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However, they shouldn't be used in lieu for the use of explanation trials. The idea of pragmatism is controversial, and there are questions about whether pragmatic trials can be used to replace explanation tests or if they should be an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove the validity of a clinical or physiological hypothesis, and pragmatic trials that inform the policy and practice of. They also proposed a framework called PRECIS for pragmatic trials.2 This tool tried to define the elements of a pragmatic study which includes recruitment, design, delivery of the intervention and follow-up. There is a growing increase in the number pragmatic trials that have been published. A recent Medline search using the keywords naturalistic and pragmatic, which was limited to controlled trials that are randomized (RCTs), yielded 34 articles, which are shown in red in Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatism. However, it is important to remember that the majority of these studies were conducted in primary care settings.