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However, they should not be used as a substitute for explanatory studies.<br><br>The pragmatism concept is controversial and there are questions about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which validate a physiological or clinical hypothesis, and pragmatic trials, which inform the practice and policy decisions. They also suggested the framework for pragmatic trials, dubbed PRECIS.2 This tool attempted to define the features of a practical trial that include the recruitment process, the design and delivery of the intervention, and monitoring.<br><br>There is an encouraging increase in the number pragmatic trials that are published. A recent Medline search using the terms naturalistic and pragmatic, limited to controlled trials that are randomized (RCTs), yielded 34 articles, as shown in red in Figure 2. This is an indication that the health science community is becoming increasingly sensitized to the subject of pragmatism. It is important to keep in mind that the majority of these studies were conducted in primary care settings.