Breast and prostate cancer head the list of the most common cancers, regardless of race, among American women and men. Cancer is the second-leading cause of death in the US and the American Cancer Society estimates that in 2016 approximately 1.5 million Americans received a new diagnosis and over half-a-million Americans died of the disease.
Just four types account for half of all cancers in the U.S.: prostate, breast, lung and colorectal tumors.
Those who are tall are more likely to get this disease which may account why men have a slightly higher incidence, particularly of kidney, melanoma, and hematological malignancies. Many cancer survivors have unresolved physical and mental health issues long after being cured.
Each day, your immune system spots and
destroys cells that could easily go on to become cancerous,
Walter and Eliza Hall Institute, news release, Feb. 2, 2014.
Knowing one's genetic risk for cancer may not have a strong influence in changing behavior which makes one question whether such tests are necessary or helpful, Oct. 21, 2014, Annals of Internal Medicine.
Chemotherapy may worsen quality of life for some cancer patients who are nearing death. Cancer specialist doctors may presume there to be no harm in giving dying patients chemotherapy, but data point to more harm than benefit.
cancer diet and foods, what to eat and what not to eat
Cancer risk is heavily influenced by extrinsic factors with only 10-30 percent of cancers down to intrinsic risk factors such as mutations. And food choices are an important way to alter the risk. No single food can prevent cancer, but the right combination of foods can reduce the risk.
There are a variety of ways foods can prevent, slow down, or fight this disease. Genetic differences in taste preference, food tolerance, and nutrient absorption and metabolism all influence the effect of diet on cancer risk. Some foods block natural bodily processes such as inflammation that stimulated cancer growth. Other foods influence cancer cells to die through a process called apoptosis. Still other foods help the body in detoxifying cancer-causing toxins or protecting against free radicals. Colorful vegetables and herbs are at the top of the list of anti cancer foods. Colorful berries are also excellent. Some of the most promising dietary chemopreventive agents are green tea polyphenols (i.e. catechins), long-chain polyunsaturated fatty acids, carotenoids, glucosinolates / isothiocyanates, vitamins (i.e. vitamin D and folate).
Reduce your risk naturally
Cancer supplements, herbs, vitamins,
plant extracts with potential anti cancer
There are countless herbs that have been found to have anti-tumor activity in laboratory studies. Whether these herbs and dietary supplement have a role to play in cancer treatment or prevention in humans is not clear at this time. Even if they do, the appropriate dosage and best way to use them is not well known. However, if your doctor approves, you could try some of these herbal and nutritional supplements.
There are numerous reports of cancer preventive activity of dietary botanicals, including cruciferous vegetables such as cabbage and broccoli, allium vegetables such as garlic and onion, green tea, citrus fruits, soybeans, berries, and ginger, as well as medicinal plants. Several compounds, such as genistein (from soybeans), lycopene (from tomatoes), brassinin (from cruciferous vegetables), sulforaphane (from asparagus), indole-3-carbinol (from broccoli), and resveratrol (from grapes) are being tested.
Amla herb has polyphenols and tannins with anti-cancer activities.
Berries and berry extracts such as acai, black or red raspberries, strawberries, blueberries, noni, and wolfberry have numerous anticancer compounds.
Broccoli vegetable and broccoli sprout extract are excellent options.
Nutr Cancer. 2017. Antioxidant, Anti-inflammatory, and Genomic Stability Enhancement Effects of Zinc l-carnosine: A Potential Cancer Chemopreventive Agent?
Chrysin flavonoid is
beginning to be studied with good potential.
Curcumin may help fight breast, colon, and prostate cancer. Researchers have found in the lab that curcumin can enhance the cancer-fighting power of treatment with TRAIL, a naturally occurring molecule that helps kill cancer cells. TRAIL stands for tumor necrosis factor-related apoptosis-inducing ligand. In an experiment with human prostate cancer cells in a laboratory dish, the combination treatment killed off two to three times more cells than either treatment alone. Curcumin exerts multiple different suppressive effects on human breast carcinoma cells in vitro.
Carotenoids show a prominent role in decreasing the incidence of various cancers.
