transmission itself ('The Trouble with Hubble Bubble', 24/8/09).

The headline-grabbing claim that shisha pipes are 'worse' than cigarettes is based on unpublished research carried out by an unnamed University at the behest of the Tobacco Control Collaborating Centre (TCCC) and released exclusively to the BBC's Asian Network.

The TCCC's Hillary Wareing appeared on the radio programme to reveal the startling results:

"We found that one session of smoking shisha - that's about 10mg for 30 minutes -- gave CO levels that at their lowest were 4 or 5 times as high as having a cigarette but at worst were coming out at 400, 450 times more dangerous. The results would suggest that in most cases it's more harmful and in some cases it's extremely more harmful [sic] than cigarettes."

As always with science by press release, we will have to wait to see how the research was conducted (if, indeed, it is ever published). Incidentally, Wareing reveals her own ignorance of shisha by saying that a 30 minute shisha session uses just 10mg of tobacco. A typical amount of tobacco smoked in one shisha setting is 10-20g, leaving Wareing out by a factor of a thousand.

If the TCCC's experiment involved testing CO levels in smokers, it will be fascinating to see how they came up with the claim that shisha smokers have up to 450 times the carbon monoxide levels of cigarette smokers. Such a level would be in excess of 1,000 parts per million, much higher than the human body can withstand without dying. No living person could give such a reading. If, on the other hand, the experiment merely took CO readings in a laboratory, it is of negligible practical value since smoking has been prohibited in all enclosed places in the UK since July 2007.

More fundamentally, the researchers make the mistake of equating carbon monoxide with risk, as if CO were the sole (or even the main) cause of ill-health in smokers. They say nothing at all about cancer, which is the chief health hazard associated with tobacco use. Instead, they assume that risk of brain damage, stroke, heart disease and death is directly correlated with CO levels in the body. It is not.

An expert's view

Dr Kamal Chaouachi is a Paris-based tobacco researcher and arguably the world's leading expert on the science of hookah smoking. Dr Chaouachi has authored or co-authored two comprehensive transdisciplinary books and dozens of biomedical publications. He has already lodged a complaint with the BBC about the programme which he says was based on "misinterpretation" and "gross exaggeration".

"There are numerous studies on this issue and there is absolutely nothing new in this scare-mongering report," Dr. Chaouachi said. "What has been done is recycling and laundering the old stuff and trying to present this as "new research" that would "reveal" new "facts".

"The bottom line is that shisha smokers actually experience the same CO exposure as cigarette or cigar smokers do. Besides, their exposure is, unlike cigarette smokers who generally smoke every day, not chronic. Indeed, for the great majority of them, they indulge in their habit only 1 to 3 times a week. Even in the case of a daily exposure, keep in mind that the CO is quickly washed out from the body because its half life is only about 3 to 4 hours."

"CO is only one chemical out of thousands in cigarettes, so one cannot compare. But even if we look only at CO, shisha is not "worse" than cigarette smoking because regular cigarette use results in chronic intoxication. Shisha use is sporadic and occasional and the CO is quickly washed out of the body."

None of these points were raised in the BBC programme. Indeed they upped the ante by suggesting that shisha use also raised the risk of everything from herpes to swine flu. This could come about, they said, from pipes becoming infected, as the rather inarticulate spokesman for the NHS stop smoking service told listeners:

"There's no kinda, like, direct correlation, but at a time when we're quite protective about, y'know, passing on of germs and being quite, y'know, up on our hygiene it's not the best activity to be taking part in right now."

Despite there being "no direct correlation" and no evidence, the BBC dwelt on the possibilities of a shisha-related swine flu outbreak for some time. In response, Akram, the owner of a London shisha bar told the programme that every shisha is cleaned "from top to bottom" with boiling hot water and disinfectant. In addition, every customer used a disposable mouth-tip. He quite reasonably pointed out there was no more reason to think that reusing a washed shisha could spread infection any more than reusing a washed cup in a coffee bar.

Education or scare-mongering?

There is a case to be made for informing shisha smokers about the potential health hazards of the device. This is particularly true if, as the programme asserted, some smokers believe that shisha is completely risk-free. Unfortunately, a calm assessment of the facts is not sufficiently alarming for Britain's anti-smoking tzars. They strongly resist any suggestion that some tobacco products are less hazardous than others, despite overwhelming evidence that shisha, snus, chewing tobacco, pipes, e-cigs and cigars are all significantly less hazardous than cigarettes.

In the ideal world of public health, overstating the dangers of shisha will persuade its users to cease using tobacco products. In the real world, claims that shisha can be up to 450 "more dangerous" than cigarettes is more likely to encourage users to switch to cigarettes. It is the kind of unintended (but hardly unforeseen) consequence that has dogged the anti-smoking movement efforts for decades.

Dr Chaouachi wonders whether public health is really the issue at all:

"If these people were truly concerned about "public health", the best thing they could do is to invite shisha users not to smoke in ill-ventilated places, as I have been doing for 12 years. However, and cigarette users know this well, the question of ventilation is taboo talk. Therefore, the objective of this new campaign is targeting a lifestyle, not an unhealthy habit."

"This renewed attention is very similar to that about E-cigarettes (banned in some countries on unscientific grounds). Both smokes have, contrary to conventional cigarettes, many common points (a high proportion of DHMO (DiHydrogen MonOxide) and glycerol), far fewer chemicals and crowds around the world are growing mad about them."

"I have the strange impression that this story is the harbinger of a new step towards prohibition..."

[Originally published August 25th 2009 at]


Michael J. McFadden said...

"one session of smoking shisha resulted in carbon monoxide levels at least four to five times higher than the amount produced by one cigarette."

Er... since a "session of smoking" shisha generally involves four or five people all smoking for a half hour what else would one expect? And as Chris brilliantly points out later in the piece, warning about the "threat" produced because CO is known to be dangerous is like warning about the "threat" produced by "deadly radiation" from watching TV!

Chris, that TV observation is definitely a keeper! I'll be borrowing it sometimes if you don't mind!


V said...

Gorgeous leaflet I saw in a Liverpool hospital 9 months or so ago. It was the glossiest leaflet I've ever touched and they must have cost a bomb. I facepalmed so so so much at all the shitty propaganda