Objective The aim of this study was to investigate to which extent Direct-to-Consumer Advertising...
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Objective The aim of this study was to investigate to which extent Direct-to-Consumer Advertising (DTCA) for pharmaceutical is disseminated-if present- in Jordan and to identify gender differences among consumers in this regard. Methodology Two questionnaires were designed for data collection, based on “Consumer’s Reports on the Health Effects of Direct-To-Consumer Advertising” and “Physicians Report on Patient by Encounters Involving Direct-To-Consumer Advertising” by Prof Joel Weissman from Harvard University. The first was distributed to 10% of patients came to the Jordan University Hospital (JUH) from 20-30 Sept 2008 i.e. (550) male and female patients, and-consequently- based on its results a second questionnaire was designed and distributed to 57% (200) male and female in JUHphysicians available in October 2008 Results Background All forms of pharmaceutical promotional activities are widely distributed worldwide including pharmaceutical company’s medical representatives’ visits to physicians, the distribution of leaflets, free medical samples, gifts as well as educational posters and brochures. This kind of promotion is currently permitted in Jordan if directed to health professionals (physicians, pharmacists and even nurses) and not directed to consumers (patients), and if complied with drug promotion code of ethics set by the Jordan Food and Drug Administration (JFDA). Although the latter instructions were announced 2 years ago, the real practice in Jordan is something else. Although regulations in most countries all over the world (except USA and New Zealand) prohibit Direct -to-Consumer Advertising for pharmaceuticals (DTCA), it was widely disseminated recently through television satellite channels and the internet. Many western Non-Governmental Organizations (NGOs) were actively opponent the DTCA, such as the women's movement in The European Parliament is considering allowing the drug industry to have a much greater role in providing information to patients, with no restriction on the type of media. The importance of this study that it is expected to reveal the extent of consumer exposure in Jordan - a man or woman - of the pharmaceutical advertisements against him directly i.e. DTCA specially using modern technology. The practical importance of the study lies in drawing the attention of NGOs in Jordan's civil society to look at the issue of selling the drug to consumers and methods of promoting medicines ensuring its questionable effectiveness and safety (counterfeit drugs). DIRECT–TO–CONSUMER ADVERTISING FOR PHARMACEUTICALS IN JORDAN FROM A GENDER PERSPECTIVE Hadeel Ashour and Ibrahim Alabbadi ABSTRACT Objective: the aim was to investigate to which extent Direct-to- Consumer Advertising (DTCA) for pharmaceuticals is disseminated -if present- in Jordan and to identify gender differences in this regard. Methods: the study was conducted on two samples: the first represents the patients (drug consumers) coming to the Jordan University Hospital and the second represents the physicians working there (the prescribers). Two questionnaires were designed, the first was distributed to (550) male and female patients, and- consequently-based on its results a second questionnaire was designed and distributed to (200) male and female physicians. The response rate was high (513 and 144 respectively). Results: although the Jordanian Drug and Pharmacy Law prohibits promotion of medicines directly to public; either over the counter drugs (OTC) or prescription only drugs (Rx-only), consumers in Jordan were directly exposed to the pharmaceutical advertising through different ways. Both patients and physicians agreed that the most drug class being advertised directly to consumers are vitamins while drugs used to treat mental illness are the least. Unexpectedly, the 10 top drug classes (out of 31 investigated) found to be advertised