Evidence-based policy making calls for the use of the best available evidence to support decision-making. Traditional hierarchies of evidence interpret this as focus on RCTs with most placing systematic reviews at the top. The proliferation of systematic reviews has now led to ‘tertiary analysis’ – reviews of multiple sources of secondary analysis. However, experienced users recognise there are good and bad systematic reviews. The systematic review may not answer the exact policy question being posed and it is only as useful as good as the underpinning evidence base. Best practice would suggest new systematic review is undertaken for each policy decision. Yet there are often time constraints and funding pressures and a limited skill set. Prioritisation is therefore necessary.

On a strategic level, the use of average data derived from RCTs to make decisions about individual patients is being questioned. There are multiple stratified and personalised medicine initiatives backed by funding for methods and infrastructure to support the use of observational data for comparative effectiveness research. Yet little attention has been given as to how to integrate these different types of evidence to make decisions.

Dr Garner has provided technical advice to NICE for the past 12 years and in addition to consuming systematic reviews for policy decisions she is a writer and editor of systematic reviews. Dr Garner will provide insights into the policy maker’s dilemma and the scientific arguments underpinning the debate. She will share a number of initiatives at the policy level and put forward potential options for how the evidence-based medicine community can address the policy maker’s dilemma.