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The pragmatism idea is controversial and there are questions about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which prove the clinical or physiological hypothesis and pragmatic trials, which guide the practice and policy decisions. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool tried to define the elements of a practical study which includes the recruitment, design, and delivery of the intervention and its follow-up. There is a positive increase in the number of pragmatic trials published. A recent Medline search using the keywords pragmatic and naturalistic, restricted to randomized controlled trials (RCTs) resulted in 34 articles, as shown in red in Figure 2. This is an indication that the health sciences community is becoming more sensitive to the subject of pragmatism. It is important to keep in mind, however, that the majority of these studies were conducted in primary-care settings.