It's late in the day, and I'm on the phone with Pat Durkit. We have never met. But immediately I know this: She's one of those people whose steadfast pleasantness is actually brute resistance, a refusal to accept just how hideous the world can become.
Consider the details: In 2001, Durkit's granddaughter, Jessica, then 2 years old, was diagnosed with leukemia. In 2004, Jessica's half-sister in Phoenix, Kellie, was given the same diagnosis.
Their father and Pat's son, Dale Durkit, a heavy-equipment operator on Sierra Vista's Fort Huachuca Army base, grew obsessed with finding a cause for the disease. There is a reason for this: By then, at least 12 Sierra Vista children had developed the ugly affliction that ravages their fledging blood and bone marrow. (See "Cancer Wars," Feb. 12, 2004, and "For the Kids," May 18, 2006.)
Since then, the cluster continues, with one case in 2006 and another a year later. Four years ago, after much prodding, the U.S. Centers for Disease Control and Prevention joined Arizona's Department of Health Services to investigate the cancer cluster.
Government scientists came up with nothing. Many people were not surprised by this. Disappointed? Yes, bitterly so. But not surprised.
In the spring of 2007, Dale was picking up railroad ties at work. One tumbled onto his hand and shin. He didn't even turn in workers' compensation papers; it was just a scrape. But the scrape grew infected, and the infection spun out of control.
He went to the doctor. He'd learn that he, too, had leukemia. Ten days later, Dale Durkit was dead. He left behind his three girls and his wife, Kelley.
Pat Durkit explains everything to me as though it were normal conversation. She is gracious to a fault, even though I've clumsily intruded on her family's pain.
"It has been incredible for us," she says quietly. "We've really been hit hard. Dale was really active in investigating the cancer cluster. And then when we lost him, I said, 'We're not doing that anymore. It hurts too much.'"
Pat Durkit is among those who are not happy with the government's attempts to either explain this outbreak, or worse, to whitewash it away.
"Why would Dale get leukemia?" she asks. "He was a health nut. He was a body-builder; he was as strong as an ox—the strongest man I ever knew in my life. Why would two of his three children have it?"
Mark Witten is an enormous man, with the pile-driving manner of the righteously possessed. He is a research professor in the UA College of Medicine's Department of Pediatrics, and for years, he's chased the ghost behind these bursts of leukemia—first in the small town of Fallon, Nev., and then here, in Sierra Vista.
Each year, this disease strikes only about 3,000 children in the entire nation. The incidence of childhood leukemia in Sierra Vista is triple the normal rate for a city its size. And Fallon is home to the nation's worst per-capita outbreak, with 16 cases over less than a decade.
Mark Witten has a theory. It is this: A hard, steel-gray metal called tungsten is behind the outbreaks. It exists in the mountains around Sierra Vista, and in a Fallon metals-processing plant. Ongoing drought means that windswept dust gets into everything.
Witten has nothing but contempt for government's failure to make this connection. So the work falls to him and to Paul Sheppard, a UA tree-ring researcher. Sheppard gathers atmospheric samples off sidewalks, squeezes them from leaves and retrieves traces from tree corings. In Sierra Vista, he attaches atmosphere-sucking lichen to the rocks.
For many years, Witten drove a beater car. Several times, he and Sheppard nearly drained their own bank accounts shuttling between Fallon, Sierra Vista and their UA labs.
These days are less lean. Over time, Witten has garnered upward of $1 million in grants to study the effects of tungsten, and the possible role of military jet fuel, in outbreaks of childhood leukemia. Today, he and Sheppard dominate the scholarly literature on this topic.
"The CDC came in and did their botched up, half-assed Sierra Vista study after they had been at Fallon," Witten tells me. "Unfortunately, not many of the leukemia families in Sierra Vista participated, which certainly hurt the study."
Nonetheless, the CDC found that 25 percent of the people they tested had higher levels of tungsten than the national average.
But not even the state took this seriously, he says. "The Arizona Department of Health hasn't done squat down in Sierra Vista. They don't have the money; that's part of the problem."
Nor could Witten get any traction with political leaders. "I went to (former) Gov. (Janet) Napolitano's Southern Arizona coordinator several years ago and told her about those tungsten hotspots," he says. "I said, 'We know where these hotspots are. One is behind Sierra Vista Middle School, and the other one is in the northeast section of Sierra Vista.'"
