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The concept of pragmatism is controversial, and there are questions about whether pragmatic trials can be used to replace explanation tests or if they should serve as an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove the clinical or physiological hypothesis as well as pragmatic trials, which guide policy and practice decisions. They also proposed an approach to pragmatic trials, called PRECIS.2 This tool was designed to define the features of a pragmatic study which includes the recruitment process, the design and delivery of the intervention, as well as follow-up. There is a growing trend in the number of pragmatic trials published. A recent Medline search using the terms naturalistic and pragmatic, which was limited to randomized controlled trials (RCTs) resulted in 34 articles, which are shown in red in Figure 2. This is a sign that the health science community is becoming more acquaint to the issue of pragmatic thinking. It is important to note that the majority of these studies were conducted in primary care settings.