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BRITISH BROADCASTING CORPORATION
RADIO SCIENCE UNIT
CASE NOTES
Programme 5. - Blood Pressure
RADIO 4
TUESDAY 27/02/07 2100-2130
PRESENTER:
MARK PORTER
REPORTER: CAROLINE SWINBURNE
CONTRIBUTORS:
GRAHAM MACGREGOR
DADDY ERNIE
PAUL PADFIELD
LALIT KALRA
DAVINIA SPRINGER
PRODUCER:
PAULA MCGRATH
NOT CHECKED AS BROADCAST
PORTER
Hello. Over a quarter of British adults have raised blood pressure, that's more than 15 million people in the UK, and although it's a problem that becomes more common with age, it can happen to anyone.
One in twenty women develop high blood pressure, or hypertension, before their mid 30s - one in five men before their mid 40s.
So, do you know what your blood pressure is? Chances are you don't, and nor did this man - but now he's become something of an evangelist.
CLIP
I'm quite well known and people see me, they kind of think to their self alright well you know it's Ernie, so yeah we'll go and have a little [indistinct word] and a little check up. And then of course a lot of them oh yeah man I train every day and I'm fit man and I'm this and I'm that, quite a few of them come back and went oh they said it's kind of high and quite a few come back and said they were alright, you know.
PORTER
More from DJ Daddy Ernie later.
Well if you don't know your blood pressure, you should. And, over the next half hour, I'll be finding out why.
My guest today is Graham MacGregor, he's Professor of Cardiovascular Medicine at St George's Hospital, London and Chair of the Blood Pressure Association.
Graham, let's start with some numbers. What's normal - and why do we use two different figures?
MACGREGOR
Well the problem is that blood pressure throughout its range is an increasing risk for strokes, heart attacks and heart failure and they're the biggest causes of death in the UK and raised blood pressure is the biggest primary cause of death and disability in the UK. So whatever the level you're at risk from it but we arbitrarily cut off at 140 over 90, that is when we think right you should go and see a doctor and get something done about it medically. But people below that - particularly in the upper range of the average or what's called normal level - should also be doing things.
PORTER
But at what sort of level would you say the risk starts to rise then?
MACGREGOR
Well it's throughout the range but around 115 systolic that is and only 15% of the adult population have a blood pressure below that. If it is below that you need to be congratulated, take out a good pension policy, you're going to live longer than others.
PORTER
Now there are two figures, you've already mentioned the word systolic, why do we have two figures, what do they mean briefly?
MACGREGOR
Well one is when the heart contracts and that's the maximum pressure in the artery and the other is when the heart's relaxed and that's the lower pressure - the top one is called systolic, the lower diastolic. So it is a bit confusing, we have these two pressures.
PORTER
Why is it such a common problem here in the UK?
MACGREGOR
Well it's common everywhere in the world, it's the biggest cause of death in the world and every country in the world that has access to salt has high blood pressure.
PORTER
And salt affects it how?
MACGREGOR
Well salt causes retention of fluid in the body and that retention with a bigger blood volume slowly puts up your blood pressure as you get older.
PORTER
Looking at salt intake here in the UK we eat much more than we should do, what difference would it make if we were to cut down to the recommended guidelines and what are they?
MACGREGOR
Well the recommended guidelines - we eat around 10-12 grams of salt a day, most of it hidden already in foods - processed, restaurant, canteen foods ...
PORTER
So what's that - one and half teaspoons?
MACGREGOR
It's two teaspoonfuls a day but we're not saying people eat two teaspoons because most of it's hidden in the food they already - it's there before they've had any choice. And the recommendation is to half it to five to six grams and we can work out from a variety of studies that have been done - and remember blood pressure's the best of all the preventive health things that have been studied - that if we reduce it by half, that's the target in the UK, it would prevent 70,000 stroke and heart attacks a year, 35,000 of which are fatal. So that's why there's such a big campaign in the UK now to reduce salt.
PORTER
Well the salt message seems to be hitting home. People we spoke to all seemed to know they should be eating less - although there was some confusion about how to spot it. Particularly how much is too much? And what's the difference between salt and sodium?
