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The aim of pragmatic trials is to mimic real-life scenarios and gain maximum validity externally. They are usually commissioned by policy makers and practitioners to guide their decision-making. They can be used to determine the causal relationship between an intervention and its results. They should not, however be used to replace explanation studies. The idea of pragmatism is controversial, and there are questions regarding whether pragmatic trials could be used to replace explanation tests or if they are an addition to them. Schwartz and Lellouch1 proposed a distinction between explanatory studies, which confirm the physiological hypothesis or clinical hypothesis, as well as pragmatic trials, that inform the practice and policy 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, including recruitment, design and delivery of the intervention, as well as the follow-up. There is a growing increase in the number of pragmatic trials published. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This is an indication that the health sciences community is becoming more acquaint to the subject of pragmatics. It is important to note that the majority of these studies were conducted in primary care settings.