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They are also a good method of determining the cause-effect relationship between an intervention and its results. However, they shouldn't be used to substitute for explanation trials. The concept of pragmatism is controversial, and there are questions about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which validate the validity of a clinical or physiological hypothesis and pragmatic trials that inform the practice and policy decisions. They also proposed a framework for pragmatic trials, dubbed PRECIS.2 This tool was designed to define the features of a pragmatic trial, including the recruitment process, the design and implementation of the intervention, and monitoring. There is a growing increase in the number pragmatic trials that have been published. A recent Medline query that used the words naturalistic and pragmatic, restricted to randomised controlled trials (RCTs), returned 34 articles. These are shown in red on Figure 2. This is a sign that the health science community is becoming more acquaint to the subject of pragmatism. It is important to remember that the majority of these trials were conducted in primary care settings.