Vitamin D has an important role to play in prevention. Cancer rates are different at different latitudes of the globe. Rates of breast, colon and ovarian cancer are lower in sunnier regions of the world than in Northern climates where cold winters limit people's sun exposure. Sunlight triggers the synthesis of vitamin D in the skin, and people who get little sun exposure tend to have lower stores of the vitamin. More than three-fourths of people with a variety of cancers have low levels of vitamin D, and the lowest levels are associated with more advanced cancers.
Goji berry could be of benefit, but human studies are lacking.
Green Tea has polyphenolic compounds
such as EGCG that are
protective against various forms of cancer.
Graviola fruit, also known as soursop, grows in the Amazon jungle and some of the Caribbean islands. See graviola cancer latest research, a web site that is updated regularly.
AHCC -- Active Hexose-correlated Compound -- is a mushroom extract that has been tested as an immune enhancing, liver protective and anti-cancer agent.
Ashwagandha has many compounds that have been found to have activity against lung, colon, breast, and central nervous system tumors.
Calcium D Glucarate
is a natural supplement.
Cat's Claw extracts exert a direct anti-proliferative activity on MCF7 breast cancer cell lines. Cats-Claw supplements can improve quality of life in those with advanced tumors.
DIM-Diindolylmethane supplement is another good option.
Indole 3 Carbinol is available as a supplement. See Indole3Carbinol I3C for more information.
Mangosteen has powerful xanthones. As of 2011, I am not aware of human studies with mangosteen in the prevention or treatment of cancer.
Milk thistle contains silymarin and other
flavonoids that have been found to have anti-tumor action in bladder and
prostate cancer cells.
Noni fruit juice contains a polysaccharide-rich substance called Noni-ppt with anti-tumor activity.
Reishi mushroom water soluble extracts inhibit colon tumors in mice. Reishi may be helpful in advanced-stage cancers and has shown activity against prostate cancer cells.
Agaricus mushroom has been studied as a mushroom extract cancer treatment with good early results.
Resveratrol shows promise in neuroblastoma and
Integr Cancer Ther. 2014. Efficacy of Antioxidants as a Complementary and Alternative Medicine (CAM) in Combination With the Chemotherapeutic Agent Doxorubicin. Resveratrol and curcumin have the potential to be clinically applied to prevent cardiac toxicity and hand-foot syndrome and enhance the anticancer efficiency of Doxorubicin.
Maitake mushroom is often used in Japan
Calcium mineral has been associated with a lower
risk of colon cancer, so has vitamin D.
IP-6, Inositol hexaphosphate, is a naturally polyphosphorylated carbohydrate found in beans, brown rice, corn, sesame seeds, wheat bran, and other high fiber foods. IP-6 has been reported to have in vivo and in vitro anticancer activity against numerous tumors, such as colon, prostate, breast, liver, chronic myeloid leukemia, and rhabdomyosarcomas. Significant human trials are lacking and hence we do not currently know whether taking IP-6 supplements is helpful in cancer prevention or therapy.
Melatonin, a pineal hormone, is a potent antioxidant and has been shown to inhibit estrogen-responsive human breast cancer cells and augment the effectiveness of tamoxifen.
Supplements that may be helpful for those on chemotherapy:
Carnitine improves fatigue in those who are undergoing chemotherapy.
Glutamine supplementation can lessen loss of protein in the muscle and protect immune and gut-barrier function during radio-chemotherapy in patients with advanced cancer. Glutamine supplement may also be helpful for mucositis induced by cancer treatment.
SAM-e may have a protective effect in cancer chemotherapy-induced liver toxicity, do not use more than 100 mg a day.
Improved survival in patients with end-stage cancer treated with coenzyme Q10 and other antioxidants: a pilot study.
J Int Med Res. 2010.
This pilot study evaluated the survival of patients with end-stage cancer who received supplements of coenzyme Q10 and a mixture of other antioxidants (e.g. vitamin C, selenium, folic acid and beta-carotene). During a period of 9 years, 41 patients who had end-stage cancer were included. Primary cancers were located in the breast, brain, lungs, kidneys, pancreas, esophagus, stomach, colon, prostate, ovaries and skin. The median actual survival was 40% longer than the median predicted survival.
Additional Herbs and compounds
Tongkat ali -- Beta-carboline alkaloids isolated from tongkat ali have demonstrated significant cytotoxicity against human lung cancer (A-549) and human breast cancer (MCF-7) cell lines. In plain English, this means that some compounds in this plant can kill cancer cells. The practical significance of this finding in humans is not clear at this time.