VOX POPS
When I was young we just used to put salt and vinegar on say chips and fish without even thinking about it. Salt would be put in vegetables as you cooked them and also most things that you made - stews etc. Nowadays, I would think twice before putting salt in anything because we know it isn't good for us. When I see processed foods on the shelves in supermarkets I always look at the ingredients now, which I never seemed to think about it years ago, but I always look at the salt contents before I buy because I'm not sure what the level it should be, however, if it was red, green and amber and made clear on the labels that's what I'd go on.
When we were growing up we did have salt at dinner times and just generally used to just pick up the salt and just sprinkle it on, regardless of what the hell you were eating. But as I've got older I tend not to do that anymore, I don't know why, just subconsciously I just stopped doing it, which is great because it's not very good for you. When I'm shopping for things like muesli I tend to look to see whether sugar has been added but increasingly these days I also look to see if salt has been added.
PORTER
Professor Graham MacGregor - do you think food labelling is as clear as it should be? We heard there about the traffic light system, that's the new Food Standards Agency system, that seems to be a way forward.
MACGREGOR
I think it definitely is, it's front of pack with red, amber and green for salt, sugar, fat and calories - very clear to the public, liked by the public. Unfortunately some of the major food companies and a leading supermarket have developed a rival system, admittedly front of pack, which is not nearly so clear.
PORTER
Do we have any evidence that people look at the labels and heed the advice?
MACGREGOR
I think there's quite good research from the Food Standards Agency and a recent study showing that the signpost labelling is far preferred by the public and I don't understand why these other companies are not adopting it, I think it's a great tragedy. And I think if they go on persisting, my own view is, that people should avoid foods from those companies.
PORTER
And it's important because as you've said most of our intake, 80% or more of our intake, actually comes in processed foods, so it's not what we add at the table or during the cooking that's the most important.
MACGREGOR
Exactly but I'd just add something that is in canteen, restaurant, fast foods as well and they need to be labelled as well, it's not only in manufactured food and ready prepared meals, there are other sources of salt.
PORTER
Getting back to self help measures, including salt restriction, how effective are self help measures at lowering blood pressure? I mean take for instance the salt - if I cut my salt intake down to the recommended daily intake what sort of effect might it have on my blood pressure?
MACGREGOR
It will lower, on average, in people with blood pressure below 140 over 90 about five millimetres of mercury and if it's above that by about seven, i.e. the effect almost of one drug in terms of its effect in people with high blood pressure. So it is very effective if you do it - you really halve your salt intake. Difficult to do at the moment, need a lot of information but if you go - look at the blood pressure - Blood Pressure Association website you'll see very good information about how to do it.
PORTER
And what about other things - weight loss, exercise - are they helping?
MACGREGOR
Very important too, I mean eating more fruit and vegetables is very effective in lowering blood pressure, you need to eat not 5 - 7-10 to get the biggest fall in blood pressure of fruit and vegetables, quite difficult to do but at least be above 5. Lose weight if you're overweight, take more exercise. Alcohol - if you drink very large amounts of alcohol, yes it puts up your blood pressure, but modest - i.e. two to three units in women, maybe three to four units in men - is okay, it does not affect your blood pressure.
PORTER
What about smoking - not a good combination to have with high blood pressure but does it have a direct effect on your blood pressure?
MACGREGOR
No it doesn't have any effect at all on blood pressure itself but it's an added risk for strokes and heart attacks and taken with raised cholesterol that makes up 80% of the cause of all strokes and heart attacks. So what we want to focus on in the UK is blood pressure, cigarette smoking and raised cholesterol, due to our high fat - saturated fat intake.
PORTER
And if the blood pressure is raised do we need to do tests to find out why?
MACGREGOR
Well I think yes we do but they're pretty simple tests to be honest. One is to assess the severity of the blood pressure and the other is to look for an underlying cause and they actually intermingle. But the severity - the most important thing is getting good measurements of what level it is when you're relaxed and rested and so on. We want to check kidney function and look at the heart and other things like that - diabetes, cholesterol and so on. But those are looking at the severity and then the underlying causes - only about 5 out of a 100 have an underlying cause, i.e. very rare.
PORTER
So we never find a cause for blood pressure?
MACGREGOR
Well we know that salt, lack of fruit and vegetables ...
PORTER
Yeah, there's nothing wrong that we can identify in a test?
MACGREGOR
No and that's the important thing for people to realise - don't eat salt, eat more fruit and vegetables, don't be overweight.
