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The pragmatism idea is controversial, and there are questions about whether pragmatic trials can replace tests for explanations or if they should be an alternative to them. Schwartz and Lellouch1 proposed a distinction between explanatory studies, which prove the validity of a physiological or clinical hypothesis, as well as pragmatic trials, which inform the practice and policy decision-making. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool attempted to define the traits of a practical study which includes recruitment, design, implementation of the intervention and follow-up. The number of pragmatic trials is increasing. A recent Medline search using the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs) returned 34 articles. These are highlighted in red on Figure 2. This indicates that the health sciences community is becoming more aware of the importance of pragmatic thinking. It is important to remember that the majority were conducted in primary-care settings.