Teissenb

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Eric: With regard to the 1963/4 SG's report, that report represented the best knowledge available at that time. It was valid at the time it was printed. Since then, MANY new studies have been conducted with larger samples, better methods, etc. etc. These new studies render that report an interesting historical document that is not valid in our time. Science often works this way: conclusions reached based on data from some period ago are supplanted by new conclusions based on new/better data. For example, the prevailing thought in the early 1800s was that cholera was spread through the air (especially very smelly air). Thanks to the pioneering work of the brilliant "father of epidemiology" Dr. John Snow, we learned in the mid-1800s that cholera was spread by germs contained (often) in contaminated water/food (he didn't actually tell us about the germs, he told us about the means by which they were spread). If there were SGs reports written about Cholera in 1840 and 1890, they would each have come to very different conclusions about how to avoid/stop cholera epidemics. The earlier one would have been a sincere attempt at preserving public health that was based on the best available evidence and it would have been valid for its time. The later one would have been equally sincere, also based on the best available evidence, and also valid for its time. Looking at the two today, we would CLEARLY see that the earlier report was flat out wrong, and its recommendations useless for preserving the public health. We would also see that the later report was essentially correct and its recommendations hold true today. So it goes: as we learn more, we write new reports based on new data. We hope that, with each new report, there is a corresponding increasing in the health of the public and that, at some point, we can feel that we have the threat completely contained (as with smallpox, for instance). I cannot address your statistical questions in detail. I agree that, based on the one study to which I linked us, the risk of dying of tobacco-caused disease is lowest in non tobacco users, higher in pipe/cigar smokers, and highest in cigarette smokers. With regard to smoking-caused cardiovascular disease, one possible explanation for this ordering of risk (cigarette > cigar/pipe > nonsmokers) might be related to the fact that CO exposure follows the same pattern (e.g., Wald et al., 1981). I may be wrong, but I think that you are saying that, for you, the risks of dying of tobacco-caused disease from years of cigarette smoking are so great that you won't engage in that behavior, but you feel that the risks of dying from tobacco-caused disease from years of hookah smoking (or cigar, or pipe) are not so great (though you recognize that they are greater than not smoking anything), and so you will engage in this behavior. Given no one has yet quantified the risk of hookah smoking, I cannot fault you for this logic. Imagine a scale measuring "risk of dying from tobacco-caused disease" and that not smoking puts you at a 1 and smoking 2 packs of cigarettes each day puts you at 100 (you recognize that I am making up this scale, I'm sure). If hookah smoking puts you at a 2, then you might feel better about your decision than if hookah smoking puts you at a 50. What I think a lot of people on this board and elsewhere fail to realize is that finding the right number for hookah is what my colleagues and I are trying to do as precisely, accurately and quickly as possible (this includes the folks at the World Health Organization). We want YOU to be informed so that when you make this decision, you are making it using accurate information. Many hookah smokers have told me that they don't smoke cigarettes because they know how dangerous they are. OK. What if smoking a hookah were equally or more dangerous? What if it were only slightly less dangerous? What if it were much less dangerous? We are trying to answer these questions the best way we know how.

In the quote below, are you suggesting that Dr. Shihadeh and I were not commissioned by WHO to write the background paper? Because, in fact, we were. This was awhile ago, and I doubt I could dig up the contract to prove it to you, but I can assure you that it happened. I am not sure if this document will convince you or not, but check out the acknowledgments page (p. 7 in the PDF) of this official WHO document: http://www.who.int/tobacco/global_interaction/tobreg/Waterpipe%20recommendation_Final.pdf Please note that this document IS NOT the background paper that Dr. Shihadeh and I prepared -- it was much, much longer. This document is a very brief summary aimed at providing some basic information and conclusions/recommendations for WHO member states. It was prepared and published by WHO, not by me or Dr. Shihadeh So where is the "bullshit"? ***you wrote*** "[font="Verdana, Geneva, Arial, Helvetica, sans-serif"]This document is mainly based on a background paper drafted by Dr Thomas Eissenberg (USA) and Dr Shihadeh (Lebanon), actually commissioned for this purpose by Dr Yumiko Mochizuki, Director of the WHO [i]Tobacco Free Initiative"[/i][/font] [font="Verdana, Geneva, Arial, Helvetica, sans-serif"][i] [/i][/font] [font="Verdana, Geneva, Arial, Helvetica, sans-serif"][i]That sounds like some bullshit to me.[/i][/font] [font="Verdana, Geneva, Arial, Helvetica, sans-serif"][i] [/i][/font]

