The CDC 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, the first of 30 other such reports from the Surgeon General on smoking. Internal tobacco industry memos document their response. Major criticisms of the report included a cavalier treatment of the costs of smoking. The Surgeon General argued that smoking costs the U.S. nation 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 things like social security and Medicare. In fact, if we were truly patriotic, maybe we should be encouraging smoking to help balance the budget.

But they also criticized the Surgeon General for a lack of balance regarding benefits of smoking. One has to search pretty hard to find any concession anywhere in the report that smoking is not all bad, something the tobacco industry liked to bring up when testifying before Congress. 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.

More than 50 studies over the last half century quite unexpectedly showed that tobacco use is associated with a lower incidence of Parkinson’s disease. Now up to more than five dozen studies. Yeah, but smokers are probably dying off before they even have a chance to get Parkinson’s. No, that didn’t seem to be it; they found a protective effect at all ages.

Maybe it’s because smokers tend to be coffee drinkers; we know coffee consumption alone appears protective. But no, the protective effect of smoking remained even after carefully controlling for coffee intake.

Maybe we inherit some propensity to both not smoke and get Parkinson’s. If only we could like 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. Maybe smoking doesn’t protect against Parkinson’s; maybe Parkinson’s protects against smoking. Maybe there’s something about a Parkinson’s brain that makes it easier to quit. Or maybe 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 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 that first Surgeon General’s report. Even if we didn’t care about dying from lung cancer and emphysema, even if we just cared about our brain, we still wouldn’t smoke, because smoking is a significant risk factor for having a stroke. So, why do I even bring this up? Unless there was a way we could get the benefits of smoking without the risks through our diet… which we’ll cover next.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

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