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In this series’ first two articles, Tansa reported how, through their respective subsidiaries, Dentsu compensated Kyodo News for publication of an article about blood thinners. The article was carried in eight regional newspapers in June and July of 2013. The Kyodo News senior staff writer who penned the article told us, “I suppose I must say that I was [aware that money changed hands].”

The article was presented to readers as normal news and contained no mention of being a paid promotion. But, in reality, it had been based on a press release made by Dentsu Public Relations, a Dentsu subsidiary. The Kyodo staff writer had lifted the article’s quote from a doctor straight from the press release, without interviewing the man himself. We also revealed how the Dentsu Group was using a national health campaign to further its business.

Centered on our interview with the former Dentsu PR employee who had handled the article, this time we will delve into how Dentsu PR approached the Kyodo camp about running a story, including their communications and payment arrangement.

In fact, the article about blood thinners wasn’t a one-off. Another was released in October 2013 — penned by the same Kyodo staff writer, handled by the same Dentsu PR employee, and prompted by the same pharmaceutical company’s commission to Dentsu. Payment for the second article’s “successful publication” was 600,000 yen (about $5,500), bringing the total paid for articles about blood thinners to 1.15 million yen (about $10,500).

If too effective, blood thinners can cause cerebral bleeding, sometimes resulting in death. Getting the dosage right is tricky. Nevertheless, according to the former Dentsu PR employee, “Articles about life-threatening matters are easy to get published.”

“Naturally, some article ideas are bad”

A little past 1 p.m. on Jan. 6, 2017, we met with a former Dentsu PR employee in Tokyo’s Bunkyo City. The man, in his 50s, had been the one to bring the press release about blood thinners to K.K. Kyodo. He had left Dentsu PR and was currently working for another company.

The article about blood thinners, which we covered in the first part of this series, was released by Kyodo News at 12:22 p.m. on May 29, 2013. It was picked up by eight regional newspapers in June and July of that year. Dentsu PR, which had received the assignment from its parent company Dentsu, paid Kyodo News’ 100% subsidiary K.K. Kyodo 550,000 yen (about $5,000) after the article was released.

We wondered why Dentsu PR had taken the article request to K.K. Kyodo rather than bring it up directly with Kyodo News, the media organization that eventually disseminated it.

“What determines whether Dentsu PR takes article ideas directly to Kyodo News or to K.K. Kyodo?” we asked.

“Although of course [Kyodo News] is the priority, they don’t accept all our proposals,” the former Dentsu PR employee explained. “Naturally, some article ideas are bad, but maybe the way we presented them is at fault. When that happens, we consult with K.K. Kyodo.”

So Dentsu PR relied on K.K. Kyodo to smooth the way for article ideas that Kyodo News’ reporters weren’t eager to take on.

“What do you think about this strategy of working through K.K. Kyodo to get to Kyodo News?”

“I never saw it that way,” he replied. “I mean, it was easy enough to do, and we’ve got to make our quotas in the sales section. We’ve got to make a certain amount every six months.”

The former employee explained that, for example, if Dentsu PR receives 1.5 million yen from a client company but pays K.K. Kyodo 500,000 yen in “media expenses,” the ad agency only nets 1 million yen.

In order to increase profits, it’s preferable to directly ask Kyodo News reporters for articles without going through K.K. Kyodo. But that leaves the decision to publish to the reporters. If a reporter decides that an idea doesn’t have news value, no article.

In those cases, Dentsu PR resorts to plan B: “consult with K.K. Kyodo,” as the former employee put it.

“[K.K. Kyodo] also includes former [Kyodo News] employees, so naturally they know what kind of article is more likely to get published,” he said. “They spruce up our article ideas a little before sending them on to Kyodo News. But we don’t compensate them at that stage. You could say it’s a kind of payment for successful publication.”

Money only changed hands after an article was released.

Another individual familiar with Dentsu said, “Usually, Dentsu PR takes article ideas that would be difficult to get published to K.K. Kyodo rather than to Kyodo News, and the ad agency says it’ll pay K.K. Kyodo following publication.”

A K.K. Kyodo representative explained that “K.K. Kyodo received remuneration from Dentsu PR as consideration for PR activities.”

The former Dentsu PR employee said that remuneration wasn’t related to the number of regional newspapers that carried the article. He described the process as “They’d tell us ‘it’s out [the article has been released],’ and then we’d give them a little something for it.”

Payments recorded in Dentsu Group internal documents obtained by Tansa match the former employee’s account.

