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The pragmatism idea is controversial, and there are questions regarding whether pragmatic trials could replace tests for explanations or if they should serve as an addition to them. Schwartz and Lellouch1 proposed the distinction between explanation studies, which prove the physiological hypothesis or clinical hypothesis, and pragmatic trials, that inform the practice and policy decision-making. They also suggested a framework for pragmatic trials, dubbed PRECIS.2 This tool attempted to define the characteristics of a pragmatic study, including recruitment, design and delivery of the intervention, and follow-up. The number of pragmatic trials is increasing. A recent Medline search using the terms pragmatic and naturalistic, restricted to randomized controlled trials (RCTs), yielded 34 articles, as shown in red in Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatism. It is important to note, however, that the majority of these studies were conducted in primary care settings.