1. 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 ≥ (0.05and 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 Major questionnaires domains Patients’ (consumers) percentage use for different media in Jordan 37% Using internet regularly 86%Watching TV regularly 64.7%Reading magazines 88.1%Reading newspapers Media exposure: DTCA for pharmaceuticals in Jordan SDMeanMedia type 0.7813.28Brochures and Posters.879 0 3.05 TV.894 0 2.75 Newspaper 0.9792.63 Magazines 0.9742.6 0 Medical campaigns 1.1262.25 Internet 0.9282.13 Radio Gender differences (α)٭(α)٭F-value Mean (SD)Advertise by MalesFemales.090 0 2.8892.97 (0.860)3.11 (0.861)TV.076 0 3.1522.83 (0.848)2.69 (0.924)Newspaper.331 0.94802.17 (0.920)2.09 (0.934)Radio.883 0.022 0 2.64 (0.938)2.63 (1.011)Magazines.165 0 1.9332.33 (1.115)2.19 (1.133)Internet.8080 0.0592.59 (0.910)2.61 (1.020) Medical campaigns 0.2941.1023.24 (0.812)3.31 (0.757) Brochures and posters Sources of medical information SD MeanDomain.683 0 3.55Physician visit.954 0 2.79 House medicines insert leaflet 1.0242.76Health centre visit.878 0 2.60Pharmacist consultation.999 0 2.54Relatives or friends.990 0 2.53 TV or radio program 1.0062.52 Reading a related medical book.978 0 2.23 Reading brochure or poster.938 0 2.00Homeopathy 1.0181.97 Internet search Types of medicines in DTCA %ClassificationMedicines 59.10 ٭ OTC Vitamins 57.50 OTC Analgesics 52.00 OTC Anti flu 47.40 OTC Anti cough 46.00 **Rx-only For Diabetes 44.60 Rx-only Anti Acne 41.10 Rx-only For Obesity 36.60 Rx-only Antibiotics 36.50 Rx-only Contraceptives 36.10 Rx-only Anti rheumatics 31.20 OTC Anti flatulent 30.20 OTC Appetizers 30.20 Rx-only Anti cholesterol 29.40 Rx-only Gastro 28.50 Rx-only Sexual disorders 28.30 OTC + Rx-only Dysmenorrheal 24.60 Rx-only For Osteoporosis 23.60 Rx-only Anti allergy 21.80 Rx-only Cardiovascular 21.40 Rx-only Dermatological 20.70 Rx-only Asthma 20.30 Rx-only Colon 19.30 OTC Ant diarrhea 17.20 Rx-only Anticancer 16.80 Rx-only Sleep disturbances 14.20 Rx-only Antifungal 11.90 Rx-only Antidepressants 8.80 Rx-only Psychiatry 8.80 Rx-only Nocturnal 8.00 Rx-only Menopause 2.30 Rx-only Mental illness Gender based believes on Reasons behind targeting women > men SDMeanN=513 0.8711.67 Less dependent on physician's diagnosis and treatment 0.7982.37 Didn’t give information about drugs’ benefits and side effects in balance 0.8522.26 Encourage drug marketing before making sure of its safety and efficacy 0.7192.40 Considered as a main reason for e of increasing drug cost 0.6982.60Lead to buying unnecessary drugs 0.8552.35 Considered a good source for diagnosis and treatment 0.8162.49 Helps me to discuss disease/drug with physician/pharmacist more efficiently Gender differences of patients believes (SD) Mean F-value(α)٭(α)٭N=513 malesfemales (1.129) 1.74 (1.095) 1.62 1.7560.186 Less dependent on physician's diagnosis and treatment (1.009) 2.37 (1.005) 2.38 0.0000.985 Didn’t give information about drugs’ benefits and side effects in balance (1.175) 2.35 (1.262) 2.19 4.0570.045 Encourage drug marketing before making sure of its safety and efficacy (0.948) 2.40 (1.007) 2.39 0.1470.701 Considered as a main reason for e of increasing drug cost (0.927) 2.60 (0.993) 2.59 0.0290.866Lead to buying unnecessary drugs (1.083) 2.30 (1.100) 2.38 1.4840.224 Considered a good source for diagnosis and treatment (1.083) 2.45 (1.010) 2.52 0.4670.496 Helps me to discuss disease/drug with physician/pharmacist more efficiently Target group response (gender wise) %No. 42.3217Women > men 3.116Men > women 30.6157Women=men 24.0123Not sure 100513total Reasons behind targeting women > men Yes %N=217 94.1Women are influenced more than men when exposed to drugs advertising 89.1Women are exposed more to advertising media 86.9Most of drugs’ advertisements are concerned with drugs to treat women 79.0Internationally, women are in charge of health care in the family 75.9Women visit pharmacies more than men 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