directly to consumers in Jordan were Rx-only drugs such as antibiotics and diabetes drugs. Although the results revealed that there are no gender differences towards pharmaceutical DTCA (as there are no significant statistical differences; α (0.05 ≥ and in the tools used for pharmaceutical DTCA (α (0.05 ≥ , the results showed a gender gap in most targeted group exposed to pharmaceutical DTCA as approximately 45% agreed that women are more likely to be targeted by DTCA than men, while only 2% believed that men are more likely to be targeted by DTCA than women. Conclusion: it was concluded that the prohibition of pharmaceuticals DTCA did not prevent Jordanians to be exposed to pharmaceuticals DTCA Statistical analysis Demographic data including gender, age, education and profession Health status and sources of information when being ill You refer to: clinicians, advertisements in newspapers, internet, TVs, books, radios, brochures & posters, journals and magazines, medical campaigns, or friends when need medical information Effect of DTCA of pharmaceuticals on behavior when being ill Disease areas in this regard and differences between males & females after exposed to such advertisements respondents answers were on Likert scale from 1-4 SPSS package was used for analyses to describe the sample Analysis of Variance – ANOVA to measure the gender variance-if any Cronbach Alpha was used to measure reliability Major questionnaires domains Patients’ (consumers) percentage use for different media in Jordan Using internet regularly 37% Watching TV regularly 86% Reading magazines 64.7% Media exposure: DTCA for pharmaceuticals in Jordan Media type Mean SD Brochures and Posters 3.28 0.78 1 TV 3.05 . 8790 Newspaper 2.75 . 8940 Magazines 2.63 0.97 9 Medical campaigns 2.60 0.97 4 Internet 2.25 1.12 6 2.13 0.92 8 Gender differences Advertis e by Mean (SD) F- value ) α ( ٭Females Males TV 3.11 (0.861) 2.97 (0.860) 2.889 . 090 0 Newspape r 2.69 (0.924) 2.83 ) 0.848 ( 3.152 . 076 0 Radio 2.09 (0.934) 2.17 (0.920) . 9480 .331 0 Magazine s 2.63 (1.011) 2.64 (0.938) . 0220 .883 0 Internet 2.19 2.33 1.933 . 165 2.61 (1.020) 2.59 (0.910) 0.059 . 808 0 3.24 (0.812) 1.102 Sources of medical information Domain Mean SD Physician visit 3.55 .6830 House medicines insert leaflet 2.79 .9540 Health centre visit 2.76 1.024 Pharmacist consultation 2.60 .8780 Relatives or friends 2.54 .9990 TV or radio program 2.53 .9900 Reading a related medical book 2.52 1.006 Reading brochure or poster 2.23 .9780 Homeopathy 2.00 .9380 Internet search 1.97 1.018 Types of medicines in DTCA Medicines Classifica tion % Vitamins ٭OTC 59.10 Analgesics OTC 57.50 Anti flu OTC 52.00 Anti cough OTC 47.40 For Diabetes ** Rx-only 46.00 Anti Acne Rx-only 44.60 For Obesity Rx-only 41.10 Antibiotics Rx-only 36.60 Contraceptiv es Rx-only 36.50 Anti rheumatics Rx-only 36.10 Anti flatulent OTC 31.20 Appetizers OTC 30.20 Anti cholesterol Rx-only 30.20 Gastro Rx-only 29.40 Sexual disorders Rx-only 28.50 Dysmenorrhea l OTC + Rx- only 28.30 For Osteoporosis Rx-only 24.60 Anti allergy Rx-only 23.60 Cardiovascul ar Rx-only 21.80 Dermatologic al Rx-only 21.40 Asthma Rx-only 20.70 Colon Rx-only 20.30 Ant diarrhea OTC 19.30 Anticancer Rx-only 17.20 Sleep disturbances Rx-only 16.80 Antifungal Rx-only 14.20 Antidepressa nts Rx-only 11.90 Psychiatry Rx-only 8.80 Nocturnal Rx-only 8.80 Menopause Rx-only 8.00 Mental illness Rx-only 2.30 Gender based believes on Reasons behind N=513 Mean SD Less dependent on physician's diagnosis and treatment 1.67 0.871 Didn’t give information about drugs’ benefits and side effects in balance 2.37 0.798 Encourage drug marketing before making sure of its safety and efficacy 2.26 0.852 Considered as a main reason for e of increasing drug cost 2.40 0.719 Lead to buying unnecessary drugs 2.60 0.698 Considered a good source for diagnosis and treatment 2.35 0.855 Helps me to discuss disease/drug with physician/pharmacist more efficiently 2.49 0.816 Gender differences of patients believes N=513 ) α ( ٭F- value ) SD ( Mean females