I agree that the study you suggest is potentially interesting. These studies are also quite expensive and we have other issues that we are pursuing at the moment. I can tell you that, as far as CO goes, we have done some studies with people smoking when using "traditional" charcoal in Syria and the CO exposure is virtually identical with that observed when people are using "quick light" charcoal. However, this does not address your PAH question, I admit. I cannot comment on the bowl packing in Shihadeh's preparation as I have not observed him or his staff pack a bowl. When I pack the bowls in my laboratory there is not much space, if any, between tobacco and foil. More importantly, many of the folks in our study report that they enjoy the bowl and that it was packed well. We also have offered folks the opportunity to pack their own bowls and hope at some point to have enough of these people to compare exposure in "self-packers" with that of "staff packed" bowls -- but I sincerely doubt this variable influences the results. Tom E. [quote name='Tikhman' date='24 December 2009 - 08:56 AM' timestamp='1261670188' post='441479'] Ha, thats what I get for being lazy and not checking pubmed to begin with. Here's are a couple of other questions. So the studies showed that majority of PAHs come from the coal and you happen to be using the quick light coals that have added chemicals to help with quick combustion. Do you know of plan to look at various kinds of coals, lets say lemonwood, orangewood, coconut and quicklights. I'd be interested to see if those numbers come from the actual coal or if some of that is the effect chemicals added for combustion. A minor comment, from one of their diagrams is looks like they leave a good amount of empty space when they pack tobacco in the bowl (between tobacco and foil), something that is not a common practice, at least not with that brand of tobacco. [/quote]

It sounds to me as though you have been reading popular media reports in which I have been quoted, and not the scientific publications to which I refer. I am going to send you Eissenberg & Shihadeh, 2009 via PM. I cannot link to it due to copyright issues. If, after reading that paper, you still feel that "no kind of methods were given", the please ask about the methodological detail you feel is lacking. In addition, if you'd like any other of my scientific papers, feel free to ask. But please, please, do not confuse popular media reports for science. Dr. Thomas Eissenberg [quote name='Tom16689' date='24 December 2009 - 05:15 AM' timestamp='1261656924' post='441463'] [quote name='Teissenb' date='24 December 2009 - 05:25 AM' timestamp='1261650357' post='441455'] [quote name='Tom16689' date='23 December 2009 - 04:18 PM' timestamp='1261610294' post='441358'] Nothing from that article is original research. Just drawing their own "conclusions" from other people's research... [/quote] Incorrect: the Eissenberg and Shihadeh (2009) article is original and novel. Read it and see. [/quote] I couldn't find the entire original paper, only other articles discussing it. Could you link it? I wasn't impressed with the other papers that Eissenberg took part in, their results were backed by nothing other than the authors saying that the results they got were correct, no kind of methods were given. The OP's article seems shady to me at best... "[font="Verdana, Geneva, Arial, Helvetica, sans-serif"]This document is mainly based on a background paper drafted by Dr Thomas Eissenberg (USA) and Dr Shihadeh (Lebanon), actually commissioned for this purpose by Dr Yumiko Mochizuki, Director of the WHO [i]Tobacco Free Initiative"[/i][/font] [font="Verdana, Geneva, Arial, Helvetica, sans-serif"][i] [/i][/font] [font="Verdana, Geneva, Arial, Helvetica, sans-serif"][i]That sounds like some bullshit to me.[/i][/font] [font="Verdana, Geneva, Arial, Helvetica, sans-serif"][i] [/i][/font] [font="Verdana, Geneva, Arial, Helvetica, sans-serif"][i]"Prevention is the most important and pressing issue and no suggested action (page 7) is given in this report whereas a public health catastrophe is looming and so many ideas could immediately be put forward to avoid it and reduce the harm caused by this new widespread form of smoking "[/i][/font] [font="Verdana, Geneva, Arial, Helvetica, sans-serif"][i] [/i][/font] [font="Verdana, Geneva, Arial, Helvetica, sans-serif"]Propaganda. They're just trying to stop the fire.[/font] [/quote]

[quote name='Tom16689' date='23 December 2009 - 04:18 PM' timestamp='1261610294' post='441358'] Nothing from that article is original research. Just drawing their own "conclusions" from other people's research... [/quote] Incorrect: the Eissenberg and Shihadeh (2009) article is original and novel. Read it and see.