Supplements used for radiation
Natural cancer treatments worth trying
Yoga, hypnosis, meditation, biofeedback, imagery, and support groups can help ease the anxiety and post-chemo or radiation treatment consequences. Different vitamins and other micronutrients in vegetables, fruits, and other natural plant products may prevent cancer development (carcinogenesis) by interfering with detrimental actions of mutagens, carcinogens, and tumor promoters. There's a lot of controversy surrounding alternative treatments, and more research is needed before we have more confidence in these approaches.
Factors that cause cancer
What about high alkaline foods and water?
The kidneys and lungs can easily make the blood the normal pH necessary for proper body functioning even if high alkaline foods or water are consumed.
Role of alcohol
and physical activity
Pollution and environmental exposure
This is the fourth and eighth most common cancer in men and women in the United States, respectively. Flavonoid phytochemicals are being studied for both prevention and therapy of various human malignancies including bladder Cancer. One such naturally occurring flavonoid is silibinin isolated from milk thistle. Cigarette smoking is confirmed as a risk factor for bladder cancer.
Green tea extract may interfere with a process that helps early bladder cancer to spread throughout the body. The findings, say researchers, bolster ongoing studies into green tea extract as a cancer treatment -- and may give green tea drinkers more reason to savor every cup. The investigators found that when they exposed human bladder cells to both a cancer-causing chemical and green tea extract, the extract interfered with a particular process by which early cancer cells become invasive and spread throughout body tissue. This process involves the "remodeling" of actin, a structural protein in cells that is essential for cell movement. Actin remodeling allows cancer cells to move and invade nearby healthy tissue. Based on the new findings, green tea extract may get in the way of this process by activating a protein known as Rho, which helps regulate actin's organization in cells and has been implicated in tumor development and progression.
Breast Cancer -- for a fuller discussion, click the link below
Esophageal or esophagus
Carbonated drinks may raise the risk of esophageal cancer. A team at Tata
Memorial Hospital in India found a strong correlation between the rise in per
capita consumption of carbonated soft drinks in the past 50 years and a
documented increase in rates of esophageal cancer in the United States. Team
members studied U.S. Department of Agriculture data to find that per capita
consumption of carbonated drinks rose by more than 450 percent, from 10 gallons
on average in 1946 to 49 gallons in 2000. And over the past 25 years, the
incidence of esophageal cancer has risen by more than 570 percent in white
American men. Esophageal cancer affected 13,900 U.S. men and women in 2003, of
whom more than 10,000 were men, and killed almost all of them, according to the
American Cancer Society. The number of esophageal cancer cases clearly followed
the rise in intake of carbonated soft drinks, the researchers found.
Research in China provides further evidence that exposure to silica dust raises the risk of cancer of the esophagus, the organ that connects the mouth with the stomach. The association was first noted in 1968, when a high rate of esophagus cancer was observed among residents of a South African village, which seemed to result, in part, from silica contamination of their diet. Since then, numerous other reports have verified this association. In the present study, Dr. Ignatius Tak Sun Yu, of The Chinese University of Hong Kong, and colleagues evaluated death from esophagus cancer among nearly 3000 caisson workers and non-caisson workers exposed to silica. Caisson workers were defined as subjects who worked underground in settings with high levels of silica dust. The researchers' findings appear in the International Journal of Cancer. Compared with the general population, the workers were 2.2-times more likely to die from esophageal cancer. The elevated risk was 4.21-fold for the caisson subset of workers.
In patients with early-stage cancer of the esophagus, those who were treated with radiation and chemotherapy before surgery lived more than twice as long as those who were treated with surgery alone.
Persistent hiccupping in addition to weight-loss and difficulty swallowing could be a warning sign of cancer of the esophagus. Hiccups are caused by the involuntary spasm of the diaphragm, which causes the vocal cords to close very briefly. Eating too quickly or too much, coughing, laughing and too much alcohol are thought to cause hiccups. In cancer patients, hiccups could be linked to the vagal nerve or phrenic nerve, the motor nerve of the diaphragm.
There is no association between the use of carbonated beverages and risk of subsequent development of cancer of the esophagus.
About a third of East Asians -- Chinese, Japanese and Koreans -- have an enzyme deficiency that puts them at higher risk of developing esophageal cancer when they drink alcohol.
