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They should, however, not, be used to replace the need for explanation studies.The idea of pragmatism is controversial and there are doubts about whether pragmatic trials can replace explanatory tests or if they should be an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which validate a physiological or clinical hypothesis as well as pragmatic trials, which inform the practice and policy decisions. They also proposed a framework called PRECIS for pragmatic trials.2 The tool was designed to define the characteristics of a pragmatic research study that includes recruitment, design, implementation of the intervention and its follow-up.There is a positive increase in the number of pragmatic trials published. A recent Medline search using the keywords pragmatic and naturalistic, restricted to controlled trials randomized to control (RCTs), yielded 34 articles, which are shown in red in Figure 2. This is a sign that the health sciences community is becoming increasingly sensitized to the issue of pragmatic thinking. It is important to remember that the majority were conducted in primary-care settings.