Ilya: Thanks for the comments. Dr. Alan Shihadeh has done exactly as you propose in a series of excellent studies starting with Shihadeh 2003, then Shihadeh & Saleh, 2005, then several more that I have linked to in this thread. If you go to Pubmed and search for "Shihadeh" you'll find them easily. Tom E. [quote name='Tikhman' date='23 December 2009 - 04:06 PM' timestamp='1261609579' post='441355'] Tom, your study is actually one of the better designed ones I've seen and I'm curious why you haven't put smoke samples through a GC/MS. It would have been very simple to place the absorbent fiber for the GC in place of your flow censors. While there is merit to measuring CO and nicotine blood levels, there are multiple other compounds in cigarettes that are known to be carcinogenic/related to other problems. I saw the 2 lines addressing this in your conclusions, but you did not show any data on anything other than CO and nicotine. I've given thought to hijacking our GC/MS but unfortunately its being extensively used at the moment and bringing a hookah into lab is also a bit questionable. Maybe somewhere down the road [img]http://www.hookahforum.com/public/style_emoticons/default/_sheesha2__by_Majunka_aurore.gif[/img] Ilya [/quote]

Eric, You keep trying to puzzle out some flaw in the study. Of course it has limitations, but the overall message, which I will not reiterate in detail here again, is clear: hookah smokers are exposed to the toxicants CO and nicotine. Even after 5 minutes, the CO exposure is greater than a cigarette and the nicotine level does not differ. You can quibble about this detail or that detail, but you are not going to change these observations. If you look at the plasma nicotine figure in the Eissenberg and Shihadeh (2009) paper, you will see data that supports your position that more nicotine is delivered at the beginning of the hookah session than at the end. From the CO figure you will see that the CO increases are fairly constant throughout the session. So if you are arguing that hookah smokers should decrease their smoking from 45 minutes (on average) to 5 minutes (so as to maximize nicotine and minimize CO exposure), I agree that such a decrease would be a nice first step toward total cessation. I have not seen an analysis of the glycerine content of hookah smoke. What I have seen, and what I've sent to you now, are high quality scientific papers that clearly indicate that hookah smoke contains carcinogenic PAHs (in the "tar") and lung-disease causing volatile aldehydes (in the gas phase). I have always maintained that the "tar" content of hookah smoke is likely to differ from that of cigarette smoke in some ways. Because we ALL believe that, Dr. Shihadeh has been investigating, and continues to investigate, what compounds specifically are in the smoke. Your point that the gross "tar" weight may be influenced by glycerine is well-taken. My point that the tar contains substantial amounts of carcinogenic PAHs is not altered by yours and, I would think, would be the more relevant to hookah smokers' health (though long-term inhalation of glycerine may also be damaging to the lung). And, as an aside, I can ASSURE you that his waterpipe preparation includes perforated foil covering the tobacco; he DOES NOT put the charcoal directly on the tobacco. I must caution you strongly about basing an argument in 2009 on data presented in a 1963 Surgeon General's report. We can all learn a lot in 46 years. I make no claim to being an expert on all aspects of tobacco, and happily acknowledge that any information I could give you regarding death rates and causes of death in cigar and pipe smokers would come from the same sort of internet searches that you might do (I would weight wikipedia low and pubmed high on my source list ). I see from a quick search that a 2003 paper (Shaper et al., 2003; [size="-1"][i]International Journal of Epidemiology[/i];[b]32[/b]:802-808[/size]) reports the following results (note that CHD = coronary heart disease): Compared with never smokers, pipe/cigar smokers (primary and[sup] [/sup]secondary combined) showed significantly higher risk of major[sup] [/sup]CHD events (relative risk [RR] = 1.69, 95% CI: 1.32, 2.14) and[sup] [/sup]stroke events (RR = 1.62, 95% CI: 1.08, 2.41) and of cardiovascular,[sup] [/sup]non-cardiovascular, and total mortality (RR = 1.49, 95% CI:[sup] [/sup]1.13, 1.96, RR = 1.40, 95% CI: 1.08, 1.83 and RR = 1.44, 95%[sup] [/sup]CI: 1.19, 1.74, respectively), after adjustment for lifestyle[sup] [/sup]and biological characteristics. They also showed a significantly[sup] [/sup]higher incidence of smoking-related cancers (RR = 2.67, 95%[sup] [/sup]CI: 1.70, 4.26), largely due to lung cancer (RR = 4.35, 95%[sup] [/sup]CI: 2.05, 8.94). Overall, the effects in pipe/cigar smokers[sup] [/sup]were intermediate between never-smokers and light cigarette[sup] [/sup]smokers, although risks for lung cancer were similar to light[sup] [/sup]cigarette smokers. So, I am reading these data to say that pipe/cigar smokers ARE at increased risk for cardiovascular disease and at least some cancers relative to a non-smoking population, but that the level of increased risk is less than that of pack/day cigarette smokers. Again, this area is not my expertise and, of course, this study is only one of many addressing these points. Having now scanned the article itself (link below), I read: The American Cancer Society (1998) concluded that (1) smoking[sup] [/sup]cigars instead of cigarettes does not reduce the risk of nicotine[sup] [/sup]addiction, (2) cigar smoke contained higher concentrations of[sup] [/sup]toxic and carcinogenic compounds than cigarettes and was a major[sup] [/sup]source of carbon monoxide, (3) cigar smoking causes cancers[sup] [/sup]of the oral cavity, larynx, lung, and oesophagus, and (4) with[sup] [/sup]increasing numbers of cigars smoked, the risk of death approached[sup] [/sup]that of cigarette smoking.[url="http://ije.oxfordjournals.org/cgi/content/full/32/5/802#R31"][sup]31[/sup][/url] The findings in the present study[sup] [/sup]in middle-aged men who are pipe and/or cigar smokers supports[sup] [/sup]these conclusions and suggests that ‘cessation of all[sup] [/sup]tobacco products is the best strategy for decreasing exposure[sup] [/sup]to tobacco smoke’.[url="http://ije.oxfordjournals.org/cgi/content/full/32/5/802#R32"][sup]32[/sup][/url] Please take a look: http://ije.oxfordjournals.org/cgi/content/full/32/5/802 For what its worth, a 1981 study (Wald et al) reported that "Using a COHb cut-off level of 2%, 81% of cigarette smokers, 35% of cigar and pipe smokers, and 1.0% of non-smokers had raised COHb levels." These data suggest to me that cigare smokers are exposed to less CO than cigarette smokers but more CO than nonsmokers, which could account for the intermediate levels of cardiovascular disease in cigar smokers in the Shaper et al 2003 study. I think the data are clear, Eric: tobacco smoking is bad for people's health. Smoking tobacco is bad for people's health because the smoke contains CO, and carcinogens, and volatile aldehydes and all sorts of other stuff that the human lung has not evolved to deal with. Smoking tobacco is bad for people's health whether they are using a cigarette or a cigar, or a pipe. Based solely on the data I have reviewed on this thread, smoking tobacco is also bad for people's health if they are using a waterpipe (hookah, shisha, narghile). Tom E.

