【Global Leader Interview】Dr. Kazuo Tsubota, CEO of Tsubota Laboratory, Inc. and Professor Emeritus, Keio University

As the word suggests, dry eye is a disease that makes the eyes dry. It may not sound serious, but it is estimated that around 24 million people in Japan suffer from it. There really are a lot of people suffering from eye discomfort. The outbreak of COVID-19 has further exacerbated the problem by forcing many people to sit in front of their computer screens all day. You won’t necessarily go blind due to dry eye, but we do know that it interferes with one’s work, causes depression, provokes insomnia, and lowers levels of well-being. Dry eye is now considered a chronic illness, similar to back pain, and both garner global attention.
　Eye drops are used to treat dry eye. In addition to drops that increase tears or suppress inflammation, I have developed spectacles that prevent eye dryness. These spectacles have water wells at the temple area that sustain hydration. Furthermore, the meibomian glands—which secrete an oil that is an essential component of tears—sometimes get clogged and require treatment. This can usually be prevented by proper eye washing and care and can be treated using pain-free eye shampoo. For patients who suffer from secondary symptoms such as no longer being able to use contact lenses due to dry eye or from corneal abrasions, I would recommend LASIK eye surgery.

I initiated Tsubota Laboratory, a start-up from Keio University School of Medicine. There are currently 14 university-funded startups there, one of which is Tsubota Laboratory, whose goal is to take on the world. Our motto is: “Through innovation in health and medical fields, we will make the world happier and healthier,” and with this in mind we develop innovative solutions for myopia, dry eye, and presbyopia.

My father was a venture capital entrepreneur. As a child, I actually planned on taking over his company until the oil shock sent the whole world into recession, botching my future career plan. In my senior year of high school, my father advised me to acquire a professional skill. I figured that a medical degree could get me anywhere, so I studied like mad and got accepted to a medical school.
　After graduating from university, I chose my specialty based on who I wanted as my mentor. I was fortunate to have been able to study under Dr. Yasuo Uemura. As Dr. Uemura’s specialty was ophthalmology, I decided to pursue that field.

I think one positive aspect of Japanese education is the sense of strong camaraderie among your peers at school. But the catch is, you sometimes have too much fun, and you lack self-discipline. I matriculated to Keio University from its middle school; it was an ideal environment for nurturing a culture of friendship. On the other hand, the United States is a more competitive society. Moreover, unlike Japan, the U.S. is rich in diversity. When I was in Boston (Harvard Medical School), there were people from all over the world: India, Thailand, Taiwan, Lebanon, and many other nations. The U.S. is no doubt the leader when it comes to competition and diversity. Imagine fostering friendships that could last a lifetime in that kind of environment.

The quality of medical care and of the medical system in Japan is generally very high. Within the field of ophthalmology, I would say that Keio University School of Medicine is at the same level as Harvard Medical School. But the problem is that the majority of medical equipment used at Keio is not manufactured by Japanese companies. In essence, the more we use world-class medical equipment, the more we see an outflow of foreign currencies. The economic impact of this is estimated to be a loss of 4 trillion yen a year.
　Currently, 75% of researchers in the field of life science are at universities. Accordingly, without universities seizing the initiative, we cannot expect to see a rise in innovation. Until recently, universities in Japan have not had such a mentality. Japan has been successful with nurturing physicians who care a great deal about their patients, but in the eyes of the international pharmaceutical or medical equipment industries, they are seen merely as “good customers.” Hence, it is difficult to come up with innovative ideas in Japan. Conversely, for good or bad, there are just so many ambitious people in the U.S. that they are the ones who flourish in new industries and create opportunities.
　At this rate, Japan will fall into destitution in the future. It would require a great deal of labor to compensate for a deficit of 4 trillion yen per year. As the business model of doctors and physicians merely curing patients’ diseases becomes ineffectual, the industry will call for professionals with great depths of medical and health knowledge, who are equipped to become innovators. I wanted to set an example in this realm, which is one of the reasons why I decided to initiate Tsubota Laboratory. With hard work and success comes the responsibility to care for others, and celebrating that with some champagne from time to time wouldn’t hurt!

