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However, they should not be used in lieu for explanatory trials.The concept of pragmatism is controversial and there are concerns about whether pragmatic trials should be used to replace explanation tests or if they are an alternative to them. Schwartz and Lellouch1 proposed the distinction between explanation studies, which confirm the validity of a physiological or clinical hypothesis, as well as pragmatic trials that aid in the practice and policy decision-making. They also suggested the framework for pragmatic trials, dubbed PRECIS.2 This tool attempted to define the characteristics of a practical trial, including the recruitment process, the design and implementation of the intervention, as well as monitoring.There is a positive increase in the number pragmatic trials that are published. A recent Medline query using the keywords naturalistic and pragmatic, restricted to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to keep in mind that the majority of these studies were conducted in primary care settings.