The CO levels are lower than if you ran your car in your garage for 20 minutes because the exposure is less. Look, I am not saying that cigarette smokers or hookah smokers die from acute CO poisoning, as might happen to someone who ran their car in an airtight garage. That assertion would be absurd on its face. The health effects of long-term, low-level exposure to CO are much more insidious, and are thought to underlie the pronounced risk of cardiovascular disease seen in cigarette smokers. In the hookah context, there are at least three reasons why the CO exposure data are important: 1) They dispel the myth that hookah smokers do not inhale smoke toxicants (i.e., the water filters the bad stuff out). It doesn't. Hookah smokers inhale CO and nicotine, these toxicants are in their blood, and the nicotine is physiologically active (i.e., it raises heart rate). We know that there are PAHs and volatile aldehydes in hookah smoke that has passed through water and there is every reason to believe that hookah smokers are also exposed to these toxicants. 2) They dispel the myth that hookah smoking is somehow associated with less toxicant exposure than cigarette smoking. Comparing 5 minutes of hookah smoking to 5 minutes of cigarette smoking, hookah smokers have been exposed to MORE CO than cigarette smokers and the nicotine exposure does not differ. At 45 minutes (a typical session, we have seen and are told), hookah smokers are exposed to 3 times as much CO. We know that PAH yield in hookah smoke can be 20-200 times that in cigarette smoke (depending in the particular PAH being looked at) so, again, there is every reason to believe that a single hookah session can lead to more carcinogen exposure than one cigarette, perhaps many times more. 3) They suggest that, just as cigarette smokers die from cardiovascular disease that is caused by long-term, low level CO exposure, hookah smokers may also be at risk for death from cardiovascular disease. FYI, our study took place in a well-ventilated room with a MYA hookah. Hookah smokers are INHALING the CO, so the level of ventilation is not the main issue (though, yes, I suspect if you smoked in an unventilated space, and/or with many other hookahs around, your CO exposure would be even greater). Certainly, I agree that the danger is related to how long-term the exposure is. If everyone here quit smoking tobacco now, there is every reason to believe that they will be spared tobacco-induced addiction, disease, disability, and death. [quote name='Bulldog_916' date='22 December 2009 - 05:27 PM' timestamp='1261528075' post='441069'] Why is it that mean levels of CO in hookah are so low when compared to a condition that might cause real harm like a leaking natural gas stove or running the car in the garage for a minute or 2? You're talking about the intake of a fractional percentage of CO for a short period of time in the day or during the week, whatever the frequency of smoking is. It seems that the larger the hookah the lower the CO exposure is. And in that same breath, with adequate ventilation, the danger of carbon monoxide exposure in hookah is relatively low when compared other much more dangerous conditions. The danger really is based on how long the exposure is, how long after the exposure that the user is not exposed, and the quality/quantity of the exposure...correct? [/quote]

No he is not correct about that "competing" interest. He has raised the issue to numerous journals and all that have reviewed the situation have stated that I had no competing interest. For the record, [font="Default Sans Serif,Verdana,Arial,Helvetica,sans-serif"][size="2"]my role as paid consultant and principle investigator had nothing to do with hookah (we were working on a portable device to measure puff topography in cigarette smokers, see Blank et al., 2009) and it ended [/size][/font]in 2002 (before my first work on hookah even began). Here is the published conflict of interest statement from the Blank et al (2009) paper: From June 2001 to October 2002, Plowshare Technologies, Inc., supported research conducted at Virginia Commonwealth University via an NIH grant (R43DA013882); this research involved testing the portable topography system described in this study. In addition, in May 2000 and again in December 2002, Thomas Eissenberg served as a paid consultant to Plowshare Technologies, Inc. At the time of this study’s design, conduct, and reporting, no financial conflicts of interest existed between any of the authors and Plowshare Technologies, Inc. [quote name='Bulldog_916' date='22 December 2009 - 05:04 PM' timestamp='1261526645' post='441065'] So is the doctor right about your competing interest with Plowshare Technologies (it seems that the interest itself assumes that nicotine is a substance that causes dependence out of hand)? He addresses the competing interest that he had before the critique of the WHO study was actually done (2006). [/quote]

If you don't go the whole seven days, some annoying scientist is going to say that your excuse of "I really got nothing here" was just a rationalization for your inability to abstain. You do realize "failure to abstain when attempting to do so" is an official diagnostic sign of dependence, right? Keep it up. Nicotine/tobacco withdrawal isn't always knock-you-over-with-a-hammer aversive. What it all to often is is a pervasive force that keeps you using tobacco. If you hope to have any chance at claiming you are not dependent, you'll need to at least meet your stated goal of seven days. [quote name='Sonthert' date='22 December 2009 - 02:50 PM' timestamp='1261518616' post='441024'] Crap! I was right! They're after me Lucky Charms. I did have to stop myself from eating my wireless phone earlier. Apparently I thought it was the tasty part of a computer. I was actually ready to give up the 7 Day fast thing because I really got nothing here. I was expecting some sort of withdrawal, something, even very subtle, but I really got nothing. Then Jacob Shock had to mention the second day was the tough part. Now I have to see for myself. Progress Report: +34 Hours More caffeine and some food got everything going fine. I had to get up early, so I went to sleep early and then woke up really early. Sleep seemed really shallow and non-restful. I had the worst Thai food ever. Usually that would upset me. I got nothing here. I'm waiting for the withdrawal. Bought those AC/DC CDs I was thinking about. I'm trying to remember...oh yeah, I had Mexican food for dinner. Unusual bowel movements. Not bizarre like "OMG! Call a priest!". Ate some leftover pasta Alfredo when I threw away most of my Thai food. I'm tired again. Might go back to sleep for a few. [/quote]