Overweight teens are at increased risk for developing it later in life. Cancer, news release, Oct. 14, 2013. Exercise lowers the risk.
Bisphosphonates, drugs sold as Fosamax, Actonel, Boniva and other brands, are widely used after menopause to prevent or treat osteoporosis. They increase the risk.
Dig Liver Dis. 2008. Synergistic effect of paeonol and cisplatin on oesophageal cancer cell lines.
Drinking plus being overweight is a bad combo when it comes to esophageal cancer.
Head and Neck
Melanoma skin cancer
A sexually transmitted virus that causes cervical cancer is also a cause for half of all cases of cancer of the penis, Perhaps human papillomavirus (HPV) vaccines for cervical cancer are also likely to be effective in the fight against penile cancer. Merck & Co's Gardasil and GlaxoSmithKline's Cervarix are both used widely to immunize girls against HPV infection, which can lead to cancer of the cervix. However, penile cancer is quite rare, accounting for less than 1 percent of adult male cancers in Europe and North America, although the incidence can be as high as 10 percent in parts of Africa and Asia. Worldwide, there are more than 25,000 new cases every year.
Testicular or testis
What is it?
Cancer cells develop from normal cells in a complex process called transformation. The first step in the process is initiation, in which a change in the cell's genetic material primes the cell to become cancerous. The change in the cell's genetic material is brought about by an agent called a carcinogen--such as a chemical, virus, radiation, or sunlight. However, not all cells are equally susceptible to carcinogens. A genetic flaw in the cell or another agent, called a promoter, may make it more susceptible. Even chronic physical irritation may make cells more susceptible to becoming cancerous. In the next step, promotion, a cell that has been initiated becomes cancerous. Several factors, often the combination of a susceptible cell and a carcinogen, are needed to cause cancer. About 15 to 20 percent of cancers are associated with an infection, for instance viruses with cervical cancer and helicobacter pylori with gastric cancer.
Nuclear industry workers exposed to chronic low doses of radiation have a slightly higher risk of developing cancer. Approximately one person out of 1,000 would develop cancer from exposure to the amount of radiation from a single, average whole body CT-scan. Even very low doses of radiation pose a risk of cancer over a person’s lifetime, including radiation from routine X-rays.
People who get whole-body X-ray scans in the hope of finding tumors at their earliest stages may, ironically, be raising their overall risk of cancer. The scans are marketed as a way to catch cancer before symptoms begin, but the radiation from the scans themselves could cause cancer.
Work exposure of
Death rates, both overall and cancer -related, are considerably higher among workers engaged in manufacturing computers and component parts, when compared with the general population. Similar findings have been reported among employees who work in plants that manufacture computers, semiconductors, integrated circuits and other components
Diesel fumes from the ports of Los Angeles and Long Beach -- the busiest U.S. seaport complex -- raise the risk of cancer for people living up to 15 miles inland. The report by the California Air Resources Board said 50,000 people living closest to the two ports face a higher-than-average risk of developing cancer from port pollution alone. But even residents living within 15 miles of the complex face a slightly higher risk than Californians as a whole.
Treatment with a shark cartilage product does not prolong life in patients with advanced cancer, nor does it improve quality of life. Shark cartilage has become a popular alternative medicine for people with advanced cancer. Its use is based on the belief that the reason sharks rarely develop cancer is because of their high cartilage content. Previous reports examining the benefits of shark cartilage as an anti-cancer therapy, however, have yielded mixed results. In one of the few randomized trials to evaluate this treatment, Dr. Charles L. Loprinzi, from the Mayo Clinic in Rochester, Minnesota, and colleagues compared the outcomes of 89 patients with incurable breast or colon cancer who were treated with shark cartilage or placebo in addition to standard care and treatment with chemotherapy if appropriate. The shark cartilage and placebo were supplied as a powder, mixed with water or juice, and consumed three to four times per day. There was no difference in overall survival between subjects drinking shark cartilage and those drinking placebo, the researchers report in the journal Cancer.
Growing body of evidence linking increased night light to certain types of cancer has led researchers to suspect it could be connected to the steady increase in cases of childhood leukemia. Scientists presenting research at the First International Scientific Conference on Childhood Leukemia said that light at night and working shifts, which disrupts the body's internal clock, have been associated with an raised risk of breast and colorectal cancer.