He had ore veins assayed in the Dragoon Mountains north of town, and the Huachuca Mountains to the south. Tungsten concentrations in both places were nearly identical. "What that tells me," he says, "is there's a vein running between those two mountains."
But he had more for the governor's assistant: "I told her, 'I want the state to go out there, take soil samples—we just don't have the money to do it—and prove that our air sampling was correct. Dig out those tungsten outcroppings, and get rid of that stuff so people won't continue to get cancer down there.'"
He heard nothing from the governor. He contacted the offices of Sens. John McCain and Jon Kyl, and got no response from them, either. "They brushed me off," he says. "They don't give a damn about these kids."
When I called both senators for comment, neither one replied.
The bullshit continues to this day. "I go every semester and give a talk in one of the (UA) College of Public Health classes," Witten says, "and they bring down somebody from the Arizona Department of Health to give their song and dance about their 'study' they did in Sierra Vista. And then I get up there, and I have data and published papers. So you tell me who's doing the work."
The most striking aspects of Sierra Vista are its soaring mountain backdrop and the meandering San Pedro River to the east. Otherwise, this is just a bustling base town, largely indistinguishable from any other, with its squat, uniform base housing and throngs of military retirees who stick around for the weather and commissary discounts.
But because this is Arizona, Sierra Vista is also a growing town, with shiny box stores and subdivisions and a real estate industry. So it's not surprising that many in local business and political circles are not enthusiastic about Sierra Vista also being labeled a "cancer town." When Mark Witten was busy meeting families here several years ago, some questioned his motivations. One accused him of "using anything he can to obtain a large federal grant to continue his work with a possible leukemia cluster."
Even now, the issue remains raw. That seems evident one morning when I meet with Sierra Vista Mayor Bob Strain in his big, hushed office. We sit at a conference table, and a city public information officer joins us, to ensure that the mayor's words are not misconstrued.
Mayor Strain, it seems, is not a fan of Mr. Witten's work. Nor does he harbor much patience for kicking this old cow. "I'll tell you right off the top," he says, "that I haven't heard it mentioned since the last report, which was three or four years ago from, I believe, the Centers for Disease Control."
In an earlier phone conversation, I had asked the mayor about Witten. "I have heard absolutely nothing about this researcher, who thought he found it in his best interest to research it," the mayor told me. "There's nothing going on. No effect on the community, and no conversation about it."
So are Whitten and Sheppard just chasing the money—especially since the CDC found nothing? "I think probably they're a little desperate, searching around for accusations with no foundation," said Mayor Strain.
Today, the mayor seems a bit defensive about even discussing the matter. He uncrosses his legs and crosses them again. "They are researchers trying to prove their thesis," he says, "rather than keeping an open mind. The fact is that in Fallon, Sierra Vista and probably a half-dozen other cancer clusters in the United States, nobody has ever found anything."
Mayor Strain pauses, and his eyes harden slightly. "To be perfectly frank," he says, "if they continue to try to prove their thesis, even though the CDC has decided to let the case go, I would say that they should go find something else to look at."
When Witten learned of the CDC's intent to visit Sierra Vista, he said he welcomes the agency's input. "The bottom line is we don't want any more kids getting sick with leukemia," he said. "I think it's about time the CDC made Sierra Vista a priority."
—The Sierra Vista Herald, February 5, 2004
"We have a list of questions we plan to ask them," Dale Durkit said. "We want to know what they're planning to do to get to the bottom of this problem."
Kelley Durkit added, "I'm glad they're coming here to talk to us. I think they've ignored Sierra Vista's cluster long enough. They're (CDC) going to be getting an earful from us."
—The Sierra Vista Herald, February 23, 2004
In late February 2004, CDC officials rolled into Sierra Vista on a "fact-finding mission." It had taken three years to reach this point, as the pressure from families with afflicted children became impossible to ignore. By May 2005, CDC researchers began gathering blood and urine samples from some of the affected children, and from a control group of healthy families. Their analysis method, it is said, can detect chemicals at parts per trillion.
The investigation was applauded by Cochise County Supervisor Pat Call, who took time for a little chat with CDC officials. "When I asked them why they were involved with Sierra Vista, they said it was because they received so many letters asking them to get involved," Call told the Herald. "I was pleased to hear that. This community has made a real effort to address the cluster issue head-on. We don't bury our issues, and that's something we should be proud of."
