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To the Editor:
The recent study by Gorell et al.1 proposes a risk-reducing effect of tobacco smoking on PD because they found, as in a number of prior investigations, an inverse relationship between smoking and PD. Although the authors consider several possible explanations for the rarity of smoking in PD, they do not consider the most likely explanation for this well-known inverse association. Rather than interpret the findings as indicative of a “protective” effect of smoking on development of PD, the correct interpretation may be that PD is “protective” against being a smoker (e.g., see reference 2, which was not cited by the authors but has an almost identical title to that of their work). Thus, despite the pathoetiologic attractiveness of a protective effect of smoking, a likely explanation for the under-representation of smoking among PD patients is that the patients-to-be lose interest in smoking as a very early presymptomatic feature of their neurodegenerative condition.2
It is generally agreed that PD, like many other neurodegenerative conditions, develops over years, and only becomes noticeably symptomatic …
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