Loss of weight and muscle mass, common among people with cancer, may be improved with fish oil supplements, according to a report. Intestinal upsets make high-dose fish oil capsules difficult for many people with cancer-related wasting to tolerate, but those who are able to take the supplements regularly may be able to stabilize their weight or even gain pounds, according to Dr. Patrick Burns of the University of Iowa Carver College of Medicine in Iowa City and colleagues. Animal studies and some clinical investigations have suggested omega-3 fatty acids found in fish oils may protect against cachexia, as weight loss related to a chronic disease is called.
The intake of 400-600 g/d of fruits and vegetables is associated with reduced incidence of many common forms of cancer, and diets rich in plant foods are also associated with a reduced risk of heart disease and many chronic diseases of ageing. These foods contain phytochemicals that have anti-cancer and anti-inflammatory properties which confer many health benefits. Many phytochemicals are colourful, and recommending a wide array of colourful fruits and vegetables is an easy way to communicate increased diversity of intake to the consumer. For example, red foods contain lycopene, the pigment in tomatoes, which is localized in the prostate gland and may be involved in maintaining prostate health, and which has also been linked with a decreased risk of cardiovascular disease. Green foods, including broccoli, Brussels sprouts and kale, contain glucosinolates which have also been associated with a decreased risk of cancer. Garlic and other white-green foods in the onion family contain allyl sulphides which may inhibit cancer cell growth. Other bioactive substances in green tea and soybeans have health benefits as well.
The Unending Debate: Do Vitamin Pills Prevent Cancer?
For several decades the scientific community has debated whether vitamin and mineral supplements prevent or reduce the risk of cancer. Over the years numerous studies have given contradictory results leaving the medical community uncertain of what to recommend to the public. In this latest study, scientists, from the Scientific and Technical Institute for Nutrition and Diet in Paris, France gave a vitamin/mineral supplement to thousands of men and women. A total of 13,000 men and women aged 35 to 60 took part in the study. Half were given a daily supplement containing 6mg of beta-carotene, 120mg of vitamin C, 90mg of vitamin E, 100 micrograms of selenium, and 20 milligrams of zinc. A dummy capsule was given to the other participants. At the end of seven years, the researchers found that taking the supplement had no effect on heart disease, and did not influence cancer rates in women. But they found a 31% reduction in the risk of all cancers in men taking the antioxidants. And, overall, the death rate was 37% lower among men who took the supplement. The researchers, said: "Our findings support recommendations for following a healthy diet, particularly one rich in fruit and vegetables which are major dietary sources of antioxidant vitamins and minerals, for all ages in life and for both sexes." They added that women may not have received the same benefits because their diet were better than those of men and they perhaps were already ingesting many healthy antioxidants through their diet.
Dr. Sahelian says: The debate seems to continue regarding the role of vitamin/mineral supplements and the prevention of cancer. It appears that those with a very health diet rich in fresh fruits and vegetables are not likely to reap much benefit from supplements, but those with a marginal diet would.
Vitamin B17, laetrile for cancer
What do you think of laetrile as a cancer remedy?
I have not seen convincing studies that vitamin B17 is effective as a cancer remedy.
The last days of cancer
There appears to be a disturbing rise in the number of cancer patients getting chemo and other aggressive but futile treatment in the last days of their lives. Rather than letting these dying patients live the last days of their lives in peace, they are subjected to painful and nauseating chemotherapy. Nearly 12 percent of cancer patients who died in 1999 received chemotherapy in the last two weeks of life, a large review of Medicare records revealed. That is up from nearly 10 percent in 1993, and the percentage probably is even higher today. Overly aggressive treatment gives false hope and puts people through grueling and costly ordeals when there is no chance of a cure.
