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Schwartz and Lellouch1 made an distinction between explanation-based studies, which prove a physiological hypothesis or clinical hypothesis, and pragmatic trials, that inform the practice and policy decision-making. They also proposed a framework for pragmatic trials, dubbed PRECIS.2 This tool was designed to define the elements of a pragmatic study which includes the recruitment process, the design and delivery of the intervention, as well as the follow-up. There is a growing trend in the number of pragmatic trials that are published. A recent Medline query using the keywords pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs), returned 34 articles. They are displayed 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 note that the majority of these studies were conducted in primary care settings.