males Less dependent on physician's diagnosis and treatment 0.18 6 1.756 ) 1.095 ( 1.62 (1.129) 1.74 Didn’t give information about drugs’ benefits and side effects in balance 0.98 5 0.000 ) 1.005 ( 2.38 (1.009) 2.37 Encourage drug marketing before making sure of its safety and efficacy 0.04 5 4.057 ) 1.262 ( 2.19 (1.175) 2.35 Considered as a main reason for e of increasing drug cost 0.70 1 0.147 ) 1.007 ( 2.39 (0.948) 2.40 Lead to buying unnecessary drugs 0.86 6 0.029 ) 0.993 ( 2.59 (0.927) 2.60 Considered a good source for diagnosis and treatment 0.22 4 1.484 (1.100) 2.38 (1.083) 2.30 disease/drug with physician/pharmacist more 0.49 6 ) 1.010 ( 2.52 (1.083) 2.45 Target group response (gender wise) No . % Women > men 217 42.3 Men > women 16 3.1 Women=men 157 30.6 Not sure 123 24.0 total 513 100 Reasons behind targeting women > men N=217 Yes % Women are influenced more than men when exposed to drugs advertising 94.1 Women are exposed more to advertising media 89.1 Most of drugs’ advertisements are concerned with drugs to treat women 86.9 Internationally, women are in charge of health care in the family 79.0 Women visit pharmacies more than men 75.9 Over The Counter Drugs, * (OTC) Prescription Only Drugs,(** Rx-only) Mean values: Sig. α ≥ 0.05 1= never, 2= rarely, 3=sometimes, 4= almost Conclusion Prohibition of pharmaceuticals DTCA did not prevent Jordanians to be exposed to it
Transcript of Objective The aim of this study was to investigate to which extent Direct-to-Consumer Advertising...
Objective The aim of this study was to investigate to which extent Direct-to-Consumer Advertising (DTCA) for pharmaceutical is disseminated-if present- in Jordan and to identify gender differences among consumers in this regard.
MethodologyTwo questionnaires were designed for data collection, based on “Consumer’s Reports on the Health Effects of Direct-To-Consumer Advertising” and “Physicians Report on Patient by Encounters Involving Direct-To-Consumer Advertising” by Prof Joel Weissman from Harvard University. The first was distributed to 10% of patients came to the Jordan University Hospital (JUH) from 20-30 Sept 2008 i.e. (550) male and female patients, and-consequently-based on its results a second questionnaire was designed and distributed to 57% (200) male and female in JUHphysicians available in October 2008
Results
Background
All forms of pharmaceutical promotional activities are widely distributed worldwide including pharmaceutical company’s medical representatives’ visits to physicians, the distribution of leaflets, free medical samples, gifts as well as educational posters and brochures. This kind of promotion is currently permitted in Jordan if directed to health professionals (physicians, pharmacists and even nurses) and not directed to consumers (patients), and if complied with drug promotion code of ethics set by the Jordan Food and Drug Administration (JFDA). Although the latter instructions were announced 2 years ago, the real practice in Jordan is something else. Although regulations in most countries all over the world (except USA and New Zealand) prohibit Direct -to-Consumer Advertising for pharmaceuticals (DTCA), it was widely disseminated recently through television satellite channels and the internet. Many western Non-Governmental Organizations (NGOs) were actively opponent the DTCA, such as the women's movement in The European Parliament is considering allowing the drug industry to have a much greater role in providing information to patients, with no restriction on the type of media. The importance of this study that it is expected to reveal the extent of consumer exposure in Jordan - a man or woman - of the pharmaceutical advertisements against him directly i.e. DTCA specially using modern technology. The practical importance of the study lies in drawing the attention of NGOs in Jordan's civil society to look at the issue of selling the drug to consumers and methods of promoting medicines ensuring its questionable effectiveness and safety (counterfeit drugs).
