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The concept of pragmatism is controversial and there are doubts regarding whether pragmatic trials could be used to replace explanation tests or if they should serve as an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which validate the validity of a clinical or physiological hypothesis as well as pragmatic trials that inform the policy and practice of. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool tried to define the traits of a pragmatic study which includes the recruitment, design, and delivery of the intervention, and follow-up. There is a growing trend in the number of pragmatic trials that have been published. A recent Medline query using the keywords pragmatic and naturalistic, limited to randomised controlled trials (RCTs) returned 34 articles. They are displayed in red on Figure 2. This is a sign that the health science community is becoming increasingly sensitized to the subject of pragmatics. However, it is important to remember that the majority of these trials were conducted in primary care settings.