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They should not, however, be used to replace the need for explanation studies.<br><br>The pragmatism idea is controversial, and there are questions about whether pragmatic trials can replace explanatory tests or if they should serve as a complement to them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which confirm the clinical or physiological hypothesis and pragmatic trials, which guide the practice and policy decisions. They also proposed a framework called PRECIS for pragmatic trials.2 The tool was designed to define the traits of a pragmatic study that includes the recruitment, design, and delivery of the intervention and its follow-up.<br><br>There is a growing trend in the number of pragmatic trials that have been published. A recent Medline search using the terms naturalistic and pragmatic, which was limited to controlled trials that are randomized (RCTs) produced 34 articles, as shown in red in Figure 2. This is an indication that the health science community is becoming more sensitive to the subject of pragmatism. It is important to remember, however, that the majority were conducted in primary-care settings.