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The pragmatism idea is controversial and there are doubts regarding whether pragmatic trials could be used to replace explanation tests or if they should serve as an alternative to them. Schwartz and Lellouch1 proposed the distinction between explanation studies, which confirm the physiological hypothesis or clinical hypothesis, and pragmatic trials that aid in the decision-making process for policy and practice. They also proposed an approach to pragmatic trials, which they called PRECIS.2 This tool was designed to define the characteristics of a pragmatic study, including recruitment, design and delivery of the intervention, as well as monitoring. The number of pragmatic trials is increasing. A recent Medline search using the keywords pragmatic and naturalistic, restricted to randomized controlled trials (RCTs), yielded 34 articles, which are shown in red in Figure 2. This is a sign that the health science community is becoming more acquaint to the issue of pragmatics. However, it is important to note that the majority of these trials were conducted in primary care settings.