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Narguile a allumage simplifie [Narghile with simplified ignition]
Abstract
Important note: In order to avoid the burning of the smoking mixture (moassel) at some point, a small mechanical lever allows the user to bring closer to the bowl the heating element or keep it away, at bay, when the smoke gets thicker.
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Acknowledgement of no potential competing interests:
“I have unfortunately never received direct or indirect funding [$] neither from pharmaceutical companies (nicotine "replacement" therapies and products) nor from the tobacco industry. If I had, I would certainly have earned a better living. I was the first to publish results of (ambient and alveolar) Carbon Monoxide levels in hookah lounges and their patrons (Tobaccology thesis 1998; Alcoologie 1999; Doctoral thesis 2000) and subsequently issued public health recommendations in this respect. Out of this concern, I have participated by year 2004 in the design of a harm reduction hookah (cutting down CO by 95%) of which I am an official co- inventor (Patent 2005. "Narguile a allumage simplifie" [Narghile with simplified ignition]. Appl. EP20050291196. Filed 3 June. Published 14 Dec). My participation in the project was frozen by Autumn 2004. However, the official termination was formalised only by 15 June 2005, date by which I have signed away and ceded all my rights regarding the invention (legally certified by State Attorney in Paris). I began to publish hookah studies in peer-reviewed biomedical journals only beyond that date”[1]. [1] Chaouachi K. Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences. Int. J. Environ. Res. Public Health 2009; 6(2):798-843. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=19440416
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 “standardised”. 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 “waterpipe” 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. Conclusion: 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.
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