By November 2006, results were in: The researchers had uncovered no environmental smoking gun. "We analyzed a number of substances and really found nothing of medical significance," CDC epidemiologist Beverly Kingsley told the newspaper. "Some individuals had slightly elevated levels of tungsten in their bodies, but it was so slight that it was not something that would be of concern."
According to the CDC's report, most substances—some 128 in all—detected in study participants were lower than the national average. The agency also zeroed in on a gene that revealed a variation in how unsafe chemicals are converted by the body.
"The data were carefully collected and analyzed," the report concluded, "and although we did not discover an environmental exposure that explained the cluster of cases of leukemia among children in Sierra Vista, we collected information and laboratory samples with vigor. We envision that the analytic results and stored biologic samples may be useful in future studies and aggregation of data among similar occurrences of leukemia."
But many residents heard only this: Blah, blah, blah.
"I've been in Sierra Vista for a long time, and I've been watching both kids and adults die of leukemia since 1974," said one parent. "We just keep attending these funerals. There's something wrong here. Everyone knows someone who has leukemia or cancer. This has been going on for a long time."
In the end, Dale Durkit kept his family out of that study after watching a similarly limp investigation unfold in Fallon. "I knew the findings would be 'inconclusive,'" he told a reporter. "They were inconclusive in Fallon, which has 10 times the leukemia problem we do, so I knew they'd be inconclusive here. I just was not willing to put my family through all that poking and prodding for no reason."
Four years later, CDC spokeswoman Vivi Abrams defends her agency's Sierra Vista excursion. "We had to keep going until the science is exhausted," she says. "If we thought there was a chance that we would find answers for people, of course we would continue to pursue it. But sometimes it gets to the point where you've gone down all the paths that you can, all the paths that are reasonable."
Abrams suggests that the CDC is sometimes the victim of unrealistic expectations. "I understand peoples' concern about not being able to find a cause," she says. "But you usually have only a small number of cases, so it's hard to get statistical significance. Also, people move away, or they move into the site, which makes it really hard to compare one person's exposure to another. Also, you can get cancer from so many things that are not environmental. It's those things that make it so challenging."
But the lack of concrete answers does not surprise veteran CDC watchers. Among them is Renée Sharp, senior scientist and California director for the Environmental Working Group. "Of all the cancer cluster cases I've seen," she says, "when the federal government comes in and does a study, it almost always comes up with no environmental connection.
"Part of the reason is that it's honestly hard to do those kinds of studies, because there are so many potential environmental factors. But the other thing is that the government doesn't really want people to get scared. So (researchers) are incentivized to find nothing."
Others argue that the very structure of testing is skewed toward failure. They point to Inconclusive by Design, the seminal 1992 report by Sanford Lewis, Dick Russell and Brian Keating that cast a cold eye on CDC and its sister organization, the Agency for Toxic Substances and Disease Registry.
"Two federal agencies, the Centers for Disease Control (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR), bear the primary responsibility for safeguarding the nation's environmental health," the authors wrote. "They are responsible for studying communities exposed to toxic pollution and wastes and making recommendations for public protection.
"Instead of ensuring a margin of safety and recommending measures to end public exposures to toxics," the report continued, "both of these agencies have routinely funded and conducted studies of effects of toxic pollution on public health which are inconclusive by design. These intentionally inconclusive studies have been used by polluters and government officials to mislead local citizens into believing that further measures to prevent toxic exposures are unnecessary.
"In systematically engaging in such practices, the two agencies are violating sound public health policy."
According to Stephen Lester, very little has changed in the nearly two decades since that report was published. Lester is science director for the Center for Health, Environment and Justice, an organization founded in 1981 by Lois Gibbs, a former housewife turned activist.
In the 1970s, Gibbs lived in Niagara Falls, N.Y., where her own children suffered from rare illnesses. She eventually discovered that her home in the now-infamous Love Canal neighborhood sat next to a 20,000-ton toxic-chemicals dump. Soon, Gibbs had organized her neighbors and forced the government to relocate the contaminated area's 833 residents.
