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The concept of pragmatism is controversial and there are concerns regarding whether pragmatic trials could replace explanatory tests or if they should be an addition to them. Schwartz and Lellouch1 made an distinction between explanation-based studies, which support the validity of a physiological or clinical hypothesis, as well as pragmatic trials, that inform policy and practice decision-making. They also suggested an approach to pragmatic trials, dubbed PRECIS.2 This tool attempted to define the features of a pragmatic trial that include the recruitment process, the design and implementation of the intervention, as well as follow-up. There is an encouraging trend in the number of pragmatic trials that have been published. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs), returned 34 articles. They are displayed in red on Figure 2. This indicates that the health sciences community is becoming more sensitive to the subject of pragmatic thinking. It is important to note that the majority of these studies were conducted in primary-care settings.
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