I remember in my residency days at a Philadelphia hospital encountering so many patients who very on their to dying, but rather than providing supportive care in a hospice or with their family, the oncologists pushed more and more drugs on them. One particular patient, a 74 year old man with metastatic lung cancer, had come for intensive chemotherapy. He was actually alert and in relatively good shape when he first came in. He was started on chemotherapy and within a couple of days he started losing weight at a rapid pace, his hemoglobin level dropped, he started getting rashes and bruises all over his body, his white blood cell count dropped, and soon he had chemotherapy induced nausea, vomiting, and diarrhea. He got infected with a gastrointestinal bug, was given antibiotics which made him even more sick. Even as he was rapidly deteriorating, the oncologist kept prescribing more chemotherapy. I was a first year resident and thought at the time that the doctor must know what he was doing. As I reflected on this more later, it became apparent to me that specialists do make mistakes or may be suggesting medical treatments just so that they can continue charging for their visits. Within 6 weeks of being admitted into the hospital he passed away, a miserable, painful, death. I've long thought about him and whether he would have been better off staying home. All all the medical dollars that were wasted on him could have been used to immunize poor children or helping those with no medical insurance.
Food additives and cancer
Food coloring Red 2G (E 128), which is added to some breakfast sausages and burger meat, may cause cancer. Tests using animals indicated that aniline, a substance into which Red 2G is converted in the body, might cause cancer in animals and humans, possibly hitting the genetic material of cells.
Q. I've seen promotional material for glyconutrient and cancer, can you shed some light on this?
A. I have a full discussion on glyconutrients here.
Q. i wanted to ask as i read many herbs that
could treat cancer like Essaic Tea, Noni Juice, Goji Berry mangosteen, so i
wanted to ask what is the difference between them and which do u think is more
effective. Aslo, can you comment on Dr. Johanna Budwigs flaxseed oil and cottage
cheese cancer cure?
A. It is impossible to know which is better or which combination is best since so little study has been done on humans with these herbs. As to Dr. Johanna Budwigs flaxseed oil and cottage cheese diet treatment, I have not seen such studies that show it to be effective.
Q. Should a patient with cancer take any
supplements that increase testosterone? I understand that testosterone feeds
A. There are a number of different types of cancer, some are responsive to blood hormone levels or hormone usage, others are not. Testosterone is particularly associated with prostate cancer.
This is the problem. We can't "trust" the laymen and we
can't trust the corporations and we can't trust many doctors and we certainly
can't "trust" the internet. I trust in God, who told me He helps those who help
themselves, so now I am studying integrative medicine. Because I am too poor to
go back to the University, and I live in a remote rural community, I have to
educate and make decisions for myself. I would no more follow the advice of
Florida Congresswoman's advice than I would that of the Cancer society or the
doctor I am assigned to, without researching thoroughly. They are only dangerous
to those who do not take the time to research her position. Most people do not
have the time to do as I do. They will take "on faith" that anyone in
"authority" knows what he is talking about. They
are too busy juggling stressful lives, and easily intimidated. And most of them will add the stress of ill health to the rest of their problems. I subscribe to your newsletter because I consider you a relatively knowledgeable and intelligent person. You and Dr. Weil, Dr. Pauling, Dr. Hoffer and Dr. Strand all share a trait I have come to appreciate on the internet ... you are all conservative both in discussion and the language used to present it, and you cite references. You are also
Integrative or orthomolecular physicians, not snake-oil salesmen with instant cures. Much of this is above my head, but I am learning. No one person can store all this in his head. I have decided it is the essence of wisdom not to retain it all but to retain its sources and its references. You offer a good reference and are a good source.
Could you answer which of the following you feel might
be good or bad: Cesium Chloride - DMSO/MSM/Cesium Chloride (DMCC), MMS (chlorine
dioxide), Gerson Therapy, Bob Beck Protocol, Cellect-Budwig Ozone Therapy, Dr.
Stananislaw Burzynsk antineoplastons and Aminocare, Lifewave, Insulin
Potentiation Therapy (IPT), Matthias Rath Oral Amino Acid Protocol, Brandt Grape
Protocol, Intravenice C. Supplements covered on your site: Avemar Dong quai (for
anemia caused by Multiple Myeloma) Energy Kampo Force-C (Ginsenoside - Aglycon
Sapongenin) Germanium 132, Graviola MaxHerbal C (Taxus Brevifolia, Ginsenoside
aglycon sapogenin), Immune C Spray (Baccharis Trimera, Plantago Majora Extract,
Rosmarinus Officinalis) NTense NTense-2, Pancreatic Enzymes, Peony root (for
anemia caused by Multiple Myeloma), Poly-MVA, Pawpaw, SaliciniumVitalsil (Antrodia
camphorata), Zolite, limu.
I have not looked into these alternative cancer therapies to any great extent to have a thorough and educated opinion.