PORTER
We talked about a threshold of 140 over 90 but given how much normal blood pressure fluctuates from day to day, hour to hour, even minute to minute, how do we go about measuring it?
MACGREGOR
Well it is a problem, and people will know if they've had it measured it varies depending on how anxious you are, what you've just been doing and it does vary and that's quite normal. But the best way is a. to see your GP or practice nurse, have it measured several times and if you want to go and buy a properly validated upper arm sphygmomanometer, look at the BHS website to find one and you can measure your blood pressure at home, I mean everyone has a weighing machine at home, they know what their weight is, but why don't they know what their blood pressure is, it's much more important. So I'd advocate every family in the UK going out buying a blood pressure machine and knowing what their blood pressure is.
PORTER
Well DIY blood pressure monitors are certainly becoming more commonplace, GPs and practice nurses often loan them to patients for a week to get an idea what their blood pressure is like in the real world, away from the stresses of the GP's surgery. And a growing number of people are buying their own. But how accurate are these monitors and how do the readings compare to those taken in the surgery? Does the more calming environment of a person's home reflect in the readings on their machine. Dr Paul Padfield is Consultant Physician at the Western General Infirmary in Edinburgh.
PADFIELD
It is true that the readings obtained outside of a doctor's surgery tend to be lower than those that are measured in the surgery. And on average that difference is about 10 millimetres over 5 millimetres - systolic and diastolic. Which is the difference between when the heart pumps for the systolic and relaxes for the diastolic. So one considers a different normal range, as it were, that average difference of course can be quite considerably variable in different patients but we would normally regard a blood pressure of above 135 over 85 millimetres of mercury would be an abnormal average and would be equivalent, broadly speaking, to somewhere between 140 and 145 over 90 millimetres of mercury.
PORTER
So when interpreting these readings we need to take that 10 over 5 reading into consideration?
PADFIELD
Yes we do, although I'm against taking that as a gold standard difference. I make the point that that's an average difference, it's very variable and I think it's better to look at the 135 over 85 as the sort of upper limit of normal and consider intervention above that, depending upon an individual's overall risk. It's maybe simple to say that one doesn't always treat the same level of blood pressure in different people.
PORTER
What about accuracy of machines, there's a vast range of different products on the market from the very expensive to the very cheap, I mean you can even buy machines now for £9.99?
PADFIELD
Yes I'm not sure what it actually costs to make these devices but it's quite likely that one can make a very cheap and very accurate machine, in the same way as a cheap and accurate watch can be obtained. I think it is important though that people - doctors and patients - who consider buying these devices do choose a device that's been validated formally. It seems rather odd that there is no obligation on a manufacturer to do this, they only have to show that the machinery is safe, it's not going to electrocute somebody or do them harm. And it's quite clear that some of the marketed devices, when tested appropriately, do not come up to standard for accuracy. The British Hypertension Society has a website, part of which defines monitors that have been validated, and are therefore acceptable for clinical use. And anybody wishing to use these devices would be advised to look at that website or discuss with somebody who knows about the website.
PORTER
Okay, so they should look for a machine that's been approved by the BHS but what sort of features might people look for, perhaps what should they avoid, I'm thinking here of wrist compared to machines that measures upper arm - is there a difference between those two?
PADFIELD
There is a difference. The wrist - the further away from the heart you go the higher the blood pressure basically. And so the blood pressure at the wrist will naturally be higher than at the upper arm. The problem with the devices that measure blood pressure at the wrist is that they involve an algorithm - a correction factor - for that difference, so that somewhere in the machinery they are giving a figure which is corrected back to what they think it would be in the upper arm. Many of us are concerned that because that's an average correction factor it may be inaccurate in some people and it's absolutely critical that if people use a wrist monitor that the wrist is held at the level of the heart. For all these problems the British Hypertension Society remains sceptical about the widespread use of such devices and we would caution against their use given the current technology.
PORTER
Paul, we've talked about measurements that are initiated often on the GP's advice, they're suggesting you know measure - bring in your measurements from home or indeed here's a machine you can borrow to do that, what about people who are buying these machines on their own without even contacting their doctor, what are they actually doing with them, do we know?
