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