Here’s the record of the payment made for the first article about blood thinners, introduced in part one of this series.

Payment for: Support in promoting blood thinners
Expense date: June 2013
Client: Bayer Yakuhin
Payee: K.K. Kyodo News
Payment amount: 550,000 yen
Expense type: Media expense

Kyodo News released the article on May 29, 2013, and Dentsu PR paid K.K. Kyodo 550,000 yen in June 2013. The former Dentsu PR employee’s expression “payment for successful publication” referred to this practice of compensation following an article’s release.

The article was picked up by eight regional newspapers, with a total of over 1.8 million copies printed.

Blood thinners are used to prevent stroke. In 2015, 64,523 people died from strokes in Japan. Strokes cause about 60% of deaths from cerebrovascular disease, the fourth leading cause of death in the country.

“Articles about widespread, life-threatening matters are easy to get published,” said the former Dentsu PR employee.

600,000 yen for the second article

The article about blood thinners we first raised issue with was published in regional newspapers in June and July of 2013. In October of that year, Kyodo News released another compensated article on the same subject.

The second article was picked up by 10 regional papers in October and by one in December, with a total of over 3.4 million copies printed. This time, the papers included the prominent Kahoku Shimpo and Chugoku Shimbun. Although the Shimotsuke Shimbun, Saga Shimbun, and Okinawa Times had published the first blood thinners article, they didn’t run the second.

The following chart has a full list of newspapers that published the compensated articles about blood thinners in 2013 (cities where the papers’ headquarters are located are given in parentheses).

Once again, Dentsu PR paid K.K. Kyodo following the article’s release. Here’s how it was recorded in the Dentsu Group internal documents.

Payment for: Support in promoting awareness about atrial fibrillation
Expense date: October 2013
Client: Bayer Yakuhin
Payee: K.K. Kyodo News
Payment amount: 600,000 yen
Expense type: Media expense

According to an individual familiar with Dentsu, “media expenses” refer to compensation paid to media organization such as newspapers, magazines, and TV stations for publishing ads.

K.K. Kyodo was paid 550,000 yen (about $5,000) yen for the first article and 600,000 yen (about $5,500) for the second.

A total of 1.15 million yen (about $10,500) changed hands for articles about blood thinners.

Number of atrial fibrillation patients “twice the existing estimate”

Let’s take a look at the second article.

Once again, it was about a survey conducted by the Healthy Japan 21 Promotion Forum. The forum was managed by Dentsu PR and was chaired by Japanese Association of Medical Sciences President Fumimaro Takaku. Please refer to this series’ second article for a detailed account of the relationship between the forum and Dentsu PR.

The second blood thinner article’s main points were as follows.

1. According to an internet survey of 26,130 women and men 60 and over, one in 10 men 65 and over have been diagnosed with atrial fibrillation.

2. The “one in 10 men 65 and over have atrial fibrillation” figure is about twice the existing estimate based on periodic health examinations.

3. Among the people who answered that they had been diagnosed with arterial fibrillation, almost 40% are currently not receiving treatment.

4. In order to prevent stroke, these individuals should choose a blood thinner compatible with their lifestyle and continue to take it for the rest of their life.

Here’s the full text of the article.

“One in 10 men aged 65 and over have been diagnosed with arterial fibrillation, putting them at risk of stroke. This figure, about twice the existing estimate based on periodic health examinations, was revealed through a survey conducted by the Healthy Japan 21 Promotion Forum (chaired by University of Tokyo Professor Emeritus Fumimaro Takaku).

“The survey, conducted online this past summer, was completed by 26,130 men and women aged 60 and over. Among the respondents, 1,793 had been diagnosed with arterial fibrillation, revealing that 7.7% of people 60 and over have the condition.

“Arterial fibrillation is a kind of abnormal heart rhythm in which the heart’s atrial chambers beat irregularly. It is more common in the elderly. At 10.7%, one in 10 men aged 65 and over have been diagnosed with arterial fibrillation.

“Among the 1,793 people who responded that they had received a diagnosis, only 61.1% were currently receiving treatment. With 19.8% having received treatment in the past and 19.1% having never received treatment, nearly 40% of respondents were currently not receiving treatment for the condition.

“Additionally, in a concurrently conducted survey of 250 individuals receiving treatment for arterial fibrillation, less than 40% had the condition diagnosed through consulting a doctor after noticing an irregular pulse. The remaining respondents received their diagnosis through health checkups or while seeing a doctor for a separate condition.

