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The pragmatism concept is controversial, and there are doubts about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove the clinical or physiological hypothesis as well as pragmatic trials that inform the practice and policy decisions. They also proposed an approach to pragmatic trials, dubbed PRECIS.2 This tool was designed to define the characteristics of a pragmatic trial that include the recruitment process, the design and implementation of the intervention, as well as 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 shown in red on 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 of studies were conducted in primary-care settings.