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However, they should not be used as a substitute for the use of explanation studies. The pragmatism idea is controversial and there are concerns about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which confirm a physiological or clinical hypothesis and pragmatic trials that inform the policy and practice of. They also proposed the framework for pragmatic trials, called PRECIS.2 This tool sought to define the elements of a pragmatic study, including the recruitment process, the design and implementation of the intervention, and the follow-up. There is a positive trend in the number of pragmatic trials that have been published. A recent Medline search using the terms pragmatic and naturalistic, restricted to controlled trials that are randomized (RCTs), yielded 34 articles, as shown in red in Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to remember that the majority were conducted in primary-care settings.