Lester says that story and Sierra Vista's current saga reveal the inadequacy of government studies. While conceding that environmental causes for illness are tough to pinpoint, "what's not fair or appropriate are the methods (agencies) use to do the investigations, and the hopes that they raise in communities—when the truth is that they have very little hope or possibility of ever finding anything."
He says the way study participants are gathered dooms any research from the outset. "Sometimes they use zip codes or a census or something like that to define the exposed population. And that's just totally inappropriate.
"There are two steps: You want to identify whether there's an increased rate or increased risk of the illness, and the other step is finding what it's attributable to.
"If you're trying to link illness to a cause, then you have to truly identify a population at risk or a population that's exposed," he says. "For example, if you think the risk might come from a certain drinking-water supply, that the groundwater is contaminated because of leaking from a landfill or discharges from a military base or whatever it might be—then you need to identify that plume, where it is, and specifically who is exposed to it."
That could include a small fraction of people identified through census tracking, or it could include 90 percent of them in a given area. Ferreting participants out—not simply linking them through a particular zip code or census profile—is the only worthwhile approach, says Lester.
And that requires plenty of shoe leather. "But it's very, very rare that (researchers) actually go door to door now," he says. "That's a very expensive proposition, and government won't do it anymore."
Unfortunately, Lester says, residents are led to expect much more—and that's the true tragedy. "There's really a lack of disclosure (by the government) about the ability of their studies to distinguish or identify a problem. If the scientists were more straightforward about what they can and can't do, then I don't think people would have so much expectation.
"They go through with these studies knowing that they're useless, but they won't say anything like that to anybody—except to their friends around the bar or their colleagues at a meeting."
Still, such inept research practices persist, he says, because they are useful—if for all the wrong reasons. "They're useful to the politicians, because they have scientists addressing the question that the public wants to ask, and yet there doesn't have to be a resolution. They're useful to the responsible parties—the companies that have polluted and created the problem—because there are no answers. And yet it appears as if you're doing something.
"It's also useful to government, which (has the appearance of) being responsive and not ignoring the public's interest. But all of those stakeholders are served by useless studies. And the public that has the exposures, that has the health problems—that really needs some answers—is not served."
The Sierra Vista report likewise contains what some see as obfuscation, particularly regarding an emphasis on possible genetic factors. The report mentioned genes for an enzyme called SOUX, or sulfite oxidase.
"One locus in SOUX was significantly associated with case status," the report said. "... We do not know the function or significance of this gene variant. ... Although genetic studies did not provide evidence that a common agent or genetic susceptibility factor had caused the leukemia, the association between a SOUX gene locus and disease status warrants further investigation."
Terry Nordbrock is co-founder of Families Against Cancer and Toxins, a group formed after her son Linus was diagnosed with leukemia in 2001.
She finds the genetic theory ludicrous. "I spoke to a researcher," she says, "and he told me that this genetic variation is as common as blue eyes."
Ultimately, she says the CDC study left Sierra Vista families with a sour taste. "Now there's a real lack of optimism about government and society, just a real disappointment. When the kids are first diagnosed, their parents tend to be pretty optimistic. It's like, 'Yeah, let's shine a spotlight on this.' Then there's all this foot-dragging and promises and delays."
After a while, the parents start to sound like conspiracy theorists, she says, talking as if the government wants to kill their kids. "I feel so full of dismay when I hear that. But I see it happen. I see the progression."
However, Nordbrock can't entirely dismiss the conspiracy theories, given that one detail from the study sticks in her own mind. "The airplanes weren't flying when the CDC came to do the Sierra Vista bio-sampling," she says. "They were grounded. And the only ones that were allowed to fly were the ones that didn't use radar. Did they do that on purpose because the CDC was here?"
I made a call to Fort Huachuca to find out, but fort spokeswoman Tanya Linton didn't call back.
Its chamber of commerce pitches Fallon as the "Oasis of Nevada." The bucolic burg of 8,000 souls was once known for "Hearts o' Gold" cantaloupes and expansive turkey farms. After 1942, it was known as home to the Fallon Naval Air Station.
Located 60 miles from Reno, Fallon is also remarkable for its cancer cluster, considered the worst per-capita in American history.
An internist named Dr. Gary Ridenour came to Fallon in 1982. Some three decades later, he calls it "the Mount Everest of leukemia clusters."
Not that government scientists would approve of that designation. "When you start talking about clusters, they lump you in with the UFO people," he says.