I hope you also take the time to read the comments regarding that article: [url="http://www.jnrbm.com/content/5/1/17/comments"]http://www.jnrbm.com...5/1/17/comments[/url]

[quote name='Arcane' date='21 December 2009 - 02:29 PM' timestamp='1261430985' post='440798'] just curious, but how did the study come up with 171 puffs(a near 3 second pull spaced 17s apart) count as a session? the norm, at least around these forums, is 1-2 pulls per minute. this seems like a significant factor... [/quote] From the Sepetdjian et al 2008 paper: "These puffing parameters were derived from a field study in which topographies of 52 smokers in a cafe´ in Beirut were recorded, and represent an ‘‘average” waterpipe smoking session (Shihadeh et al., 2004)." Note that in our paper comparing hookah and cigarette toxicant exposure (Eissenberg and Shihadeh, 2009) we observed in U.S. hookah smokers a mean of 71.7 puffs in 45 minutes with a mean interpuff interval of 42.9 seconds. We speculated: The waterpipe puff topography data differ from previous reports: The mean puff volume of 0.8 L is greater than the approximately 0.5 L reported previously,(25,31) and the 43-second IPI is greater than the previously reported 13–16 seconds.(25,31) These cross-study differences may reflect differences in study populations: Smokers in Lebanon and Syria may be more experienced (e.g., ~30 uses/month),(31) leading to smaller but more frequent puffs. You see, nothing nefarious. Different populations may smoke differently. That is why we report these data: so that people like you can ask these questions and hypothesize (reasonably) that different topographies may lead to different toxicant yields (I think everyone would agree that this hypothesis is very reasonable). However, I think reasonable people would also agree that any lifelike topography parameters are likely to demonstrate some level of PAH yield in hookah smoke, and that really is the point: hookah smoke contains these dangerous carcinogens. The more you smoke, the more you get; the more you get, the greater the risk.

