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The pragmatism idea is controversial, and there are questions about whether pragmatic trials should replace tests for explanations or if they should serve as an addition to them. Schwartz and Lellouch1 made an distinction between explanation-based studies, which confirm the physiological hypothesis or clinical hypothesis, as well as pragmatic trials, which inform the decision-making process for policy and practice. They also suggested an approach to pragmatic trials, called PRECIS.2 This tool was designed to define the elements of a pragmatic study which includes the recruitment process, the design and implementation of the intervention, and the follow-up. The number of pragmatic trials is growing. A recent Medline query using the keywords pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. These are highlighted in red on Figure 2. This is an indication that the health sciences community is becoming increasingly sensitized to the issue of pragmatic thinking. It is important to note, however, that the majority of studies were conducted in primary-care settings.