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The concept of pragmatism is controversial, and there are questions regarding whether pragmatic trials could replace tests for explanations or if they should be an addition to them. Schwartz and Lellouch1 suggested a distinction between explanatory studies, which confirm the validity of a physiological or clinical hypothesis, and pragmatic trials, that inform policy and practice decision-making. They also suggested the framework for pragmatic trials, called PRECIS.2 This tool attempted to define the features of a pragmatic trial which includes the recruitment process, the design and implementation of the intervention, as well as monitoring. The number of pragmatic trials is growing. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs) returned 34 articles. They are displayed in red on Figure 2. This is a sign that the health sciences community is becoming increasingly sensitized to the subject of pragmatics. It is important to note that the majority of studies were conducted in primary care settings.