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They should not, however, be used to replace the need for explanation studies. The pragmatism idea is controversial, and there are questions about whether pragmatic trials should replace tests for explanations or if they should be a complement to them. Schwartz and Lellouch1 suggested an distinction between explanation-based studies, which support a physiological hypothesis or clinical hypothesis, and pragmatic trials, which inform the practice and policy decision-making. They also proposed a framework called PRECIS for pragmatic trials.2 The tool was designed to define the traits of a pragmatic research study which includes the recruitment, design, and delivery of the intervention and its follow-up. The number of pragmatic trials is increasing. A recent Medline search using the terms naturalistic and pragmatic, limited to controlled trials randomized to control (RCTs), yielded 34 articles, as shown in red in Figure 2. This indicates that the health sciences community is becoming more aware of the importance of pragmatism. It is important to keep in mind that the majority of studies were conducted in primary-care settings.