When Willie Ramirez was admitted to hospital in Florida his Spanish speaking family said he was intoxicado. There is no exact equivalent of intoxicado in English. It doesn’t mean intoxicated, but that’s how it was translated by the bilingual person who interpreted for the medical staff. Willie was diagnosed as having taken a deliberate overdose. In fact he had had a cerebral haemorrhage. He received the wrong treatment, ended up quadriplegic, and later received a $71m malpractice settlement.

This is a celebrated story among translators as it shows the terrible consequences that may follow a failure to used trained professionals: indeed, among them intoxicado is known as the $71m word. Intoxicado means a state of poisoning, usually from ingesting something. Willie’s relatives thought that he had food poisoning from eating an undercooked hamburger. A professional interpreter would not simply have rendered the word as intoxicated but would have asked more questions to establish exactly what the family meant. (The doctors too should not have jumped to a false conclusion on the basis of one word, but we all know how once we start down the wrong intellectual path it can be hard to turn back, especially in a busy emergency room.)

Willie’s story comes from Found in Translation  by Nataly Kelly and Jost Zetzsche, a book that makes clear just how important interpreting and translation are in a globalised world. (Like most people, including me, you probably hadn’t realised that interpreting refers to spoken language and translation to written language. Now you won’t forget.)

Interpreting and translating are a large, rapidly growing, and highly profitable business. In 2012 the market was worth $31 billion and had some 26 000 businesses, most of them small. The market has grown each year, even during the global financial crisis. Companies commonly grow at 20% a year, and profit margins often exceed 30%.

The business is growing because there are many circumstances in which interpreting and translating are essential–health care, global diplomacy, law, war, and tourism–but also because businesses and other enterprises aspiring to be global recognise that translation and interpreting are fundamental to growing their business and their influence. Three quarters of consumers say that they are more likely to buy products and services provided in their own language, and more than a half say that having information in their own language is more important than price in deciding whether they will buy.

It’s because of this business importance that United Airlines, which flies to 170 countries, translates between 144 000 and 355 000 messages into 11 languages every month, the 2010 edition of Windows 7 was released in 36 languages, the ATM machine in the Vatican is translated into Latin (Inserito scidulam quaeso ut faciundam cognoscas rationem), Agatha Christie has 6598 translations of her works (the world record), Wikipedia is in 250 languages, and Facebook in 77.  “Language is the most critical enabler of communication. Without translation, connecting the world simply isn’t possible,” says Ghassan Haddad, director of internationalisation at Facebook. He thinks that translations have contributed the most to the growth of Facebook. The book also contains many accounts of businesses losing business from bad translations: HSBC, for example, ran a campaign entitled “Assume nothing” but in many countries the phrase was mistranslated as “Do nothing.”

I’m impressed to see that the newly released video from the Cochrane Collaboration celebrating 20 years of the collaboration and its work in low and middle income countries is available in 60 languages. The collaboration can do this not because it has an army of translators but because it has used Google Translate, a remarkable tool that I use more and more. Will technology replace translators and interpreters? The answer from Kelly and Zetzsche is a clear no, but not because they are Luddites, far from it. Kelly spoke at Google when launching the book, and she praises organisations for using technology to do a lot of the heavy lifting in translation but then using skilled translators to make the words euphonious.

Anybody who has ever read a poem, surely most of us, can recognise why technology will never replace humans. Translating poetry is almost impossible, but even more difficult is to translate a libretto. Kelly and Zetzsche in their highly readable and enjoyable book comprised mainly of stories and interviews describe the work of Mark Herman and Ronnie Apter who work together translating into English the librettos of Italian, Russian, French, German, and Czech operas. It’s like translating poetry only the words must be fitted perfectly to the music, the rhythm of the language and cadence must match the melody, the historical flavour must be kept, and the translator must consider the physical limitations of what the singer can actually sing. Once they complete their first draft Herman and Apter sing the words to each other and then make final changes. Google will not be doing this.

Found in Translation covers every area of life, including sex and love. Tetsu Nakama lived close to a US airbase in Japan and was asked by his cousin to translate a letter from a US soldier. This was the beginning of a 50 year career translating love letters, sometimes up to 30 a day. Kelly tells the story of translating on the phone between an American man and his Colombian lover. As they described what they would like to do when they next met each other she had to work to retain “the same level of flirtatiousness and sexual innuendo.” As they discussed their next meeting and what they might do Kelly had to translate “I am all yours. Every last bit of me. Any day you choose.” Then things became a little more awkward. The man kept asking when exactly he should fly to Colombia and the woman kept saying whenever. Kelly grasped what all this what about, but the women didn’t. The man tried to express his worry in another way, but the woman still didn’t understand. Do you go on translating the confusion or do you help out? This ethical decision is complicated by Kelly being paid by the minute: the longer the confusion lasts the more she makes. Interpreters must face many ethical decisions, but in this case, without the aid of a committee, asked the woman in Spanish when she would be having her period.

My personal experiences are more with interpreters than translators, and simultaneous interpretation seems to me miraculous. I imagine myself listening to somebody in English and telling somebody else what they are saying in English, and I simply couldn’t do it. Yet the interpreters are moving from one language to another, and when interpreting my vernacular English into Spanish or Italian they need a third more words. One time in Bologna it was signalled to me that the interpreter wanted to talk to me. I listened with an earpiece, and she said “Please, Dr Smith, will you stop? I’m exhausted.” Usually there are two interpreters, but one didn’t make it. I’d probably benefit from a similar message in every talk I give, whether or not I’m being interpreted.

My best experience was also in Italy, in Verona. I was being interpreted not simultaneously but consecutively, by a Welshman who had lived in Italy for years. As is often the case, I think, many of those in the audience knew English, and at the end of my talk nobody spoke to me me but people crowded around the interpreter to congratulate him on the excellence of his interpretation.

I try always to remember to thank interpreters at meetings, not least because they are often interpreting from the foreign language to English for just me and one or to others. And I’ve discovered that the very best way to thank them is to give them a copy of this excellent book, which anybody interested in language, the ways of the world, and human quirkiness will enjoy.

Competing interest: RS is the unpaid chair of the Cochrane Library Oversight Committee and has had his expenses paid for attending Cochrane meetings, the last one being in Auckland in September. He is also a friend of Nataly Kelly, who blogs for the Huffington Post and has blogged for the BMJ.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.