Clinical practice guidelines: reality bites

In 1995, the National Health and Medical Research Council (NHMRC) announced its commitment to developing evidence-based clinical practice guidelines " to promote best practice linked to outcomes and effective cost management". To date, resources for dissemination and implementation have been identifi ed for only two guidelines developed by the NHMRC as part of that commitmen t. Clinical practice guidelines for the management of men with lower urinar y tract symptoms (LUTS) were launched in 1997. We were members of the worki ng party that developed these guidelines, and here we give our personal acc ount, offering insights into the tensions and contradictions impeding the t ranslation of political commitment to evidence-based medicine into policy a nd practice.