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Schwartz and Lellouch1 suggested the distinction between explanation studies, which confirm the validity of a physiological or clinical hypothesis, and pragmatic trials that aid in the practice and policy decision-making. They also proposed the framework for pragmatic trials, which they called PRECIS.2 This tool attempted to define the elements of a practical trial, including recruitment, design and delivery of the intervention, as well as monitoring. There is a positive increase in the number pragmatic trials that have been published. A recent Medline search using the keywords pragmatic and naturalistic, restricted to controlled trials that are randomized (RCTs) resulted in 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 pragmatic thinking. It is important to keep in mind, however, that the majority were conducted in primary-care settings.