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Pragmatic trials are designed to replicate real-life situations and attain maximum external validity. They are usually commissioned by policy makers and practitioners to aid in their decision-making. They also provide a useful method to determine the cause-effect relationship between an intervention and its results. However, they should not be used as a substitute for explanatory trials. The pragmatism concept is controversial and there are questions about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 proposed a distinction between explanatory studies, which confirm the validity of a physiological or clinical hypothesis, as well as pragmatic trials, that inform policy and practice decision-making. They also proposed a framework called 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 its follow-up. The number of pragmatic trials is growing. A recent Medline search using the terms naturalistic and pragmatic, limited to randomized controlled trials (RCTs), yielded 34 articles, which are shown in red in Figure 2. This is an indication that the health science community is becoming more acquaint to the issue of pragmatic thinking. However, it is important to keep in mind that the majority of these studies were conducted in primary care settings.