DIRECT–TO–CONSUMER ADVERTISING FOR PHARMACEUTICALS IN JORDAN FROM A GENDER PERSPECTIVE
Hadeel Ashour and Ibrahim Alabbadi
ABSTRACTObjective: the aim was to investigate to which extent Direct-to-Consumer Advertising (DTCA) for pharmaceuticals is disseminated -if present- in Jordan and to identify gender differences in this regard. Methods: the study was conducted on two samples: the first represents the patients (drug consumers) coming to the Jordan University Hospital and the second represents the physicians working there (the prescribers). Two questionnaires were designed, the first was distributed to (550) male and female patients, and-consequently-based on its results a second questionnaire was designed and distributed to (200) male and female physicians. The response rate was high (513 and 144 respectively).Results: although the Jordanian Drug and Pharmacy Law prohibits promotion of medicines directly to public; either over the counter drugs (OTC) or prescription only drugs (Rx-only), consumers in Jordan were directly exposed to the pharmaceutical advertising through different ways. Both patients and physicians agreed that the most drug class being advertised directly to consumers are vitamins while drugs used to treat mental illness are the least. Unexpectedly, the 10 top drug classes (out of 31 investigated) found to be advertised directly to consumers in Jordan were Rx-only drugs such as antibiotics and diabetes drugs. Although the results revealed that there are no gender differences towards pharmaceutical DTCA (as there are no significant statistical differences; α ≥ (0.05and in the tools used for pharmaceutical DTCA (α≥ (0.05, the results showed a gender gap in most targeted group exposed to pharmaceutical DTCA as approximately 45% agreed that women are more likely to be targeted by DTCA than men, while only 2% believed that men are more likely to be targeted by DTCA than women. Conclusion: it was concluded that the prohibition of pharmaceuticals DTCA did not prevent Jordanians to be exposed to pharmaceuticals DTCA
Statistical analysis
Demographic data including gender, age, education and profession
Health status and sources of information when being ill
You refer to: clinicians, advertisements in newspapers, internet,
TVs, books, radios, brochures & posters, journals and magazines,
medical campaigns, or friends when need medical information
Effect of DTCA of pharmaceuticals on behavior when being ill
Disease areas in this regard and differences between males &
females after exposed to such advertisements
respondents answers were on Likert scale from 1-4
SPSS package was used for analyses to describe the sample
Analysis of Variance – ANOVA to measure the gender variance-if any
Cronbach Alpha was used to measure reliability
Majorquestionnaires
domains
Patients’ (consumers) percentage use for different media in Jordan
Using internet regularly 37%
Watching TV regularly 86%
Reading magazines 64.7%
Reading newspapers 88.1%
Media exposure: DTCA for pharmaceuticals in JordanMedia type Mean SD
Brochures and Posters
3.28 0.781
TV 3.05 .8790Newspaper 2.75 .8940Magazines 2.63 0.979Medical campaigns 2.60 0.974
Internet 2.251.126
Radio 2.13 0.928Gender differencesAdvertise
byMean (SD) F-
value(α)٭
Females Males
TV3.11
)0.861( 2.97
)0.860(2.889 .0900
Newspaper
2.69 )0.924(
2.83) 0.848 ( 3.152 .0760
Radio2.09
)0.934(2.17
)0.920(.9480 .3310
Magazines
2.63 )1.011(
2.64 )0.938(
.0220 .8830
