These are only the latest in a large collection of similar studies in many countries, extending over the last 30 years. Rarely have these studies elicited any systematic response. A case in point is the rate of Cesarean sections. Since the mid-1980s, lower rates have been promoted but in many areas they remain high.
Physicians claim that multiple guidelines exist and that evidence is confusing and conflicting.
Cost effectiveness of watchful waiting is questioned by some providers who imply that extra testing and drug prescriptions may be just as costly as surgical intervention. These providers are demanding more conclusive information to convince them that a practice change is best for both the patient and the overall health system. They place the onus on the researchers to provide sound and compelling evidence which will convince them to change practice standards. Variations in practice may also be linked to economic conditions that threaten income. In the case of BPH, there is an economic disincentive for some physicians to adopt best evidence which might point to a reduced need for surgical intervention and thus a related reduction in income.