Misleading people about risk of tobacco products: unethical and harmful Clive Bates, Counterfactual 29 September 2014 This paper uses an inappropriate and unethical experiment to advocate misleading people about risk in order to modify their behaviour in ways that the authors favour. The authors appear untroubled by the fact that smokeless tobacco and e-cigarettes actually are of the order 95-100% less risky than smoking . If you smoke this is important health-sensitive information. If you don't smoke, this information is merely true. Yet the authors advocate removing any communications of the truthful relative risk and replacing these with a text warning [not a safer alternative to cigarettes] that is misleading, or, even worse, graphic warnings suggesting that smokeless tobacco and e-cigarettes cause oral cancer. There is not one single piece of evidence from anywhere that e-cigarettes cause oral cancer, and there is not even a speculative mechanism that has been identified by which it would be plausible. The communication is pure fabrication. Likewise, the most recent assessments of modern American and Scandinavian smokeless tobacco also suggest zero or minimal risk of oral cancer  - yet the risks of smoking are well understood and orders of magnitude greater than either use of smokeless tobacco or e-cigarettes. The authors appear oblivious to the potential harms that may arise from misleading people about the risk of alternatives to cigarettes - namely that they will continue to smoke or start using cigarettes unaware that there are much lower risk alternatives that they could choose instead. It appears that the authors approach is to mislead subjects of the experiment in order to increase the subjects' aversion to using these products. On the basis of results showing that they are 'successful' in creating false perceptions of risk, they make a policy proposal to generalise this to a regulatory intervention. The ethics of deceiving people with false or misleading information deserves greater scrutiny given the harm it can cause, and the individuals and institutions that engage in this disreputable practice this should face professional sanctions . I am surprised that this paper is published without some challenge on these themes from peer reviewers.  Hajek P, Etter J-F, Benowitz N, et al. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction 2014;:n/a–n/a. doi:10.1111/add.12659  Lee PN. Summary of the epidemiological evidence relating snus to health. Regul Toxicol Pharmacol2011;59:197–214. doi:10.1016/j.yrtph.2010.12.002  Lee PN, Hamling J. Systematic review of the relation between smokeless tobacco and cancer in Europe and North America. BMC Med 2009;7:36. doi:10.1186/1741-7015-7-36  Kozlowski LT, O’Connor RJ. Apply federal research rules on deception to misleading health information: an example on smokeless tobacco and cigarettes. Public Health Rep;118:187–92. Competing interests None.