The educational environment in Japan lacks diversity. In addition to embracing more diversity, this country needs to focus on teaching students how to apply their knowledge. I think Japan’s education system has done a good job at producing a well-educated workforce and nurturing middle-management talent within large corporations, but this does not enable Japan to compete on a global scale. It is vital to cultivate innovative thinking. For example, rather than merely teach that 5+5=10, why not ask students to think of how many various combinations of numbers add up to a value of 10? This way, we can generate limitless results and enhance creativity. Without incorporating creativity into our education, I think we will not be able to compete globally. We (in Japan) tend to teach our children not to make mistakes and that there is always a right answer to every problem: The person with the most correct answers is considered superior. To foster creativity, we need education that allows or rather encourages mistakes. Perhaps we should even have children make mistakes deliberately.
　Another unique aspect of our education system is that Japan is perhaps the only advanced nation that does not conduct higher education in English. I don’t necessarily believe that this is a disadvantage, but I do think that we need to reconsider why this is so.

To study medicine abroad (in the United States in particular), you need a medical license approved and issued by the country’s government. You can always be involved in the research field, but I wanted to pursue deeper studies in clinical pathology in the United States. As a foreign doctor, I had to study for the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS). There was a scholarship in this particular field for acquiring a medical license in the United States, so I applied soon after I got all my ducks in a row. This was granted by the Japanese government, and although there is usually only one candidate eligible for the scholarship, it was always vacant—I was fortuitously accepted, as I was the only applicant that year.
　I took my family with me to study at Harvard Medical School. The fondest memory of my time there would have to be having the honor to meet the world-renowned physicians Dr. Scheffer C.G. Tseng from Taiwan and Dr. Dimitri Azar from Lebanon (both now reside in the United States). We all became close friends and all of our children were playmates. I was fortunate to have forged a special bond with them through friendly competition, which has certainly become a life asset.

I feel happiest when I can fully apply myself through my strengths. I consider myself to have three strengths: Curiosity, leadership, and persistence.
　My first strength being curiosity—also known as love of knowledge—I simply feel exuberant when I learn new things. As I was reading someone else’s thesis this morning, I felt excited when I discovered something interesting! As a physician, it indeed pleases me the most to hear, “I now have better vision” from my patients, but I would have to say it excites me more when I find clues relating to new medical syndromes and treatments. As an educator, it would be when I find new ways to make things better. And, as an entrepreneur, I feel happiest when I come up with a new business model and conduct further research.
　My next strength is leadership: As a researcher, I established my own research team, and I was also the first ophthalmologist in Japan to launch a refractive correction eye facility. Further, I started the first dry eye subspecialty clinic in Japan. My third strength of persistence may seem a little fickle, but this is because once I start doing something, I tend to keep doing it. I’ve actually continued my dry eye research for thirty years. This may conflict with curiosity, but in reality, I distinguish between exploration and profundity in research.
　Fundamentally, I consider myself to be an educator. Teaching is learning: I learn through teaching. In addition to my research, I run Tsubota Laboratory, as I am strongly motivated to make this model a success and pass it on to the next generation.

This may sound generic, but I wish them to be conscious of what it means to be a Japanese individual in this world. When competing against one another, you are not only running against your fellow citizens in Japan, you are also up against the world. In spite of providing good medical care, we are facing a trade deficit from an outflow of foreign currencies; understanding this reality and perceiving what is happening around the world will be extremely important. At this pace, our bright, young generation will realize that reality is not so great and may feel the need to take action. Thus, it is vital that our citizens go abroad at least once while they are young.

Now that I spend most of my time running the lab, I have great respect for Mr. Yanai of UNIQLO (CEO of Fast Retailing Co., Ltd.). I met him as part of a personal project in which I meet someone interesting once a month. There really are so many interesting people in this world and when you feel you want to meet them, I recommend you to take immediate action and go see them!
　Mr. Yanai is extremely wise with his words. I remember being struck by one thing he said: “Leaders are people who think big.” A vision is important for a company, and UNIQLO’s vision is: “Changing clothes. Changing conventional wisdom. Change the world.” Isn’t that just marvelous? This further motivated me to polish Tsubota Laboratory’s vision of, “Through innovation in health and medical fields, we will make the world happier and healthier,” and to share it with all my employees.

Always be aware of what is happening around the world. The world’s top leaders constantly study and learn new things. A good friend of mine is undoubtedly well educated in medicine, but is also well-versed in art, well-read through many books, and fluent in French and Spanish! Seeing him like this makes me think that I need to work harder. If the readers of this interview are currently high school students who have yet to meet interesting people, imagine what your fellow high schoolers who are aiming to enter Harvard are currently doing or how much they are studying—that should get you motivated!