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The pragmatism concept is controversial, and there are concerns about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove the validity of a clinical or physiological hypothesis and pragmatic trials that inform the policy and practice of. They also suggested the framework for pragmatic trials, dubbed PRECIS.2 This tool was designed to define the characteristics of a pragmatic study which includes the recruitment process, the design and implementation of the intervention, and monitoring. The number of pragmatic trials is growing. A recent Medline query that used the words naturalistic and pragmatic, 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 more acquaint to the subject of pragmatics. However, it is important to keep in mind that the majority of these trials were conducted in primary care settings.