To the Editor: The article by Dr Ross and colleagues1 was widely reported to show that coffee is an independent
"protective factor" against the development of Parkinson disease (PD). Using
a prospective longitudinal epidemiological database, the authors did, in fact,
find an inverse association between higher caffeine intake and risk of developing
PD. However, association does not prove causation. They did not consider another
potential explanation of this association; namely, that incipient or preclinical
PD causes decreased novelty-seeking behaviors.2,3
Several studies have shown inverse associations between tobacco, alcohol,
and coffee intake and PD,1- 3
and it is more plausible that these various substances (including other caffeinated
beverages such as tea, cola, and chocolate) are underused by persons with
incipient PD, rather than that each agent independently protects against PD.
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