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Mistranslation of ICC by Japan ME Association

The chief of the Japan ME Association, Shinohara’s translation of the International Consensus Criteria contains a fair amount of inaccuracies. The translator is not just incompetent in maintaining accuracy required for a medical reference, but quite likely purposefully unfaithful; apparently she is trying to make the disease as severe as possible without regard for the original.

Disclaimer: I may be wrong in some parts, as I am just a layperson from Japan, not proficient in English (can’t even speak English fluently in real life). I didn’t have enough energy to scrutinize both the documents either. Correct me where I’m wrong.

Table 1 Myalgic encephalomyelitis: international consensus criteria


Although signs and symptoms are dynamically interactive and causally connected, the criteria are grouped by regions of pathophysiology to provide general focus.
[Although signs and symptoms interact dynamically and also etiologically relate to each other, the criteria are grouped by regions of pathophysiology to provide clues shared in [or by] the disease.]


My interpretation of the original passage is that although the grouping gives you the big picture of how signs and symptoms are located in regions of pathophysiology with respect to one another, it doesn’t mean the ones in each group exist in isolation from ones in other groups. General is used synonymously with broad/vague.

The translator, however, interpreted general as a synonym of common/widespread.

A. Postexertional neuroimmune exhaustion […]


1. Marked, rapid physical and/or cognitive fatigability in response to exertion, which may be minimal such as activities of daily living or simple mental tasks, can be debilitating and cause a relapse.
[1. Marked physical and/or cognitive fatigue that occurs rapidly in response to (minimal) exertion (such as activities in daily life or simple mental tasks)[, ][can] debilitates the body and can cause a relapse of symptoms.]

1. (日常生活での活動や簡単な知的作業のような最小限の)労作によって起こる著しく急激な身体的及び/又は認知疲労が、身体を衰弱させ、症状の再発を引き起こしうる。

The clause "which may be minimal such as activities of daily living or simple mental tasks" makes it clear that exertion is used in the technical sense, in contrast to the ordinary usage, where it usually implies strenuousness, to prevent such misinterpretation as:

She is housebound and can’t exert herself; she gets fatigued even without any exertion; her condition has to be something else.

And the threshold of fatigability doesn’t have to be as low as can’t tolerate minimal exertion: "The pathological low threshold of fatigability of ME described in the following criteria often occurs with minimal physical or mental exertion […]"

By contrast, the corresponding translation allows no other interpretation than that it requires such a minimal threshold of fatigability.

3. Postexertional exhaustion […]
[3. Extreme exhaustion after exertion […]]

3. 労作後の極度の消耗 […]

Exhaustion in the literal sense is complete consumption (of one’s energy), whereas 消耗 literally means any amount of consumption/attrition (of one's energy). (消耗 is used here for lack of a better word.) One might argue 極度の (extreme) is necessary to compensate for this.

However, in reality, if you run out of energy in the literal sense, you will be dead. There is still some allowance of energy left after you get exhausted. This allowance can be as vast as the context and/or qualification dictates, and I assume the threshold where exhaustion becomes applicable would be just above negligible levels. This is also where 消耗 would usually start to be appropriate.

Therefore, even though their undertones can be different, they work almost in the same way unless the context prompts 消耗 to be interpreted as being (possibly) of a negligible level. It is clear from the context the severity has to be of pathological levels. The qualification of 消耗 with 極度の (extreme) is excessive by far.

Operational notes: […]

Mild (an approximate 50% reduction in premorbid activity levels) […]
[Mild (approximately 50% or less of premorbid activity levels) […]]

軽度 (発症前の活動レベルのおおよそ 50%以下) […]

Impact: e.g. An outstanding athlete could have a 50% reduction in his/her pre-illness activity level and is [be?] still more active than a sedentary person.
[Impact: e.g. Even when his/her pre-illness activity level has decreased by 50%, an outstanding athlete looks as if he/she were still more active than a person who leads an inactive life.]

影響: 例えば、傑出した運動選手は発病前の活動レベルが50%低下したとしても、非活動的な生活をしている人よりは活動的に見えるのである。

I think this is a blatant falsification, as you can make it more accurate simply by replacing に見えるのである (looks as if … were) with でありうる (could be).

B. Neurological impairments
2. Pain
b. Significant pain […]
[b. Intense pain […]]

b. 激しい痛み […]

Again, exaggeration.

The above is not exhaustive, but I will stop here because I’ve been exhausted.

I emailed the Japan ME Association and told them that their translations are inaccurate and asked if I should suggest corrections. No reply so far.

I’m a little infuriated by her malpractice, but I don’t know what I should do about it. Maybe I should just stop caring?

JMEA’s website only lists the CCC and the ICC, both translated by Shinohara, as the diagnostic criteria, and treats them like bibles, in a way. This is problematic because, the way I understand it, no criteria are conclusive until the etiology and the pathophysiology are ascertained, and it can lead to false negative diagnoses, especially when the criteria are falsified such that they will exclude mildest cases, and can hinder early, prompt treatment, which the authors call for.
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Other impacts of this mistranslation might include people's suspicion on the validity of the concept of myalgic encephalomyelitis and the trustworthiness of researchers who approve of it. Shinohara presented the ICC, into which her translation introduced self-contradiction and nonsense, as "internationally accepted criteria" at Cabinet Office's committee on policies for persons with disabilities.

Reportedly, when she notified her new translation to Dr. Miwa, one of the authors, he was pleased with it and said he would distribute copies to staff members and patients who had been looking forward to a translated version. By the way, Dr. Miwa mentions as examples of triggers of CFS overwork, house moving/new employment, changes in environment, and rise in mental stress, leaving out infection.
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