PADFIELD
I don't think we do in the United Kingdom. There are several countries in Europe - Germany for example - where machines are extensively bought by consumers without any necessary reference to family doctors but we still don't know quite what they do with them. We assume they multiply measure their blood pressure and the problem with that of course is the blood pressure is variable and without proper discussion with a healthcare professional it could cause concern because some readings will be high, some will not and if people are not advised they might get worried about a particular high reading. The point I would make again is that it's the average of multiple readings that gives us the confidence to rely on these devices. The sort of advice that's generally given now is that individuals would measure their blood pressure in a seated relaxed position in the morning and in the evening three times maybe each day for a week and average all of those readings to give something for the family doctor. Then as long as it's normal infrequent measurements every two or three months or something would be perfectly sufficient. If it's abnormal and particularly if medication doses are being changed then that's the time to repeat measurements. And my own view would be that the future would be that - that we will not see patients trooping up to their family doctors but they will be phoning in or blue tooth technology just sending in blood pressure readings and management would be planned on the basis of that.
PORTER
Dr Paul Padfield talking to me earlier. And if you would like to check out the BHS recommendations before buying your own monitor then we have a link on our website at bbc.co.uk/radio4. Or, if you don't have access to the internet, do call our Action Line on 0800 044 044.
You are listening to Case Notes. I'm Dr Mark Porter and I am discussing high blood pressure with my guest Professor Graham MacGregor.
Graham, let's assume that we have confirmed someone's blood pressure is too high. Self help measures like cutting back on salt have helped, but not enough. Time to turn to medication - which type?
MACGREGOR
Well there's a range of different tablets that have different mechanisms for lowering blood pressure and I think the important thing to realise is that we can to a limited extent predict, depending on age and ethnicity, which are the most effective as single drugs. But I think everyone should realise that when you start using these tablets to lower blood pressure the body doesn't like it and it tries to stop the blood pressure coming down, there're reactions to it. And that's why in the majority of individuals we have to use two or three tablets to get good control. So don't be surprised if you have to go on two or three, you're lucky if you get away with one.
PORTER
And there's been quite a lot of advances in this area, I mean I remember when I first entered general practice you know you could pick and choose whatever you wanted really, to put people on, now there's quite rigid guidelines - you said it depends on your age and maybe your ethnicity. But these protocol managements they're there because they've been shown to be the effective interventions presumably?
MACGREGOR
That's correct and they work. I mean we have a big problem in that many individuals with high blood pressure are not having it controlled to the target levels and because of that many unnecessary strokes and heart attacks are occurring, so we're very keen to see GPs and particularly practice nurses and patients getting better control of their blood pressure, getting it down to the target of 140 over 90, which does require using the right tablets and the right combinations, some combinations are very effective, others aren't.
PORTER
Roughly speaking, as a gestimate, what proportion of people do you think that are out there in the UK who are being treated are not below target, so they're not below 140 over 90, do we know?
MACGREGOR
Well we know that - a recent survey hasn't been done - but it's around 20% are controlled at 140 over 90, so 80% are not being controlled. And we know again that if they were all controlled we can work out that very approximately that would save 60,000 deaths from strokes and heart attacks a year in the UK. So you can see the overwhelming importance of raised blood pressure in causing strokes and heart attacks and the really good evidence that we need to get better control. And individuals need to get that message and say right my blood pressure's not being controlled, I want to get it controlled, I'm going to sort it out with my GP or practice nurse.
PORTER
There is some resistance to taking more than one drug, we've explained why that might need to be the case, the other problem we have in general practice is a lot of people think their blood pressure can be "treated" (in inverted commas) and that they don't need to take continuing therapy but that's not the case.
MACGREGOR
No unfortunately once you're on tablets and it's been established that you've got high blood pressure, you go on tablets, you're on them for life. And the thing is that you know you take your tablets, you check your blood pressure every so often and providing they don't cause side effects you just forget about it, you just take them in the morning or whatever and that's it, you're perfectly normal, there's nothing wrong with you, you get on with life but you're controlling your blood pressure and reducing the risk of you having a stroke or a heart attack or developing heart failure.
PORTER
You say you get on with it, of course the other problem with taking any form of medication are side effects.
MACGREGOR
Well the modern tablets we use have very few - they don't have the serious side effects, there are well known side effects with some of the tablets. Many of them have very few. Nevertheless, there are individuals who get minor side effects that affect their lifestyle and again our view, from the Blood Pressure Association's point of view, that they should discuss with their GP or practice nurse these minor side effects because it may well be possible to change them to a different type of treatment which they'd feel a lot better on. So there's no point in suffering unnecessarily and what to doctors may seem fairly minor are to individuals quite major things affecting their lifestyle.