Internet2.19
)1.133(2.33
)1.115(1.933 .1650
Medical campaigns
2.61 )1.020(
2.59 )0.910(
0.059 .8080
Brochures and posters
3.31 )0.757(
3.24 )0.812(
1.102 0.294
Sources of medical informationDomain Mean SD
Physician visit 3.55 .6830House medicines insert leaflet
2.79 .9540
Health centre visit 2.76 1.024Pharmacist consultation 2.60 .8780Relatives or friends 2.54 .9990TV or radio program 2.53 .9900Reading a related medical book 2.52 1.006Reading brochure or poster 2.23 .9780Homeopathy 2.00 .9380Internet search 1.97 1.018
Types of medicines in DTCAMedicines Classification %Vitamins OTC٭ 59.10Analgesics OTC 57.50Anti flu OTC 52.00Anti cough OTC 47.40For Diabetes **Rx-only 46.00Anti Acne Rx-only 44.60For Obesity Rx-only 41.10Antibiotics Rx-only 36.60Contraceptives Rx-only 36.50Anti rheumatics Rx-only 36.10Anti flatulent OTC 31.20Appetizers OTC 30.20Anti cholesterol Rx-only 30.20Gastro Rx-only 29.40Sexual disorders Rx-only 28.50Dysmenorrheal OTC + Rx-only 28.30For Osteoporosis Rx-only 24.60Anti allergy Rx-only 23.60Cardiovascular Rx-only 21.80Dermatological Rx-only 21.40Asthma Rx-only 20.70Colon Rx-only 20.30Ant diarrhea OTC 19.30Anticancer Rx-only 17.20Sleep disturbances Rx-only 16.80Antifungal Rx-only 14.20Antidepressants Rx-only 11.90Psychiatry Rx-only 8.80Nocturnal Rx-only 8.80Menopause Rx-only 8.00Mental illness Rx-only 2.30
Gender based believes on Reasons behind targeting women > men
N=513 Mean SDLess dependent on physician's diagnosis and treatment
1.67 0.871
Didn’t give information about drugs’ benefits and side effects in balance
2.37 0.798
Encourage drug marketing before making sure of its safety and efficacy
2.26 0.852
Considered as a main reason for e of increasing drug cost
2.40 0.719
Lead to buying unnecessary drugs 2.60 0.698
Considered a good source for diagnosis and treatment
2.35 0.855
Helps me to discuss disease/drug with physician/pharmacist more efficiently
2.49 0.816
Gender differences of patients believes
N=513 (α)٭ F-value( SD )Mean
females malesLess dependent on physician's diagnosis and treatment
0.186 1.756)1.095 (
1.62(1.129)
1.74Didn’t give information about drugs’ benefits and side effects in balance
0.985 0.000)1.005 (
2.38(1.009)
2.37Encourage drug marketing before making sure of its safety and efficacy
0.045 4.057)1.262 (
2.19(1.175)
2.35
Considered as a main reason for e of increasing drug cost
0.701 0.147)1.007 (
2.39(0.948)
2.40
Lead to buying unnecessary drugs 0.866 0.029)0.993 (
2.59(0.927)
2.60Considered a good source for diagnosis and treatment
0.224 1.484(1.100)
2.38(1.083)
2.30Helps me to discuss disease/drug with physician/pharmacist more efficiently
0.496 0.467)1.010 (
2.52(1.083)
2.45
Target group response (gender wise)
No. %Women > men 217 42.3
Men > women 16 3.1
Women=men 157 30.6
Not sure 123 24.0
total 513 100
Reasons behind targeting women > men N=217 Yes %Women are influenced more than men when exposed to drugs advertising
94.1
Women are exposed more to advertising media 89.1Most of drugs’ advertisements are concerned with drugs to treat women
86.9
Internationally, women are in charge of health care in the family
79.0
Women visit pharmacies more than men 75.9
Over The Counter Drugs, * (OTC)Prescription Only Drugs,(** Rx-only)
Mean values: Sig. α ≥ 0.051= never, 2= rarely, 3=sometimes, 4= almost
ConclusionProhibition of pharmaceuticals DTCA did not prevent Jordanians to be exposed to it
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