Is Something in Tobacco Protective Against Parkinson’s Disease?

The Centers for Disease Control and Prevention recently celebrated the 50-year anniversary of the landmark 1964 Surgeon General’s report on smoking, considered one of the great public health achievements of our time and the first of 30 other such reports from the Surgeon General on smoking.

Major criticisms of the report include a “[c]avalier treatment of costs of smoking”: The Surgeon General argued that smoking costs the United States billions, but the tobacco industry noted that “smoking saves the country money by increasing the number of people dying soon after retirement,” so we don’t have to pay for Social Security, Medicare, and the like. In fact, the industry argued, if we were truly patriotic, maybe we should encourage smoking to help balance the budget.

The tobacco industry also criticized the Surgeon General for a “[l]ack of balance regarding benefits of smoking,” asserting that “[o]ne has to search pretty hard to find any concession anywhere in the Report that smoking is not all bad.” This is something the tobacco industry liked to bring up when testifying before Congress, saying that health benefits include “the feeling of well-being, satisfaction, and happiness and everything else.” But beyond just all the happiness the Surgeon General was trying to extinguish, he failed to even mention that smokers appear protected against Parkinson’s disease. 

“Quite unexpectedly…[m]ore than 50 studies over the last half century consistently demonstrated reduced prevalence of Parkinson’s disease among smokers compared with never-smokers.” Now there are more than five dozen studies.

But smokers are probably dying before they even have a chance to get Parkinson’s, so is that the explanation? No, that didn’t seem to be it. Researchers found a protective effect at all ages. Maybe it’s because smokers tend to be coffee drinkers, and we know coffee consumption alone appears protective. But, no. The protective effect of smoking remained even after carefully controlling for coffee intake. Well, maybe we inherit some propensity to not smoke and to get Parkinson’s. If only we could clone someone to have the same DNA. We can! They’re called identical twins. And still, the relationship remained, suggesting “a true biologic protective effect of cigarette smoking.”

Not so fast. Maybe finding unusually low rates of Parkinson’s among smokers is an example of reverse causation. That is, maybe smoking doesn’t protect against Parkinson’s—maybe Parkinson’s protects against smoking. Could there be something about a Parkinson’s brain that makes it easier to quit? Or perhaps failure to develop a smoking habit in the first place is an early manifestation of the disease.

To put that to the test, researchers studied children exposed to their parents’ smoke. If they grew up to have less Parkinson’s, that would confirm the protective link—and indeed they did. So, smoking really does seem to be protective against Parkinson’s disease, but who cares? How does that help us? “More than 20 million Americans have died as a result of smoking since the first Surgeon General’s report…” Even if we didn’t care about dying from lung cancer and emphysema, even if we only cared about our brain, we still wouldn’t smoke because smoking is a significant risk factor for having a stroke, as well.