“Japan Stroke Association Chairman Takenori Yamaguchi notes: ‘It was thought that in Japan, one in 20 to 30 people aged 65 and over have arterial fibrillation. Arterial fibrillation makes individuals about five times more at risk for stroke. In order to prevent stroke, those with arterial fibrillation should choose a blood thinner compatible with their lifestyle and continue to take it for the rest of their life.’”

According to Dentsu Group internal documents and the testimonies of those familiar with the matter, K.K. Kyodo received 600,000 yen in compensation for the publication of this article.

Compensated article published in Kahoku Shimpo on Oct. 9, 2013

“The two aren’t really separate”

Let’s return to our interview with the former Dentsu PR employee whose job it had been to pass article ideas to K.K. Kyodo.

“Is it correct to say that the work Dentsu assigned to Dentsu PR was in line with its client companies’ aims?” we asked.

“If you put it like that, first of all I have to say that the two aren’t really separate. I think [Dentsu and Dentsu PR] probably work together to come up with ideas,” he replied.

“When they’re throwing around an idea, they first discuss how difficult it would be to pull off. That, of course, depends on the idea in question, and they talk about the pressure they’re under, the complexities of the matter, what approach they should take based on those factors, stuff like that. The point is, they work hard to sell the idea, such as by preparing more than just the original document or by mentioning article angles related to current events.”

“In that case,” we followed, “The K.K. Kyodo employee handling the matter would also be aware that [prime contractor] Dentsu had been tasked with promoting Bayer Yakuhin’s new blood thinner.”

“That’s right. And, you know, K.K. Kyodo belongs to Kyodo News. That relationship has always been used to help the Kyodo Group’s business.”

Our interview lasted over an hour.

Blood thinners can save or take life. Did he feel any kind of responsibility because of this?

“The Japan Stroke Association checked everything, from the survey design to the press release announcing its results,” the former employee said. “The doctors gave their honest feedback as professionals; they know they can’t fudge the facts.”

We decided to ask for The Japan Stroke Association’s side of the story.

“What?!”

On Jan. 24, 2017, about three weeks after we interviewed the former Dentsu PR employee, we paid a visit to Japan Stroke Association Executive Director Dr. Hirofumi Nakayama at his practice in Osaka’s Naniwa Ward. As executive director, Nakayama coordinated the practical side of the association’s work.

According to Nakayama, the former Dentsu PR employee had asked him in person to oversee the Healthy Japan 21 Promotion Forum’s surveys about blood thinners. He remembered the employee’s name and said he had received from him two business cards: one for the forum, the other for Dentsu PR.

Nakayama explained his association’s dealings with the forum.

1. The Japan Stroke Association didn’t have the capacity to conduct large-scale surveys, so he agreed to work with the forum, thinking it a good opportunity.

2. Nakayama’s role included determining what length of time without taking medication meant that a patient had “discontinued” it and checking whether the press release’s graphs matched the survey data. The association’s chairman, Takenori Yamaguchi, had signed off on his comment used in the press release.

3. The forum implemented two surveys. Dentsu PR paid The Japan Stroke Association 105,000 yen (about $940) in “supervision fees” each time.

Speaking with us in his practice’s examination room, Nakayama had given matter-of-fact answers to our questions. But he let out a sudden “What?!” as he read Dentsu PR’s internal report (introduced in the second article of this series).

The internal report explained how to use the Healthy Japan 21 Promotion Forum’s surveys to advertise Dentsu Group client companies’ products. And it gave the blood thinners press release as an example of copy that had used a survey — one supervised by The Japan Stroke Association — effectively.

“This really pisses me off, you know,” Nakayama said. “This was certainly not my intention [in supervising the survey].

“We were used.”

He continued: “If the Healthy Japan 21 Promotion Forum — if that damn organization does this sort of thing all the time, it’s just despicable.”

A doctor’s regret

Press releases announcing the surveys’ results were used as the basis for two articles released by Kyodo News, we explained to Nakayama. And a total of 1.15 million yen had been paid for these articles.

We asked him whether the press releases overemphasized the benefits of blood thinners and underemphasized side effects such as hemorrhage.

“I don’t think they were aware of the necessity of presenting both the benefits and the risks,” Nakayama replied. “As a medical professional, I regret not stressing that point.”

Compensated articles were promoting corporations’ products to unsuspecting readers, with Dentsu’s and Kyodo News’ subsidiaries acting as middlemen.

How long had this been going on?

… To be continued.

(Originally published in Japanese on Feb. 21, 2017. Titles are given as of the time of original publication.)

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