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The pragmatism concept is controversial, and there are concerns about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which confirm a physiological or clinical hypothesis as well as pragmatic trials, which inform the policy and practice of. They also proposed the framework for pragmatic trials, called PRECIS.2 This tool sought to define the characteristics of a practical trial, including the recruitment process, the design and delivery of the intervention, as well as follow-up. The number of pragmatic trials is growing. A recent Medline query using the keywords naturalistic and pragmatic, restricted to randomised controlled trials (RCTs), returned 34 articles. They are displayed in red on Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatism. However, it is important to note that the majority of these trials were conducted in primary care settings.