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Schwartz and Lellouch1 suggested an distinction between explanation-based studies, which prove the validity of a physiological or clinical hypothesis, and pragmatic trials that aid in policy and practice decision-making. They also proposed the framework for pragmatic trials, which they called PRECIS.2 This tool sought to define the elements of a pragmatic study which includes the recruitment process, the design and implementation of the intervention, and the follow-up. There is an encouraging trend in the number of pragmatic trials that have been published. A recent Medline query using the keywords pragmatic and naturalistic, limited to randomised controlled trials (RCTs) returned 34 articles. These are highlighted in red on Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatism. It is important to keep in mind that the majority of these studies were conducted in primary care settings.