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The idea of pragmatism is controversial and there are doubts about whether pragmatic trials can replace tests for explanations or if they are an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which validate the clinical or physiological hypothesis and pragmatic trials that inform policy and practice decisions. They also suggested a framework for pragmatic trials, called PRECIS.2 This tool attempted to define the characteristics of a pragmatic trial that include recruitment, design and delivery of the intervention, as well as monitoring. There is a positive increase in the number of pragmatic trials that have been published. A recent Medline search using the keywords pragmatic and naturalistic, restricted to controlled trials randomized to control (RCTs), yielded 34 articles, shown in red in Figure 2. This is a sign that the health sciences community is becoming more acquaint to the issue of pragmatics. It is important to remember that the majority of these trials were conducted in primary care settings.