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The concept of pragmatism is controversial and there are concerns about whether pragmatic trials can replace tests for explanations or if they should serve as a complement to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which validate the clinical or physiological hypothesis, and pragmatic trials, which inform the practice and policy decisions. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool tried to define the traits of a pragmatic study that includes the recruitment, design, and delivery of the intervention and follow-up. The number of pragmatic trials is increasing. A recent Medline search using the keywords naturalistic and pragmatic, which was limited to controlled trials that are randomized (RCTs), yielded 34 articles, shown in red in Figure 2. This indicates that the health sciences community is becoming increasingly sensitized to the issue of pragmatism. It is important to remember that the majority were conducted in primary-care settings.