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The pragmatism concept is controversial, and there are doubts about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 made a distinction between explanatory studies, which confirm the validity of a physiological or clinical hypothesis, as well as pragmatic trials, which inform the practice and policy decision-making. They also suggested an approach to pragmatic trials, called PRECIS.2 This tool attempted to define the elements of a pragmatic study that include the recruitment process, the design and implementation of the intervention, as well as monitoring. The number of pragmatic trials is growing. A recent Medline search using the terms naturalistic and pragmatic, limited to randomized controlled trials (RCTs) resulted in 34 articles, which are shown in red in Figure 2. This is a sign that the health science community is becoming more acquaint to the subject of pragmatic thinking. It is important to remember that the majority were conducted in primary-care settings.