If you were to look at the paper, you would see that we assessed blood CO (technically COHb) and plasma nicotine levels at 5, 15, 30, and 45 minutes after the onset of smoking in both conditions. The five minute time point corresponds to the end of the cigarette. At that time point (5 minutes), the folks in the hookah condition had significantly MORE CO in their blood than when in the cigarette condition, and the amount of nicotine in the blood plasma did not differ across the two conditions at the 5 minute time point. That is at 5 minutes for both. So the time is equal for the hookah and the cigarettes, but the blood CO is greater and the plasma nicotine does not differ. At 5 minutes. For both. You ask why we compare one hookah use episode to one cigarette: it is because the unit of analysis that interests me is the episode. Here is a formal explanation: [font="Default Sans Serif,Verdana,Arial,Helvetica,sans-serif"][size="2"]Obviously these tobacco smoking methods differ in amount of tobacco consumed, duration of use, and other features. I acknowledge these differences, and assert that they are precisely the reasons that the two tobacco use methods should be compared in a manner that approximates actual use conditions. Indeed, this position is exemplified in a classic paper (Benowitz et al., 1988) in which the cardiovascular effects and toxicant exposure of 12 puffs from a cigarette (~1 gm) were compared to those of smokeless tobacco (SLT; 2.5 gm, 30 min exposure period). This paper revealed that, relative to a cigarette, SLT is associated with similar nicotine and heart rate increases, but that nicotine and heart rate levels remained elevated for a substantially longer period (see Benowitz et al., Fig 1, p. 24 and Fig 3, p. 26). These results have been central to discussions of the association between SLT use and nicotine dependence and cardiovascular disease (e.g., Henningfield et al., 1997; Winn, 1997), and also have been cited in reference to SLT treatment strategies (e.g., Hatsukami et al., 1992; Severson et al., 2000) and SLT as a tobacco harm reduction method (e.g., Hatsukami et al., 2004). Thus, there is valued precedent for comparing, as we did, the cardiovascular and toxicant exposure of two methods of tobacco use that differ in amount of tobacco consumed, duration of use, and other characteristics. As an aside, ethical considerations would make us extremely reluctant to compare the toxicant exposure of a 45-minute waterpipe tobacco smoking episode with that of 5-10 cigarettes smoked in a similar period of time. Indeed, this frequency of cigarette smoking is relatively abnormal for most cigarette smokers, and such a study, already questionable on ethical grounds, would also have uncertain generalizability. You are free to conduct other studies using different methodology. I agree that the results may well be interesting. I thought I explained the 45 minutes -- that is the mean we have observed when watching smokers in cafes in the US and abroad, and that is the mean when smokers report the duration of their episodes to us. Yes, there is variability, some people smoke in shorter sessions and others smoke in longer sessions. That is the thing about the mean: it is an index of central tendency. Again, you could design and conduct a different study where everybody smokes for as long or as short as they want. I chose to do it this way not because I have some nefarious agenda, but because, as a first attempt at understanding the relative toxicant exposure of these two tobacco use methods, it made sense to me. Your mileage may vary. [/size][/font] I am not sure why someone might feel that these studies are slanted one way or another. Of course there are other studies that can and will be done. We cannot do every possible study all at once. [quote name='Arcane' date='21 December 2009 - 01:08 PM' timestamp='1261426084' post='440781'] after reading the posts, i can't help be see a slight disadvantage to hookah...you are comparing a so-called "total" exposure from a 45 minute hookah session to a single cigarette? what about the people that smoke 2 cigarettes back to back? why isn't that taken into account? or people like me, who smoked 4-5 cigarettes in one sitting? why weren't people like me or several of my others friends habits considered? also, why weren't people who only smoke hookah for 15-30 minutes taken into account? there are so many variables or "what if's" to consider...it seems the only equal ground is to do a true 1:1 comparision. either going by time, or by amount of tobacco...not a so-called "session". so, why aren't studies fighting against hookah doing that kind of comparison? are they aware that their arguments or the "fear" they're trying to instill won't have a bigger impact when the data says, cigarettes appear to expose the consumer far more toxins than hookah when you compare them "equally"? [/quote]

UPDATE: Dr. Shihadeh from Lebanon DOES have the data with respect to comparing charcoal and electric heat sources. Here is the abstract (below). If anyone has tried an electric heater, please let me know how acceptable it was to you. Did you like the smoke? Do you still use it? Abstract from Monzer et al., 2008 (Food and Chemical Toxicology 46, 2991–2995) Burning charcoal is normally placed atop the tobacco to smoke the narghile waterpipe. We investigated the importance of charcoal as a toxicant source in the mainstream smoke, with particular attention to two well-known charcoal emissions: carbon monoxide (CO) and polyaromatic hydrocarbons (PAH). CO and PAH yields were compared when a waterpipe was machine smoked using charcoal and using an electrical heating element. The electrical heating element was designed to produce spatial and temporal temperature distributions similar to those measured using charcoal. With a popular type of ma’assel tobacco mixture, and using a smoking regimen consisting of 105 puffs of 530 ml volume spaced 17 s apart, it was found that approximately 90% of the CO and 75–92% of the 4- and 5-membered ring PAH compounds originated in the charcoal. Greater than 95% of the benzo(a)pyrene in the smoke was attributable to the charcoal. It was also found that the relative proportions of individual PAH species, the ‘‘PAH fingerprint”, of the mainstream smoke were highly correlated to those extracted from the unburned charcoal (R2 > 0.94). In contrast, there was no correlation between the PAH fingerprint of the electrically heated and charcoal-heated conditions (R2 < 0.02). In addition to inhaling toxicants transferred from the tobacco, such as nicotine, ‘‘tar”, and nitrosamines, waterpipe smokers thus also inhale large quantities of combustion- generated toxicants. This explains why, despite the generally low temperatures attained in the narghile tobacco, large quantities of CO and PAH have been found in the smoke. [quote name='Teissenb' date='21 December 2009 - 03:25 AM' timestamp='1261391109' post='440709'] I have no data comparing charcoal and electric heat sources but I am willing to bet that the smoke toxicant content would be lower with an electric heater (I also am not advocating the practice). I also would bet that hookah smokers will find electric heaters less acceptable. Tom E. [/quote]