PORTER
Well Graham mentioned there that ethnicity can affect the choice of treatment, but it can also influence the likelihood of developing high blood pressure in the first place. Afro Caribbeans in this country are twice as likely to develop high blood pressure as Caucasians.
The Modernisation Initiative is running a campaign in Brixton to increase awareness of the problem among the Afro Caribbean community there. We sent Caroline Swinburne to meet Choice FM DJ, Daddy Ernie, to find out more.
CLIP FROM CHOICE FM
SWINBURNE
Daddy Ernie's nightly programme Super Jam on Choice FM attracts a large following amongst African and Afro Caribbean communities in South London. Until recently most of the audience were unaware that the DJ himself suffered from high blood pressure. Like many people Ernie had no symptoms and only discovered he had a problem by chance.
DADDY ERNIE
I got up one morning and my knee felt a bit wonky, I had a little twinge in there and I thought ah nothing, as usual, it'll go away. And after about three or four days it was still there. And during the course of it the missus said oh go round to the doctor. And I thought no, don't worry about it. So anyway after plenty of nagging I thought oh let's keep her happy, I'll go round there. So I went round there and they - you know they looked at it and they done a few tests and they said more or less what I said - you probably just got out of bed but while you're here, you haven't been round for about five years, we'll do a little blood test and blood pressure and bits and pieces and get you up to date. So they strapped the machine on me arm and immediately she said oh forget about your knee, you've got high blood pressure. And I was quite shocked actually.
SWINBURNE
Daddy Ernie is not unusual. Studies have long shown worryingly high levels of hypertension in men of African descent, particularly amongst those now living in urbanised Western societies. There are many theories, both genetic and social, as to why this should be. Lalit Kalra is Professor of Stroke Medicine at King's College London.
KALRA
There are various theories around. Changes in diet, changes to salt intake, changes to the level of exercise people undertake. There are also some papers which show that there might be an increased psychosocial stress which is operant under these circumstances which increases prevalence of hypertension. There are also some people who are talking about the sodium gene, there are lots of genes which control the function of the blood vessels and high blood pressure in terms of actually either conserving levels of sodium or how the blood vessels react and these genes are differently distributed between different populations. And there is a theory that the genes which predispose to hypertension may be more frequent in people of Afro Caribbean origin. Again a theory not proven.
ACTUALITY - DADDY ERNIE ON THE STREETS
DADDY ERNIE
Good afternoon sir. I'm Daddy Ernie, Choice FM.
PASSERBY
Oh yeah.
DADDY ERNIE
Alright, how are you?
PASSERBY
I'm fine thank you.
SWINBURNE
In a supermarket in Brixton Daddy Ernie is finding out just how many people realise how important it is to get their blood pressure checked regularly.
DADDY ERNIE
I'm doing a little survey on - in the Afro Caribbean - where we tend to have high blood pressure. When last have you had yours checked?
PASSERBY
Two years ago.
DADDY ERNIE
About two years ago and what was the reading?
PASSERBY
Normal.
DADDY ERNIE
Why haven't you been back since two years?
PASSERBY
I haven't got time.
DADDY ERNIE
Really? You haven't got time. How important do you think it is that you get it checked regular?
PASSERBY
It's important but I really haven't got time during the day. If it was open weekends, which it's not, I can have time.
DADDY ERNIE
Okay. So what if you was to drop down then you'd say well you know it's because I hadn't had time.
PASSERBY
Yeah more likely, yeah.
DADDY ERNIE
When last have you had your blood pressure taken?
ANOTHER PASSERBY
About six months ago.
DADDY ERNIE
Six months and what was the result?
ANOTHER PASSERBY
It was good.
DADDY ERNIE
When you say good, was it high, level or under?
ANOTHER PASSERBY
[Indistinct word]
DADDY ERNIE
Borderline.
ANOTHER PASSERBY
Yeah borderline.
DADDY ERNIE
Okay. Do you go to the doctor regularly? Before you had your last check up when was it before that you went ...
ANOTHER PASSERBY
That is the first, it's not the last, it's the first.
DADDY ERNIE
That's the first time you've been for ...
