DIRECT–TO–CONSUMER ADVERTISING FOR PHARMACEUTICALS IN JORDAN FROM A GENDER PERSPECTIVE
Hadeel Ashour and Ibrahim Alabbadi
Background
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 (α0.05( ≥, 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
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-consequentlybased on its results a second questionnaire was designed and distributed to 57% (200)
male and female in JUHphysicians available in October 2008
 respondents answers were on Likert scale from 1-4
Statistical
analysis
 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
 Demographic data including gender, age, education and profession
 Health status and sources of information when being ill
Major
questionnaires
domains
 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
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).
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.
Results
Patients’ (consumers) percentage
use for different media in Jordan
37%
Using internet regularly
Watching TV regularly
86%
Reading magazines
64.7%
Reading newspapers
88.1%
Media exposure: DTCA for
pharmaceuticals in Jordan
Media type
Mean
SD
Brochures and Posters
TV
Newspaper
Magazines
Medical campaigns
Internet
Radio
3.28
3.05
2.75
2.63
2.60
2.25
2.13
0.781
0.879
0.894
0.979
0.974
1.126
0.928
Gender differences
Advertise
Mean (SD)
F-value ‫)٭‬α(
Females
Males
by
TV
3.11 (0.861) 2.97 (0.860) 2.889 0.090
Newspaper 2.69 (0.924) 2.83 (0.848) 3.152 0.076
Radio
2.09 (0.934) 2.17 (0.920) 0.948 .3310
Magazines 2.63 (1.011) 2.64 (0.938) 0.022 .8830
Internet
2.19 (1.133) 2.33 (1.115) 1.933 0.165
Medical
2.61 (1.020) 2.59 (0.910) 0.059 0.808
campaigns
Brochures
3.31 (0.757) 3.24 (0.812) 1.102 0.294
and posters
Sources of medical information
Domain
Mean
Physician visit
3.55
House medicines insert leaflet
2.79
Health centre visit
2.76
Pharmacist consultation
2.60
Relatives or friends
2.54
2.53
TV or radio program
2.52
Reading a related medical book
2.23
Reading brochure or poster
Homeopathy
2.00
Internet search
1.97
SD
.6830
.9540
1.024
.8780
.9990
.9900
1.006
.9780
.9380
1.018
Types of medicines in DTCA
%
Medicines
Classification
OTC‫٭‬
Vitamins
59.10
OTC
Analgesics
57.50
OTC
Anti flu
52.00
OTC
Anti cough
47.40
Rx-only**
For Diabetes
46.00
Rx-only
Anti Acne
44.60
Rx-only
For Obesity
41.10
Rx-only
Antibiotics
36.60
Rx-only
Contraceptives
36.50
Rx-only
Anti rheumatics
36.10
OTC
Anti flatulent
31.20
OTC
Appetizers
30.20
Rx-only
Anti cholesterol
30.20
Rx-only
Gastro
29.40
Rx-only
Sexual disorders
28.50
OTC + Rx-only 28.30
Dysmenorrheal
Rx-only
For Osteoporosis
24.60
Rx-only
Anti allergy
23.60
Rx-only
Cardiovascular
21.80
Rx-only
Dermatological
21.40
Rx-only
Asthma
20.70
Rx-only
Colon
20.30
OTC
Ant diarrhea
19.30
Rx-only
Anticancer
17.20
Rx-only
Sleep disturbances
16.80
Rx-only
Antifungal
14.20
Rx-only
Antidepressants
11.90
Rx-only
Psychiatry
8.80
Rx-only
Nocturnal
8.80
Rx-only
Menopause
8.00
Rx-only
Mental illness
2.30
Over The Counter Drugs, * (OTC)
Prescription Only Drugs,(** Rx-only)
Mean values: Sig. α ≥ 0.05
1= never, 2= rarely, 3=sometimes,
4= almost
Target group response (gender wise)
No.
%
Women > men
217
42.3
Men > women
16
3.1
Women=men
157
30.6
Not sure
total
123
513
24.0
100
Gender differences of patients believes
‫)٭‬α(
F-value
0.186
1.756
0.985
0.000
Encourage drug marketing before
making sure of its safety and efficacy
0.045
4.057
Considered as a main reason for e of
increasing drug cost
0.701
0.147
Lead to buying unnecessary drugs
0.866
0.029
0.224
1.484
0.496
0.467
N=513
Less dependent on physician's
diagnosis and treatment
Didn’t give information about drugs’
benefits and side effects in balance
Considered a good source for
diagnosis and treatment
Helps me to discuss disease/drug
with physician/pharmacist more
efficiently
(SD) Mean
females
males
(1.095)
(1.129)
1.62
1.74
(1.005)
(1.009)
2.38
2.37
(1.262)
2.19
(1.175)
2.35
(1.007)
2.39
(0.993)
2.59
(1.100)
2.38
(0.948)
2.40
(0.927)
2.60
(1.083)
2.30
(1.010)
2.52
(1.083)
2.45
Reasons behind targeting women > men
N=217
% Yes
Women are influenced more than men when
94.1
exposed to drugs advertising
Women are exposed more to advertising media 89.1
Most of drugs’ advertisements are concerned
86.9
with drugs to treat women
Internationally, women are in charge of health
79.0
care in the family
Women visit pharmacies more than men
75.9
Gender based believes on Reasons behind targeting
women > men
N=513
Mean
SD
Less dependent on physician's diagnosis
1.67
0.871
and treatment
Didn’t give information about drugs’
2.37
0.798
benefits and side effects in balance
Encourage drug marketing before
2.26
0.852
making sure of its safety and efficacy
Considered as a main reason for e of
2.40
0.719
increasing drug cost
Lead to buying unnecessary drugs
Considered a good source for diagnosis
Conclusion
and treatment
Prohibition of pharmaceuticals DTCA did Helps me to discuss disease/drug with
not prevent Jordanians to be exposed to it physician/pharmacist more efficiently
2.60
0.698
2.35
0.855
2.49
0.816