Shisha pipes: Is smoking them really harmless?

2012-04-04

The sweet smelling tobacco is gaining in popularity, but most people who smoke it in cafes are unaware of the potential risks.
You might call it shisha in Egypt and Sudan, nargile in Turkey and Syria or hookah in India. Some are made from clay, others from ornately carved metals or plastics. But the principle is same – these water-pipes allow you to smoke flavoured tobacco as it is bubbled through water. Maybe you know it simply as hubble-bubble.

Sharing a water-pipe is thought to be harmless, relaxing fun. They are now enjoying something of a resurgence in popularity in India and the Middle East, where they are said to have originated. In the Middle East the trend has extended to teenagers and women, many of whom do not smoke cigarettes.

This shisha cafe culture has also extended to Europe, Brazil and the United States. If I run home from my office in London, I pass a street filled with cafes where groups of people sit outside engulfed in clouds of honey-scented smoke. In the United States many hookah cafes have opened in college towns and a recent study found that as many as a fifth of American students have tried it. In many countries these pipes are seen as safe enough to be exempt from legislation on smoking in public places.

But the idea that these pipes are harmless is a myth.

Smoke on the water

One of the main misconceptions is that the risks of tobacco are minimised because it is purified as it passes through the water. But this ignores the complete source of the smoke that enters your mouth.

The tobacco burns in a small dish on top of the main body of the water-pipe. You inhale through a mouthpiece connected by a pipe to a reservoir of water at the bottom. As you breathe in smoke is drawn from the burning tobacco and bubbles through the water and up into your mouth. The tobacco is sweetened with glycerine, which can make it damp, so charcoal is added to keep the tobacco burning. This means the smoke inhaled derives from charcoal too, and charcoal contains several toxic substances, including carbon monoxide, heavy metals and tar.

Some water-pipes are sold with mouthpieces containing cotton filters or a plastic mesh. This does result in smaller bubbles, but a report by the World Health Organisation says there is no evidence that these mouthpieces reduce the harm.

Unknown risk

But surely the water cools the smoke, making it less dangerous than a cigarette? It is true that this might make an individual puff less harmful, but this does not factor in the quantity of puffs. A typical water-pipe session lasts for at least 20 minutes, often for an hour. So instead of taking 8-12 puffs of a single cigarette a person is inhaling 50-200 puffs in a session. This, in effect, makes it more like chain smoking. In an hour-long session a person can inhale the equivalent of 100 to 200 times the smoke from a single cigarette, which may come as a surprise to most people. A survey carried out this year by the British Heart Foundation found that 84% of respondents thought the amount of smoke inhaled was equivalent to 10 cigarettes or fewer.

In a study in Florida, USA, customers’ carbon monoxide levels were tested as they left bars that allowed the smoking either of cigarettes or hookah pipes. The people leaving the bars that had water-pipes had triple the levels of carbon monoxide in their bodies. Some reported feeling high, which the authors say could have been the early stages of carbon monoxide poisoning.

But what do we know about any long-term consequences? Here, the science is incomplete, as long-term studies of the kind conducted on cigarette tobacco have not been carried out. Researchers admit the evidence is scant, but suggest that smokers of water-pipes could be at long-term risk for nicotine dependence, cardiovascular disease and even cancer. Professor Hani Najm, Head of Cardiac Surgery at National Guard Health Affairs in Saudi Arabia told me in an interview that he fears that water-pipe smoking could result in an escalation in heart disease in the Gulf States.

So bear in mind one thing. Whether you call it shisha, nargile or hubble bubble, it might smell nice, but it is not as harmless as you might think.

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Study: Mammograms May Overdiagnose Some Early Breast Cancers

For years, women have been urged to get screened for breast cancer because the earlier it’s found, the better. Now researchers are reporting more evidence suggesting that’s not always the case.

A study in Norway estimates that between 15 and 25 percent of breast cancers found by mammograms wouldn’t have caused any problems during a woman’s lifetime, but these tumors were being treated anyway. Once detected, early tumors are surgically removed and sometimes treated with radiation or chemotherapy because there’s no certain way to figure out which ones may be dangerous and which are harmless.

“When you look for cancer early and you look really hard, you find forms that are ultimately never going to bother the patient,” said Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, who was not part of the research. “It’s a side effect of early diagnosis.”

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The study is the latest to explore overdiagnosis from routine mammograms — finding tumors that grow so slowly or not at all and that would not have caused symptoms or death. Previous estimates of the problem have varied.

The researchers took advantage of the staggered decade-long introduction of a screening program in Norway, starting in 1996. That allowed them to compare the number of breast cancers in counties where screening was offered with those in areas that didn’t yet have the program. Their analysis also included a decade before mammograms were offered.

They estimated that for every 2,500 women offered screening, one death from breast cancer will be prevented but six to 10 women will be overdiagnosed and treated.

Study leader Dr. Mette Kalager and other experts said women need to be better informed about the possibility that mammograms can pick up cancers that will never be life-threatening when they consider getting screened. The dilemma is that doctors don’t have a good way of telling which won’t be dangerous.

“Once you’ve decided to undergo mammography screening, you also have to deal with the consequences that you might be overdiagnosed,” said Kalager, a breast surgeon at Norway’s Telemark Hospital and a visiting scientist at Harvard School of Public Health. “By then, I think, it’s too late. You have to get treated.”

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Kalager and her colleagues looked only at invasive breast cancer. The study did not include DCIS, or ductal carcinoma in situ — an earlier stage cancer confined to a milk duct.

Under the Norway program, screening was offered every two years to women ages 50 to 69.

Researchers analyzed nearly 40,000 breast cancer cases, including 7,793 that were detected after routine screening began. They estimated that between 1,169 and 1,948 of those women were overdiagnosed and got treatment they didn’t need.

Their findings appear in Tuesday’s Annals of Internal Medicine.

The problem of overdiagnosis has been long recognized with prostate cancer. Darthmouth’s Welch said it’s also a problem in thyroid and lung cancer, a childhood tumor called neuroblastoma and even melanoma. He considers breast cancer screening a close call.

“The truth is that we’ve exaggerated the benefits of screening and we’ve ignored the harms,” he said. “I think we’re headed to a place where we realize we need to give women a more balanced message: Mammography helps some people but it leads others to be treated unnecessarily.”

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An editorial published with the study said overdiagnosis probably occurs more often in the United States because American women often start annual screening at an earlier age and radiologists in the U.S. are more likely to report suspicious findings than those in Europe.

Radiologists could help by raising the threshold for noting abnormalities, wrote Dr. Joann Elmore of the University of Washington School of Medicine and Dr. Suzanne Fletcher of Harvard Medical School.

A “watch-and-wait” approach has been suggested instead of an immediate biopsy, but the editorial writers acknowledge that could be a “tough sell” for some women and radiologists alike.

They said most women aren’t aware of the possibility of overdiagnosis.

“We have an ethical responsibility to alert women to this phenomenon,” they wrote.

Read more: http://healthland.time.com/2012/04/02/study-finds-some-early-breast-cancer-overdiagnosed/#ixzz1r3vMcTZs