Gizeller Baker is the Vice President of Global Scientific Engagement at Philip Morris International. She leads a team of scientists who are engaging and sharing the science behind PMI’s non-combustible alternatives to facilitate awareness and understanding of tobacco harm reduction. She also led the Epidemiology and Biostatistics team within the department responsible for designing and conducting clinical and post-market assessment programs.

She has 18 years of experience in biostatistics and data management and has published numerous articles in international scientific journals. Gizelle, a Canadian by birth, holds a Ph.D. in biometry and epidemiology from the Medical University of South Carolina, USA.

Following are the edited excerpts of a recent conversation BR Research had with her:

BR Research: Tell us about the heated tobacco products and alternatives to smoking that you have been working on at PMI.

Gizelle Baker: There are two key characteristics of such a product. The first is that smoke has solid and liquid particles; the solid particles remain suspended in the air for much longer and embed in things like fabric. So traditional tobacco smoke in a room dissipates very slowly. On the other hand, the aerosol from the heated tobacco product doesn't burn, and the solid particles aren't there. So you are dealing with liquid droplets in the aerosol that evaporate quickly and dissipate. Since it remains in the air much less than traditional smoke, the chances of people getting exposed to it also decrease tremendously.

Secondly, over 85 percent of environmental tobacco smoke is generated from sidestream smoke, which comes directly from burning cigarettes, cigars, or smoking pipes. There is no sidestream smoke in a heated tobacco product, which means that 85 percent of smoke is eliminated immediately. Also, there is a reduction in aerosol exhaled, which is 90-95 percent less toxic than regular smoke.

We have ISO qualified indoor air quality laboratory where we run tests to replicate what it's like in a house with very low air turnover or work settings and in hospitality settings where air turnover is much higher. These tests are done three times: once with only people in the room (the background test), once with people in the room smoking cigarettes, and once with people in the room using heated tobacco. We found that only three chemical products could be detected when heated tobacco was used above the background. And these were multiple times lower than what is produced by a regular cigarette. They were also below the limits set in indoor air quality guidelines under similar conditions, like inside a house or a workplace. From all this, we concluded that the use of the product indoors does not negatively impact the air quality because the levels do not rise above the background.

We have also looked at passive exposure, e.g., what happens to people who are non-smokers and may be in a restaurant setting and use heated tobacco products. We found out that the level of exposure was again multiple times lower with heated tobacco products than the passive exposure from cigarettes.

BRR: Compared to a regular cigarette, the alternatives are the vape, heated tobacco, and nicotine pouches. Do you think people could eventually be shifted to nicotine pouches and quit smoking because of the negligible environmental impact and passive exposure?

GB: The pouches have the most negligible impact on the people around because you are essentially exhaling nothing into the air. But it would help if you considered how to get people away from cigarettes. Each smoker smokes for different reasons and finds satisfaction in another product. And pouches might not be the ultimate choice for some because they don't deliver the ritual and the sensory experience. This is also why nicotine patches don't help everyone quit smoking. So we have to balance the two sides of the equation in terms of population harm: you have to balance what it means in a passive setting, but you also have to look at how to maximize the number of people who quit.

BRR: Definitely, having a broader portfolio that addresses the needs, as well as the health concerns, works for you. But a country like Pakistan, where 80 billion cigarette sticks are consumed, translates into 20 million active smokers and most smoking cheap cigarettes. The alternatives are much more expensive. How will such products work here, and what are you doing about it?

GB: You are correct. One way to look at it is the cost burden – how do you sell these products? Even in the US, these products are sold on a lease because it is difficult to convince them to invest all the money upfront for the device when motivating them to quit smoking. It was how we incentivize financial ways to deliver a product that might be a burden preventing people from entering this phase. There are a lot of interesting financial models when selling phones and other electronics that we can also adopt for our devices and alternatives for cigarette smoking. We have to think outside the box.

BRR: Alternatives to cigarettes and products that help quit smoking are best suited for those already smoking. But what are the reasons for so many youngsters taking up smoking?

GB: In general, how cigarette smoking is viewed has changed. Smoking has a lot to do with the educational as well as cultural and societal aspects. You also have to consider that even countries that have made tremendous progress have segments of the population that you can feel left behind. E.g., the smoking rates of manual labor in the UK look a lot like they did 12 years ago at the population level. Similarly, the unemployed segments of the population or those exposed to high-stress levels like the military are smoking more. Who is predisposed or who will take up smoking is not identical across the board; we have to look at the cultural and societal pressures and the context. How do we address it? We must do it through regulation, education, and helping people have alternatives, not just for those who already smoke but also other means for young people and minimize the risk of habitual smoking.

BRR: How would you recommend that these alternatives to smoking are regulated and communicated in Pakistan? And do you think these alternatives and regulations could end smoking sometime in the future?

GB: You don't want your youth population starts using nicotine. So there needs to be some regulation to limit the access to such products for youth. But you also need to ensure that it is more than just the regulation you enforce. Saying that you have to be a certain age to buy it but selling it to people anyhow is not wouldn't help. You need a regulatory structure, but the enforcement piece of the puzzle must be put in place. With these alternative devices, I would say that it's a little easier to regulate access – which does prevent people from using them but prevents them from being accessible to youth and things like device sophistication can be a help.

There is a need for a proper framework: it is not prudent to completely ban such products, as that will give rise to even more influx via the black market. Instead, it is recommended that sensible measures are taken to regulate these products to prevent youth access and protect consumers - research has shown that smokers will move away from deadly smoking in favor of less harmful nicotine products if given a chance. An end to smoking is within reach - if we take a sensible approach and create a proper framework around it.