ANOTHER PASSERBY
For that, yeah, that was the first and probably - I don't know.
DADDY ERNIE
You have no intention of going back to have it checked?
ANOTHER PASSERBY
I will - I will but I don't really sit down and say let me go.
SWINBURNE
The Modernisation Initiative commissioned research to gauge attitudes to the issue of blood pressure amongst different ethnic groups. The organisation's Davinia Springer told me about the findings.
SPRINGER
Caribbean men talked a lot about their fear of seeing the GP and the fact that they didn't feel that the consultation was long enough and ideally they would need a lot more time to have an in-depth conversation about their health and health issues. For the West Africans they just said that they didn't have time because it was really important for them to go and work and provide for their families. Which meant that they ended up a lot of the time sacrificing their health and a lot of them didn't see their GPs very regularly. They talked a lot about - when we - when we offered them the suggestion of maybe providing blood pressure checks at work they said that they - out of all the groups - they said that they hated that idea the most and that was because they felt that if they weren't in the best of health it may put their jobs at risk.
SWINBURNE
The research also involved asking questions about people's lifestyles.
SPRINGER
For all of the groups there were issues around diet. For the Caribbean men they talked a lot about having salt - food had to have salt in it, particularly they mentioned salt fish and salt fish as a dish would not be salt fish without it being filled with salt. So that was an issue. And a lot of people said that they were unwilling to change their dietary habits in regard to tradition and traditional meals. And that was the same for West Africans - they said that they would - they feel quite comfortable with adding salt at the table as well as adding salt and seasoning while they're cooking. So we felt that was a key issue for those groups.
SWINBURNE
How about attitudes to exercise?
SPRINGER
Again it was about time and about money. I think throughout all the groups people talked about just not having the time and that was less of a priority.
SWINBURNE
The campaign involves events in supermarkets, mosques and churches. Sometimes they arrange a facility for people to get their blood pressure checked on the day in a mobile clinic.
CLIP FROM CHOICE FM
Because you know we've been on the road with the Modernisation Initiative, who is making people in the Afro Caribbean, especially the men, more aware of high blood pressure.
DADDY ERNIE
You know maybe it's something that you should do, you should go maybe two or three times a year.
ANOTHER PASSERBY
Well if that is good advice I will take it because for my heart to be good and care for myself I would do that actually.
SWINBURNE
So do you think this is a good job that Daddy Ernie is doing?
ANOTHER PASSERBY
Oh yes because I would take his example and do what he did.
PORTER
DJ Daddy Ernie ending Caroline Swinburne's report there. And if you'd like more details of the South London venues being visited by the Modernisation Initiative then you can visit our website at bbc.co.uk/radio4.
Graham, let's end by looking at how often people should have their blood pressure checked.
MACGREGOR
Well I think ideally what we'd like is everyone to have a blood pressure monitor validated one at home, demystify blood pressure, measure it in the whole family, see what it is.
PORTER
I liked your analogy with the weighing machine earlier on, most people have a weighing machine in their bathroom, which they spend a lot of time on.
MACGREGOR
And obesity is a major problem but blood pressure's an even bigger problem than obesity and I think everyone should know what their blood pressure is and be doing things about it.
PORTER
Briefly, to end, are there people who are at particular risk - we heard the Afro Caribbean community there - who else should be particularly concerned about their blood pressure?
MACGREGOR
Well I think the Asian community are at risk, particularly for cardiovascular strokes and heart attacks and particularly through cholesterol, abdominal obesity, lack of exercise but they need to take blood pressure very seriously. I think also people with a family history of strokes or family history of high blood pressure are more likely to develop it and should be doing something about it now to prevent it occurring later in life.
PORTER
But your key message is that if you don't know your blood pressure?
MACGREGOR
Go and get it measured. I mean everyone - at least every adult in the UK should know what their blood pressure is, have some way of measuring it at home and if not go and see your GP or practice nurse, not tomorrow but over the course of the next three months, and get it measured because it's the most important thing you can do in your life because if it's raised you can prevent yourself having a stroke or heart attack.
PORTER
We must leave it there. Professor Graham MacGregor thank you very much.
Next week I will be leaving the studio and travelling to the Midlands to meet the staff and patients at Birmingham Children's Hospital for a special programme on the latest in the battle against the most common childhood cancer in the Western world - Leukaemia.
ENDS
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