One day, a father and daughter walked into his office. The daughter had leukemia. "But they told me they weren't being included in the Fallon study because they were 'out-of-towners,'" Ridenour says.
They had moved to Fallon from Sierra Vista.
So he grilled them on what he considered the most likely culprits in Fallon's leukemia cluster. "I asked if they had a (fuel) pipeline and a military base in Sierra Vista. And they said yeah. It turns out that a pipeline supplies that town with JP8 jet fuel also. So I alerted Mark Witten."
But how would any doctor discover whether those common elements were truly so common in the air of both cities? "Mark said, 'We happen to have the tree-coring center of the world right here on the University of Arizona campus," Ridenour recalls. "So he brought Paul Sheppard in. Consequently, Paul opened up a whole new field of environmental studies by coring trees and opening up the tree rings.
"We started sampling our tree rings up here," Ridenour says. "And once Sierra Vista started popping, Paul and Mark went down there and did tree-core samplings also."
In Fallon, as in Sierra Vista, government scientists largely deny any link between JP8 jet fuel and acute lymphocytic leukemia. Nor were they eager to investigate tungsten, though there was a metals plant in the middle of Fallon.
Political pressure from Sen. Harry Reid and then-Sen. Hillary Clinton convinced them otherwise. The pair held a press conference in Fallon in 2001, and by the fall of 2002, the CDC was releasing a series of reports on the plagued town. Those reports showed high levels of tungsten in the urine of residents.
But the government played down its findings. "We really can't interpret what the levels mean," Dr. Carol Rubin of the CDC told a gathering of Fallon residents. Dr. Randall Todd, Nevada's state epidemiologist, agreed. "It's another piece of the puzzle," he said. "It's like when you work a jigsaw puzzle, and you get a piece that's kind of unusual, and you wonder, 'Where does this fit?' We don't know where it fits yet, but it sure is an interesting piece."
Ridenour considered it a charade. "When the CDC came and laid out what they were going to do, I told them, 'You're laying out an eighth-grade science study,'" he says. "In fact, it wouldn't even pass an eighth-grade science class. They didn't even have a hypothesis. They were just going to draw blood and things. But I told them they should be gathering these people and doing genetics."
He says a standard gauge of studies, called a p-value, or probability value, reflects how accurate the research is. "And when the CDC started presenting their findings, the p-values were so low that you'd have to throw them out.
"At one point, I stood up and said, 'Do you really think you can publish this junk?' And they said, 'Oh yeah, of course we can.' It was a bunch of people who didn't know what they were doing."
All of which doesn't leave him optimistic about finding a cause for these cancer clusters.
"You run into such resistance," he says, "that it's just unbelievable."
Paul Sheppard stands in his concrete office in the bowels of the UA's West Stadium. He's holding a piece of Canary Island pine, retrieved during a recent trip to Long Beach, Calif. Sheppard says the core sample reveals 60 years of climate and elements in the atmosphere. He couldn't resist carrying it back to Tucson. "Let no cut log go to waste," he tells me with a smile.
Beginning in 2002, Sheppard joined Witten's efforts and began sampling trees around Sierra Vista to learn what they were absorbing from the air. Later, he moved to the lichens.
This seems an odd match, the aggressive Witten and the soft-spoken tree-ring researcher. But the team works smoothly. "It may seem illogical," Sheppard says, "but it's not. Actually, it's a perfectly logical arrangement."
He won't speak directly to a link between tungsten and leukemia. "However, I would say that, in Fallon, there's at least a correspondence between excessive amounts of leukemia and the presence of elevated levels of tungsten in the atmosphere.
"But I'm warned again and again by others that that doesn't mean there's a linkage—that exposure to airborne tungsten causes leukemia. That work needs to be done in the lab, by people like Mark."
In some parts of Fallon, specifically, he found high levels of airborne tungsten and cobalt. "As an environmental result, it seems quite clear, and multiple lines of evidence indicate that," he says. "We have various monitors from the environment like lichens and surface dust and airborne dust and even tree leaves showing the same thing. And all in a town that has too much cancer. The question is: Are they related?"
