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However, they shouldn't be used to substitute for the use of explanation studies. The pragmatism idea is controversial, and there are questions about whether pragmatic trials can be used to replace explanation tests or if they are an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove the validity of a clinical or physiological hypothesis, and pragmatic trials, which guide the policy and practice of. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool tried to define the traits of a practical study which includes recruitment, design, implementation of the intervention, and follow-up. There is a growing trend in the number of pragmatic trials that are published. A recent Medline search using the keywords naturalistic and pragmatic, which was limited to controlled trials that are randomized (RCTs) resulted in 34 articles, as shown in red in Figure 2. This indicates that the health sciences community is becoming more aware of the importance of pragmatic thinking. It is important to keep in mind, however, that the majority of these studies were conducted in primary-care settings.