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September 20, 2000

Relationship Between Caffeine Intake and Parkinson Disease—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(11):1378-1379. doi:10.1001/jama.284.11.1378

In Reply: We agree with Dr Honig that "association does not prove causation," and we clearly stated that the observational nature of our study does not support the conclusion that coffee or caffeine are protective against PD. How others report or interpret our results is beyond our control.

We also agree that very early PD may affect the development of habits such as coffee drinking, cigarette smoking, and alcohol consumption that characteristically begin in late adolescence or early adulthood. As Honig points out, we noted that individuals with a constitutional propensity to develop PD could have a physiological intolerance to caffeine. Honig states that individuals with preclinical PD may have a "neurophysiologically based disinclination" to caffeine use. The distinction between "physiological intolerance" and "neurophysiologically based disinclination" is not clear to us. We also disagree with Honig's statement that patients destined to develop PD are symptomatic for 5 to 20 years preceding diagnosis, as there is no evidence for this assertion.