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The pragmatism idea is controversial and there are doubts about whether pragmatic trials can replace tests for explanations or if they are an alternative to them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which validate a physiological or clinical hypothesis as well as pragmatic trials, which guide the practice and policy decisions. They also suggested a framework dubbed PRECIS for pragmatic trials.2 This tool attempted to define the characteristics of a practical study, including recruitment, design, implementation of the intervention and its follow-up. There is a growing increase in the number pragmatic trials that have been published. A recent Medline search using the terms naturalistic and pragmatic, limited to randomized controlled trials (RCTs) produced 34 articles, shown in red in Figure 2. This indicates that the health science community is becoming increasingly sensitized to the issue of pragmatic thinking. However, it is important to note that the majority of these studies were conducted in primary care settings.