The greatest concentration of airborne tungsten is found in the center of Fallon. That's also where you'll find the Kennametal processing plant. "But (the plant owners) steadfastly deny that they're the source of any airborne contamination of tungsten and cobalt," Sheppard says. "And I acknowledge their denial. But I have to be careful with that. So does Mark. We're both under subpoena." (In 2003, Richard and Pilar Jernee filed a wrongful death lawsuit against the city of Fallon and several companies, regarding the leukemia death of their 10-year-old son, Adam.)
Even if the Sierra Vista study was unsatisfying, the question remains: Why did it take so long to happen at all? To find out, I called Dr. Tim Flood, medical director of the state cancer registry at the Arizona Department of Health Services. But when I reached Dr. Flood, he told me that he wasn't permitted to talk until I first contacted the department's public information officer. One day and much hullabaloo later, I was allowed to chat with the good doctor again, this time with the PIO listening in.
If this seems a bit Orwellian, it is. But it also appears to reflect the defensiveness of this state agency regarding the Sierra Vista cancer cluster.
Dr. Flood insists that we not call it a cluster, though, since such a term does not exist in epidemiological science. "Significant event" seems more appropriate, more sterile.
Regardless, he calls the Sierra Vista leukemia significant event "elevated but statistically similar to Arizona and the U.S."
Regarding parents' concerns that some affected children were not included—such as the girl who moved to Fallon—Dr. Flood says sticking to the rules is critical. "When we calculate rates and compare our rates to other areas, there are very strict guidelines and rules as to how it's to be done. We followed those rules in order to allow a comparison to other areas."
That's how the count was tabulated. "It totaled 11 cases," he says. However, in response to residents' concerns, he did include six more cases in the analysis of various factors, though they weren't part of the rate analysis. "I included them in just to see if adding them in would give us a better pattern or some suggestion of what's going on there. And it didn't seem to matter if they were included in or not included in."
Which leads to the tungsten question: "I don't think there's enough evidence to suggest that it's causing the problem," he says. "I know there's another doctor at the University of Arizona who's analyzing that, and he's doing some interesting research. And we certainly hope he can come up with an answer one way or another.
"But right now, in my opinion, there's not enough to point any fingers at tungsten. ... There's no known route of exposure from tungsten to people. If that had been different, we may have thought about it differently."
In April, Mark Witten presented his latest findings to an experimental biology conference in New Orleans. He thinks he may have found the bedeviling, missing link. It lies in exposing lab mice to tungsten plus a respiratory syncytial virus. The researchers have since replicated the study; about a month ago, one of the mice died of leukemia, confirmed by the huge number of white blood cells in its bone marrow.
He says Dr. Ridenour told him there was a herpes-virus outbreak in Fallon right before the leukemia cases began to appear. Then one of the women working on Witten's project—her own son sick with leukemia—became acquainted with the Sierra Vista parents. When Witten came back from Fallon and told her about the herpes, her eyes "grew big as saucers," he says. "She told me that the parents from Sierra Vista told her their kids had had an outbreak of herpes, too."
Now he's begun a new $120,000 grant project for the Army to see if jet fuel also affects the immune system. "The Army knows that Army personnel always have a higher cancer rate than the normal population," he says. "Is it because they're around jet fuel all the time, or because they're around tungsten? Or is it a combination of the two?"
On my second call to Pat Durkit, I explain that I'm visiting Sierra Vista. I ask if I might stop by. But she doesn't think so. Her youngest granddaughter—the one diagnosed with leukemia as a toddler—is now in the hospital with pneumonia. "She's going to be in there until at least Thursday," Durkit says. "And I have the other two kids here. So I'm going in circles."
These days, Pat Durkit thinks the cancer cluster may have been caused by the 1986 Chernobyl nuclear disaster in Russia. Radiation could have drifted in the upper atmosphere. "Before then, nothing was happening here," she says. "And since then, everything is happening. So I think that's where you guys need to look.
"That's why I wasn't behind Dale in any of his endeavors to accuse military bases and all this and that."
But paranoia remains, too. "Every time one of the kids gets sick," she says, "Kelley goes into a panic and says, 'I'm moving away from here.' But I tell her, it's everywhere. It's everywhere."
Silence again. "Down here," she says, "there was a lot of fear in people, you know. ... I've lost my son. He was my golden boy. I don't know the cause."
Then Pat Durkit cries a bit. Just a bit. And just as quickly, her pleasantness returns.
Resistance is everything.