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The concept of pragmatism is controversial and there are doubts about whether pragmatic trials should be used to replace explanation tests or if they are a complement to them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which prove a physiological or clinical hypothesis as well as pragmatic trials, which guide the policy and practice of. They also suggested a framework for pragmatic trials, called PRECIS.2 This tool sought to define the features of a pragmatic study that include the recruitment process, the design and delivery of the intervention, and monitoring. There is an encouraging increase in the number pragmatic trials that have been published. A recent Medline search using the keywords pragmatic and naturalistic, restricted to randomized controlled trials (RCTs), yielded 34 articles, as shown in red in Figure 2. This is an indication that the health sciences community is becoming increasingly sensitized to the subject of pragmatics. It is important to note, however, that the majority of studies were conducted in primary-care settings.